Connect Physical Therapy: It's time to Own Your Body
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Read about insights and research updates in
​orthopedic and pelvic physical therapy.

Splinting to help empty the bladder or bowel

5/25/2022

 
by Katelyn Sheehan, PT

Splinting

Have you ever experienced any of these symptoms? 
  • Constipation 
  • Fecal incontinence
  • Heaviness in the Vagina
  • Feeling like you haven’t emptied your bladder all the way
  • Having drops of urine come out as you stand up from the toilet 

If you answered yes, then splinting may be a useful tool for you. Splinting is a technique often used by patients with pelvic organ prolapse to help them fully empty their bowels or bladder. Splinting is primarily suggested for helping with constipation, but certain splinting techniques can also help with urinary symptoms. Typically, splinting is performed by inserting a clean finger into the vagina to help hold, or splint, the pelvic organs and stabilize them in a more optimal position while using the bathroom. This can help hold the bowels or bladder in a more upright position to allow for full emptying when you go to the bathroom. You may also find that splinting externally can also help; this involves applying some gentle upward pressure to the perineum (see pictures and video below).

Internal splinting for the bladder/urethra

Begin by sitting on the toilet. Then use a clean finger with or without some toilet paper around it. Insert the tip of your finger into the vagina and gently apply some pressure forward, away from your spine.
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External view (from below)
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Internal view (from above)

INTERNAL splinting for the bowels

Begin by sitting on the toilet. Then use a clean finger with or without some toilet paper around it. Insert the tip of your finger into the vagina and gently apply some pressure backward, toward your spine. ​
Picture
External view (from below)
Picture
Internal view (from above)

EXTERNAL splinting for bowels

Begin by sitting on the toilet. Then use a clean finger with or without some toilet paper around it. Next gently apply some pressure with your finger to the perineum upward, toward your head.
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CrossFit and pelvic floor dysfunction

2/28/2022

 
By Jennifer Watt, PT

​This time of year for Crossfitters is the CrossFit Games season, where it starts with a worldwide event called the CrossFit Open. Hundreds of thousands of people all over the world and of all ages and physical abilities compete in three workouts given across the timespan of three weeks. As someone who has been doing CrossFit since 2018, this will be my fourth CrossFit Open season that I have competed in. CrossFit has become my passion. 
​
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Now as a pelvic floor physical therapist, I have run into a common situation at my gym. We look up on the white board that has the WOD (workout of the day) and I would see the term “double unders.” Double unders is a form of jump roping where your jump rope must go under you twice. As soon as I see that, I see many of both my female and male buddies head to the bathroom, and in many cases multiple times before the workout starts. 

There is a well known video clip from CrossFit titled “Do You Pee During Workouts?” And when I watched it I got some interesting topics from the CrossFit community. Some say they definitely leak urine during double unders and box jumps. Many basically said it was a part of life as a CrossFitter and simply manage with pads. But is it okay?

As a pelvic floor physical therapist, I would say it is not okay. Peeing when exercising is telling us that there is a problem with our pelvic floor. A normal pelvic floor is simply one that can do all its functions – maintain continence, support the pelvic contents and contribute towards optimal movement during functional tasks. Now there are several reasons why it may not be normal or that there is pelvic floor muscle dysfunction. 

What is pelvic floor dysfunction exactly? Pelvic floor dysfunction is simply where your pelvic floor is not doing its job properly. The pelvic floor is designed to provide support for your pelvic organs, help control intra abdominal pressure, control your urine and bowel movements, and help provide pleasure during sexual intercourse.  One form of dysfunction could be that you have a weak pelvic floor. Common reasons why it is weak are: pregnancy and childbirth, surgery or other medical procedures, posture and behavioral habits, and lack of exercise. Another could be an overactive pelvic floor which is a condition where there may be increased pelvic floor muscle tension at rest, increased voluntary or involuntary contractile activity, or a decreased ability to fully relax the pelvic floor muscles. You could also have a damaged pelvic floor. Your pelvic floor might have been through a lot. Childbirth, cancer and radiotherapy, and other conditions can contribute to tearing, scarring and damage to the pelvic floor muscles. The nerves to the area can be damaged, the muscles themselves can become detached from the pubic bone, scarring from surgery and childbirth can cause asymmetrical contractions.

