Pelvic Health Blog

The Self-Care Corner

11/18/2018

By Karen Bruno, PT

The old healer to the soul:
It's not your back that hurts, but the burden.
It's not your eyes that hurt, but injustice.
It's not your head that hurts, it's your thoughts.
Not the throat, but what you don't express or say with anger.
Not the stomach hurts, but what the soul does not digest.
It's not the liver that hurts, it's the anger.
It's not your heart that hurts, but love.
And it is love itself that contains the most powerful medicine.
Author: Ada Luz Marquez

As we sink deeper into autumn, the leaves are changing colors, the daytime light is decreasing and the temperature is getting cooler. This can be a difficult time for many people. In addition, there is much to do in preparation for the upcoming holidays. Here is a quick "go to" exercise to restore coherence and calm.

Place one or both hands over your heart.
Begin to take some deep breaths in and out through your nose. One to three breaths is sufficient.
Shift your attention to your heart. Imagine breathing in and out through your heart.
Imagine breathing in love, and as you exhale, let that love expand in, through and around you. Surround yourself in a field of loving and compassionate, heart-centered energy. Take it in. Allow yourself to receive this gift.

For extra-credit: put a smile on your face.
For double extra credit: Smile into your heart.

Use this exercise anytime you want! Here are some suggestions for convenient uses:
As you awaken in the morning.
When you to go to bed.
Anytime you need or want a boost of energy, nourishment or connection to yourself or others.
When you are driving.
Anytime you are feeling upset or stress.
Anytime!

The overarching benefit of heart-centered practice is to live a fuller, healthier and happier life, even in the midst of the day to day demands.

My intention for each of you is to have a happy, peaceful, joyful and healthy holiday season.

After Prostatectomy: Kegels and Clamps

11/17/2018

By Bryn Zolty, PT

Kegels
Yes, men do Kegels too! In fact, you can start Kegels as soon as your doctor clears you to begin contracting your pelvic floor. After a prostatectomy, physical therapy can help educate men on how to reduce pelvic dysfunction and urine leakage. Some of this education can include: reducing excessive pressure on pelvic muscles, improving tissue mobility, re-educating deep core muscles, and strengthening pelvic floor muscles. A pelvic health physical therapist can tailor a program for you, as there isn’t a one-size-fits-all treatment.

How do men Kegel? In the literature, the phrase that was found to be most associated with stopping urine leakage was, “Shorten the penis.” This simple cueing creates the greatest displacement of the muscles that close the urethra. Other cues like “lift the bladder” were not as effective and increased pressure in the abdomen and pushed down on the pelvic floor. (1) It is important to be aware that you are not contracting other muscles in the legs, buttocks, and abdomen when isolating the pelvic muscles.

Every Kegel or pelvic floor strengthening program should be customized to each person. In the clinic, we work on endurance and quick contractions. For example, a home exercise program may include:

Endurance contractions: Shorten the penis and hold that contraction for 10 seconds. Release the contraction and rest for 10 seconds. Perform 10 times in a row. Do this set 3 times a day.
Quick contractions: Shorten the penis and hold that contraction for 2 seconds. Release the contraction and rest for 5 seconds. Perform 10 times in a row. Do this set 3 times a day.
For everyday activities that cause urine leakage, perform a Kegel simultaneously. For example, if standing up from a chair causes leakage, take a deep breath first and allow your abdomen to expand. Next, exhale and perform a Kegel prior to standing. Hold the Kegel while getting up to stand. Did you leak less?

Clamps
Some men lose large amounts of urine after prostate surgery, which can have a huge impact on normal daily activities. It may take time for kegels to make a difference in symptoms. A penis clamp may be an appropriate option to stop large leaks. The clamp places gentle pressure on the urethra to block urine loss. It may not stop all leakage but can significantly reduce it. When the clamp is removed, the release of pressure allows for normal urination. The amount of time recommended for wearing the clamp is variable between different devices. If you have any interest in a using a clamp, contact your physician or pelvic physical therapist to see if you are a good candidate.

According to the Journal of Neurourology and Urodynamics, men " found the device easy to use, felt more confident wearing the device, and had increased levels of physical activity with device in situ." They had significantly improved urinary incontinence symptoms per the Incontinence Impact Questionnaire. (2)

If you are going to have a prostatectomy or already have, ask your physician for a referral to a pelvic physical therapist. They can guide you through your pre- and post-surgical rehabilitation and reduce urinary incontinence.

(1) Stafford, R. E., Ashton‐Miller, J. A., Constantinou, C. , Coughlin, G. , Lutton, N. J. and Hodges, P. W. (2016), Pattern of activation of pelvic floor muscles in men differs with verbal instructions. Neurourol. Urodynam., 35: 457-463.

(2) Barnard, J. and Westenberg, A. M. (2015), The penile clamp: Medieval pain or makeshift gain? Neurourol. Urodynam., 34: 115-116.

Cable television discovers the pelvic floor

11/14/2018

By Becca Ironside, PT

I have been working as a pelvic floor physical therapist for a few years now. As with many people with hold this job title, we were often met with confused looks, raised eyebrows and a generalized misunderstanding as to what physical therapy of the pelvic floor could possibly entail. This is entirely understandable, as I had been a physical therapist for sixteen years before taking the dive into getting my pelvic floor specialty.

Why did I change paths and redirect my craft towards the pelvis? In part, because I had become a little bored with the other facets of physical therapy I had worked within and wanted a new challenge. But the larger reason why I felt compelled to undergo this very specific training for the pelvic floor is because I suffered from pelvic pain. It was unpredictable pain, which manifested itself in odd and various ways. I went to so many different physicians, yet none of these specialists I went to for treatment could help me with my symptoms.

