Pelvic Health Blog

Postpartum rib flare

6/17/2021

by Bryn Zolty, PT

Rib Flare
Rib flare refers to an altered ribcage position. This means the rib cage is tipped up/forward, flattened and wide, or both. Rib flare has many potential causes. For this article, we will focus on the postpartum individuals.

Ribs Tipped Up Flare
First, let's look at the rib cage position from the side to identify the ribs tipped up flare. Ideally, the rib cage would line up over the pelvis and the curve in your lower back is greatest in your lower back. You can feel the top of your hips and walk your hands around to your back, this is where your lower back curve should be located. See the arrow from her hips to her lower back.

The first picture (left) demonstrates fairly neutral (good) posture. Notice the horizontal arrow from the top of the hip bone to the low back showing the curve. Also, note the vertical line running through the middle of the shoulder, trunk, and hip. The line is fairly centered in these locations. The ribs below her bra line are tucked in the abdomen.

The second picture demonstrates the tipped up rib flare. Notice the curve in the spine compared to the first. The curve in the back is higher. It continues throughout the middle back and her shoulder blades sit further back. The ribs are tipped upwards and stick out further than her abdomen. Also, note the vertical line running through the shoulders, trunk, and hip. The trunk is more forward and not centered as in the first picture.

This rib tipped up position, the second picture, in a postpartum population is common. Later in pregnancy as the baby grows, the ribs tip up to make room. Women may lean back to maintain balance as their weight has increased forward. Next, women carry around a growing baby and continue to lean back. After standing in this position for months, your body begins to recognize this posture as straight.

Postpartum, the front abdominal muscles are stretched and weakened. The muscles in the lower back have been in a shortened position and can become painful and overworked as their counter parts in the front need time to regain strength. However, to do that, we need to restore posture. It is difficult to strengthen abs that are lengthened if the ribs stay tipped up! When this position is maintained for a long period of time, the back muscles can become tight and even maintain the tipped ribs when laying down.

Note in the picture the space between the floor and the back. The left rib cage here is sticking up. This individual will require some release work and stretching in addition to posture modifications.

Infrasternal Rib Flare

Another type of rib flare is seen in a front view. This is the infrasternal angle, the angle formed by the ribs coming together under the breastbone. A normal angle is 90 degrees. Place your thumbs together in this space and see if they form a 90 degree angle. When this angle is greater than 90 degrees, there is a rib flare.

Commonly with a rib flare, the internal oblique muscles tend to be dominant, creating muscle imbalance. The internal oblique muscles flare the ribs wide.

Here is the same individual lying flat looking at the front view to check for infrasternal rib flare. Now you can see the left rib is more pronounced and wider than the right. This angle is greater than 90, and is asymmetrical.

In the picture below, she was asked to start to curl up her shoulders off the ground. Note the ribs pulling wide and as her internal oblique muscles contract strongly demonstrating her muscle imbalance.

Rib flare does not get better on its own and needs individualized care to improve posture and muscle recruitment. So many functions in the body rely on the diaphragm and rib position. Dysfunction can alter digestion, create back pain, increase your sympathetic nervous system, and decrease pelvic floor muscle flexibility. Muscle imbalance can create compensatory patterns and resulting pain and/or weakness. Many women tell us they want their core back and their stomach to look pre-baby. Rib flare can prevent abdominal muscles from contracting well and even push(pooch) out the lower abdomen if muscle imbalances exist.

The key to treating rib flare is improving alignment and muscle balance. And not just muscle imbalance in your back and abdomen, but also shoulders, legs, feet, and pelvis. How you stand, sit, carry your kids, and exercise at the gym can all be part of improving rib flare.

At Connect PT we are happy to help evaluate and treat your posture, muscle coordination, and improve your strength!

It's coming out time!

5/2/2021

by Michelle Dela Rosa, PT

We know that things aren't back to normal yet. But we've all seen the resiliency of the human spirit and how people have been able to adapt to our new norms.

We posed this question to the community recently: "After one year with COVID and living in quarantine, can you share one way you've been able to increase physical activity?

We loved reading about all the dog-walking, trail hiking, and playing with kids and grandkids that helped to keep people moving this past year. Here are more ideas from the community board:

Hula hoop!
Walk to the park/lake and meditate at sunset
Stand up between commercials and march
Park a bit further when grocery shopping

As the spring weather allows, we encourage you to grab a friend, get outside, and soak up some vitamin D!