So what are some things to help? First and foremost, like I said before peeing when working out is NOT normal and should be addressed. Seeing your primary care physician, urologist, gynecologist, and to get a referral for pelvic floor physical therapy. These are health care providers who have taken extensive coursework, some even board certified, on the pelvic floor muscle anatomy and will be able to properly assess your own situation and create a plan specifically for you. Other things to consider, particularly in the realm of CrossFit. Try not to rely on items like lifting belts, braces, wraps, and other means of support. This allows you to really be aware of your physical limitations and hopefully will keep you from moving or lifting something you shouldn’t. Rely on good technique with all movements. Sometimes during these WODs, we push ourselves so much that technique goes out the window. And lastly what ties both the supports and technique is straight ego. Focus and train on your weaknesses and build upon them. If we’re leaking when we hit a certain amount of double unders or box jumps, then make that your target and to slowly build upon that. As I said, leaking during workouts is not normal and one should address it and not let it go.
Pelvic floor symptoms can be the reason that women stop exercising and end up living a more sedentary lifestyle. Don’t let this be you!
Reference used
https://academic.oup.com/ptj/article-abstract/102/3/pzab284/6478875?redirectedFrom=fulltext

Q&A for Men: urinating with BPH + erections after abdominal surgery

1/16/2022

 
By Becca Ironside, PT
Q&A for men by Becca
​Question from Sam: I am 52 years old and have been having difficulty starting and maintaining a urinary stream. I went to a urologist, who diagnosed me with having an enlarged prostate. Why is this happening and what does it mean for me?

​Answer from Becca: Your prostate gland is located just below the bladder and in front of the rectum. It produces the fluid that contributes to semen with ejaculation. In your twenties and thirties, it was likely around the size of a walnut. As men age, the prostate gland can grow to be the size of a ping pong ball or an apricot.
Your urologist has likely performed a digital exam (meaning they inserted a finger) to assess the size of your prostate. It is the test that NOBODY wants from their doctors. But the test is valuable because it can determine if your prostate is enlarged. And you are in good company, Sam, because the chances of having an enlarged prostate are as high as 50% in guys over the age of fifty. This condition is referred to as BPH, or benign prostatic hypertrophy, in the medical world. [1]

As a pelvic floor physical therapist, I have treated many men with enlarged prostates, or BPH. Their complaints range from difficulty peeing (hesitation, weak stream or dribbling) to the sensation of sitting on a golf ball (or a ping pong ball, if you prefer this sport over golf)! Furthermore, erectile dysfunction can also result from having an enlarged prostate.

While pelvic floor physical therapists cannot shrink enlarged prostates (we are not magicians), we can help with techniques to improve urinary flow, educate on the mechanics of urination to maximize that stream, and even teach men how to perform Kegel exercises to strengthen their pelvic floor muscles. Stronger muscles in the saddle region can lead to better erections.

​In response to your question, Sam, having an enlarged prostate is not a huge cause for concern. Remind yourself that roughly half of the guys from your graduating high school class now have the same condition. And if you want to refine what your pelvic floor muscles are doing for you, pelvic floor physical therapy is a nice option to take control of your symptoms and improve the quality of your life.


Question from Lars: I had my appendix removed over 6 months ago. I have noticed that my erections are not the same since my surgery. I spoke about it with my surgeon, who prescribed Cialis. Why is this happening? Is this normal?
​
Answer from Becca: This is such an interesting question, Lars. Erections are obviously governed by blood flow, which is likely why your doctor prescribed the Cialis. But there is also more involved with arousal than meets the naked eye (please excuse the pun. I just get so enthused when talking about this, I cannot help myself!)

