Today, I’m talking with Cate Arima, a board-certified nurse practitioner at Stanford Health Care, fellowship-trained in integrative medicine, and creator of Stanford’s Yoga for Incontinence program.

In this conversation, we explore the connection between stress, the nervous system, pelvic floor health, and the subtle ways our bodies try to get our attention long before we stop long enough to listen.

What if stress has been showing up in your body in ways you didn’t expect? I think you’ll find this conversation both fascinating and reassuring.

Let’s see what Cate has to say.

How Stress Shows Up in the Body: The Hidden Connection Between the Nervous System and Pelvic Floor Health

Dr. Cindy: Today’s guest is Cate Arima, a board-certified nurse practitioner at Stanford Health Care in urology, where she blends conventional medicine with a deeply integrative approach to healing.

Cate is fellowship trained in integrative medicine through the Andrew Weil Center for Integrative Medicine at the University of Arizona. She’s also a 300-hour certified yoga teacher with advanced training in pelvic floor yoga and yoga for incontinence. What I find especially fascinating about her work is that she’s helping bridge conversations we don’t often hear about in medicine, and that’s the connection between stress and the nervous system, pelvic floor health, and the body’s deeper signals.

She even created Stanford Health Care’s first Yoga for Incontinence program for patients with a history of prostate cancer, and I’m sure we’ll get into that in just a moment. Thank you for being on the show today. Welcome, Cate.

Cate: Well, thank you so much. I’m so happy to be here. Thank you.

Dr. Cindy: So Cate, I’d love to start with your story. I know you work in urology and pelvic health, which I think is a unique space in medicine. What drew you to this area of work?

Why Pelvic Floor Dysfunction Is More Common Than You Think

Cate: You know, it’s really quite interesting. So I was a labor and delivery nurse before I became a nurse practitioner, and I wanted to be a nurse practitioner in OBGYN.

And actually, in NP school, I was like, “Don’t even waste your time showing me man parts because, um, I’m not gonna work with men, like, ever, professionally, like, ever.” But you know, it’s just really, really funny how the universe guides you and has its own plan for you because I somehow ended up in urology, of all places.

When I had graduated from graduate school, there were no jobs available in OBGYN for me, and MinuteClinics were really popular at the time, and so I got a job at a MinuteClinic. It shut down. And then I just was placing my application everywhere, and the VA in San Francisco had a job in urology of all places, and I thought, “Did they see my background?”

But the interview went really well, and it was so interesting. I had no idea I would fall in love with the vets so much, and that I would actually fall in love with urology so much. I call urology the secret pot of gold that just endlessly fills with gold.

So you’re like “Oh my gosh, I gotta tell my friends about this endless pot of gold.“

This is urology. So that’s urology to me.

Dr. Cindy: Oh my goodness. So today, are you working at the VA only,

Cate: Um, no,

Dr. Cindy: Or at Stanford

Cate: Yeah. So I’ve actually been at Stanford Health Care since 2015.

Dr. Cindy: Okay.

Cate: And whenever I do meet a vet, it’s interesting. We have vets who come to Stanford Health Care in urology, but they also still see a urologist at the VA, which I find so interesting. So any time I see a vet come in, I’m just so happy to see them. I’m like, “Oh, yay.”

Dr. Cindy: Wow. Yeah, I remember my time working at the VA in residency and it was a very different feel from all the other settings in medicine, and just patients were so grateful, and so stoic too.

Cate: Well, that’s it. You know, I know patients get very frustrated when there’s long wait times. But what I found so interesting about the vets was exactly that. They were just so grateful. You know, they’ve been to hell and back with war. Like, they don’t care if they had to wait an hour to see you.

They’re just so happy and grateful to see you.

Dr. Cindy: I’ve noticed in medicine, I think there is a greater recognition among providers or practitioners, whatever word you choose, and patients alike, that stress and emotional health are really tied to physical health. And I’m curious how that affects pelvic floor health.

The Brain-Bladder Connection: How Stress Can Worsen Urinary Symptoms

Dr. Cindy: What have your urology patients taught you about this new connection between stress and physical health, but especially the pelvic floor? How does that tie in?

Cate: Oh, my goodness. So it’s so incredibly interesting. It wasn’t until I started working in urology that I realized how much our brain is connected to our bladder.

