Copyright © 2009 by Amy Stein. Click here for terms of use.
It's not exactly headline news that diet affects health. Today, we're bombarded by advice about what to eat, when to eat, and how to eat to stay healthy. We're told by everybody from government guidelines writers to gourmet chefs to focus on plant foods, avoid saturated fats, stay away from sugars, limit processed foods, balance our protein and carbs, and eat in moderation. It's all excellent advice, and the fact is, what's good for our overall health, nutritionally speaking, is also good for pelvic floor health.
But it is also the case that some foods and some ways of eating are particularly helpful if you have a pelvic floor disorder, while some other foods and ways of eating can be particularly irritating to the disorder. To the extent that irritating a disorder can slow down your healing process, eating the right foods in the right way can be seen as an important way to support the healing you're doing with the exercise and massage programs you're undertaking. That's what this chapter is about. It offers guidelines for what to emphasize and what to avoid to make sure you get the most out of the natural healing process you've begun.
I'm going to assume that you know how to read a nutrition label—that you understand that serving size is the key to the label, for example, and that you know the basic nutritional definitions. I'm also going to assume that you have no known food allergies or, if you do, that you are under a doctor's care for the treatment of these allergies. And certainly, if you are suffering from a specific pelvic floor dysfunction, you should consult with your health-care practitioner about precisely what you should eat and what you should avoid eating to deal with your individual condition.
But if you're reading this book because you have a pelvic floor disorder that is causing you pain or problems, there are some general nutritional guidelines you can follow and some specific tips for bladder and bowel disorders. All of these guidelines are also general good-health recommendations; following them will help you to have a healthy pelvic floor and a healthy body for life.
Generally speaking, anything that makes digestion easier—anything that calms the gut—is good for you if you're experiencing pelvic floor disorder. Keep in mind, for example, that cooked foods are easier to digest than raw foods, while still offering sufficient nutrition. Something else that's very good for the digestion is to eat four to five smaller meals scattered throughout the day rather than three big meals morning, noon, and night. Both sides of the equation ease the digestive process: the fact that you are eating less at any one time, and the fact that you are allowing time for the smaller portions to be digested between meals.
What should you eat at those smaller, more frequent meals? The government-issued food pyramid sanctioned by the Department of Agriculture—http://www.mypyramid.gov—is a good place to start, with its recommendations for five servings of fruits and vegetables every day, four servings of whole grains, and moderate amounts of protein.
The fruits and veggies are particularly important if you have pelvic floor disorder because they add fiber to the diet, and fiber is key in advancing the digestive process. In fact, it's advisable to have some 20 to 35 grams of soluble and insoluble fiber daily to ensure the smooth running of your digestive tract. Twenty to 35 grams is really not that much in terms of weight; 35 grams is just a little over an ounce of food.
What are soluble and insoluble fiber? Soluble fiber disperses in water and slows down the process of digestion through the intestinal tract, whereas insoluble fiber—what we typically think of as "roughage"—doesn't break down easily and thus speeds the process.
Soluble fiber is found in cereals, fruits, and colorful vegetables like carrots and broccoli, beans, and peas.
Some Common Sources of Soluble Fiber
Cereal grains: barley, oatmeal, oat bran
Seeds: psyllium, flax
Fruit: pears, citrus fruits, apples, peaches, plums, and more
Beans: lima, black, navy, pinto, lentils
Peas: chickpeas, black-eyed peas
Vegetables: carrots, broccoli
For insoluble fiber, look for the leafy green vegetables, root vegetables, nuts, and whole wheat products—and be aware that if a product is truly whole wheat, the label will say so by putting "100% whole wheat" first in its listing. The skins of fruits and of root vegetables in particular are also excellent sources of insoluble fiber. One caution about insoluble fiber: if you have abdominal cramps, foods rich in insoluble fiber can exacerbate your pain, so eat them in moderation or stick to soluble fiber instead; it is easier to digest. Ditto if you have constipation or diarrhea: in either case, you can eat insoluble fiber, but you want to limit it initially. After your constipation or diarrhea calms down, then you can add more insoluble fiber—slowly and carefully.