The beginnings of an erection start with blood flow that is shunted to the groin. What makes erections so complex is that once the blood gets into the penis and testicles, it needs to remain there during the arousal process. In order for the blood to remain there, the pelvic floor muscles are required to lengthen to accommodate this new influx of pressure.

If the muscles responsible for containing this blood are too tight, they won’t be able to do their job, which is to act as a water balloon that expands to take in more water. With tight pelvic floor muscles, guys are left with a water balloon with a much smaller reservoir and volume capacity.

Now, let’s add another factor into your specific situation, Lars. The muscles of the core, specifically a deep abdominal muscle known as the transversus abdominus, have a very close relationship with the pelvic floor muscles. When the pelvic floor muscles contract in ejaculation, so does the transversus abdominus; conversely, when the pelvic floor muscles lengthen to accommodate blood in the penis and testicles, the transversus abdominus follows in suit.

Given the location of your appendix and the scar tissue incurred from its removal, there may have been a disruption in the coordination of your pelvic floor and core muscles. Decreased erectile function can certainly happen if these two muscle groups are not communicating in the exquisite and refined manner which they once did.

Pelvic floor physical therapists often hear of decreased quality of sex after abdominal surgeries in their patients. It is often one of the first questions I ask people who report a change in sexual habits. Lucky for you, Lars, and so many others, is that seeing a professional to manually release the scars of your surgical incisions and learning how to breathe properly during very basic life activities can reunite these muscle groups who have parted ways.

As a review, the appendix removal might have caused the abdominal muscles to become bound down and unable to expand. As a result, the pelvic floor muscles might have shortened and less blood was then allowed into the penis and testicles for Lars. There are so many people for whom this is the case. And there is help in pelvic floor physical therapy!

[1] http://utswmed.org/medblog/what-we-know-about-your-prostate/
​

I can't pee

10/6/2021

 
By Bryn Zolty, PT
Take a second and imagine your bladder filling. A constant filling. You go to the bathroom, but you cannot urinate. It’s been hours, you feel that the bladder is full, but it will not come out.  You try again and again. Nothing. The worry starts to increase. You go to the emergency room, they help you empty your bladder, but tell you they cannot find anything wrong. Now you are sent home with the fear that this may happen again. This is what brought a woman desperately seeking answers to our care. 

Her physician noted increased pelvic floor muscle tension and recommended she seek our help.  Her urinary issues included frequency, urgency, incomplete emptying, and pain. All of her tests kept returning with normal results. She felt desperation, as her symptoms were real, but no one could find anything wrong with her.   ​​
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As she described her urinary symptoms to me, I decided to check the fascia located near the urethra for any restrictions or asymmetries. There I palpated a very large round dense mass. It was on the right side and felt as if it was altering the position of the bladder. The most likely cause was a fibroid, and the patient did then confirm that she had a history of a small fibroid. I had concerns that this fibroid had grown and might have been the cause of the urinary symptoms. It was certainly large, and very close to the urethra and bladder. I referred her back to her physician to have the dense mass evaluated. The physician confirmed it was a fibroid and immediately ordered a surgical consult. The fibroid was removed.  

We have all been through such moments of anguish where symptoms don't add up. This patient is a reminder that we are not alone in our fear and confusion. She had a fibroid that had been driving many of her symptoms all along. It was through her persistence in getting the right care and her practitioners actually communicating with each other that a solution was found. She was her own advocate with a powerful alliance of team members to help her find an answer. She is an example of how sometimes we have to fight through the anguish and fear to find true healing.   

I am so thankful that this patient was kind enough to share her story to help other women  continue to search even when they feel at a loss as to where to turn for answers. A pelvic physical therapist is one of the few practitioners that spends each session one-on-one for at least 45 minutes. As a result, we are able to re-evaluate and treat each session. Consider a physical therapist on your treatment team.

