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The Staff of Femina Physical Therapy Blogs About Vaginismus, Pregnancy and Postpartum Best Practices, Treatments for Incontinence, and More

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Featured From the Blog:

Getting Back to Exercise Postpartum

Getting Back to Exercise Postpartum

A healthy lifestyle includes getting back to exercise postpartum

Exercise has shown to be beneficial in all stages of life, and the postpartum period is no exception.

Some of the benefits of postpartum exercise are:

  • Strengthen and tone abdominal muscles
  • Boosts energy
  • May help prevent postpartum depression
  • Promotes better sleep
  • Relieves stress
  • Can help you lose the extra weight that you may have gained during pregnancy
    (ACOG, July 2019).

Even with all these benefits, research shows that most mothers stop participating in exercise programs which leads to increased weight gain and obesity (Minig et al., and O’Toole et al., 2003). There are many adjustments that have to be made when becoming a new mother and the information on the internet regarding postpartum exercise can be misguided and overwhelming. Let's break down what the literature says about guidelines for returning to exercise postpartum.

Read more ...

Sexual Health Awareness Month | Safe Sex During Covid-19

Safe Sex During Covid | Image Courtesy of Jasmin Chew via Unsplash
Image Courtesy of Jasmin Chew via Unsplash | Safe Sex During Covid

Whether you're asking for a friend or for yourself, it's an important question these days.

Practicing social distancing and wearing a mask can make it quite difficult to have intimate relationships.

Through the last year and half, we have learned more about COVID-19 and each and every day new data helps us better understand this virus and how to practice safe sex during COVID.

How is the virus transmitted?

The virus spreads through infected saliva, mucus, or respiratory particles entering the eyes, nose, or mouth. This means it can be transmitted through kissing and close contact. Studies have also detected the virus in feces and in sperm in those infected (Diangeng et al., 2020). It is unknown at this point if the virus can be spread through sperm or feces.  Educating yourself can be the key to safe sex during COVID-19.  

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Urinary Incontinence and Depression | What's the Connection?

Urinary Incontinence and Depression
Photo by Anthony Tran on Unsplash

A recent study connects anxiety, urinary incontinence and depression in women

What is urinary incontinence?

Urinary incontinence refers to the loss of urine, out of your control. There is actually more than one kind of urinary incontinence: the two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence (also called overactive bladder, or OAB).

  • Stress Incontinence: urine leaking with physical activity - sneezing, coughing, laughing, lifting, pushing/pulling, jumping.
  • Urge Incontinence: urine leakage that is coupled with urgency to go- leaking while you’re in line for the toilet, leaking/urgency when you’re parking your car in the driveway, putting the key in the door, fumbling with your pants, etc.
  • Mixed UI: a combination of stress and urge symptoms
Read more ...
Labor Positions | Vaginal Childbirth Positioning Series | Image Courtesy of Jimmy Conover via Unsplash

Labor Positions for First/Second Stages of Labor

If you missed part 1 in the vaginal childbirth positioning series, go back and read it here.

Childbirth/labor is quite an experience, and it can be scary waiting for the unknown. Being prepared, knowing, and being familiar with different options and labor positions is the best way to approach childbirth to help decrease as much anxiety should surprises arise.

This article will go over specific labor positions that help progress labor, and prevent perineal trauma.

As mentioned in Part 1: Pre-Birth article, it’s important to keep changing labor positions to help progress, preferably in different upright labor positions. As a reminder, the first stage is all about increasing the pelvic inlet to help guide the baby through the mid pelvis and finally towards the pelvic outlet/vaginal canal.

Read more: Vaginal Childbirth...

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Childbirth Positioning For Each Stage of Labor | Image Courtesy of FreeStocks via Unsplash


What to Expect and What to Focus On: 

If you have been pregnant for many months now, it is time to get ready for your upcoming birth! Similar to a marathon, we need to train for childbirth to prepare the muscles and body for the big event. For this reason, it is a good idea to start practicing being in different positions either with movement or holding a position for a long time. The first stage of labor involves contractions to dilate and open the cervix. Once the cervix is fully dilated, the second stage includes the passive and active phases of the baby crowning and coming out of the vaginal canal. The third stage involves the delivery of the placenta. We will go over how to best support our bodies throughout your childbirth journey.

