Bladder irritants, go f*** yourselves.

That's what I have to say about it.

There are many kinds of pelvic floor therapists in this world.

I, for one, am pretty chill. I know many colleagues who review clients’ intake of bladder irritants upon evaluation and give them harsh recommendations: Never drink seltzer again! Lemon water is evil! Tomato sauce will end you!

Or at least that’s how it sounds in my head.

But what the fuck are bladder irritants, and if it's shrill to freak out about them, are they worth caring about at all?

Let’s do this thing.

Here’s the tl;dr:

• Yes, bladder irritants matter if you are experiencing symptoms of painful bladder syndrome or interstitial cystitis and/or if you experience urge incontinence and frequency. Basically, if your bladder is freaking out, you should look into it.

• With that said, elimination diets of irritants are, um, stupid. They can make your world small, and any elimination should be temporary and under supervision of a support professional!

• Consider nervous system regulation as the key to getting more irritants back into your life in a more flexible way, especially if you’ve eliminated a bunch!

• Water is your friend. The end.

The deep dive:

I’m writing this on my third cup of coffee, and I also had a matcha at 5 am this morning when I went out for a swim. (I’m not bragging, I promise, it’s just the only time I have to do it because parenting while working is a vibe.)

So, I’m a fan of bladder irritants.

If you’re asking yourself, Yeah Cait, could you tell me wtf they ARE already? — I would be thrilled to. Basically, they are the apex of all that is good and holy in the culinary kingdom.

source: mypfm.com

Like, are we for real with this?

We are. It’s true. These foods (and importantly but not listed — any artificial sweeteners) can irritate your bladder. The tissue can become more friable and likely to go into spasm, which can result in pain, urgency, and, if you’re prone to them, leaks.

I’ve worked with and coached many folks on the spectrum of painful bladder symptoms who have made their edible world incredibly small. It sucks to live in fear of onions, tomato sauce, and god forbid, coffee. What is so tricky and insidious about bladder irritant elimination diets is that they can help improve symptoms, but it’s because this triggers have an excitatory effect on the nervous system — not because they are inherently evil.

This is why folks who have done work to support their nervous systems can successfully re-introduce bladder irritants (and you can, too!). It’s also why being super strict can result in continued symptoms. It’s not the food — it’s the nervous system’s response to the food. This is especially true when folks are struggling with pain (think more painful bladder/interstitial cystitis).

But I digress. IMO, there is a time and a place to pull back on bladder irritants. When someone comes in with a primary complaint of urinary urgency and associated leaking (i.e. I have to pee all the time, the urge hits me fast and when it does I leak), it’s worth asking about what that person is drinking.

Similarly, if someone is struggling with constant UTI symptoms and associated pain, checking in on bladder irritants is relevant. Frequently folks with a painful bladder/fakeout UTI presentation will be more sensitive to one thing more than others (and sorry, it’s often caffeine).

I’ve known many a client to hit the coffee-seltzer-wine trifecta. If these are the drinks you’re primarily consuming, then yeah, we have an issue worth looking at.

But! Hold on! It’s generally not necessary to cut out your irritant(s) of choice, and definitely not entirely.

Here’s the take-home:

You’re not screwed. Here’s a step-by-step in thinking about how to approach bladder irritants:

• Drink plain-Jane water. Drink a lot of it. The more you hydrate, the more you dilute the irritant of your choice. I like to recommend a “water sandwich” around your favorite irritant, so for example, drink a glass of water, then have your coffee, and then top it off with another glass of water. Yes, I know it’s a lot of liquid, and yes, you’ll have to pee. But the inner lining of your bladder will be less irritated, making you less prone to leaking and/or pain. FYI, dehydrated urine is also a bladder irritant, so cut out the whole “I’ll drink less” thing, too.

• Consider the role of pelvic floor tension. Even if you’re only experiencing increased frequency, this can actually be your body’s way of telling you that there is way too much tension in your pelvic floor (this happens to me reliably every few years). There are lots of ways to address this: breath work, manual work, abdominal release, movement. Paid subscribers can scroll down to get free access to some of my fave moves!

• Consider the role of your nervous system. It’s weird to think about holding tension in your bladder, but the reality is that it happens. Or rather, tension in your lower abdominal wall and pelvic floor create a lot of stress on the fascia around your bladder, making it really fucking sad and prone to spasm. So if you’re constantly stressed/holding your breath/stretching yourself far too thin, know that this is a part of the equation.

• Figure out what bothers your system the most. Bodies are different. It’s true that some folks respond strongly to individual irritants, so it’s worth trying to figure out what’s bothering you. If you have more severe symptoms, or if you have any history of eating disorders, I strongly recommend working with a team (nutritionist, therapist, pelvic floor therapist, etc.) to support you in this process.

I can’t stress enough that addressing pelvic floor tension and nervous system regulation should be done as a priority before you begin aggressively messing with your diet. For real, y’all.

As always, I am rooting for you. Email me any time at cait@ritualpelvichealth.com with questions, feedback, or if you’d like to work together for pelvic restoration coaching.

Lastly, I would love to see you in one of my small groups! Postpartum is Forever (for folks 18+ months to infinity years out) begins this week, and Pregnancy and Postpartum groups will begin August 14/15. Pelvic pain support group begins in September. See you there! <3