Some Common Sources of Insoluble Fiber
Fruits: fruit skins, berries, grapes, prunes
Vegetables: beets, carrots, brussels sprouts, cabbage, cauliflower, broccoli
Other: kidney beans, bran
Some foods contain both soluble and insoluble fiber—broccoli, carrots, some fruits. The key is that foods containing insoluble fiber are harder to digest than those containing only soluble fiber. This means if you're having digestive problems, avoid foods containing insoluble fiber—at least at first until the digestive problem calms down.
But just as important as the foods that provide particular benefit to the health of your pelvic floor are the foods that can harm your healing. Specifically, try to avoid the simple carbohydrates or simple sugars. You know the foods I mean: cakes, candy, white bread, cookies, and the like. Also to be avoided are other "white" products—the starches like white flour, white rice, plain pasta, and white potatoes that can inject added yeast into your system. In addition, these foods can cause constipation, which of course is totally detrimental to digestion. There is also some speculation that too much of these sugars and starches can increase inflammation in the body and exacerbate the symptoms of such conditions as endometriosis. As for artificial sweeteners, unfortunately, they're no better, as they tend to irritate the gut and the bladder both.
It's also a good idea to limit your intake of alcohol and caffeine, both of which dehydrate the body, and both of which can aggravate bladder problems. Sometimes, it is true, an alcoholic drink can relax the muscles, including the pelvic floor muscles, and sometimes a cup of coffee or tea can help to stimulate a bowel movement and thus ease constipation. But as a general rule, both alcohol and caffeine are best in moderation—for any number of health reasons!—and there are, of course, other ways to relax the pelvic floor muscles and ease constipation.
Instead, drink plenty of nonalcoholic and noncaffeinated fluids. Six to eight glasses a day will keep the body hydrated. The taller and bigger you are, or the more you tend to perspire, the more you should drink. Moreover, if you have bladder or bowel issues, it's essential to take in plenty of these fluids.
Avoid fried foods and foods high in saturated fat whenever and wherever possible; that's good advice for health in general, but it's also true that these foods can contribute to clogged arteries, which decrease blood flow. If you have a pelvic floor disorder, chances are the blood flow to the pelvic region is already constricted because of pelvic congestion or tight muscles, so fried and fatty foods will only make the situation worse. What's more, you need good nutrition to help your healing process, and fried foods and foods high in saturated fats simply don't qualify as nutritional.
For those women who suffer vulvar vestibulitis, one more set of foods to think about avoiding is those high in oxalates. Oxalates occur naturally in certain foods such as blackberries, blueberries, raspberries, strawberries, spinach, Swiss chard, beet greens, collards, okra, almonds, cashews, peanuts, legumes, grains, even hot chocolate—many of the foods otherwise considered good for overall health and for pelvic floor health as well. Yet recent research suggests that the acid content of oxalates can increase the pain and skin irritation that can occur in the vestibule of the vagina in women. And while the verdict is still out on this claim, it's important to be aware of the possibility if this is a condition you experience.
If you are changing your diet to help heal pelvic floor disorders, be aware that it may take at least one month—and more probably, anywhere from three to six months—for you to notice a change in your bladder or bowel. If after eight months there is no significant change, or if you are not satisfied with your progress, you should consult with a nutritionist or with a health-care provider who specializes in nutrition as it affects bowel, bladder, and chronic pain issues.
If stress incontinence is your problem, follow these guidelines as best you can:
1. Drink at least six and preferably eight 8-ounce glasses of noncaffeinated, nonalcoholic beverages a day. Water is the top choice, but juices or herbal teas are also okay. But do try to finish your last intake of liquid at least two hours prior to bedtime.