They’re like this. They’re like best friends. The brain and the bladder. So when we are anxious or when we are stressed, it does worsen our urinary symptoms. So for example, we have something that’s called urge incontinence. That’s when you have the urge to pee, you can’t get to the bathroom in time, and then you leak urine.

There’s also something called turnkey incontinence, which is basically urge incontinence. So we call it turnkey incontinence because this is back in the day when people would enter their home through their front door, and they would have a key to open the front door. And so, turnkey incontinence is, you know, you’re driving home, you feel the urge to pee.

You know you’re gonna make it, you know you will, and then you pull into your driveway, you’re running up to your doorsteps, you’re fumbling with your keys. You’re about to open the door with your key, turn the key, and oh, darn it, you leaked all over the place. So we call it turnkey incontinence.

So the thing is that when we’re so anxious and so stressed like that, just like in that example, it actually causes more tension in our body or more contractions in our body, and then we can’t control the… In terms of the bladder, we can’t control the bladder from leaking.

What’s interesting is that when we feel that urge to pee, if we just do a pelvic floor contraction, or Kegels, which many people know, it is then that automatically sends a message to the brain, which then sends a message to the bladder to relax. So for people who are constantly stressed, constantly anxious, constantly have tension within their body, their pelvic floor muscles are always somewhat tight or contracted.

So when they try to do that contraction, it’s not a very strong contraction, ’cause it’s already starting off tight. So, you know, I always give the example of the bicep muscle. So a strong muscle has to contract well and stretch and relax well. If you keep the bicep muscle or your muscle contracted all the time, and then you contract it again it’s t- it’s not as strong of a contraction as if you were to relax the muscle out first, then come back and contract it, then that’s a stronger contraction, stronger muscle.

So the same thing with your pelvic floor muscles. And then additionally, with people who have tight, contracted muscles, it can lead to pelvic pain. It can lead to pain in the back, pain in the groin, pain with urination, just a whole bunch of additional symptoms.

Signs of a Tight Pelvic Floor and Why Relaxation Matters

Dr. Cindy: What it sounds like you’re saying is people who are under a lot of stress and have this constant contraction in their pelvic floor muscles need a way to somehow relax that muscle or band of muscle.

So that leads into how do they know they need to do that, and how do they do that?

Cate: Yeah. So, this is why pelvic floor physical therapy is absolutely wonderful, because oftentimes when people have pelvic floors that are too contracted, they pee frequently, not because they’re afraid of leaking, but because as their bladder fills they start to have a pain sensation in the pelvis area. So first identifying that, “Ah, this pelvic pain I’m having is from a tight pelvic floor.” So first identifying that is really key.

And one of the treatment options is pelvic floor physical therapy, where they teach you, “Okay, can you sense the pelvic floor when I press my finger here or here? Does it cause any pain?” We call them trigger points. And then once we identify those, then the pelvic floor physical therapist teaches the patient how to relax those muscles. And additionally, we tell patients to take a warm bath, a warm shower, just anything to release some tension in the body.

Yoga for Incontinence: Can Yoga Strengthen and Relax the Pelvic Floor?

Dr. Cindy: Okay. And then I’d love to also hear how yoga plays into this, because you have started a yoga for incontinence program. Yeah. So explain that part.

Cate: Yeah. So yoga, I absolutely love yoga, because what yoga does is it does get us in tune with the sensations within the body.

So we often go through life not even knowing if we’re stressed or tense, or we don’t necessarily feel the weight of the burden that we’re carrying. Because in this very fast-paced society, especially in this fast-paced world of medicine, it is all about go, go, go. I don’t, I don’t have time, I don’t have time to think about my feelings or to feel my feelings or to feel my body, because I need to keep going.

So what I love about yoga is it actually gets us in tune with the body and makes us realize, “Oh, gosh, there is tension.” So when I teach and if I say, “Relax the shoulders,”

“Ah, relax the shoulders. I didn’t even know I was tensing my shoulders until you said relax the shoulders.”

So that’s why I love yoga, because it gets us in tune with seeing where the areas of tension are and then how we can relax them.