Show your colon who's boss: rectal balloon therapy

4/27/2021

by Becca Ironside, PT

As pelvic floor practitioners who treat a variety of disorders of the digestive tract, we are proud to participate in retraining of the sensation of the bowel with a unique type of therapy. Rectal balloons have long been used in the past by gastroenterologists for diagnostic purposes to observe how patients attempt to void stool from the sphincters of the anus. More recently, pelvic floor physical therapists have been using rectal balloon catheters to aid in treating constipation by providing contact against the bowel wall. This stimulates the sensors which leads to better coordination of the pelvic floor muscles and ultimately, improved passage of stool without straining or discomfort.

Here is how it works: The patient lies on their side and the PT inserts a deflated lubricated balloon into the rectum. The PT then begins to pump small amounts of air into the balloon to inflate it. This mimics the sensation of having a full bowel and “needing to go” for the patient. Small sensors which line the bowel walls are being trained with the presence of the expanding balloon that it is time to void; this unique sensation is historically ignored or suppressed by the brains of people with chronic constipation. Yet with the use of rectal balloon training, such people are afforded the opportunity to show their colons who is truly in charge of having healthy, soft and regular bowel movements (their own brains are!).

The use of rectal balloons might sound weird and like the stuff of science fiction. But once patients experience this treatment in the relaxing and supportive environment of a pelvic floor clinic, they often discover how they might have been contributing to their own unconscious tension which leads to a lifetime of constipation. Rectal balloon therapy has also proven to be effective for the management of people with chronic diarrhea and poor stool quality. In short, it is a wonderful adjunct to a balanced pelvic floor treatment plan aimed at improving bowel health. If you have bowel concerns, please ask us at Connect PT about rectal balloon training.

Barthelemy, Anne1; Shifferd, Jennifer1; Erickson, Kim1 Balloon Training for Bowel Dysfunctions, Journal of Women's Health Physical Therapy: Spring 2009 - Volume 33 - Issue 1 - p 18

Body Talk

4/8/2021

by Karen Bruno, PT

It has been recognized for a long time that there are interactions between the mind and the body. Our thoughts inform our emotions and that triggers a cascade of events in our bodies. (1) Emotions that are expressed freely and without judgement can uplift us, make us feel happier and improve our overall health. Repressing our emotions, especially anxiety and anger, can produce a physical reaction of tension in the body (Tension Myositis Syndrome). Prolonged tension can lead to pain disorders, stiffness and loss of function. (2)

If you are experiencing chronic pain, stiffness or discomfort, what is your body trying to tell you? Here is a short, fun practice to begin dialogue and partnership with your body.

Allow yourself to acknowledge your body’s wisdom.
Acknowledge anything that feels like discomfort or pain is really not discomfort or pain, but rather your body’s desire to call your attention to it and give you information.
Talk to the pain or discomfort. Acknowledge the part of the body from where the pain is coming and speak to it directly.
You may choose to use a mirror and look in the mirror as you speak to that part of your body or you may talk to the body and say, ”Body part, I love you. I am grateful for what you are doing for me. Tell me what you would like me to know”, and then listen.

This may seem awkward or strange at first; it may seem silly or even uncomfortable, but if you do this more and more, you shall receive the answers and your body begins to trust you and you begin to trust your body, thereby creating a partnership for health. Through practicing this over and over you may notice that the pain begins to subside and may eventually be gone.

You may choose to combine this with a very clear intention that it is your intention to 100% enjoy your body fully, and that your body enjoys you inside of it fully and completely. This supports your collaboration with your body for a maximum amount of enjoyment.

Although the pain may not leave immediately, recognize that the physical form takes longer to change, but the change starts once you make a connection and change your thoughts. It is new energy; it is new consciousness; it is new awareness. Your job now is to stay in a mode of receiving and know that you have started the process of feeling better, and while it might not be an overnight healing, it will be steadfast and continuous, and with ease and grace. We want this with ease and grace in the most gentle way for you.

According to Dr. John Sarno, in his book, Healing Back Pain, for a condition like chronic back pain, once you call out the emotion that your body is repressing, there is no longer any need for the pain and the body will no longer need to generate tension. (2)

All of us here at Connect Physical Therapy are here to support you to feel your best.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585554/
Sarno, John (1991), Healing Back Pain, Grand Central Life and Style, New York

Am I even doing this right?

