Dr. Colene Arnold
Oh, my Bladder, Oh, my Bladder
Oh my Bladder hurts again
I feel pain & frequency
Dreadful leakage, urgency
In a pickle, always looking
For the bathroom, once again
I won’t make it, another minute
Once the key goes in the hole
Oh, my Bladder, Oh, my Bladder
Oh my Bladder hurts again
I feel pain & frequency
Dreadful leakage & urgency
Now that you’ll be humming that tune, all day, give me a few moments to try to distract you with why I’ve got you singing about your bladder.
If you’ve opened this blog I suspect you or someone you know suffers from some form of bladder dysfunction, you are not alone! My focus today is on a syndrome that masquerades as a urinary tract infection, or UTI. You know all too well what its’ like, peeing every hour, sometimes urgently, sometimes not where you intend to go & sometimes it hurts. The pressure, the burning, it’s just got to be an infection this time. That’s what Kate thought as well.
But do you, did she? Kate saw her Doctor, she provided a urine sample again, started the antibiotics, again. Two days later she got the voicemail that she didn’t have an infection and she should stop the antibiotics, have a good day,……click.
Now what? This scenario plays over and over again. Oh my bladder, oh my bladder….Not again! Cultures all negative, no sexually transmitted infections, negative cystoscopy with the Urologist. After years of getting nowhere, Kate stumbles upon a website, Interstitial Cystitis Association, www.ichelp.org, where she finds information that suggests that 4 to 12 million other folks in the United States have the same symptoms that she has and it has a name or two or three, Interstitial Cystitis, Painful Bladder Syndrome, Bladder Pain Syndrome. She doesn’t care about what they call it, she just wants to know how to make it better. Symptoms of Interstitial Cystitis vary from person to person, and even within any one individual. They can be mild or severely debilitating. Persons with IC can have intermittent symptoms that come and go or they can remain for extended periods of time. Certain triggers can cause a flare of the disorder after long periods of quiescence. “The initial evaluation typically consists of a patient history & physical exam. The four key diagnostic clues that may indicate IC are bladder and pelvic pain or discomfort, urinary frequency and urgency, symptoms that persist for longer than six weeks, negative results of lab tests checking for urinary tract or other infection.” www.ichelp.org.
Interstitial Cystitis. The paper reviews diagnostic principles, general guideline statements and statements regarding treatment. http://www.auanet.org/guidelines/interstitial-cystitis/bladderpain-syndrome-(2011-amended-2014) There are several helpful treatments and most clinicians tend to follow an algorithm. For the majority of patients, a combination of treatments is the best approach. As physicians we have an oath that we take upon graduation which includes “to do no harm”. This approach takes into consideration risks and benefits. The least invasive, more conservative options, should be recommended and trialled first. This should include self care practices and behavioral modifications such as the following first line treatments.
First line treatments:
-dietary modifications, avoiding triggers -stress management to improve coping techniques
Second line treatments:
-referral to a Gynecologist or Urologist who has a special interest/training in this disorder.
-referral to a Pelvic Floor Physical Therapist who has special training regarding the pelvic floor.
-Medications such as antihistamines, amitriptyline, pentosan polysulfate may relieve some of the symptoms associated with the disorder.
-Intravesical treatments, aka bladder instillations, with a variety of medications such as lidocaine, heparin, triamcinolone, DMSO have been proven to be effective in reducing symptoms utilizing an antiinflammatory approach.
Third line treatments:
-Cystoscopy under anesthesia for short duration with low pressure hydrodistension if first and second line treatments have not provided acceptable symptoms control and quality of life.
Fourth line treatments:
-Botulinum toxin A treatments
-Trial of a Neurostimulator
Fifth line treatments:
-Cyclosporin A orally
Sixth line treatments:
Complementary therapies include biofeedback, diet based therapies including anti-inflammatory diets, massage, yoga, pilates, herbal remedies, acupuncture, mind body medicine.
Kate, who’s name has been changed, sought treatment at our facility after 8 years of intermittent symptoms with an increased frequency of flares. She was evaluated with a history and physical exam, found to have spasm of the pelvic floor due to misalignment of her pelvis, chronic constipation and longstanding pain associated with her bladder. She benefited from life style modifications including dietary changes with increasing her water intake, reducing carbonated beverages, artificial sweeteners and caffeine, initiated pelvic floor physical therapy, as well as bladder instillations and an antihistamine. She has reduced the stress in her life which has helped her cope more positively with her symptoms during treatment and she plans to continue with yoga and a focus on self care.
