by Becca Ironside, PT

Vincent found our clinic by chance. He scoured the Internet, looking for a reason to explain the confounding pain in his pelvis. Vincent had a high-stress, corporate job wherein he sat all day long. He began to notice pain in his perineum while sitting. The longer he sat, the worse the pain became. ​

Mindfulness meditation is a practice to focus your attention on your moment to moment experience and to accept the present moment without judgment. ​

This technique draws you back to your center by bringing into the present moment the fragmented aspects of your mind-those thoughts that drift into the past and/or thoughts, fears and worries about the future. With non-judgemental awareness, these thoughts are free to come and go without gripping you and further dragging you down, resulting in a more alert, attentive and relaxed state of being.

by Bryn Zolty, PT

If I just had a baby can I return to running? I’m leaking - can I do exercise that involves jumping? My doctor says I have a prolapse - can I lift weights at the gym? As pelvic physical therapists, we hear these questions every day. It is very common to wonder if after having a baby, a surgery, or if you have pain in the pelvis, if it is okay to engage in activities that can push pressure down into the pelvis.
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While more research is needed to better answer these questions, there are a couple of studies available that have measured the pressure in the vagina with functional tasks, yoga poses, and other exercises in attempts to answer these questions. ​Here is a little of what they found with a group of women ranging in age from 20-51:​

These numbers can surprise people.  How can a crunch be so bad if the average pressure is 23.8 and a normal daily occurrence like coughing is 98? As a therapist, my focus is drawn to the large ranges within each activity. What is the woman doing differently to crunch at a pressure of 8 compared to the woman at a 75?

As therapists we evaluate how you move and conduct each of these activities. As pelvic physical therapists we look closer at your movement, alignment, breathing, coordination, and muscle tone in relation to the pelvis. All these factors play a role in the pressure your body places on the pelvic floor. This pressure is known as the intra-abdominal pressure. This is how one woman can have very low pressure on her pelvic floor while another woman has high pressure during the same activity. The key is how they complete the task.

Back to the question, can I do a crunch? Can I return to strenuous exercise? Our goal is to teach you how to do movements or activities properly while minimizing the negative impact on the pelvic muscles. A pelvic physical therapist’s job is to evaluate the movement or activity that gives you pain or makes you leak and improve it.

How do we do this? Let’s take a squat for example. If a patient comes in because she leaks urine while squatting, we would explore all the possibilities.  

• If a weak pelvic floor is causing your leaking, we would teach you techniques to strengthen/engage your pelvic floor and prevent leaking. This could be done by performing a pelvic contraction, a breathing pattern to encourage activation, or even using a high tone phonation!
• Conversely, leaking can also be caused by a tight/tense pelvic floor. In this situation, we could trial lengthening/releasing the pelvic floor during the squat.
• ​Alternatively, leaking could be caused by too much pressure on the pelvic floor and not necessarily lack of strength. It is possible that a change in alignment of the head/neck, ribs, or pelvis could increase pressure higher than the pelvic floor can support.  According to the study holding your breath and bearing down causes an average pressure of 101.7. It may be your breathing pattern might need to be adjusted!

​After having babies, surgeries, or injuries our bodies change. Some of these changes can lead to incontinence or pain. A pelvic physical therapist is a great clinician to discuss these changes along with your goals for fitness or everyday activities.  Whether it’s cueing on alignment or movement strategies, breathing, releasing or strengthening, it is our goal to help you reach yours.
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References/Citations

From the Glottis to the Pelvic Floor: Making Clinical Connections.  Julie Wiebe, PT, MPT,BSc, and Susan Clinton, PT,DScPT,OCS,WCS,FAAOMPT.

Cobb WS, Burns JM,Kercher KW, Matthews BD, Norton HJ,Heniford BT.  Normal Intra-abdominal Pressure in Healthy Adults. 2005; Journal of Surgical Research 2005; (129):231-235.

O’Dell KK, Morse AN,Crawford SL, Howard A.  Vaginal Pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines.  International Urogyneocology Journal, 2007;18: 1481-1489.