3/30/2021

by Bryn Zolty, PT

I hear this constantly. “Check my muscles, are they on?” The struggle is real. I’ve been there postpartum. Women feel hopeless at times trying to reconnect with muscles that have stretched or torn. The deep core muscles, including the transversus abdominis (TA) is one of them.

The TA muscle is part of the deep core muscles. It wraps around your trunk like a girdle. If a girdle sounds supportive to you, you are right. One of the main functions of this muscle is trunk and pelvic stability.

The TA was a big part of my postpartum rehabilitation and I would like to share some of that journey in case any part of it could help another woman find her way. My daughter was born via c-section. I knew at that time my abdomen felt weak and the middle of my muscles felt different. I waited for physician clearance and began exercising, slowly building strength and intensity. I noticed my side abdominal muscles, the obliques, looked chiseled! I was proud. However, I realized after having my c-section that a muscle tore in that area and soon found out that it had led to an inguinal hernia. I needed another open abdominal surgery. I again waited for clearance and started back up exercise and had the same results.

I noticed that I had very little strength or tension in the middle of my abdomen again. This time the separation (diastasis) was more obvious. Like many of my patients, I was guided to start trying to “find my TA.” This made me very sympathetic to my patients trying to tension their TA. It took me forever to activate it despite being a physical therapist. Two open abdominal surgeries left me with poor ability to connect to the lower deep abdominal muscles.

I tried feeling for the muscle. I tried laying on my back, side, and cat/cow. I tried using sheets, taping and bracing. I used all the breathing techniques. I also knew that a c-section doesn’t mean you can’t have pelvic organ prolapse (pelvic laxity). I was relying heavily on other muscles to compensate for my abdominal muscle weakness and it was becoming painful in my hips and tailbone. I finally found it! It took a long time. But I had motivation, not just for how the abdomen looks. I wanted to be strong.

I share this story because now there are more tools to help our patients and postpartum women learn how to start using those deep core muscles. Ultrasound imaging makes it easier for women and men to connect to the deeper muscles. We use this at Connect PT as a type of biofeedback for turning on muscles and coordinating functional movement. Being able to see the muscles while you try different breathing patterns of movement can help you see what works for you!

Here is an ultrasound image of my abdomen with me at rest.

D1 is the TA.
D2 is the internal oblique.
D3 is the external oblique.

The top of the picture is the surface of my abdomen. The TA is deeper than the obliques.

This is an ultrasound image of me turning on my TA. Compare it to the picture above. See the lower band, D1 which is the TA, widen and start to slope down, which is what we want to see.

Below is an ultrasound of my abdomen during a sit up/curl up. The TA should turn on for this movement. But there is no widening, nothing like the image above. The internal oblique, D2, does start to widen. The obliques help with side bending and rotating; the next picture on the right shows me doing those movements. My obliques are really widening and working now!

Finally, in this last image below, I exhale and gently start the TA turning on and do a sit up. I let my body start to take over with how much intensity is needed. I provide a gentle reminder to my deep core to turn on. D1, the TA, is widening and turning downwards.

There are many online postpartum and mommy fitness programs now. Many of them are great, but for some women, you need help knowing you are doing the techniques correctly. Are you doing a TA workout and not actually turning on the TA? Are you bearing down when supposed to be pulling up/in? I recommend a visit to a pelvic physical therapist, even if it’s just a few times to make sure you are on the right track. We want you back to running, back to lifting weights, and back to the activities that make you feel good. Let us help you get your confidence back.

Reduce pelvic, hip, or low back pain during intercourse

2/23/2021

Penetrative sex positions for people with pelvic, hip, or low back pain

Many people with low back, pelvic floor or hip disorders experience pain with penetrative sex. Becca Ironside, PT, goes over how they can position themselves in four different sexual positions to decrease pain and improve satisfaction with their partners.

Watch the video on YouTube.

New team member: Cynthia Chernyavsky

2/8/2021

With over 28 years of experience, Connect PT welcomes Cynthia Chernyavsky, PT, MDT, RYT to our physical therapy team.

She has treated hundreds of cervical, thoracic and lumbar conditions involving pain and physical impairments, many related to pelvic floor dysfunction. In her free time, Cynthia practices yoga and became a certified instructor.

Fun fact: Cynthia's dad taught her how to play chess at the age of 9. She became so good that she was able to bet on chess games during physical therapy school to help her get through college!

Read more about Cynthia here.

