Other than pelvic health and sex, my favorite conversation topic is cats water! Yes, good old H-2-O! You may recall a post I did a while back that discussed how diet can play a role in pelvic health. I talked about the importance of water intake, but patients still ask me questions about this topic. A majority of people report that they are not drinking enough water. Many patients ask if soda, coffee, juice and a myriad of other food and beverages count towards their water intake. While my gut reaction to these queries has always been an emphatic “NO!” I never checked to see if my instincts were correct. For this post, I decided to dive in and see if I can quench the questions surrounding water intake.
Water comprises about 60% of a human’s body weight, so it goes without saying that water is is vital to our health. Some of the ways water helps our bodies function include:
- Transporting other nutrients within the body
- Filtering out waste through urine, sweat and feces
- Maintaining homeostasis
- Keeping joints well lubricated
- Providing structure to cells and tissues
- Helping to preserve cardiovascular function
- Supporting bowel function
So, do milk, coffee, and juice count as water? Sort of. Your body absorbs a small percentage of water from (almost) everything you ingest. If you want to have a wild Saturday night, you can check out the USDA’s website which allows you to search for food composition by nutrient! Did you know that a slice of cheese pizza is roughly 42% water? A cup of chocolate frozen yogurt is about 70% water. (Finally, a diet I can get behind!) But there is only one thing that contains 100% water: WATER! Shocking right?
While fruit juice and other beverages can contain around 85% water, they can also contain a large amount of sugar and calories. With the rise of obesity and Type 2 Diabetes, these beverages should be consumed in moderation. Furthermore, The Center for Disease Control and Prevention (CDC) report that sugar-sweetened beverages are also associated with heart disease, kidney disease, tooth decay and gout.
Ok, we get it. Sugar is bad. What about coffee?
Coffee is comprised primarily of water, but for people who suffer from painful bladder syndrome/interstitial cystitis, coffee and other acidic beverages can irritate their symptoms. Water, on the other hand, has a neutral pH, so it does not irritate the bladder. Coffee also contains caffeine, which can make one feel jittery or anxious and in large amounts it can contribute to sleep dysfunction.
By now, you may have realized that I really like straight-from-the-tap water. Hopefully you want to join me in drinking the kool-aid water, but you may be asking yourself — how much water do I really need?
The amount of water a body needs varies from one person to the next, so the “8 glass per day” maximum is misleading. Here at PHRC we aren’t fans of cookie cutter medicine, therefore we don’t believe in “one-size-fits-all” dietary recommendations. The amount of water an individual needs varies based on several factors, namely:
- Gender
- Body weight/height
- Activity level
- Other health factors (Diabetes, chemotherapy, etc.)
- Pregnancy and breastfeeding
In general, the Institute of Medicine recommends that adult women consume 2700 ml per day, and that adult men consume 3700 ml per day. These figures include water that is absorbed from other beverages and food, but remember that only water will provide the body with 100% water. This recommendation is also based on a “sedentary person in a temperate climate.”
Some people, including fellow Physical Therapist and nutrition expert Jessica Drummond, recommend one’s daily water intake should be half one’s body weight. So if you are 200 pounds, you should drink 100 ounces a day.
If you exercise, your body will require more water to replenish itself. The same is true if you travel somewhere hot and humid, so if you decide to run a half marathon in the tropics, be prepared to increase your water intake!
Dehydration can impair cognitive performance. Research shows even a loss of 1% body water can have a negative impact on cognition. It can also contribute to decreased physical performance. Staying hydrated may help prevent certain illnesses, especially those involving the kidneys, which work hard to rid the body of waste. Drinking enough water can help prevent kidney/bladder stones and it may protect against chronic kidney disease (CKD).
The kidneys aren’t the only organ that can be impacted by insufficient water consumption. There is evidence that adequate fluid intake can help prevent exercise induced asthma. Additionally, hypohydration can contribute to constipation; if you follow this blog, you know that bowel health is important for a happy pelvic floor.