Let’s use male pelvic pain as an example. When pelvic pain strikes, males often wait a few months for it to go away on its own. They finally visit their primary care doctor who commonly refers them to a urologist. Urologists do their best to work up patients for any harmful pathology like infection and cancer. For males with non-bacterial prostatitis, the tests for infection will be negative, and frequently prescribed antibiotics like Cipro may not help.  Unfortunately, many men will continue to take it in hopes of future relief all whilst suffering from its many side effects. When urologists have sufficiently ruled out pathology but the pain remains, the patient is left wondering where to turn next. Many males turn to the internet to find that there are other people like them, in pain, alone and suffering but have found relief with pelvic floor therapy. Urologists are so effective at ruling out pathology that almost every male who ends up in a pelvic PTs office is suffering from a musculoskeletal issue.   ​

Written by Mary Ann White, PTA

​Are you wondering how exercise can help you during pregnancy or what kinds of exercises are safe? Exercise is appropriate for most healthy women with uncomplicated pregnancies. ​

If you have gestational diabetes

• Exercise about an hour after a meal to keep your blood glucose level stable.
• If your blood glucose levels drop below 100 mg/dL during or after exercise, consume 15-20 grams of fast acting carbohydrate every 15 minutes until blood glucose is above 100 mg/dL
• Postpone exercise if your blood glucose level is above 240 mg/dL or you are sick
• Exercise at the same time each day, if possible
• Have a bedtime snack to keep blood glucose stable overnight
• If you are on insulin or medication, check with your physician about the proper timing of exercise and medication

Avoid activities that put you at risk for falling, injury or other complications

• Contact sports like ice hockey, boxing, soccer, basketball
• Activities with a high risk of falling like surfing, skiing, off-road cycling, gymnastics
• Hot yoga and hot Pilates
• Avoid exercising in a supine position (on your back) after the 1st trimester
• Avoid prolonged standing

Stop exercising and consult your physician if you experience:

• Vaginal bleeding or leakage of amniotic fluid
• Regular painful contractions
• Shortness of breath before physical activity
• Dizziness or sudden headache
• Chest pain
• Muscle weakness that affects your balance
• Calf pain or swelling

For more information, see:

• Physical Activity/Exercise and Diabetes:  A Position Statement of the American Diabetes Association (2016)
• The American College of Obstetricians and Gynecologists Committee Opinion:  Physical Activity and Exercise During Pregnancy and the Postpartum Period (number 650. December 2015)

“I am so fortunate to live in America,” Theresa continued. “My Irish in-laws call me ‘A spoiled Yank’. I used to love it when they referred to me that way. I have everything a person could want. Except that now I am terrified of being in public and have to wear adult diapers. I do not feel like a spoiled Yank anymore.”

I knew that Theresa was at the end of her tether. She had tried prescription medication, daily Imodium, altering her diet and kept her legs tightly crossed at all times to avoid what still happened. I explained to her what Pelvic Floor Physical Therapy was all about. That in this type of clinic, we would do an internal examination to discern if the muscles of her perineum might be driving the fecal incontinence.

“I have been through so much already. If you have to do an internal examination, so be it,” Theresa declared. After an exam of the musculature of Theresa’s pelvic floor, it felt as though her muscles were in moderate to severe spasm. These muscles control urination and defecation; they were firing so rapidly that she could not contain feces within her colon, and worked incessantly to force it out. The function of the large intestine is to pull water out of our foodstuffs and allow feces to become solid. This was not happening in Theresa’s case, because the food was not in her colon for enough time, and her stool was unformed and messy. This explained her chronic diarrhea.

The treatment plan for Theresa included deep breathing, relaxation of her pelvic floor muscles and some natural over-the-counter additives to bulk up her stool. “This sounds counter-intuitive to me,” Theresa said at first. “If I relax the muscles, then won’t more feces escape unplanned?” I smiled at her and explained that if she wanted to try something new, she would have to trust me.

It took almost three months of once-weekly treatment in our clinic, with a really good home program, for Theresa’s symptoms to subside. But subside, they did. She now has solid bowel movements twice daily and can control them wonderfully. Gone are the pull-ups and the fear of accidents. Her commute to work and social life have been restored to normalcy.