Dolphin on the table & skier stretches

1/14/2021

Beat those winter blues by getting up to stretch with Marzena Bard, PTA. When you can't get to the gym, these easy stretches are great to begin and end the day or to break up sitting all day at the computer.

"Dolphin on the table" is a feel-good stretch for anyone who has tightness in the back, shoulders, or hamstrings. It increases the length and blood flow of these muscles.
"Skier" stretch is helpful for those with pelvic tension and pain. It helps to stretch the inner thighs and the entire groin area, which also improves blood flow to the pelvis.

Watch the video tutorial below.

Ultrasound imaging for constipation

12/20/2020

Get a glimpse of Connect PT's rehabilitative ultrasound with Bryn Zolty, PT. We can use the ultrasound to teach proper pelvic muscle coordination and help conditions like functional constipation.

Watch the overview video below.

Taping for diastasis recti: criss-cross method

10/12/2020

Every pregnant woman has an abdominal diastasis, or diastasis recti, at the end of their pregnancy. It's a massive stretch on the abdominal wall that makes the connective tissue at the center very thin. Some heal in the first six weeks postpartum, but many need more time. We're here to help women that need help strengthening their belly after baby.

Watch Bryn Zolty, PT demonstrate the criss-cross method with kinesiotape to support the diastasis and help activate your abdominal muscles correctly.

Planks for prolapse

9/30/2020

By Bryn Zolty, PT

Planks are one of the most well-known core exercises. Doing a plank incorporates many muscles to make us strong and support our joints. Typically an individual starting off with planks would try a modified plank and build up to a full plank. A modified plank means less difficulty when you are starting out so you can maintain a nice neutral spine, avoid holding your breath, and build strength. Two common modifications would be starting on your knees or placing your elbows on a higher surface than your feet as seen below in the Common Progression. After this position becomes easier, you can hold longer or perform more repetitions. Next you could try a full plank. Planks can continue to be progressed to have your feet above your elbows, your elbows on exercise balls, use exercise bands and more.

Now let's add prolapse to the situation. Pelvic organ prolapse can feel like heaviness in the vagina and even progress to the organs (bladder, uterus, vagina, rectum) coming out of the body. These symptoms increase with gravity. The more upright you are, the more symptoms you may have. So with a prolapse, we may consider reversing the progression. We may start with your body inverted - check out the picture with the feet on a chair and elbows on the ground in step 1 of the Prolapse Progression. We also encourage you to monitor your breathing. Holding your breath can increase symptoms. Consider what happens when you breathe in and fill your system with air, and then hold your breath and strain in a position. This can push these organs down. In addition, you could consider adding a kegel, or pelvic floor squeeze, to help support the organs. Your progression might look like the reverse of the Common Progression! As you gain better control of the pelvic muscles and breathing, you may be able to progress to being more upright with less symptoms. Good Luck! Contact us if you need help modifying your exercises, breathing, or help with pelvic muscle strengthening so you can exercise with confidence.

Self-compassion and pain management

9/9/2020

By Karen Bruno, PT

Can self-compassion really help when you are in pain?
Let’s explore this. First, what is self-compassion? Self-compassion is giving yourself kindness, forgiveness and understanding when confronted with personal failures or discomfort. Basically, it means giving yourself the care and gentleness that you would give to a beloved friend or a child who is in need of support. In the words of Dr. Kristen Neff, a self -compassion expert and teacher, "Instead of mercilessly judging yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings – after all, who ever said you were supposed to be perfect?" (1) It is an acceptance of your humanness even when things don’t go your way.

So, what does self- compassion have to do with chronic pain? Recent research suggests that self-compassion is associated with better outcomes, such as lower levels of depression, pain-anxiety, physical and psychosocial disability, and higher levels of pain acceptance. Higher levels of self-compassion supports engagement in meaningful activities and use of pain coping strategies. (2)

What does that mean for you?

Lower levels of depression, sadness and anxiety.
Less physical and psychological stress.
Higher levels of pain acceptance and engagement.
Improved ability to perform meaningful activities and use pain coping skills.
Better overall outcomes, function and quality of life.

Self-compassion has been found to be beneficial in situations related to the ineffective way we respond to things, how we talk to ourselves and the behaviors we engage in. So, when you notice yourself worrying, thinking or talking negatively, isolating yourself, or beating yourself up, choose to use a better approach of treating yourself with care, gentleness and kindness. (3)

What can you do?

