Bladder Problems Part 2

Fascial densification in the trunk affecting the bladder, like a rubber band around a water balloon.

Recall that a healthy fascial environment consists of tissue layers that are elastic, adaptable, and free to slide on each other. This is especially true in the trunk, which shelters organs, some of them hollow with constantly changing volumes – like the bladder. If the fascia looses this adaptability through the development of fascial densifications, then symptoms may arise that seem to be stemming from the organ. In the case of the bladder problems (BP), it may be urinary daytime/nighttime frequency, urgency, incontinence, pain/burning with urination, bladder/kidney stones, and much more. Often tests focused on the bladder are negative because the problem is the fascial environment surrounding the organ – not the organ itself.

Fascial densification in the trunk affecting the bladder, like a rubber band around a water balloon.
This is a great example of rigidity in the trunk fascia affecting the underlying organ. Imagine that this water balloon depicts the bladder. Certainly the volume of fluid in the bladder varies greatly. Ordinarily the bladder can accommodate such fluctuation as long as the fascia investing into it and inserting it to the trunk wall is elastic. But in the presence of a loss of slide in the fascial layers, as depicted by the rubber band around the balloon, the bladder will not be free to vary in volume without generating an abnormal signal – like frequency, urgency, incontinence. Photos used with permission of Dr. Carla Stecco, MD.

Equally important to remember is that it’s not just the fascia of the trunk that relates to the organs, but also the fascia of the upper and lower limbs. In the case of BP the lower limb is much more impactful since the bladder is housed in the lower half of the body within the segment of the pelvis. The fact that we walk on two legs forges a very strong biomechanical alliance between the lumbo-pelvic region and the lower limbs. Fascial dysfunction in the lower limbs can cause problems up the kinetic chain and into the trunk. A commonly occurring example of this is an old ankle sprain which eventually heals and no longer causes symptoms. Damaged connective tissues may heal, but often without restoration of slide in the tissue layers. This in turn can exert abnormal tension up the kinetic chain that may negatively impact the bladder – even if the ankle sprain is no longer symptomatic, and even if it happened many, many years ago. Conversely, fascial dysfunction in the trunk can impact not only the bladder, but also create tension from above to below that may manifest as knee pain, hammer toes, or bunions just to name a few possibilities. So considering both the trunk and lower extremities is essential.

Hammer toe and bunion
Fascinating (or as I like to say “Fascia-nating”) examples of tension manifesting in the limbs related to internal organ dysfunction. On the left is Dr. Carla Stecco presenting her research drawing correlations between internal organ and lower limb dysfunction (used with her permission). On the right is a photo I took of a patient who had 15 years of recurrent flank pain and kidney stones on the right side only. This is a striking example of the correlation between the lower limb and internal organs.

So with BP, like any other problem, we begin with getting a history paying particular attention to co-existing or past problems (old is gold) especially in the lower limbs. Ankle sprains are sooooo common and sooooo underestimated in their impact, even years later. My chapter in this book dealt with post-partum UI in a 33 year old runner who had a history of ankle sprains dating back to high school! Equally overlooked are past fractures, surgeries, plantar fasciitis, and pain in the hips, knees, and heels.  Sometimes people don’t remember these things because they were long ago and seemed to resolve.  Yet a lack of pain or other symptom does not signal full healing with restoration of vital slide between the tissue layers. 

Chapter on resolving UI in a post partum runner with history of ankle sprains
My chapter in this 2018 book dealt with resolving post-partum urinary incontinence in a 33 year old runner who had a history of ankle sprains dating back to high school! Available through Amazon.

This can happen anywhere in our body where the tissues are overloaded – and we overload ourselves all the time.  But the FM® method suggests that if such a loss of tissue slide occurs at specific points that are more important for movement and organ motility, then the impact will be greater.  These points are based on movement, force vectors, muscle and fascia physiology, and meticulous anatomical dissections.  So we are looking for a loss of slide in tissue layers, and paying particular attention to the segment of the pelvis since it houses the bladder, as well as the lower limb. The FM® approach gives us a road-map of sorts to follow.

