September means…
Back to school and Increasing Awareness

Somehow it is September again and all the talk is of going back to school – I must admit I am joining in this year, having enrolled in an advanced diploma in nutrition and health coaching – more of that to follow!

September is also awareness month for a number of topics that I’m passionate about – it is Gynae Cancer Awareness month, Menopause Awareness month and Interstitial Cystitis/ Bladder Pain Awareness month – all big topics for women’s healthcare professionals!
But is there a link?
Well, obviously gynae cancer and menopause are exclusively female health issues but we also know that the vast majority of patients we see with Bladder Pain Syndrome are women too, so it isn’t too hard to make an association.
For the rest of this month, I’ll be posting on Facebook (Michelle Lyons Celebrate Muliebrity) and on Instagram (michellelyons_muliebrity) about these three topics but today I’d like to focus on a starting point that’s relevant for all three – self-awareness. Self awareness of what and how we eat and drink, how that affects us, how we prioritise good self care and paying attention to what our bodies are telling us.

Let’s start with Bladder Pain Syndrome/ Interstitial Cystitis.

Bladder Pain Syndrome (BPS – but also sometimes called Painful Bladder syndrome or PBS…) is what we are now calling the disease formerly known as Interstitial Cystitis (or IC). Which makes a lot more sense because Bladder Pain Syndrome isn’t interstitial and it isn’t cystitis…It’s a a painful bladder disorder that predominantly affects young and middle-aged women, with an average age of onset of 40 years .

BPS is characterised by bladder frequency (feeling like you’re urinating too often), urgency (the sudden powerful desire to pass urine which is difficult to postpone) and of course pain (the frequency of urination is to avoid the pain of bladder filling rather than the fear of leaking)
According to ESSIC, BPS is defined as pelvic pain lasting more than 6 months, and the pain worsens with bladder filling, eases with emptying. There’s a persistent urge or increased urinary frequency but it’s without an identified bladder or urethral infection. All of which makes it maddening for the patient who presents repeatedly to their doctor with the signs and symptoms of a UTI but with clear urine culture…Ploteau (2015) said ‘…Pain is expressed as coming from or due to functions of the bladder, but the bladder itself does not necessarily elicit pain’ which can stump both medical practitioners and the patients they serve.

What does work? (Once infection and bladder cancer have been ruled out)

Well…sometimes we have to look outside the bladder, to zoom out and look at the whole person, rather than an exclusive hyperfocus on the specific organ.

Questions to consider might include – what is happening from a nutritional perspective? Can we look at what our patient is eating, how they are absorbing and how they are eliminating, both from a bladder and a bowel perspective? (We know the bladder and bowel love to talk to each other, and when one of them is unhappy, the other loves to join in). Do specific foods or beverages play a role in your bladder pain? Typical culprits may include dairy, gluten, tomatoes, citrus or spicy foods but the evidence isn’t conclusive, so the gold standard is going to be an individual approach. Eliminate one food group for three weeks, monitor symptoms, add it back for three day and then remove it again. Any change in the bladder pain? There’s your answer. A diverse but individual diet seems to work best – O’Mahony et al (2017) showed that gut microbiota is key regulator of visceral pain and Siddqui et al (2012) concluded that there is reduced microbacterial diversity in Bladder Pain Syndrome urine. It’s about knowing what irritates you and making good choices in self care.
We know that not only is there an association between Bladder Pain Syndrome and Irritable Bowel Syndrome, but there are also links between BPS and vulvodynia. Whether it is because of embryological derivation or the role of sex hormone-dependent mechanisms, the comorbidity of vulvar and bladder pain syndromes, there is evidence to suggest that topical oestrogen (a 12 week course) may be beneficial (Gardella et al 2015).
Of course, it is impossible to talk about either Bladder Pain Syndrome (or vulvodynia) without acknowledging the huge role of pelvic floor muscle dysfunction (and breathing and stress management and movement and exercise and good sleep!) will all have on overall quality of life and independent self-efficacy and self-management.
In her essential-reading 2017 paper, my learned colleague and friend, Jilly Bond, explores how ‘..Prolonged PFM tension contributes to the bladder pain, urinary frequency and urgency associated with BPS’. Her paper goes on to describe a treatment approach that takes into consideration the whole person, incorporating physio-led but also independent myofascial release, food and fibre intake, good bowel habits, movement and mindfulness relaxation – all of which build on educating and empowering patients to practise self-awareness, listen to their bodies and use their self-care toolboxes to decrease their disability (there is a high level of suicidal ideation associated with IC/BPS) and improve their wellbeing and quality of life.

Self awareness is a key factor in managing disease processes like BPS – knowing what causes a flare, knowing how to settle it down. Knowing what to eat, what to avoid, how to manage stress, how to incorporate mindfulness or other stress management strategies, what exercise can do, how to have happy, relaxed functioning pelvic floor muscles, how to prioritise good self care – ultimately, how to have a happy healthy bladder involves looking at the whole person, not just the bladder itself

I had the pleasure of interviewing Jilly earlier this year, as well as hearing her speak at Woman on Fire 2018 – you can have a listen here!

All this month, I’ll be continuing to shine a light on BPS, Gynae Cancer and of course, Menopausal health

Where I’m teaching: 

I’m teaching a one day Menopause Masterclass at Live and Breathe Pilates in Dublin on September 30th and next month, I’ll be teaching a two day ‘Integrative Approach to Menopause’ course in Toronto, in association with Pelvic Health Solutions. Prefer online? The definitive online menopause education, 3rdAge Global Online Certification, is available here. Working with women who have had a Hysterectomy? Have a look at our Optimal Health after Hysterectomy online course. Want to take our ‘Breathe Better’ course? Have a look here

Until next time,
Onwards & Upwards,