Meditate. Practices such as mindfulness, breath meditation or any other physiological quieting methods help us to reduce tension and train us to tune into our needs to better take care of ourselves. Here is a link to some guided meditations: https://self-compassion.org/category/exercises/
Consider treating yourself the way you would treat a close friend or a small child. How might you respond to them with kindness and gentleness?
Remind yourself that you are worthy of kindness and compassion.
Take a self-compassion break. What do you need to hear? What do you need to give yourself? How can you encourage yourself and be patient, kind and forgiving to yourself?
Explore self-compassion through writing. Start by writing about your concerns. Next, write yourself a letter from the perspective of a loving friend. The last step is to let yourself receive those kind words, allowing love and compassion to soothe and comfort you.
Practice supportive touch.
1. Putting your hands on your body and taking some conscious breaths can be relaxing.
2. Place your hands over your heart and breathe comfortably. Notice the rise and fall of your chest as you breathe. Do this for as long as needed to calm your nervous system.
3. If it is convenient, put your hands over the area of pain and breathe love and nourishing oxygen into the region.
4. Place one hand over your heart and one hand over the abdomen. Breathe gently and consciously- 4 seconds in and 4 seconds out. This is a great way to relax as you drift off to sleep.

This PDF download summarizes the relationship between self-compassion and pain.

Self-care is also an integral component of self-compassion.
We have heard it before from the airlines, "“put your own mask on first, then help someone else." Remember that you are your own best advocate and as you care for yourself, you model for others how to care for themselves, you teach others how you want to be treated, and you harness the resources to be of service to others. Just do it! You are worth it.

"Life is full of disappointments, failures and setbacks. None of those things can permanently stop you. You have the power within you to overcome anything that life throws at you. There is nothing more powerful than a made up mind. Surround yourself with people who remind you that you matter, and support you in ways that matter most to you. No person, situation or circumstance can define who you are. Don't give up, cave in or stop believing that it's possible. It's not over until you win."
-Unknown

Notes

Website: selfcompassion.org
Paper: The relation of self-compassion to functioning among adults with chronic pain. Eur J Pain. 2019 Sep;23(8):1538-1547. doi: 10.1002/ejp.1429. Epub 2019 Jun 11.
Audio: Integrative Pain Science Institute podcast

Poll results & managing stress with breathing techniques

8/28/2020

In our last newsletter, we asked you to share how you are managing stress during this new norm.

Drum rolllll...
"Exercise" and "meditation/prayer" tied for first!

We get a ton of questions every day about breathing and spend a lot of time teaching different breathing techniques, which can help with both exercise and meditation/prayer.

Learn about what we usually see and also what we're looking for, as we breathe with Marzena Bard, PTA, CYT.

Front lunge stretch

7/29/2020

with Karen Bruno, PT

Take a break from sitting at your desk or homeschooling by doing a Front Lunge Stretch with Karen. Sitting for long periods of time shortens the muscles and tissues on the front side of the body. Turn a chair sideways and perform this combination stretch for the upper body, lower body, and trunk. The Front Lunge Stretch can help with breathing, mobilize abdominal scars, assist with digestion, and facilitate pelvic floor lengthening to decrease pelvic pain.

Check out more exercises to break up sitting time on the Connect PT Patient Cheat Sheet.

Exercise of the season: open up the chest with a foam roller

7/18/2020

We love teaching this exercise to release tight pectoral muscles at the front of the chest. These muscles can be tightened by leaning forward over a computer, taking care of small kids, hunching forward to type on a smartphone, or just not being mindful about posture. A simple way to start loosening these muscles is by using a foam roller or rolling up a beach towel vertically.

Lie on the foam roller or rolled towel so it lines up with your spine vertically, resting your head at one end.
Bend your knees and keep your feet flat for balance.
Place your arms in 1 of the 3 positions pictured below, palms facing up.
Feel a comfortable stretch across the chest.
Focus on breathing and letting go of tension. Start with holding a position for 30 seconds, working your way up to 2 minutes.

Work smarter, not harder, from home

6/30/2020

by Michelle Dela Rosa, PT, DPT, PRPC

Kids and phone calls, cooking, and homeschooling...so where is the space to work from home? For some people, creating a proper work station at home has been challenging.

At Connect PT, we're seeing all kinds of issues from wrist pain to neck pain to low back pain and tailbone pain after making this transition. We cannot assume the table that we eat at is set up properly for zoom calls or studying. If you're still working from home, we want to help make the transition easier. Let's break it down:

Problem #1

If you're like me, at some point in the day you're using a laptop. It's terrible for long-term use.

