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Recent studies support the benefits of mindfulness for bowel health. A 2014 study of 53 patients reported that mindfulness-based stress reduction (MBSR) “had a significant positive impact on the quality of life…” on people diagnosed with ulcerative colitis compared to a control group (1).

Another study the same year examined 24 people with irritable bowel syndrome (IBS) and compared them to a control group. Authors concluded that mindfulness-based therapy was more effective than cognitive behavioral therapy (CBT) to decrease symptoms in those with IBS at a 2-month follow-up. (2)

​By Karen Bruno, PT, DPT

According to a recent article published in the American Journal of Physical Therapy, “Research continues to reveal that sleep is not a period of physiologic inactivity; rather, it represents a critical period of recovery that supports cardiovascular, neurologic, and other life functions. Sleep is a basic human need, and recent attention on sleep by researchers and media are changing sleep attitudes and behaviors. Sufficient sleep was often viewed as a luxury, and reduced sleep time was often equated with increased productivity; however, attitudes are shifting to prioritize sufficient quality sleep.  Quality sleep is recognized as a positive health behavior, and it has been recommended to consider sleep as another vital sign,  as sleep can give insight into the functioning and health of the body (3)."

You may have noticed that getting a good night’s sleep helps you to feel better both physically and mentally and this helps you function better during your waking hours.  Basically, getting a good night’s sleep is a game changer that enhances the quality of your life. “Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, and learning and memory.  Impaired sleep can lead to obesity, mood disorders, constipation and heart disease” (3).

1. https://www.sleepassociation.org/about-sleep/sleep-statistics/​
2. https://academic.oup.com/ptj/article/97/8/826/3831304
3. Siengsukon CF, Al-dughmi M, Stevens S. Sleep health promotion: practical information for physical therapists. Phys Ther. 2017;97(8):826-836. 

 
Tips for Healthy Sleep
There is good news! There are many natural ways to improve the quality of your sleep and restore your sleep health. Scroll through the list below and try one or more of the tips, and see how they work for you.

• Decrease stress - Try diaphragmatic breathing to help you wind down and de-stress. Breathing full breaths in through your nose for 4 seconds and exhaling through your mouth or nose for 8 seconds is calming to the nervous system.
• Create your bedroom space as a peaceful sanctuary - remove electronics, TV’s, exercise equipment and anything that may remind you of any form of work. Reserve your bed for sleeping and intimacy.
• Get to bed in enough time to enable you to get 7+ hours of sleep. Create a relaxing bedtime routine. Read a book or take a bath to help wind down.
• Establish regular sleeping and waking hours
• Avoid light-emitting electronic devices at least 30 minutes to 2 hours before bedtime; use amber glasses at night when watching TV or working on a laptop.
• Find the right temperature for your bedroom. The general recommendation is to keep the bedroom temperature between 60-70 degrees.
• Sleep in complete darkness. Use of an eye mask may be beneficial to keep light out. Use earplugs or a white noise machine to block out noises.
• Consider applying a hot pack to your abdomen. This can be very calming. Keep the hot pack on for no more than 20 minutes. If you tend to have cold feet, wrapping a hot pack around your feet for 10-20 minutes can be warming and relaxing.
• Consider using essential oils. Lavender, Roman Chamomile and Vetiver provide relaxing effects and calm the nervous system. You can diffuse them, put the oils on your pulse point, rub them on the bottom of your feet, lightly spray them on your pillowcase or add them to an Epsom Salt bath and take the bath before bedtime.
• Find a comfortable, supportive, neutral sleep positions. Use of a neck roll or a lumbar roll, or a pillow between your knees when you are on your side as positioning supports.
• Avoid taking naps to catch up on sleep.
• Exercise can have a positive effect on deep sleep. Find the time of day that works best for you. Stretching, strengthening, yoga, aerobics or a combination of activities may be right for you.
• Avoid alcohol, caffeine and other inflammation-causing foods, like sugary snacks, refined carbohydrates, or processed meats, late at night.
• Support through vitamins and supplements may be useful. Please check with your doctor, nutritionist, pharmacist or herbal practitioner for what may be right for you. Some common sleep nutrients include ashwagandha, valerian, chamomile, passion flower, lemon balm, melatonin, L-theanine and 5-HTP or Tryptophan.  GABA is helpful if sleep is disturbed by anxiety. Taurine and phosphatidylserine help to lower cortisol. Magnesium and magnesium glycinate are helpful in insomnia.
• Move your energy through easy Energy Medicine exercises.

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.
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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.

Written by former staff physical therapist, 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.  

​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.

It takes time to strengthen pelvic muscles, but our therapists often see muscle training instrumental in avoiding corrective surgery and in other cases, helpful in preparing for surgery. If you've been diagnosed with prolapse, speak to your doctor about physical therapy for pelvic muscle training. If you've had therapy in the past, we're here for you too for "refresher" sessions or ways to improve your current program.

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.