Fast forward, five years later: I have a very gratifying job treating the pelvic floor muscles of both women and men. The demand for this work is enormous, as there are not enough pelvic floor therapists to treat the vast number of people who have discovered its importance. Women come to our clinic and the ability to help others who have the nebulous and seemingly inexplicable symptoms that I once did is a splendid feeling. Secondly, I no longer experience pelvic pain. This is because I can utilize the techniques and knowledge that I use with my patients on myself; I also have a great bunch of coworkers who can treat me when I cannot fix the problem and need another mind or another set of eyes and hands to brainstorm and palpate the causation of it. Lastly, there is a show featured on HBO which is all about a woman with pelvic floor dysfunction. Finally, the world is being educated on a grand scale about the importance of pelvic health! The show is entitled Camping.

In this show, a woman named Kathryn plans a camping trip to celebrate her husband’s 45th birthday. Kathryn invites other friends. She has a binder of scheduled events for her guests. Within the first few minutes of the show, it becomes very clear that Kathryn (played by Jennifer Garner) has some major control issues, coupled with a pelvic floor problem.

In watching the show Camping, we learn that Kathryn has undergone a hysterectomy. The loss of her uterus and ovaries has led to other losses. For instance, Kathryn and her husband have not had sex in two years. We are led to the conclusion, by her husband’s discussion with his fishing buddies, and Kathryn’s own overt disgust and refusal of sex, that it is chronic pelvic pain that seems to be driving the boat in their marriage.

Let’s go back to what pelvic floor dysfunction really means. Some women, like Kathryn, have had pelvic surgeries which can lead to scar tissue formation. Other women have constant burning and discomfort with urination, all due to muscular imbalances. What will that lead to? Sex can often become painful and many women brace themselves before each sexual encounter, in fear of the discomfort that will ensue.

The show Camping does a fair job in unveiling how a relationship can be eroded by pelvic pain and the lack of intimacy that often accompanies it. This is a finding often seen in the pelvic pain population. Pain alters how the brain processes information. It effects our ability to be active listeners, to take care of others, either in the bedroom or out of it. But when the pain is so directed in the perineum, sex is often one of the first leisure activities to take a backseat in the relationship. That makes sense, right?

There are other manifestations to having this condition. Many people with chronic pain find themselves more withdrawn than they might have been without it and more apt to find solitude. Their threshold for chaos can often run thin. And because women are often called upon in society to act “motherly” and to be “nurturers”, many of them living with chronic pain will simply put their chins up and bear it. Even though depression and anxiety might be creeping up their backs like a snake. Lots of them soldier on, push down the pain and are reluctant to make their diagnosis public.

Obviously, this does not represent all women with chronic pelvic pain. When we are introduced to Kathryn, the main character in Camping, we get quite a different profile of how this pain can affect people. The actress Jennifer Garner plays the role of Kathryn, and Ms.Garner uses her elan in this performance to show us a woman who is highly obsessive, erratic in thought and speech and has great difficulty maintaining relationships with others. Kathryn is described as “bitter” and “angry” behind her back and she hits her husband when he attempts to initiate sex.

This characterization of a woman with pelvic pain may be what the writer of the series felt if she had similar pain. Or the character may be based on a Type A Helicopter Mom to make the series more amusing, as this series is a sitcom. But the reality of this portrayal of Kathryn as a woman suffering from pelvic floor dysfunction is that she does not represent the typical sufferer. Because this is the first exposure that the general public has had in mainstream television to the pelvic floor, it may render women less willing to acknowledge or seek help for their diagnosis, as they may not want to align themselves with the behaviors of Kathryn.

In fact, the portrayal of women in this light can seem reminiscent of the 1950’s. The term “hysterical” was used in the past as an actual psychiatric diagnosis used to label women for being overly dramatic and prone to bouts of insane behavior. The medical operation known as a hysterectomy was named because it was believed that if a physician removed a woman’s female parts, he would eradicate her insanity.

I am reluctant to bring these facts from the past for women into the cold light of today. This is what the world of pelvic floor physical therapy is trying to reverse – the notion that women with feminine troubles are irrational and unable to be around without great unpleasantness. While it is encouraging that a cable network has named pelvic floor dysfunction, it would be far more helpful in the future if women were represented as emboldened by the power to take back their own pelvic health. Because that is precisely the image of the women who come to us: bold, unashamed and ready to use available resources to uproot outmoded theories of how they should feel and who they should be.

So, where do we go from here?

If you have seen Camping, and feel that you may have something going on in your pelvic floor, you can locate a physical therapy practice which specializes in this diagnosis. To find a pelvic floor physical therapist near you, visit https://pelvicrehab.com/.
If you feel unhinged because of your pain, and other irritating symptoms associated with pelvic floor problems, you may be told that this is “all in your head”. Yes, you might have some depression and anxiety surrounding what your body is doing, but there are actual anatomic and physiologic problems for which there is now treatment available. Remember, this is not 1952 and you are not “hysterical.”
Finally, rediscovery of your own pelvic health is exciting! You can return to many painfree activities. Your goals are your own and you will set them yourself. In this way, you will become your own healer, with some other minds, eyes and hands to assist you along the way. To quote the motto of the Pelvic Floor Physical Therapy clinic wherein I work: “It’s time to own your body” Connect PT.

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After Prostatectomy: Kegels and Clamps

Cable television discovers the pelvic floor

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