Pelvis and Talus FM points
The segments of the pelvis and the calf/ankle (called talus in Latin) showing the Centers of Coordination (CC) and Centers of Fusion (CF) from the Fascial Manipulation® model. These segments are very important in the management of bladder problems. Used with permission from the Fascial Manipulation Association.

Many clinicians like to utilize a bowel and bladder diary in the management of BP. Some find this helpful in identifying problems as well as tracking changes in response to treatment. It basically consists of a log for fluid and foot intake and output, as well as activities and issues. That said, I typically do not use these as I find I can track status other ways. It’s also been my experience that patients find them a bit annoying, especially when asked to measure amounts of urine. I find counting the number of trips to the bathroom at night is an easy parameter (remember, 0-1 is ideal). Daytime frequency can also be tracked, with bathroom trips less than 10 or being able to go two hours without needing a bathroom is normal. Certainly there is some variability under circumstances where fluid intake is higher. If someone is using incontinence pads then I like to note the size and how many are used in a day/night. The number of episodes of unintentional loss of urine can also be tracked, and sometimes the number of times clothes need to be changed due to episodes. I had one very motivated patient who even weighed the used pads and compared it to the dry weight – very precise for tracking change! Improving tolerance to activity (running, jumping) without having unintentional urine loss is also another parameter to track.

Bladder Diary
An example of a bladder diary, with the top line completed for sample purposes. Many clinicians have their patients complete this for three or more days and then look for patterns. Available at the National Association for Continence website.

Being aware of bladder irritants is also important. Some clinicians caution their patients that they should avoid these items perpetually as part of their management strategy. But that’s not how I approach it. I believe a healthy bladder should be able to tolerate these substances without issue. It’s been my experience that once the environment related to the bladder is made as normal as possible, most people can tolerate these items, certainly with moderation and in reasonable amounts. From my perspective, telling a person with BP to avoid these items is like telling a person with knee pain to avoid stairs and squatting. That approach is not dealing with the problem: it’s just avoiding it. I think we can do better for BP and knee pain. But I do think it’s fair to consider temporarily curtailing these while working on BP. It’s also a good strategy to limit their intake before a particularly taxing activity such as travel or jogging. Once the BP is improved then these measures may not be necessary.


  • Coffee, tea and carbonated drinks, even without caffeine
  • Alcohol
  • Certain acidic fruits — oranges, grapefruits, lemons and limes — and fruit juices
  • Spicy foods
  • Tomato-based products
  • Carbonated drinks
  • Chocolate

As with most issues, there are potentially multiple influential factors and addressing them comprehensively will yield optimal results. I do a LOT of educating with patients (the inspiration for this site) to address the pervasive gaps there are in quality information (Dr. Google and Dr. Oz are not my favorites…).  Maybe there are a few key exercises (not Kegels or sit-ups) that will help to support the changes made with FM® treatment.  Maybe some lifestyle modifications would help (breaking up sitting, eating less salt, wearing supportive shoes, etc).  Perhaps getting a tool (percussion/vibration, 3TOOL) for self-treatment at home will help. Everyone has different needs warranting a different approach. But ultimately EVERYONE needs a self-care maintenance strategy!

I hope you can see that drugs, surgery, and living with BP are not the only options.  And please appreciate that the sooner these problems are addressed the easier they are to resolve. BP are typically not something that get better with time.    

Wishing you health and joy,


Published by Colleen Murphy Whiteford

I am a physiotherapist, graduate of Saint Louis University Class of 1984. I married my best friend and business partner, Bill, who is also a physiotherapist, in 1988. We have worked together all these years - an example of God's grace! Together we started Appalachian Physical Therapy which continues to thrive. I am a big believer in the power of touch, the manual therapies, and treating holistically. There are many alternatives to medications, surgeries, and testing, but people are often uninformed. My perspective emphasizes the role of the connective tissues including the fascia. Lack of attention to this structure is the source of many physical ailments - our bodies are truly fearfully and wonderfully made (Psalm 139)! I am passionate about helping people of all ages and diagnoses maximize their health, and empowering them to understand their role in management and prevention of problems.

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