Written by Michelle Dela Rosa, PT

A 2013 study by Kavvadias and colleagues assessed pelvic floor muscle tenderness in 17 asymptomatic female volunteers who have never been pregnant (mean age 21.5 years). Authors concluded that in women aged 18-30 who have never been pregnant, no lower urinary tract symptoms, and no history of low back or pelvic pain that tenderness “… should be considered an uncommon finding.”

Other studies like Montenegro et al. (2010) have also reported a low prevelance of pelvic muscle tenderness in healthy volunteers (4.2%), and Tu et al. reported a high prevalence of tenderness (75%) in women with chronic pelvic pain.

Kavvadias T, Pelikan S, Roth P, Baessler K, Schuessler B. Pelvic floor muscle tenderness in asymptomatic, nulliparous women: topographical distribution and reliability of a visual analogue scale. International Urogynecology Journal. 2013 Feb:24(2):281-6.

Montenegro M, Mateus-Vasconcelos E, Silva J, Nogueira A, Dos Reis F, Neto O. Importance of pelvic muscle tenderness evaluation in women with chronic pelvic pain. Pain Medicine. 2010 Feb:11(2):224-8.
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Tu F, Holt J, Gonzales J, Fitzgerald C. Physical therapy evaluation of patients with chronic pelvic pain: a controlled study. American Journal of Obstetrics &Gynecology. 2008 Mar:198(3):272.e1–272.e7.

Written by Michelle Dela Rosa, PT.

Bump et al (1991) assessed whether or not verbal instruction was enough to perform a proper pelvic floor muscle contraction, or Kegel. The study measured urethral pressure in 47 women at rest and during a pelvic muscle contraction following standardized verbal instruction. Although almost half the women performed with “an ideal effort” for urethral closure, 25% performed with maneuvers that could lead to incontinence. The authors concluded that simple verbal or written instruction is not the best approach for pelvic floor muscle training.

In 548 Dutch working women, almost half reported pelvic girdle pain at 12 weeks postpartum. Pregnancy-related predictors for pain included: history of low back pain, elevated somatization, 8 or more hours of sleep/rest per day, and uncomfortable postures at work. Pregnancy and postpartum-related predictors for pain included: disability and pelvic girdle pain at 6 weeks, elevated somatization, higher birth weight of the baby, uncomfortable postures at work, and number of days on bed rest. The authors discussed that a woman with PPGP should be cared for to prevent more serious postpartum disability (Stomp-van den Berg et al, 2012).

Another study looked at the type of delivery and pelvic girdle pain in 10,400 women with singleton pregnancies. A planned cesarean section was associated with 2-3x the rate of pelvic girdle pain at 6 months postpartum. The authors recommended vaginal birth for women with PPGP, unless there is a serious medical reason (Bjelland et al, 2013). In a study done by the same lead author, postpartum women had high recovery rates from pelvic girdle pain, but those who reported significant emotional stress during pregnancy had an independent correlation with continued pelvic girdle pain (Bjelland et al, 2013).​

​A final study looked at the relationship between exercise and PPGP. Pregnant women who exercised more than 2x per week reported a lower rate of pelvic girdle pain, and those who exercised 1-2x per week reported less low back pain and depression. The authors concluded that exercise during pregnancy could lower the risk for pelvic and low back pain (Gjestland et al, 2013).

Bjelland EK1, Stuge B, Engdahl B, Eberhard-Gran M. The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study.  BJOG. 2013 Jan;120(1):32-40.

Bjelland EK1, Stuge B, Vangen S, Stray-Pedersen B, Eberhard-Gran M. Mode of delivery and persistence of pelvic girdle syndrome 6 months postpartum. Am J Obstet Gynecol. 2013 Apr;208(4):298.e1-7.

Gjestland K1, Bø K, Owe KM, Eberhard-Gran M. Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression. Br J Sports Med. 2013 May;47(8):515-20.

Stomp-van den Berg SG1, Hendriksen IJ, Bruinvels DJ, Twisk JW, van Mechelen W, van Poppel MN. Predictors for postpartum pelvic girdle pain in working women: the Mom@Work cohort study. Pain. 2012 Dec;153(12):2370-9.

Written by Michelle Dela Rosa, PT.

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.

Written by Michelle Dela Rosa, PT.

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. ​

Written by Michelle Dela Rosa, PT.

New research presents visceral manipulation as a modality to reduce adhesions post-operatively. 
Researchers employing an experimental animal model reported significantly less adhesions in the 
group that received VM after an adhesion-producing surgery (as compared to controls). The authors 
believe that VM encourages tissue mobility and decreases fibroblast invasion of tissues in animals as 
it would in humans. They suggest that patients may benefit from VM in post-surgical care and patient 
education by preventing/treating abdominal adhesions.

Bove, G.M., Chapelle, S.L., Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model, Journal of Bodywork & Movement Therapies (2011), doi:10.1016/j.jbmt.2011.02.004