Interview with Becca Ironside, PT: "On the Sneaktip: The Male Pelvis Revealed"

6/8/2020

 
We are thrilled to announce to the Connect PT community the birth of a different kind of book about male pelvic dysfunction, written by our own Becca Ironside, PT, MSPT:

On the Sneaktip: The Male Pelvis Revealed
onthesneaktip
​Michelle: Becca, what makes this book different than other books about men’s pelvic conditions?
Becca: There are lots of books written for men about the pelvis; and they are fantastic and also very helpful to the guys that we treat. These books are typically written in a nonfiction format, but I am a reader of fiction. I resonate with people more than facts. I decided to write a book about the male pelvis from a fictional point of view. There are five characters within this story with different problems. I wanted to create personalities around their symptoms, to delve into the backstory of each person living with pelvic floor dysfunction and how it impacts their day-to-day lives. It is important to read nonfiction about how to address erectile dysfunction or pelvic pain, but another thing altogether to be inside a private treatment room with a man whose world is collapsing because of his pelvic pain or prostate cancer. I wanted to give the reader a glimpse into the mind of a man struggling with pelvic floor dysfunction in a very personal format.
Michelle: Can you tell us more about the actual conditions that these men have been diagnosed with?
Becca: I would be delighted to. One main diagnosis of men which is highlighted in this book is known as Chronic Pelvic Pain Syndrome. One of the reasons that I needed to write about this topic is because it is little known in the general population. Chronic Pelvic Pain Syndrome, or CPPS, is a cluster of symptoms which often include urinary burning and urgency, penile, testicular or rectal pain, constipation, pain with arousal and ejaculation and difficulty sitting due to these symptoms. In pelvic floor physical therapy, we treat men with this condition, though we are aware that there are many more men out there with such problems who don’t know where to turn.

One character in the story is named Tom; he is a successful sommelier (also known as a professional wine-taster, which sounds like a fun job if you ask me), with a wife and two daughters. Tom begins to have crippling constipation and he experiences pain in his pelvis after having sex with his wife. At first, Tom hides his pain and stops having sex with his partner, due to his great anxiety about the matter. But Tom has money and good medical insurance, so he is able to navigate through the medical quagmire to get the treatment he needs.

Kirk is another character who has Chronic Pelvic Pain Syndrome. But Kirk is only 24 and he is a drummer in a band. Kirk has searing urinary pain and pain having sex with the women he meets on tour with the band. Kirk attempts to treat his pelvic pain with drugs and alcohol (a very common finding for men with this diagnosis), but he has no medical insurance and is financially broke.

I wanted to show two vastly different outcomes for men with Chronic Pelvic Pain Syndrome with these two characters. They have exactly the same problem, but one has the means to get help for his condition, the other does not.
Michelle: What about prostate cancer? Can you tell us about how you created a character around this diagnosis?
Becca: Oliver is a biracial man raised in Alabama. His father is a white police officer and his mother is Jamaican. Oliver’s father teaches his son how to hunt wild turkey when he is merely ten years old. He then grows up and becomes a sharpshooter in the U.S. Army. Oliver is sent to Iraq and then Afghanistan and takes pride in his shooting abilities and time spent serving his country. When he comes home for Thanksgiving one year to visit his parents, he meets a woman named Talulah. They fall in love, Oliver returns home to the States and takes a job as a state trooper, the couple gets married and has a baby. Tada! Life is beautiful, right?
​

