Pelvic Health Blog

vincent's story: pain with sitting

5/2/2018

Written 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.

There were other symptoms, and they were even more troubling. Vincent began to have difficulty urinating. He would have the intense urge to void his bladder, but upon rushing to the bathroom, nothing would come out. Then there was the constipation. Days would go by, with no bowel movements. The discomfort and bloating in Vincent’s stomach made eating food feel like he was a beaver actively working to dam up the river of his intestines. So, he stopped eating for a few days. But that did not help and the constipation persisted.

The final symptom which prompted Vincent to become desperate for help was testicular and penile pain during arousal. Vincent could no longer have intercourse with his wife without searing pain. He called a urologist and a gastroenterologist. He scheduled appointments for both specialists around his busy schedule.

The urologist prescribed a pharmaceutical named Flomax to improve Vincent’s ease in urination. The gastroenterologist recommended Miralax, a bowel aide which allows water to be retained in the stool, thereby promoting softer stool and more frequent bowel movements. Both of these agents helped Vincent with about one-third of his overall complaints; but he was still unable to sit at his desk without pain, and his sex life had taken a turn for the worse. Vincent’s wife was unhappy, though not as unhappy as Vincent. There has to be something out there to help me, he wondered. But what?

This was when Vincent initiated his full-throttle search on the Internet. He looked for stories of men with similar complaints. Vincent lives in Central New Jersey. There came a day when he found Connect PT online. The office was merely 14 miles from his home! He booked an appointment for the following week and crossed his fingers as he paced around his office, trying to stop the throbbing in his pelvis by willpower alone.

Upon his initial Pelvic Floor physical therapy evaluation, Vincent told his entire history to his evaluating therapist. She sat and nodded, and then proceeded to ask him a series of questions about his symptoms. To every one of the questions, Vincent longed to shout: YES! I have trouble maintaining a urinary stream! I have severe constipation! I cannot sit without pain! I cannot have sex anymore, because the discomfort is not worth the release!

The PT gave Vincent some relaxation exercises, a home program to stretch his own pelvic floor and even a link to a seat cushion which Vincent could use to take the pressure off of his perineum, rectum and tailbone. This would allow him to sit for longer periods of time with less pain, the PT said. Within a few months, Vincent was able to urinate more freely, have more consistent bowel movements, and was able to return to having sex with his wife.

How had all of this happened? Was it magic? No. But it seemed that way to Vincent. Vincent’s recovery had everything to do with his willingness to seek treatment and the newfound availability of Pelvic Floor physical therapy. His symptoms were far more common than he knew. Now, Vincent writes blogs about pelvic pain in order to share his experience with other men who may be suffering from similar complaints.

The greatest outcome of Vincent’s recovery was his decision to retire from his high-stress, corporate job. He still uses the special seat cushion which takes pressure off of his pelvic floor to drive across the country in an RV. Vincent and his wife have seen Yellowstone National Park, and they even take their English bulldog named Lola along for the ride. In sum, everyone is happier. Vincent, his wife and Lola. All because of one fortuitous Internet search and the prevalence of Pelvic Floor physical therapy.

“Looking back, I see that my symptoms really began to change when I began talking about this,” Vincent says. “Giving a voice to the pain, isolation and embarrassment has changed everything. I just want more people to know that they are not alone.”

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:

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.

Did you know: nighttime urination

3/8/2018

40-70% of older adults suffer from insomnia, and the greatest cause for disturbed sleep is having to urinate in the middle of the night (nocturia). Read about it in the Journal of Clinical Sleep Medicine.

Contact your doctor if you are urinating more than once per night to see if medical conditions, medications, or food can be contributing factors. Otherwise, your local pelvic physical therapist may be able to help!

How Often Should I Be Peeing?

11/9/2017

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!

Case Study: Male Pelvic Pain with Urinary Urgency

3/1/2015

Chief Complaint: Left groin/hip pain 7/10 after urethral procedure, disturbed sleep, day-time urinary urgency, bladder pressure and bloating. No night-time voiding.

Past Medical History: Type II diabetes, hypertension, umbilical hernia.

Patient: 55-year-old male who had urethral dilatation 3 years ago to improve urine flow.

Diagnostic Testing: Urine test last month negative, x-ray of hips negative.

Physical Therapy Treatment: Manual therapy to hips; low back and hip stretches; posture correction; gentle abdominal and low back strengthening; home program.

Results: Left groin/hip pain 3/10 only after prolonged sitting, undisturbed sleep, 0 urinary urgency or bladder discomfort in 5 visits! No pelvic floor work necessary.

Case Study: Urinary Frequency

3/5/2014

Patient: 35-year-old female, diagnosed with interstitial cystitis many years ago, controlled with diet.

Chief Complaint: Increased urinary frequency to every hour, sometimes 20-30x per day, 5-6x per night; low back pain. No change with diet noted. Tests rule out infection.

Past Medical History: Asthma, thyroid condition

Physical Therapy Treatment: Biofeedback to pelvic floor; manual therapy to pelvic floor, low back, hips; posture education; hip stretching; core trunk strengthening; home program

Results: Patient voids once every 2 hours, 2x at night. Patient reports having control of urinary urgency. 0 low back pain. 10 visits!

Did You Know: Smoking and Urinary Urgency and Frequency

11/18/2012

Thinking of kicking the habit? Women who smoke are three times more likely to have urinary urgency and frequency than women who have never smoked.

(Tahtinen RM et al., “Smoking and bladder symptoms in women”. Obstet Gynecol. 2011 Sep; 118(3): 643-8.)

Did You Know: Irritating Bladder

10/30/2011

Caffeinated and carbonated drinks can be irritating for the bladder and cause episodes of urinary frequency.

So curb the coffee, cut down the soda, and cut out an extra trip to the bathroom!

Did You Know: Intervals for Urination