“I cannot believe how this treatment has helped me! I wonder if this would be available to my relatives in Ireland? I hope so. But at any rate, I feel like a ‘spoiled Yank’ once more,” Theresa remarked. Pelvic Floor Physical Therapy is gaining rank, accessibility and respect all over the world. It likely is available to her in-laws in Donegal, Ireland. The trick is to find ways to talk about these issues and overcome the embarrassment surrounding words like rectum, feces, and stool.

This is what we do, as pelvic floor physical therapists. One client at a time. For spoiled Yanks, people from Ireland and every other continent, men and women, young and older, there is help. We live in a time when anything is possible.

​We often hear the term mind/body used in various wellness, medical and healing platforms. What this means is that there are powerful and complex interactions that take place between our thoughts, our bodies and the outside world and these factors can directly impact our health.  Our thoughts, feelings emotions and attitudes can affect the health of our body and our physical body (what we eat, our posture, and how we move) can positively or negatively affect our mental and emotional states. Simply put, the body can affect the mind and the mind can impact the body. Meditation, a practice of focused awareness, is a mind/body technique that can mitigate the effects of stress on our bodies by bringing calm to our bodies through calming our minds.

​Benefits of meditation closely resemble and often overlap with the benefits of deep breathing and exercise. Some benefits of meditation include:

• Relaxation
• Eases pain,decreases muscle tension
• Improves metabolism, assists in weight loss
• Reduces  perception of stress and anxiety
• Improves concentration
• Increases self awareness and self acceptance
• Supports healthy living
• Increases happiness
• Fosters well being
• Benefits lungs and heart-slows respiratory rate and lowers blood pressure
• Benefits  immune system so you stay healthy
• Slows aging

People often get anxious about the thought of meditating, perhaps because they think they can’t do it, or they don’t have enough time, or for a myriad of other reasons. Meditation can take many forms and is practiced in a variety of ways. Even a few minutes of deep breathing, relaxation or meditation can elevate your mood, sharpen your focus and improve your physical and emotional state of well being. The following are two examples of simple ways to comfort your mind and receive the benefits of meditation.

1. Sit quietly in a comfortable position with your feet on floor and your back supported.
2. Close your eyes.
3. Focus on your breathing, the gentle rising and falling and your abdomen as you inhale and exhale. Breathe comfortable breathes-inhaling to a count of 4 and exhaling slowly to a count of 5-8.
4. Become aware of any tension you are holding in your body.
5. Invite the beautiful, healing, nurturing energy of the breath into every area of your body. Allow these breaths of love to fill your cells, molecules, atoms and the space in between these particles  with appreciation and love.
6. Continue this exercise for as long as you like, then gently open your eyes and enjoy the positive and loving feelings you have created as you go about your day.

Here is another quick meditation technique to expand your heart energy:

1. Breathe in through your nose and direct your breath down into your heart .Slowly breathe out, allowing the breathe to radiate out from your heart.
2. Additionally, you can envision a beautiful emerald green light flowing into your heart and expanding out from your heart.
3. Place your hands over your heart and hold yourself in love, reverence and honor.

I wish you well. I wish you peace.

Written by Michelle Dela Rosa, PT

By Aisling Linehan, PT

​​Infertility is on the rise and as pelvic floor physical therapists we want to do our part to help our patients get pregnant. According to this study, 15% of couples will struggle with infertility. Reasons for infertility can be broken down to ovulation disorders (27%), male factors (25%), tubal disorders (22%), unexplained factors (17%), endometriosis (7%); and “other factors” (4%). Pelvic floor physical therapists specialize in manual & movement therapy. It makes sense that the type of infertility that we can help with is “mechanical”. ​

Release of fascial and ligamentous restrictions can decrease pressure on blood vessels, thereby optimizing the vascular phase and improving the efficacy of the lymphatic system. Better blood flow basically means better “detox” and waste management by the body. The body, in turn, is better able to perform important processes such as reproduction. It is also important to note that reproduction is not essential in keeping a person alive; thus, if the body feels under threat in any way reproduction is not a priority. Check out the study to see how pelvic floor PT can help you get pregnant.