Oliver is then diagnosed with prostate cancer as a 42-year old. In working with men with prostate cancer, there are some pretty consistent variables in how they respond emotionally, and these variables can be seen through Oliver’s journey. Oliver is my favorite character in this book. Maybe because prostate cancer is the second most commonly diagnosed cancer in the U.S. and I wanted men to feel that they could read the thoughts of a guy who is being told the worst news of his life; but who then gets treated for his cancer and still has a great life thereafter.
Michelle: Got it! Next, how about men with erectile dysfunction who don’t have prostate cancer or pain with sex? Does your book assign this very common issue to a character?
Becca: Yes. His name is Rick and he is a plumber in Pittsburgh, PA. Rick owns the plumbing company, in fact, and his son Francis will be the first man in his family to go to college. The main fly in the ointment in Rick’s life is his eroding marriage to his wife Nicole. Their partnership is devoid of intimacy and Rick notices newly-developed erectile dysfunction as his marital communication worsens. Rick goes to a female urologist for bioidentical hormone replacement. It is through his conversations with his urologist that we get to see underneath his tough exterior to the vulnerability of a man who has erectile dysfunction.
Michelle: I see that this female urologist is also a character in the story. Can you tell us how she enhances the book?
Becca: The character of Dr. Sheila Ashtiju is based on a very skilled physician who treats patients from our pelvic floor clinic to improve sexual function. Through Sheila’s eyes, we are able to see how she treats men with bioidentical hormones to address erectile dysfunction. We are also able to get an outsider’s viewpoint on how men react to their pelvic problems from a skilled physician, who also happens to be a female with sexual secrets that she feels she must hide.
Michelle: Who is the ideal audience for this book?
Becca: I’ll tell you a cool side-story that may answer this question. I had a choice between two cover designs for this book. One was distinctly masculine, the background was dark-blue and the vibe mysterious. The other cover was white, clean and crisp, and is the one I ultimately chose. Before choosing between the covers, I walked around a local restaurant and asked everyone there which cover they preferred, even though they had no concept as to what the book was about. 90% of men chose the blue, masculine cover and 80% of women chose the crisp, white cover.

I stayed up all night worrying, but was counseled by a very good friend who steered me in the right direction. “Women drive healthcare in this country,” she advised. “Men often won’t go to a doctor until a female partner pushes them to. Choose the book cover that will appeal to the greatest number of people, but also a cover that women will want to read. Because this book is for people of every gender and has something for everyone.”
​

This book is for any person who has experienced erectile dysfunction, pelvic pain, prostate cancer and anyone close to those with these issues. I hope that answers your question about the ideal audience, Michelle.
Michelle: Any other pearls from the book that you’d be willing to ‘sneak out’ to the Connect PT community?
Becca: While I hope that the fictional characters are people with whom the reader can identify with in some way, I realized after writing that portion that a nonfiction/scientific explanation was necessary to illustrate why the characters got the treatments that they did. I have never written a book with nonfiction within it before, so it was a stretch to get through all those research studies. I remember doing it in my attic in July of 2019. I decided not to turn on the air-conditioning to really get to the grittiness of the matter.

After four weeks of sweating and gulping down coconut water in that attic, I had a bibliography. I wanted the readers to know that Chronic Pelvic Pain Syndrome is suspected to be present in 2-16% of the population. This is the NUMBER ONE diagnosis for men under 50 who come to a urologist’s office, yet very few people know this statistic. I also wanted to rationalize why the fictional character with prostate cancer was created as being biracial. Black men are 50% more likely to develop prostate cancer than white men. The nonfiction portion of the book is extremely important and reviews treatments for Chronic Pelvic Pain Syndrome, prostate cancer and erectile dysfunction. It is a nice compliment to the fiction.

And finally, I added a backstory on where the characters came from. It was in this portion of the book where I feel I was most able to honor men, to acknowledge their struggles in a world that does not allow for male weakness or vulnerability. This was the easiest part of the book to write; I waited until September as cooler winds blew and football season had arrived. I hope you can all get something out of this book.


For a sample of one of the many topics discussed in the book, check out Becca's latest video on Erectile Dysfunction & Physical Therapy Treatment.

After Prostatectomy: Kegels and Clamps

11/17/2018

 
By Bryn Zolty, PT
kegels for men
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:
  1. 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.
  2. 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.
  3. 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.

Can I do a crunch?

4/3/2018

 
Written 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.
​
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:​
Can I do a crunch?
  • Crunch AVG pressure: 23.8, range 19-76, with an exhale AVG 12.4 range 8-75
  • Downward facing dog AVG pressure: 39.1 range 26-72
  • Exercise machines AVG 37 range 20.3-182.3
  • Jumping AVG 171 range 43-252
  • Coughing AVG 98 range 49-130
  • ​Bearing down with breath hold AVG 101.7 range 45-131
​​*​Units of pressure used in the study are in cm of water. This is the height in cm of water displaced by pressure. (O’Dell et al.2007) (Cobb et al. 2005)
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.
​

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.

