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Bladder Care in the Time of Covid

Let's face it-the past three months have been quite a roller coaster ride. It's been a time of wide-ranging emotions with stress and anxiety possibly topping the list. Stress and anxiety can have a whole host of impacts on the body but one we might not think of as related is a change in bladder issues.
Have you found yourself going to the bathroom much more frequently or urgently?
Feeling that you need to urinate even though you just went to the restroom and emptied your bladder? Feeling that you need to urinate but then not able to produce any urine? Experiencing a new onset or reoccurrence of urinary incontinence? All these issues could be related to what is happening with our emotions and nervous system.

As the bladder fills, nerve cells in the bladder send signals to the brain that create a sense of urinary urgency. As more urine enters that bladder, the sense of urinary urge gets stronger. When the bladder is full, the brain sends the signal to the smooth muscle of the bladder to contract and the pelvic floor muscles/urinary sphincter to relax which allows the urine to come out.

In times of stress or anxiety, our body releases cortisol and adrenaline which causes a "fight or flight" response which targets various organ systems in our body to be able to deal with a perceived oncoming threat. Our nervous system then becomes on "red alert" and operates on a higher level which can impact our bladder function. If this happens only on occasion the body can recover quickly without any lasting changes.
If the stress response happens frequently or consistently over a prolonged period of time, the body has a more difficult time recovering and can stay in a period of hyperarousal of the nervous system which can trigger unwanted bladder symptoms among others.
Stress and anxiety can also change our breathing patterns and habits of muscle holding and guarding. This can lead to changes in our intra-abdominal pressure and over-activation of our core and pelvic floor musculature. All of these actions can exacerbate bladder symptoms and contribute to urinary dysfunction.

Strategies such as stress management, relaxation techniques, good breathing patterns, good toileting habits, optimal hydration, exercise, and good voluntary control of the pelvic floor muscles to name a few can go a long way in helping to get your bladder back in shape. The physical therapists at CTS can help you be the boss of your bladder!

Pain, Motor Control, and Presence

Over the past few years, I have read a lot about neuroplasticity (the ability of the nervous system to change), and last year, I took a continuing education course on pain science, and an advanced course on motor control (how the brain controls the muscles and joints to produce movement). A few of the important concepts that have really stuck with me are:
1. When the body is injured, the nerves send nociceptive input to the brain. (Nociceptive input indicates harm or potential harm to the tissues. Nociceptive input is one factor that contributes to the experience of pain. Pain is an output of the brain.)

2. The brain wants to minimize the nociceptive input, so it shuts itself off from feeling the full amount of the nociceptive input coming in. This is a survival tactic.

3. However, when the brain shuts itself off from incoming nociception from an injured region, it also shuts off incoming messages from the joints and muscles about their position in space (called proprioception) from that area.

4. When the brain shuts off incoming messages, it can no longer send effective outgoing messages to the muscles and other structures either. This causes a lack of precise motor control.

5. Without precise motor control in the injured region, further injury is very likely. (This is the reason when you sprain your ankle once, without proper rehab to reestablish normal motor control, you are more likely to sprain the same ankle again.)

6. In addition to controlling muscle movement in an injured area, the brain also controls inflammation and circulation. Nerve endings are wrapped with immune cells and the nervous and immune systems are intricately linked. If you shut off brain-to-body regulatory control, the localized immune response to an injury can get out of hand.
I had a personal experience with all of these concepts last year, while cross-country skiing for the first time ever, in Voss, Norway. I have had two severe left ankle sprains (5 and 2 years prior, both due to falls), and despite being a PT, did not do all the ankle rehab that I should have done. Well, after about two hours up on the mountain, and about an hour away from the ski lift, I fell with my skis twisted under me and severely sprained (you guessed it) my left ankle. The sprain was so bad, and my ankle was so unstable, that I could barely stand. My choices were a) wait for two hours in the freezing cold while my husband got the ski patrol to rescue me, or b) see if I could make it out on my own. I chose option b. My ankle felt awful, but I remembered that if my brain blocked the sensations coming in, it would also block the motor control going out, and I needed motor control. So with every single step, I consciously directed my attention to my ankle, and kept my brain and ankle fully connected. I stayed present in my ankle. I paid attention to my hip/knee alignment, my core and leg muscle contractions, and how I was transferring weight. I actively controlled my movements and didn't let my brain shut off or wander. It took a huge mental effort to do this, but I didn't have another option. Long story short: I made it off the mountain, and compared to my two other severe ankle sprains, was very surprised to see how little swelling and bruising I had. This may have been because I kept moving after the injury, but I also think that deliberately keeping my brain connected to my ankle nerves allowed it to stay connected to my immune (and circulatory) systems as well. Staying connected also decreased the pain output of my brain.

A big part of what we do as PTs is teach patients how to reconnect injured and/or painful areas of their bodies with their brains. We help patients reestablish incoming sensations as well as outgoing control. This process changes the size of the "body map" in the brain that is dedicated to that particular area. It helps patients re-learn how to be present in the area of their body that was injured. This process works whether injuries are recent, or occurred many, many years ago. Our brains and nervous systems can adapt and change to experience less pain and more motor control, at any age. Ask your PT at CTS for more information!