A water deficit can also negatively impact a person’s mood and energy levels. In one study, individuals with mild dehydration were found to report fatigue, confusion and anger. So before you start blaming your bad mood on being hangry, grab a glass of water.
Not a fan of drinking plain water? Try adding a slice of lemon, or make yourself feel like you are at the spa by adding cucumber and mint. You could make it even more fun by adding a crazy straw! Remember, while everything we eat does contain some percentage of water and contributes to overall fluid intake, it can’t replace plain, natural water. It’s vegan, gluten free, zero calorie and all around awesome. Whatever it takes, drink up and your body will thank you!
References:
- Popkin, Barry M., Kristen E. D’Anci, and Irwin H. Rosenberg. “Water, Hydration and Health.” Nutrition reviews 68.8 (2010): 439–458. PMC. Web. 24 Apr. 2018.
- Leahy M, Ratliff JC, Riedt CS, Fulgoni VL, III. Consumption of Low-Calorie Sweetened Beverages Compared to Water Is Associated with Reduced Intake of Carbohydrates and Sugar, with No Adverse Relationships to Glycemic Responses: Results from the 2001–2012 National Health and Nutrition Examination Surveys. Nutrients. 2017; 9(9):928.
- Daniels and Barry M. Popkin. “The Impact of Water Intake on Energy Intake and Weight Status: A Systematic Review.” Nutrition reviews 68.9 (2010): 505–521. PMC. Web. 24 Apr. 2018.
- https://www.cdc.gov/nutrition/data-statistics/plain-water-the-healthier-choice.html
- http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10925
- Riebl SK, Davy BM. The Hydration Equation: Update on Water Balance and Cognitive Performance. ACSM’s health & fitness journal. 2013;17(6):21-28. doi:10.1249/FIT.0b013e3182a9570f.
- D’anci KE, Vibhakar A, Kanter JH, Mahoney CR, Taylor HA. Voluntary dehydration and cognitive performance in trained college athletes. Percept Mot Skills. 2009 Aug; 109(1):251-69.
- Sontrop JM, Dixon SN, Garg AX, Buendia-Jimenez I, Dohein O, Huang SH, Clark WF (2013) Association between water intake, chronic kidney disease, and cardiovascular disease: a cross-sectional analysis of NHANES data. Am J Nephrol 37:434–442
- Ahluwalia, Namanjeet, and Kirsten Herrick. “Caffeine Intake from Food and Beverage Sources and Trends among Children and Adolescents in the United States: Review of National Quantitative Studies from 1999 to 2011.” Advances in Nutrition 6.1 (2015): 102–111. PMC. Web. 24 Apr. 2018.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
Thank you, Rachel for the informative article about H2O. I am a 68 yr.old woman who is 5’7” and weighs 137. I exercise 5 days a week : swimming, walking, doing a core strengthening exercise routine. I have been active my entire life ( gymnastics, soccer, basketball, karate, competitive racewalking, field hockey, etc.) I drink a gallon of water a day. I am probably one of the few 65+ women whose doctor has told her to cut back on water intake, as my sodium level has been low at my past two annual physicals. I have always preferred water. I do not drink soda or juice very often. I prefer to eat fruit instead of drinking its juice….more fiber. My only point is that drinking too much water can be dangerous to one’s health as can drinking too little.
Author Rachel Gelman says:
Yes, Excellent point!While most people report they don’t drink enough water; over-hydration can happen and can lead to Hyponatremia (decreased sodium levels). Symptoms can be similar to heat stroke and can include nausea, headache, confusion, and fatigue. So it is important for people to put in the amount of water that is expelled either through urine/sweat etc. You also point out why it is important to keep regular check ups with a healthcare provider who can assess if there is an imbalance and so that a person can discuss dietary concerns, including water intake.
Thanks you, Racheal..I will try adding lemon to help me drink…am turning 25 ,152cm ,weighing 54….been feeling pain in my lower abdomen..during sex…when to help my self…both urinating ,farting back pain