Pelvic health for men

3/21/2018

 
Written by former staff physical therapist, Aisling Linehan, PT

Pelvic health therapists are sometimes known as women’s health therapists; however, it’s important to note many of them also treat men. Our pelvic floor therapists treat men as well as women. Pelvic therapy is effective and often life-changing for both genders.
Pelvic health for men
Why would a man need pelvic floor therapy? Our male patients can present with any combination of the following symptoms:  urinary retention, urinary hesitation, urinary leakage, constipation, fecal incontinence, sexual dysfunction and pelvic pain.  Male patients do wonderfully with our therapy services; however, it can take seeing 5-6 providers and more than a year before they find our office and relief.  We care about male patients and want them to find us sooner, so here is our PSA (public service announcement) to help the boys. ​
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.   ​
A pelvic floor PT evaluation consists of a movement, breathing and pelvic floor muscle assessment. Most pelvic pain patients have high tone pelvic floor musculature, poor breathing patterns, and inefficient functional movement patterns. ​
Pelvic health for men
Pelvic floor tone is assessed digitally through the rectum and electronically with biofeedback. It is important to note that a high tone pelvic floor can cause any combination of the following symptoms: urinary urgency, urinary frequency, constipation, penile pain, and testicular pain/pulling/burning/retraction.  Many of these symptoms can be relieved with PT interventions that may include: soft tissue release for pelvis and hips, breath training, rib/diaphragm mobility, internal pelvic floor trigger point and myofascial therapy, perineal mobility, light stretching, and gentle core strengthening.

Pelvic floor therapy is a safe space. It is not scary or threatening. Many patients feel immediate relief knowing that we have treated and helped patients just like them. We are here to educate and make space for the healing to happen. Knowledge is power and the more you know about your body they better you can treat it. If you’re looking for help and education regarding pelvic pain, contact your local pelvic floor physical therapist for an evaluation today.

Theresa's story: a case study on bowel incontinence

2/7/2018

 
Written by Becca Ironside, PT. Becca is also a published Author of Fiction.

​Theresa came to Connect Physical Therapy in late fall of 2017. She looked like she had it all – dark, glossy hair, olive skin and a neckline without wrinkles that belied her age of 57. Theresa has two children, is married to a man from Ireland and is gainfully employed by the State of New Jersey in Trenton. Theresa has an unmistakable air of confidence. This was surprising, given her reason for seeking help in our office for Pelvic Floor Physical Therapy.

During her first visit, Theresa confided that she had recently begun to experience fecal incontinence. It had come out of the blue, she said. A few months back, Theresa noticed severe urgency with bowel movements. She would feel spasms within her rectum and there was no warning before she would have to defecate. There were times when she could not make it to the toilet in time, and so she was forced to wear disposable pull-ups to manage her “accidents”. She had to plan her commute to work, stopping at least once in the cleanest of public bathrooms she could find, because she could not wait during traffic. Theresa’s problem was worsening. She could no longer go to social outings without scoping out for the nearest restroom. The humiliation was awful, she said.

​“After I married my husband, who is from the outskirts of Donegal, Ireland, I traveled overseas to meet his family,” Theresa explained. “They live very simply, these people. They wear the same clothing most days, drive old cars with manual transmissions, and do not have the same access to healthcare that we do.”
bowel incontinence
Theresa had gone to see a gastroenterologist for her new bowel problem. The GI doctor had ordered a colonoscopy, but it had revealed nothing. “My husband’s family in Ireland would not be able to get a colonoscopy as quickly as I did. They would have to stand in a queue. Even if they had the kind of medical emergency that I seem to be having.”

Theresa had gone for second opinions, seen several specialists, but there was no explanation for her fecal incontinence.​
“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.