Positioning for the Stages of Labor

Practicing and knowing different positions during this first stage can be helpful when pain may escalate. Upright positioning such as: walking, standing, rocking back and forth, kneeling over birthing ball, leaning against wall, holding onto partner are just some of the many, many positions that can be helpful.

Read more: Vaginal Childbirth...

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postpartum pelvic health

Postpartum recovery should start Day 1.

Here are some tips to help you get your postpartum pelvic health (and general health) back on track:

This article focuses on 5 key techniques you can use to improve postpartum pelvic health.  It covers diaphragmatic breathing to activate core muscles and kickstart lymphatic drainage, pelvic floor muscle coordination, posture, and the benefits of a pelvic floor evaluation by a physical therapist to begin improving postpartum pelvic health on day 1.  It also provides detailed instructions and references scientific studies to provide further research. 

1. Breathing With Intention

One of the most important recovery tools for postpartum pelvic health is one that we do all day, but are you doing it with intention?  Diaphragmatic breathing can help you tap into your deep core muscles and assist in the healing process. When you focus your attention on breathing into the abdomen you activate the muscles of the core (diaphragm, intercostals, transverse abdominis, and the pelvic floor muscles). This breathing technique also helps to assist the pelvic floor muscles in another important job, lymphatic drainage. This can help eliminate excess waste and inflammation to help with healing. This is a great exercise to begin right after birth, when given the OK by your medical provider.

Additional benefits of diaphragmatic breathing were seen in the study by Fiskin et al., 2018, which concluded improved psychological state and increased mother-baby attachment. Not only are you reaping the benefits but so is the baby!

Read more: 5 Things you can do to...

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Image Courtesy of Ava Sol via Unsplash | Physical Therapy Helps IC

Interstitial Cystitis, Multimodal Treatments, and How Pelvic Health Physical Therapy Helps IC

Interstitial cystitis (IC) also known as bladder pain syndrome or painful bladder syndrome, is a debilitating condition that significantly affects the quality of life of patients living with it.

The definition of IC from an international consensus is:

An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable cause" (Hanno et al, 2009).

Read more: What is Interstitial...

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Levator Ani Avulsion - Injury during Childbirth

First: Understand your pelvic anatomy to better understand your injury

The pelvic floor is a group of muscles positioned like a hammock along our saddle region.

The group of muscles attach from our pubic bone on the inside and then to our lateral pelvic walls with a bundle of collagen fibers called the levator arch, and attach to the ischial spines (the inside of the sit bones) and tailbone on the back side.  During vaginal childbirth, the pubococcygeus muscle, a group of pelvic floor muscles, stretches 3.26 times more than its normal length to make room for the coming baby in the vaginal canal! As you can imagine, this may result in some perineal tearing and/or levator ani avulsion.
Levator ani avulsion occurs when muscle fibers of the puborectalis (the innermost muscle of the pubococcygeus group) are detached from its insertion on the pubic bone. This is somewhat frequently occurring, and about 20% of women experience an avulsion during their first vaginal childbirth. Risk factors include instrumental-assisted delivery (forceps presenting a higher risk than vacuum), older age at vaginal birth, second stage lasting longer than 2 hours, baby weighing over 8 pounds and 13 ounces, and those who had a grade 4 perineal tear. 

What does this mean for folks that have this injury?

As bad as it sounds to have an avulsion, research has shown that it does not necessarily increase perineal pain in postpartum or beyond. However, it does put women at risk for pelvic organ prolapse either early in postpartum or in their later years.

Read more: Pelvic Floor Injury During...

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Pregnant belly birth prep services

Pregnancy, labor, and delivery greatly affect the pelvic floor muscles, and our birth prep services using pelvic floor therapy can bring you confidence, strength, and flexibility.