2. Limit or eliminate caffeine and acidic teas like green tea. These act as diuretics or bladder irritants that can result in increased urinary frequency, and the acid can be just as irritating to the bladder as the caffeine in these drinks.
3. Avoid constipation. It results in increased pressure on the bladder. See the next section, "If You Have Bowel Problems," for more detail on how to avoid constipation.
If your problem is irritated or painful bladder or urge incontinence, do all of the above, and add the following food no-nos. While not everybody is affected by these foods in the same way, all of them have a tendency to aggravate the symptoms of irritation and urge incontinence, so to the extent possible, try to avoid the following:
• Acidic foods and beverages like most citrus fruits and fruit drinks as well as wines that contain tannins
• Spicy foods
• Carbonated beverages: the bubbles tend to aggravate the bladder
• Yeast-producing foods such as white bread, white rice, candy, or cake
Here's a way to counterbalance something you have eaten that you know may aggravate your bladder: put a quarter-teaspoon of baking soda into a big glass of water, and drink it down. Then drink another glass of water. The solution will help alkalinize your urine—that is, counter the acidity of what you've eaten. Be careful if you have any sort of heart condition or high blood pressure, however, as the baking soda has a high salt content. Instead, just make sure you avoid the aggravating food in the first place.
Constipation and diarrhea are the two main bowel problems that can be helped—or exacerbated—by what you eat. Both are certainly unpleasant and often painful, and both constitute burdens on the digestive process.
Constipation can result in increased abdominal pressure, bloating, gas, and pressure on the bladder, the pelvic organs, and the pelvic floor muscles. Severe constipation results in increased toxicity in the bowel and in the body.
The straining that constipation gives rise to is particularly bad for you: it increases abdominal pressure, stresses the pelvic floor muscles, and could result in a hernia of the abdomen or pelvic floor muscles or pelvic organ prolapse. Here's a good way to picture it: if you have any problems with the pelvic floor muscles at all, and you strain because of constipation, it is like running a marathon with a bad knee. In other words, you could be causing real, long-term harm.
How do you get constipation? The main causes are insufficient fiber in the diet, insufficient liquids, insufficient exercise, too many simple sugars or white products, and certain diseases. Medications very often cause constipation, so be aware of this when your doctor writes you a prescription. Tight pelvic floor muscles may cause the bowel retention that can contribute to constipation.
In addition, some people have specific food intolerances that, when cured, lead to relief of bowel symptoms—an indication that these intolerances may cause the symptoms in the first place. Some folks may be gluten intolerant, unable to digest the substance found in most cereals and whole grains. Others may be lactose intolerant; in their case, the enzyme lactase, which breaks down the milk sugar lactose, is diminished or missing in the digestive tract, often leading to bloating and abdominal cramping. In both cases, curing the intolerance—or simply giving up the particular food—cures the bowel issue and ends the constipation. There are medical tests for both of these intolerances—or you can simply try doing without gluten and/or milk products for a time and seeing if your symptoms improve.
Nutritional Guidelines for Constipation. You will need to take nutritional steps to activate the gut in case of constipation. But don't make a radical change in your diet. That is, if you mostly eat high-fat foods and white foods, don't suddenly switch to a high-fiber diet; that will be a shock to the system that may actually exacerbate your symptoms. Ease into the changes instead:
1. Add fiber to your daily diet slowly, working your way incrementally to the recommended 35 grams per day. At first, focus on the soluble fiber contained in fruits, vegetables, and oatmeal rather than on the insoluble, which, although good for you, can make bowel movements harder and more difficult to pass. As your gut calms, slowly begin to add insoluble fiber to your diet, and maintain a daily balance between soluble and insoluble fiber.
2. Eliminate fried foods and foods high in fat.
3. Drink plenty of water.
4. Eat the government-recommended five servings a day of fruits and vegetables along with moderate amounts of healthy protein, but avoid gas-producing foods like broccoli and dried fruits.