Your head is forced to look down if you're using a table at standard height. That opens the gate for headaches, jaw tension, and upper back pain.

Remedy #1

Place a thick book under the back of the laptop to elevate the screen.

This allows you to pick your head up a little more while still allowing for proper wrist alignment.

Problem #2

Dangling feet or feet that can't rest on the floor comfortably gives little whole-body support when seated for long periods of time.

You'll end up needing to place more pressure on other structures like the low back or neck.

Remedy #2

Place a low step stool or other firm support under the feet to keep knees in line with hips, which will automatically decrease pressure on the spine.

Problem #3

The chair I'm using is fixed in a reclined position.

It's okay for eating, conversing, relaxing - not ok for computer work. This position puts lots of pressure on the tailbone when, contrary to popular belief, the tailbone is not meant for sitting!

PS - Watch out for children or pets who might accidentally rearrange your setup!

Remedy #3

Fold up a pillow or small cushion to place behind your mid-back to allow for sitting on your "sit bones". Sitting up straight shouldn't feel like work!

heartmath meditation for covid

6/17/2020

by Karen Bruno, PT, DPT

Restrictions, social isolation, financial concerns and disruption to our “normal” have impacted everyone. Here is a short process to assist you in connecting inwardly and connecting with others to boost your spirit, lift your confidence, support your immune system and build resilience. Through connecting to our heart’s intelligence and guidance, we can practice caring and assisting one another to uplift, inspire and support ourselves and others.

Here is my intention for you: may you take good care of yourself; may you be happy; may you be full of love; may you be blessed with health and vitality; may you live a life of peace and harmony; may you experience true joy and fulfillment; may you be free from suffering of every kind; may you live your life with ease and grace; may you live your life to the fullest extent and may you share that with all others.

The following process is from the Heartmath Institute Global Coherence Initiative.

Care Focus – Rise of the Human Spirit

1. Breathe feelings of peace and love through your heart area for a few minutes to set a calm and genuine tone.

2. Feel your heart connecting with others who are sending compassionate care to all who are suffering the challenges of this virus. See the power of the collective amplifying the effectiveness of your care.

3. Let’s send our most sincere appreciation, love and compassion to all the front‑line providers and those helping behind the scenes while risking their lives. See them surrounded by love, compassion and resilience as they serve selflessly.

4. Now, envision these times inspiring deeper connections and more harmonious cooperation among people for the good of the whole. See humanity transitioning into the crucial importance of love, compassion, cooperation and heart‑felt service, for creating the new world that we now stand at the door of.

5. Let us send all the families and friends who have lost loved ones our deepest compassionate care and heart warmth, for they bear the most suffering and pain that is being experienced. Then honor and appreciate all the souls who have lost or are losing their lives as we share this. They are all heroes. Desire the highest best for them on their next journey.

*Karen leads our individualized meditation program, which can be done in person or via telehealth.

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

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.

In the Community: Spring 2020

5/21/2020

April 2020

Michelle Dela Rosa, PT, DPT, PRPC spoke about the benefits of pelvic physical therapy for constipation in people with Parkinson’s disease, in an interview by Dr. Jill Farmer of Global Neurosciences Institute. The interview is posted on YouTube for Parkinson’s Awareness Month.

April through May 2020

Marzena Bard, PTA, CYT brought yoga to our homes over Zoom twice a week, offering Chair Yoga and Relieve Stress & Rebuild Strength Yoga to help the community stay active and connected despite sheltering at home.

Connect PT's exercise hack for the obturator

3/20/2020

By Marzena Bard, PTA

If you have a tight obturator internus, here are two go-to exercises for a release of that sneaky muscle.

Fan Pose
Keep your feet wide apart, turning your toes inward. Exhaling gently, hinge in the hips forward. Place both hands on a yoga block in front of you. Take a breath and exhaling again, lift up one arm up towards the ceiling. Stay there for a few deep breaths. Repeat on the other side.

Frog pose
Position yourself on the floor with knees wide apart and feet to the sides. Be gentle and don’t feel you have to achieve the angles that are presented in the picture. Place your hands flat on the floor, about shoulder-width apart. You may add a slow, unwinding, rocking movement back and forth, coordinating it with your breath. Inhale rock back, exhale rock forward.

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