Dr. Cindy: Okay. I watched a brief video of a presentation you gave about this, and I would really love it if you just spoke briefly about how the poses help with relaxing. Maybe the person in the yoga class is not directly thinking, “I’m gonna relax my pelvic floor muscles or my shoulders,” but they’re doing certain moves that help to do that.

How does that work?

Cate: Yes. Yes. So the pelvic floor yoga class, or I call it yoga for incontinence, the class is designed to strengthen the pelvic floor muscles. So the different poses are either working on contracting the pelvic floor muscles or stretching, lengthening, relaxing the pelvic floor muscles.

So specifically for stretching and lengthening the pelvic floor muscles, I do standing forward bends. So when you spread the legs wide and you hinge forward and do a standing forward bend, that stretches the pelvic floor muscles.

Squats, so we do a squatting pose that also stretch, lengthens pelvic floor muscles.

And then we do a happy baby, so that’s when you’re laying on your back and you’re using your hands. Most people think a happy baby, they’re laying on their back, and then they use their hands to either grab their ankles or their feet. I do a modified version of that where you actually grab your knees and spread the legs wide, and the reason for that is because I want us to keep the natural curves of the spine.

I want the pelvis to stay in a neutral position. When people are hunching forward and reaching for their feet or their ankles, it actually causes a tilting back of the pelvis, which then can cause more of a contraction of the pelvis. So by keeping the pelvis neutral or even tilting it slightly forward, that actually will stretch and lengthen the pelvic floor muscles.

And then in terms of contraction, so when we do work on contraction of the pelvic floor muscles, it’s all about contraction of the deep core muscles. So the core muscles are actually not just the abdominal muscles. It’s the pelvic floor plus the deep abdominal muscles plus the tiny muscles along the spine called the multifidus muscles.

So we do a lot of bird dog. That’s when you’re in a tabletop position and you have- you extend one hand forward and then the opposite leg back, maintaining your balance. We do marching poses that also help maintain our balance. So, those are things that we do for the contraction of the core muscles.

Dr. Cindy: So it sounds beneficial to attend one of your classes, and I hear that they are streamed live or even asynchronous so people can learn these techniques from you. Is that right?

Cate: So, they’re not asynchronous yet, but, yes, they are live streams. Okay.

So I teach at two places. So I do teach at work, and those classes are for my prostate cancer patients. And the reason why I chose them was because I wanted to choose a subset of the population who I thought would not come to a yoga class or who were afraid of coming to a yoga class. And so I chose men, and I chose older men.

And, you know, prostate cancer, the treatments for prostate cancer, they can cause urinary incontinence if they have surgery or if they have radiation, that can lead to urinary incontinence. So I thought this would be a great place to start.

And then I also teach at a local studio called Nest Yoga. It’s in Oakland. And those are on Fridays at 10:30 in the morning, and they are in the studio and they are also live streamed, so you can join from anywhere. And we’re actually taking a break right now from the classes just because I’m going on vacation, but we’re gonna resume them again on June 19th, so every Friday at 10:30 (AM Pacific).

Dr. Cindy: Okay. Ooh.

Cate: Yeah.

Dr. Cindy: I was gonna talk about that at the end, and I wanted to plug that in now while you were talking about yoga.

Cate: And I should say it’s low cost. So it’s a sliding scale, because I really want to bring this class to the community. So you could pay anywhere from $5 to $25.

Dr. Cindy: Oh, that’s a deal, yeah.

Cate: It’s a deal. It’s the cheapest yoga around.

Dr. Cindy: Oh my gosh, yeah.

Perimenopause, Stress, and the Cost of Constant Productivity

Dr. Cindy: So now turning, a few minutes ago you mentioned or you alluded to the stress and kind of the rush of life. A lot of my audience includes women, of course, with Inspired Mom MDs.

So I’m really interested in how women experience this impact of stress, from external pressure and also maybe internal drivers to be productive and to achieve. And so I’m just curious about, as a woman in medicine, what have you learned and how has this helped you personally, just knowing about this mind-body connection?

Cate: Yeah, so I would say it’s really quite interesting because you know, I teach the practice. I study all these things about embodiment, and yet I still flip my lid.

Dr. Cindy: Oh, yeah.