There are many options today for our patients suffering from Interstitial Cystitis. Here at Inner Balance Pelvic Health & Wellness Center we will assist you as you navigate the process and celebrate with you as you gain control over your bladder once again!
The below article was recently featured by the New Hampshire Medical Society:
In honor of Women in Medicine Month, NHMS asked members to contribute stories of women physicians in the state. This week we feature Dr. Colene Arnold, with a special thank you to her business partner Leslie Parker, MPT, for sharing Dr. Arnold's story!
As an Obstetrician & Gynecologist, Dr. Arnold has worked on the Seacoast of New Hampshire for 14 years. While working full time with Garrison Women's Health Center and with Goodwin Community Health Center she recognized a significant increase in the use of opioids in pregnant women, and as with every section of the population, not enough facilities to treat this vulnerable group of women.
She responded by cofounding Hope On Haven Hill, an 8-bed, nonprofit, charitable residential facility for pregnant women with addiction and their newborn babies. She worked tirelessly learning about and then forming the nonprofit, recruited a dynamic Board of Directors, spent countless hours writing grants and fundraising, then moved her family out of their home to be able to convert their lovely, historic residence into a space that 8 women and their babies now call home, while they receive the necessary treatment to recover from their addictions. The doors opened in December 2016, and the rooms have been full with a waiting list since the inception.
Helping women with addiction has been a passion for Dr. Arnold. This dedication blends well with another area of interest that she has as a Gynecologist, which is treating women with Chronic Pelvic Pain. Her goal in this area is to treat women with the respect that they deserve and to provide them with a compassionate healthcare professional that they can trust to help them heal from the physical and oftentimes emotional trauma that has contributed to their pain. While treating patients that frequently have already seen up to 10 different providers, have had multiple imaging studies, all too often without an answer for why they have pain, other than it might just be in their heads, she once again felt the need to do more than she was already doing. She recognized that a comprehensive approach to treatment of Chronic Pelvic Pain was essential to help women regain control and last month, along with myself, she opened Inner Balance Pelvic Health & Wellness Center in Newington, NH. She brought together likeminded practitioners with backgrounds in pelvic floor physical therapy, psychology, sexual health therapy, nutrition, therapeutic massage, therapeutic yoga and Reiki to join forces, under one roof, to collaborate on the best approaches to bring about healing once again in a vulnerable population of women.
Dr. Arnold has accomplished so much in such a short amount of time. I'm grateful to be with her on this journey to wellness in her latest venture to bring about transformation from the emotional and physical pain that prevents many from achieving their full potential.
Leslie Parker, MPT
I remember riding my bike when I was twelve years old with my brother and some other boys in the neighborhood. I was such a tomboy and loved every minute of it. Well, maybe not every minute.
We were riding up the street in the schoolyard, about four of us. Life was carefree and so much fun. I remember laughing about something one of the boys said, and that is when it happened; I wet my pants just a little. Talk about embarrassing! Although no one knew, I have never forgotten it.
Giggle incontinence, a term used to describe children who wet their pants when laughing, is more common than most people are aware. It occurs more frequently in girls than in boys. And, unfortunately, it can lead to bladder leakage in the teen years and far beyond. But, why does it happen to some women and not to others?
As a licensed women’s health physical therapist, I now understand. When I discuss the reason with my clients, I explain it in simple terms. “Do you know how some people have better hearts or veins than other people? Well, they can also have better bladders.” Everyone is different, and we all have our strengths and weaknesses. One of my weaknesses led to giggle incontinence.
As I grew, my bladder issues resolved. Although I was lucky, this is not always the case. One out of every three women will experience this problem. I have treated women, men, and children for bladder issues and urinary incontinence over the past 15 years. There is not much I haven’t heard or seen. And, it is quite common to hear many women who have bladder leakage as an adult can remember having had it as a child or teenager.
Remembering how I felt at 12 years old when I had my bladder accident was a large reason I chose the field I am in today. The past 15 years has taught me that this can be fixed, regardless how long you have had your symptoms. And, it can happen fast!
