This past year, I've been so fortunate to meet Kylee Arnold, a nutrition coach who works virtually with busy moms at Arnold Nutrition Coaching. After listening to her talk about her philosophy on eating and how you can optimize for your concerns, I knew I had to talk to her about diets for your pelvic health. Make sure you visit her website to grab a free recipe guide!
In this interview, we discuss bladder irritants, the IC diet (which doesn't actually exist by the way), constipation, and elimination diets. Watch the video at the top or keep reading to see what we had to say!
In my practice, I specialize in working with women experiencing conditions like endometriosis, interstitial cystitis, bladder pain, and constipation, so diet comes up frequently. If you've been experiencing bladder pain, you may have even looked up foods and beverages to avoid to keep your bladder healthy. But what does that really mean, and is that beneficial for your overall health?
1 - What does bladder pain look like, and what can it lead to?
Pain with urination
Strong urgency to urinate
Pressure in the bladder
Pain with intercourse
Feeling like you can't empty your bladder completely
Bloating in the abdomen
These symptoms can come and go, and it is often called a flare when everything comes back, and the bladder and pelvic pain is really ramped up. This long term flaring up and down can lead to global pelvic floor dysfunction. Our goal is to figure out what things are triggering these flares so you can manage the symptoms more optimally so we can get your pelvic floor healthy.
A flare can be managed with a comprehensive pelvic health physical therapy approach, which includes hands-on treatment, stretches, exercises, behavioral changes, stress management, and diet and nutrition. Sometimes I will refer out to an expert, such as Kylee, if you need to take a deeper dive into your specific eating habits.
2 - What are bladder irritants?
These are specific foods that are thought to change the acidity of the bladder and worsen bladder pain and urinary symptoms because they irritate the lining of the bladder. Some of these foods are caffeine, alcohol, orange juice, and fruit juice, to name a few.
The IC diet is essentially a more detailed list of these irritants that was put together by surveying patients with interstitial cystitis and collecting answers of what individual patients seemed to be bothered by. Because this collection of foods is so individual to each patient surveyed, the list became extremely long. The latest research actually shows that each person with bladder symptoms can be sensitive and flared by different foods. AND avoiding every food on the list may actually be too restrictive for an optimal, healthy diet.
3 - Avoiding foods in the diet
Kylee advises to find out what is true for your body versus following a blanket diet. She sees this mostly with a specific population (like those with interstitial cystitis for example) or from someone who has tested their food sensitivities.
Caffeine and alcohol are true bladder irritants because they do act like diuretics and can cause more pressure and pain.
A lot of people recommend eliminating acidic foods, however Kylee gives an example of how beneficial lemon water can be for your gut and liver, even though lemon is acidic. Many of her clients can drink lemon water without flaring their bladder if not overdone.
Kylee has her clients take a photo food journal. Take a picture of what you ate, how you felt before and after, and the time that you ate the food. You can start to catch trends of what is causing irritation to your bladder. If you've been my patient before, you know we do something similar with bladder diaries and how helpful they are to get to the bottom of your food triggers.
4 - The Interstitial Cystitis Conundrum
Many of my patients are exhausted by the time they get to me. You've probably been to other providers, like urologists, primary doctors, and your gynecologist, They've suggested cystoscopes to rule out bladder pathology, which came back normal. You've had labs drawn, which were normal. But you still experience this pain and discomfort.
Interstitial cystitis is defined as having urinary urgency, frequency, or other bladder pain along with pelvic pain. It's really quite a broad symptom presentation, which explains why no two people present exactly the same way with this diagnosis.
It's a misconception that it's solely a bladder condition and is fact often pelvic floor dysfunction driving the bladder pain.
Many of my patients will try these diets, and then they aren't seeing reduction in bladder symptoms because the bladder itself is actually not the problem, and now they're restricting too many major food groups. Addressing the nutrition aspect simultaneously can help to give the results that they need.
5 - Constipation
Many patients that come to me for bladder pain also have concurrent constipation, potentially driving some of the pelvic floor dysfunction and bladder symptoms.
The rectum is located so close to the vagina and the posterior pelvic floor musculature, if the stool can't come out regularly, it takes up space, and that can lead to a pelvic floor issue called outlet constipation.
Photo courtesy of myPFM @myPFM on instagram
A muscle called the puborectalis is responsible for tightening and relaxing to hold our bowels and to let them go at the base of the rectum. With outlet constipation, the puborectalis can't let go of the rectum, and this can lead to straining, breath holding and overuse of the pelvic floor muscles, which can further drive the bladder feedback loop.
Looking at fiber, water intake, toilet positioning, working with a pelvic PT, and a nutritionist are all ways to optimize your bowels so you don't get this overworking pelvic floor and can improve GI mobility.
Kylee explains that a watery stool and a hard stool can both be types of constipation. If your stool is more watery, consider fiber intake, such as vegetables and grains to bulk up the stool to help you eliminate without having to strain. A dry, harder stool can be exacerbated by caffeine and lack of water intake with electrolytes.
6 - Elimination Diets
Gluten is one of the ingredients that has been studied widely in the past several years and has been linked to inflammation. Many people are eliminating it and finding success with their gut health. However, gluten free products can always be processed with other ingredients that you may be more sensitive to, so eliminating gluten isn't necessarily right for everyone.
Kylee works with many new moms who experience symptoms of Hashimoto's in the first year postpartum, and they attempt to eliminate gluten to regulate their blood sugar, however the gluten-free derivatives are actually causing MORE blood sugar spikes. She suggests learning what triggers the Hashimoto's versus eliminating gluten to start with.
A proper elimination diet is the gold standard to determining what your food triggers are, and there is a systematic method to do it.
You can start slow and eliminate foods that are widely known to cause sensitivities, like dairy and gluten and track your symptoms. If you have more specific goals and really want to figure out exactly what is triggering you and when, you can try a low FODMAP diet or paleo, and then if you are feeling good on those diets, you can start to add back more foods in and track your symptoms.
Want to take a deeper dive into your pelvic health and bladder pain?