Cate: My goodness, what’s happening here? I mean, it’s just part of being human. I would say especially in the past year or so, I’m going through perimenopause, and I just love…

I’m just actually really loving how perimenopause and menopause seems to be this hot topic lately.

Dr. Cindy: Yeah.

Cate: Because I’m like, “Yay, I’m going through it.” Because yeah, my body is changing. My moods are changing. My temperament is changing. And so to feel that it’s actually okay to be having these emotions, to be having these bodily changes, and that actually nothing is wrong with me, I think is so important.

And as a woman, yes, who works in this profession where productivity and achievement is highly valued, and contemplation, rest, relaxation is not valued.

Dr. Cindy: Mm-hmm.

Cate: I feel that it’s important to understand, okay, your body is going through changes, at least for perimenopause and menopause right now. Like, your body’s going through changes.

It’s normal. There’s nothing wrong with you. You don’t have to buy into the system that only wants productivity and achievement. It’s okay. You can actually take a step back and rest, and self-reflect, which I think is so important. That’s how we know more and more about ourselves, and what really matters the most to us when we do that self-reflection.

Dr. Cindy: I agree 100%. Isn’t it nice that it’s becoming more normalized?

Cate: I feel so grateful that you and I are going through the same thing…

Dr. Cindy: We’re able to freely talk about this, whereas our moms and our grandmothers weren’t.

Cate: Oh, I know. So, yeah. I know. I feel very fortunate that I’m aging with this lovely, lovely group of women. And that we’re all talking about it.

Why Women Need to Feel Heard: The Power of Validation in Healthcare

Dr. Cindy: What do you wish that healthcare providers would talk about more or be more open about? So you and I are talking about this, but what about the healthcare providers with their patients?

Cate: Uh, with their patients or with each other?

Dr. Cindy: I think with their patients. I feel like there’s a lot of things that women are taught to normalize or dismiss their symptoms. These are just comments that I hear from other women that their symptoms are dismissed or they’re told that, “Oh, you’re feeling this way. That’s normal. Just deal with it.”

So I’m wondering what could healthcare care providers be more open about to help these women who are being kind of dismissed?

Cate: Yeah. My hope is that providers will definitely better listen to our patients, but more importantly, to validate that their feelings are real.

You know, I was thinking, I asked the question, what is it that I hope providers are talking to each other about more or to their patients about more? And actually, I would say the answer’s the same. I want people to talk about their feelings more.

I mean, feelings are almost not allowed in medicine. It’s like, who has time for feelings? But that’s where things really matter. This is actually also why I do love urology so much because, for example, if someone is coming in with a lot of urinary incontinence, they’re wearing, you know, five pads or diapers a day, okay, I’m not gonna force them to take medication or to do any sort of procedure to help the urinary leakage if they’re not bothered by it, you know?

So, it’s like, “Okay. Well, how do you feel about your leakage?” “I’m okay.” “Oh, you are? Okay. Then fine. As long as you’re not getting urinary tract infections and as long as you’re not having any irritation of the skin, you know, we don’t have to give you a pill to fix this.” You know? So, then that’s fine.

So I think I just want providers to really listen and to understand. Like, what is it that you’re most concerned with here? What are you feeling here?

Dr. Cindy: And not assume.

Cate: Exactly. Exactly. But I think it’s hard for providers if we’re not in touch with our own feelings, then we’re not gonna be open to anybody else’s feelings really.

Dr. Cindy: Mm-hmm.

Cate: We as a provider, we often enter the patient’s room with this sort of wall, and that, and the patients as well will enter the room also with this sort of wall. So until we can show the patient, like, look, I’m willing to set down my wall, then the patients could say, oh, okay.

Well, if you set down your wall, then I’ll… I feel safe then to set down my own wall.

Dr. Cindy: Right.

Cate: That’s where the true connection, true healing happens.

Dr. Cindy: Mm. So listening and opening the doors to communication.

Cate: Mm-hmm.

Dr. Cindy: Those are the actions.

Cate: As with as with every single thing in life, every single relationship in life.

Dr. Cindy: Right? So this applies to your significant other, your kids, your friends, your family, your acquaintances, your colleagues. It’s, so true. That’s a good point.

Finding Joy Again: The Surprising Health Benefits of Reflection, Connection, and Play

Dr. Cindy: What is one thing you hope that listeners will take away from this conversation today?