A Physical Therapist's Perspective on Pelvic Floor Dysfunction: Eva

11/19/2017

 
Written by Becca Ironside, PT. Becca is also a published Author of Fiction.
​
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.
Case study: Eva
It was not until I examined her a few minutes later that I learned I had been wrong to jump to this conclusion. It turned out that Eva had very tight muscles in her pelvic floor. This was preventing her from maintaining continence and these muscle spasms were forcing small amounts of urine to escape the bladder in an uncontrolled manner.

​Towards the conclusion of our first session of PT together, Eva asked me what else can be treated in our clinic. 
“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!

How Often Should I Be Peeing?

11/9/2017

 
How often should I be peeing?
Do you ever wonder if you are traveling to the bathroom too often – or too little? Six to eight times per day is the norm. That’s right, if you’re urinating above or below that:
  • Step 1 - Make sure you’re drinking close to the recommended eight cups of liquid per day.
  • Step 2 - See your doctor to rule out infection or other medical issues.
  • Step 3 - If medical tests come out negative, see your pelvic PT!

Did You Know: Urinary Void

6/6/2017

 
A healthy urinary void should last at least eight seconds with a moderate to strong stream.

A shorter void could be a sign of dehydration or going to the bathroom too often.
urinary void

What the research says: effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence

5/3/2016

 
A prospective study by Filocamo and colleagues in 2005 investigated the effectiveness of early pelvic floor muscle training (PFMT) after radical retropubic prostatectomy (RRP). After catheter removal, 300 men were randomized equally into either a structured PFMT group or a control group that did not receive exercise. Incontinence was assessed by the 1-hour and 24-hour pad test, as well as the ICS-Male questionnaire.

By 6 months, almost 95% of the PFMT group achieved continence as compared to 65% of the control group. The authors concluded that an early supportive rehabilitation program like PFMT significantly decreases continence recovery time.

Filocamo M, Marzi VL, Del Popolo G, Cecconi F, Marzocco M, Tosto A, Nicita G. Effectiveness of Early Pelvic Floor Rehabilitation Treatment for Post-Prostatectomy Incontinence. European Urology. 2005 Jun:48(5)734-8.

Urine leakage with urgency after hysterectomy

11/9/2015

 
Patient: 42-year-old female
 
Chief Complaint: Urine leakage with urgency after vaginal delivery of 2nd child + emergency hysterectomy; 6 night voids
 
Past Medical/Surgical History: Repair of prolapse the following year + Oxybutynin with 50% decrease in symptoms; history of low back pain, irritable bowel syndrome
 
Physical Therapy Treatment: proper voiding techniques; lower body stretches; prolapse management; posture and breathing exercises; abdominal scar release

Results: 0 urine leakage with 1.5 hour urinary intervals, 0 night voids, 0 Oxybutynin in 12 visits!

New Pediatric Pelvic Program

7/16/2014

 
Connect Physical Therapy is pleased to offer a program designed to treat children with bladder or bowel elimination disorders. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), up to 10% of 5-year-olds experience urine leakage during the day, and up to 30% of 4-year-olds experience urine leakage at night.
pediatric pelvi program kids
​Constipation, which accounts for almost 5% of pediatric office visits, can also contribute to urine leakage or urgency.

Our program educates children, teenagers, and families about normal anatomy and physiology, and uses safe, non-invasive modalities like: sEMG biofeedback, exercise, and behavioral training to treat pelvic conditions like stress incontinence, urge incontinence, bed-wetting, and constipation. We hope to minimize the social impact on this underserved population, and improve the quality of life of these children before they transition into adulthood.
​(Constipation in Children. (2013).Retrieved June 9, 2014 from http://digestive.niddk.nih.gov/ddiseases/pubs/constipationchild/#common Urinary Incontinence in Children. (2012). Retrieved June 9, 2014 from http://kidney.niddk.nih.gov/kudiseases/pubs/uichildren/index.aspx)