Not sure if you want to try pelvic floor PT yet? Stop by on Thursday night to try our gentle relax and renew yoga class. Getting your body in a more parasympathetic state can help you mentally and physically prepare for bringing new life into this world.  

Patient: 24-year-old female, 12 weeks postpartum after second degree perineal tear, nursing.

Chief Complaint: Painful vaginal entry 6 weeks postpartum, bleeding with bowel movements.

Past Medical History: Crohn’s disease, low thyroid, irritable bowel syndrome.

Physical Therapy Treatment: education on bowel health, manual pelvic floor and abdominal tissue release, perineal scar mobilization, pelvic alignment, vaginal dilators, hip stretches, core strengthening, postural education.

Results: Pain-free intercourse in 15 visits, 0 bleeding with bowel movements after the first 2 visits!

Written by Becca Ironside, PT. Becca is also a published Author of Fiction.
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I met a woman named Eva* at the Pelvic Floor clinic. She came for physical therapy to address urinary leakage, which she has endured for over ten years. I had to glance at her date of birth to make sure of her age. Eva is 85 years old, and she looks spectacular. “What is your secret to looking so young and vibrant?” I asked her. “Maybe it is having good friends. Wonderful children and grandchildren. Or maybe it is just my good Danish genes,” she replied.​ 

​Eva told me that she began leaking urine several years ago, but her condition is getting worse. She told me that she cannot go to the beach anymore at Point Pleasant, which is her favorite thing to do. In her medical history, I learned that Eva had had three pregnancies with vaginal births. She does not drink enough water, mostly in fear of losing even more urine. Based on her age and prior history of childbearing, I was working under the assumption that Eva had weakness in her pelvic floor muscles. Maybe a little prolapse of the bladder.

“A lot of young women come here with complaints of pain with sex,” I told her. Eva’s eyes opened wide. “Do you mean to tell me that there is treatment for that? I had two husbands and sex was awful with both of them. The pain was unbearable. I never understood what the big fuss about sex was all about.”

Here was a woman in her eighties who had lived with pelvic floor dysfunction her entire life. The painful intercourse made sense, given how much tension she was holding in her musculature. I devised a treatment program for Eva to allow the muscles of her pelvic floor to elongate. She was given a home program of self-stretching, diaphragmatic breathing exercises, and an activity known as the pelvic floor drop, which is the opposite of the famed Kegels we have all read about in McCall’s Magazine.

Eva has returned several times to our clinic. She has far less urinary leakage, is drinking more water (she has retrained her bladder to accommodate this), and practices yoga and deep breathing.  She is planning a month-long trip to Florida, wherein she will be able to go to the beach in a bathing suit encasing her lithe body without fear.

I learned something wonderful during my treatment of Eva. I rejoice in living in a time when help is now possible for these things that have plagued women for centuries. I also learned that it is never too late to change. Eva is 85. And if she responded so readily to this therapy, then anything is possible.

*The name and some personal details of this patient have been changed, according to the laws of the Health Care Portability and Accountability Act. But the symptoms of Eva and the outcome of her treatment are true. Pelvic Floor Physical Therapy works!

Connect PT hosted “The Pelvic Floor: There’s More to Your Core - A Guide for Personal Trainers.” Our therapists were thrilled to educate personal trainers about pelvic floor dysfunction and how they can help clients that have it. It is important that women and men with pelvic dysfunction feel safe while exercising and achieving their fitness goals.

​Start by lying on your back. Use a fist, heel of your hand, or fingers to apply gliding pressure on the left side of the belly from the left ribs down to the pubic bone. This works on the descending colon. Next, use the same pressure to glide just under the rib cage from right to left. This works on the transverse colon. Lastly, glide from the right side of the pubic bone straight up toward the right ribs. This works on the ascending colon. Each glide should be performed 10 times on the descending, transverse, then ascending colons. Use light to moderate pressure to comfort; nothing should hurt!
 
You can use a heating pad on the abdomen to soften the tissues prior to the massage. It can feel nice to do the massage before bed as you are winding down, but it can be performed anytime. So take some time out, slow down, and get those bellies feeling happy again.

​Written by Michelle Dela Rosa, PT