Here are three of the practices that will not only reduce but also can eliminate your symptoms for good. The solution is counter-intuitive; so don’t be afraid to try:
1. Water is your bladder’s best friend. Do not stop drinking it or your symptoms will get worse. Water helps dilute the concentration of urine. The more concentrated your urine, the worse your symptoms will be. Drink eight ounces of water every two hours from the time you wake in the morning until at least two hours before bedtime.
2. Many things can irritate your bladder. An irritated bladder will give you symptoms such as peeing frequently, peeing urgently, peeing in the middle of the night, and peeing before you reach the bathroom. The worse irritants are caffeine, carbonation, alcohol, and acid juices or drinks. You must limit these daily. There are many other options to replace these irritating liquids.
3. Do not pee ‘just in case’. Although it sounds like it will prevent you from leaking, it will not! Remember, counter-intuitive! The more frequently you pee during the day, the more frequently you will have to get up to pee at night. And, some women end up waking four to six times a night to pee because of peeing ‘just in case’. Do not make this mistake.
Although there are other practices to take into consideration, the above three will make a world of difference. And, you will see results fast!
Implement the above practices and you will no longer have to struggle. You can overcome this awful problem. It does not have to rule your life. Bladder issues are embarrassing and life altering. But, these issues can be fixed no matter how long they have been plaguing you. I know this for a fact.
Try these practices and find freedom. Life is too short to wait.
Leslie M. Parker
I do not understand why women feel compelled to hold in their sneezes. I find it quite liberating to let it all out!
I have witnessed so many women hold in a sneeze, and when they do, it makes me cringe. As a physical therapist specializing in women's health, I understand the physiology of holding in a sneeze. And, for all of you who do it, it is terrible for your bodies! Let me explain.
For one thing, think about your internal organs. Do you realize how much pressure you are exerting on those organs when you do that? Sneezes travel up to 200 miles per hour!
Picture the organs like your bladder, uterus, rectum, and vagina all of which are located in your pelvis. Years of holding in your sneezes place ridiculous amounts of pressure on them. I bet you did not realize this, but that can lead to a pelvic organ prolapse. In other words, you can push any one or more of those organs out of place. And, depending on how far your organ or organs prolapse, surgery may then be your only option.
The act of pushing pressure down your abdominal and pelvic cavities while holding your breath is called a Valsalva. Many people do this without realizing it. Here is a small list of actions, to name a few, that could lead to a Valsalva:
- Doing sit-ups while holding your breath
- Lifting heavy objects while holding your breath
- Moving furniture in your house while holding your breath
- Holding in a sneeze
- Having a bowel movement while holding your breath, especially with a long history of constipation
- Picking up your child or pet while holding your breath
- Lifting your vacuum while holding your breath
- Giving birth while holding your breath
The reason a Valsalva can lead to a prolapse is that there is no place for the pressure to go except downward. And when it pushes on your organs, they too are being pushed downward.
But, if you do any of the above things while breathing, then the pressure cannot build in your abdominal and pelvic cavities and therefore not push your organs downward and out of place.
I know all of this to be true because I have seen it many times. I remember one woman who told me she felt it, her prolapse, happen. She was at work in front of her computer and needed to grab a large file. She remembered twisting and bending awkwardly to grab the file and felt something ‘give' into her vagina. She then felt an uncomfortable pressure there the rest of the day. When she got home, she used a mirror to see if anything was wrong. She was horrified to see something bulging out of her vagina. Her gynecologist verified it was her bladder. And, in case you are wondering, she never even had children.
From that point forward she had bladder problems such as pain, urgency, urinary tract infections, and leakage. Luckily I was able to help her to avoid surgery and control her other symptoms but her prolapse will always be a concern.
I treated another woman for a rectal prolapse. Her symptoms were even more severe because not only did she have difficulty emptying her bowels, but constipation caused urinary incontinence as well.
Don't let this happen to you because it is preventable. Awareness is the key as it usually is with most other things. If you already have a prolapse and do not want it to worsen, then make sure you avoid a Valsalva. If you want help controlling the associated symptoms, make sure to contact your gynecologist and your nearest pelvic floor physical therapy specialist.
Remember, in the words of Shrek, "Better out than in!"
Leslie M. Parker