What the Research Says: Nocturia

6/2/2013

 
Written by Michelle Dela Rosa, PT.
"Nocturia" is defined as waking one or more times at night to void, according to the International Continence Society. New evidence demonstrates how the condition is associated with significant health risks and mortality. One study looked at patterns in 692 older men and women, and found that those who voided 3 times or more per night increased their risk of falls 28% over a 3 year period. The participants classified as fallers were more likely over 85-years-old, female, diagnosed with diabetes, taking diuretics, and found to have an abnormally slow walking speed. ​(Vaughan et al, Int J Clin Pract. 2010 April; 64(5): 577–583.) ​
Nocturia
Another study from Japan showed that almost half of their 784 elderly participants reported nocturia 2 times or more per night. These individuals were at greater risk for fracture and mortality. (Nakagawa et al, J Urology. 2010 October; 184(4): 1413-18.) 

Simple advice like decreasing caffeine, alcohol, or any fluid near bedtime may help improve nocturia. Physical therapists can help patients with other behavioral strategies and techniques after a thorough evaluation. Other factors to consider include: sleep disorders, diabetes, poor bladder storage, kidney dysfunction, or cardiac issues.

What the Research Says: Pregnancy and Delivery is Not Always the Culprit for UI

11/18/2012

 
Written by Michelle Dela Rosa, PT.
pelvic health blog
Pregnancy and delivery is not always the culprit for urinary incontinence (UI).

​An article on the MONASH University website concludes that “up to 1 out of every 8 healthy women who have not carried or birthed children have urinary incontinence”, which significantly affects quality of life. 
1000 healthy, young women (age 16-30 in Melbourne, Australia were surveyed about continence. 6.2% of women reported urinary leakage with stress, 4.5% with urge, and 1.9% with both stress and urge. Women were also more prone to UI if they reported a history of bedwetting beyond 5 years of age. ​

What the Research Says: Effects of Pelvic Floor Muscle Strengthening on Bladder Neck Mobility

8/4/2012

 
​Written by Michelle Dela Rosa, PT.
A recent study in Taiwan has reported on the effects of pelvic floor muscle strengthening for urinary incontinence (UI) and bladder neck mobility. 23 female participants performed a specific pelvic muscle strengthening program over 4 months. After 4 months, the ability to elevate the bladder neck with a contraction improved, as measured by transperineal ultrasonography. Everyone reported a decrease in UI, and demonstrated an increase in pelvic floor muscle strength and maximal vaginal squeeze pressure.
Muscle Strengethening
(Hung HC et al., “Effect of pelvic-floor muscle strengthening on bladder neck mobility: a clinical trial”. Phys Ther. 2011 Jul; 91(7): 1030-8.)

Pelvic Rehabilitation Recommended as First Line of Defense for Stress Incontinence

8/4/2012

 
Written by Michelle Dela Rosa, PT.

​An article in Advances in Urology was published by Dr. G. Willy Davila of the Cleveland Clinic Florida that describes non-surgical management of female stress urinary incontinence (SUI). He reviewed the literature for prospective trials and included only studies that followed participants for at least 12 months. The article confirms earlier research reviews that identify pelvic floor rehabilitation as a low cost, low risk treatment, with 60-77% of patients showing improvement in SUI symptoms.

(G. Willy Davila, “Nonsurgical Outpatient Therapies for the Management of Female Stress Urinary Incontinence: Long-Term Effectiveness and Durability,” Advances in Urology, vol. 2011, Article ID 176498, 14 pages, 2011. doi:10.1155/2011/176498)

stress urinary incontinence

Research: Incidence of Painful Pelvic Floor trigger points

2/12/2012

 
Written by Michelle, Dela Rosa, PT

A new study has highlighted the incidence of painful pelvic floor trigger points among patients diagnosed with interstitial cystitis (IC), a condition characterized by pelvic pain and urinary urgency/frequency. A retrospective chart review was performed on 186 people diagnosed with IC. 78.3% had myofascial pain with at least one trigger point, and 67.9% had multiple trigger points. 
Picture
These results demonstrate the need to screen patients with IC for pelvic floor dysfunction and painful muscle trigger points, and refer them to specialists like physical therapists who are skilled in treating pelvic pain.
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