Cate: I hope that listeners self-reflect.

Take time out for yourself. And when I say take time out for yourself, I mean do something that you love. Go out in nature. You know, do something that brings you joy. If you don’t even know yet what brings you joy, just sit back. You know, just reflect. If you need a journal to figure out what brings you joy, do something that brings you joy.

We carry so much in our everyday lives, it’s hard to remember that we do have this, like, true, deep joy, true, deep happiness within us that we can share with others.

Dr. Cindy: Mm-hmm.

Cate: So that’s my biggest hope. Yeah. Do something that makes you feel happy, and then share it. This is why I love music festivals.

Everyone’s so happy there. Everyone’s like, “Yay, I love this so- I love this song too.” You know? Strangers, right. Loving the same mutual thing is awesome.

Dr. Cindy: Yeah, they, well, they don’t have a wall up.

Cate: Don’t have a wall up.

Dr. Cindy: You take down your wall when you go to a music festival.

Cate: Yeah.

Dr. Cindy: And connect with other people.

Cate: Exactly. That’s the gift. That’s the gift. Connection. Yeah. The connection. It’s not the fact that, you know, I’m smarter than you, I sing better than you or whatever. The gift is, like, I’m willing to connect.

You’re willing to connect? Oh my gosh, look at this. And everybody could do that if they’re able just to open up to it.

Dr. Cindy: And like you said, if you don’t really know what will spark joy in your life at the moment, just you don’t have to put pressure on yourself to have joy at that moment.

It’s just reflecting. And you can just think about it. That can be your one thing for the day. I’ll spend three minutes thinking about what would be really cool for me to do. It doesn’t mean you have to do it. And then the next day maybe you do do it, and, you know, it just builds on itself.

Cate: Yes, exactly.

Dr. Cindy: Finding joy brings more joy and spreads joy. Anyway, I like that word. A good three-letter word.

Cate: Yes. For sure. It’s that endless pot of gold that you wanna start telling your friends about. Like, it’s endless. It’s an endless pot of gold. Come over, get some.

Dr. Cindy: Very good. So we talked about your yoga program. So how can people connect with you? And again, remind us how they can find your classes.

Cate: Yeah. So you could connect with me on LinkedIn, so I’m on LinkedIn under Catherine Arima. You could also find me on Instagram at CollectiveLovingCompassion on Instagram. And then, my yoga class for the public is at Nest Yoga. It’s NestYoga.com. And I teach every Friday at 10:30 starting on June 19th.

Dr. Cindy: Okay. And that’s 10:30 Pacific Time?

Cate: 10:30, yes, Pacific Time. 10:30 AM to 11:30 AM, yes.

Dr. Cindy: Okay. Got it. Yeah. I will put all those links in the show notes so people can just click. I am so glad you carved out time to talk to me today and talk to the audience. Thank you for being here.

Cate: Oh, thank you so much. This was so fun.

I love that you’re doing this podcast, and I feel like it’s so important. It’s so important for providers. It’s so important for women. I encourage you to keep, keep going. I love that you’re doing this. Yeah.

Dr. Cindy: Thank you. I appreciate that.

Cate: Yeah. Thank you.

Guest Links:

LinkedIn: Catherine Arima MSN, FNP-C | LinkedIn

Instagram: https://www.instagram.com/collectivelovingcompassion/

Yoga classes: NestYoga.com

Topics: doctor-mom, guilt-self-worth, permission-to-not-be-okay, physician coaching, physician-parenting-balance, why-physician-moms-feel-alone, women in medicine

About Cindy Van Praag, MD, NBC-HWC

Wellness Advocate for Physician Moms

Cindy talks about the current climate of practicing medicine while juggling the roles of mom, wife, daughter, and more. She brings a fresh pair of eyes and guidance for common situations physician moms face daily. In Inspired Mom MDs Podcast, Cindy delivers a fresh perspective and actionable steps to take agency and elevate your power. Listen on your favorite podcast app!

Learn more about Cindy Van Praag. →

Tagged doctor-mom, guilt-self-worth, permission-to-not-be-okay, physician coaching, physician-parenting-balance, why-physician-moms-feel-alone, women in medicine