5. Limit simple carbs, starches, and artificial sweeteners.
6. Try probiotics—dietary supplements containing good bacteria that benefit digestion.
Asparagus
Beans and other legumes: baked beans, chickpeas, kidney beans, lentils, lima beans, navy beans, pinto beans Broccoli
Brussels sprouts
Cabbage
Cauliflower
Corn
Cucumbers
Dried fruits
Leeks
Peas
Peppers
Prunes
Carbonated drinks
Beer
Red wine
Fried and fatty foods
Sugar substitutes
Dairy products
Here's another important tip, although not a matter of nutrition: engage in some cardiovascular activity. It's muscle-enhancing exercise, and since muscle expends more energy and uses more calories than fat, the exercise helps to quicken the metabolism. That in turn speeds elimination and can calm the gut.
If all of these actions still don't solve the problem, add one of the many over-the-counter treatments for constipation. Typically, these contain psyllium (Metamucil), methylcellulose preparation (Citrucel), or a hydrating laxative (milk of magnesia). Use any of these treatments sparingly and temporarily; abuse can worsen your underlying problem.
Diarrhea can be dehydrating and, if it lasts for any period of time, downright dangerous. The trick to avoiding it or healing it is to find the happy medium between too much fiber, which can cause diarrhea, and not enough fiber causing constipation. Since everyone's body is different and responds differently to various food products, finding that happy medium isn't always easy.
Once it's found, however, the nutritional guidelines for diarrhea are much the same as those for constipation; all are aimed at calming the gut.
Nutritional Guidelines for Diarrhea. Here are some simple steps you can take to combat diarrhea.
1. Start by reducing the amount of fiber in your diet in order to get the diarrhea under control. Then, reintroduce soluble fiber slowly into your diet to avoid constipation. Once you're able to tolerate the soluble fiber, slowly add small portions of insoluble fiber until you work up to a balance between the two. If you cannot tolerate insoluble fiber at all, stick to the soluble fiber.
2. Eliminate fried foods and those with high fat content.
3. Drink plenty of water.
4. Limit sugars, starches, and artificial sweeteners.
5. Try for the government recommendation of five servings of fruits and vegetables per day along with healthy protein.
6. Try probiotics.
Again, if these guidelines don't work, try an over-the-counter antidiarrhea medication. Start with a small amount; too big a dose can lead to constipation.
One of the best ways to understand how to keep your digestion calm—and your pelvic floor in good working order—is to keep a food diary.
The key to a successful food diary is to be completely conscientious about filling it out: every meal, every drink, every snack. Only in that way can you begin to see connections between what you eat and any discomfort or disorder. Also, it takes time. Patterns don't emerge overnight.
In the following food diary, you can keep track of everything you eat, noting what you eat and what time you eat it, and everything you drink and when you drink it. You should also note any discomfort you feel or disorder that occurs: again, what it is and when you first felt it.
Be patient and persistent in monitoring your intake and any consequences. In due course, your food diary will show you what aggravates your digestive tract and what soothes it—and you'll be better equipped to ensure a healthy pelvic floor.
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There is lots more information available on specific foods that can harm or potentially heal specific conditions. Moreover, the research on these issues is ongoing—and at a pretty fast pace. That's why it's important to check with your health-care provider about any specific condition you know you have to discuss which foods to avoid and which to emphasize.
I also recommend checking online with the association that addresses your particular condition. These associations—for example, the National Vulvodynia Association (www.nva.org), the Interstitial Cystitis Association (www.ichelp.com), the Irritable Bowel Syndrome Association (www.ibsassociation.org), and many others (see Appendix B)—tend to be current on the very latest research and can potentially offer the most up-to-date nutritional recommendations.
In general, however, it's important to keep in mind that a healthy, low-fat diet, one that limits simple carbs and is rich in fiber and other basic nutrients, can keep your pelvic floor healthy. And a healthy pelvic floor is the core of a healthy you.