What are the pelvic floor muscles?

The pelvic floor muscles are a group of muscles inside the pelvis that form a hammock connecting the pubic bone to the tailbone. Both men and women have pelvic floor muscles. These muscles play an important part in stabilizing the pelvis and spine, supporting your organs (bowel, bladder and uterus) and toileting. 

The Pelvic Floor and Pregnancy

During pregnancy the pelvic floor muscles are working overtime trying to stabilize and support the growing body of the mother and child. Read our previous blog post about preparing the pelvic floor for childbirth. During a vaginal childbirth, these muscles will utilize their strength and flexibility to help the baby be birthed. Whether or not the baby is born via C-Section or vaginally, the pelvic floor is involved, and this is where our birth prep services come into play.

Read more: Birth Prep Services Offered...

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Picture of dripping wet panties

The latest literature review conducted by Mazur-Bialy et al. (2020) shows the most modern methods of pelvic floor physical therapy that can help with urinary incontinence.

Here at Femina PT, we pride ourselves in keeping up with the current best practices and latest techniques. Here’s a breakdown of the latest techniques and how we utilize them at the clinic.

What is urinary incontinence?

Urinary incontinence refers to the involuntary loss of urine, which can range from a few drops (also called light bladder leakage) to complete loss that wets the floor. There is actually more than one kind of urinary incontinence: the two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence (also called overactive bladder, or OAB).

Read more: The Latest in the Treatment...

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Woman using hypervolt gun

Recent studies have shown evidence vibration therapy is just as effective as massage in reducing muscle soreness after exercise and can also help increase range of motion.

Over the past few years, we’ve been using more vibration and percussive therapy products at the clinic, such as the Hypervolt gun, vibrating foam rollers, and vibrating massage balls. But what’s all the hype about?

Effect on Muscle Soreness

In a 2014 study by Imtiyaz et al., they found that a 5 minute session with a vibration device provided as much relief to muscle soreness as a 15 minute massage session over the same area, as compared to control groups who received neither after a bout of exercise.

Read more: Vibration Therapy | A New...

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Anatomical drawing of pelvis depicting sexual dysfunction after pelvic fracture

Sexual Dysfunction After Pelvic Fracture Can be Traumatic

A 2014 study by Harvey-Kelly et al. points to the fact that the long term consequences of this injury can include sexual dysfunction and pelvic pain for both males and females.

Pelvic fractures occur most commonly with a high-energy trauma. The most common ways people fracture their pelvis include motor vehicle (57%), pedestrians hit by car (18%), motorcycle crushes (9%), falls from a height (9%), and crush injuries (5%) (Harvey-Kelly, 2014).

Chronic Issues After Pelvic Fracture

Thanks to advancements in critical care medicine and acute trauma care, the mortality rate for those who have had a pelvic fracture has been reduced over the years. However, pelvic fracture survivors often report chronic issues including chronic pain, chronic pelvic pain, changes in gait, issues with bowel and bladder, and sexual dysfunction. This is because the muscles, bones, nerves, and blood vessels, are often all implicated in these injuries, and the pelvis contains the organs of the urinary, bowel, and sexual function systems. Therefore, the subsequent rehabilitation of all these systems is more complicated than, say, a fracture of your ulna or radius in your forearm.

Read more: Sexual Dysfunction After...

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Woman crouching next to bed holding on to stomach

How do histamines effect Interstitial Cystitis?

Newly published research by Grundy et al. (2019) shows a more direct connection between histamines and interstitial cystitis (Painful Bladder Syndrome or Bladder Pain Syndrome).

In this study, to be published in the upcoming February 2021 issue of The American Journal of Physiology: Renal Physiology, Grundy et al. show correlation that histamines in the body lead to changes in the sensory nerves of the bladder, particularly hypersensitivity during bladder distension, or when the bladder is filling or full.

The study determined that certain sensory nerves in the bladder can become more sensitive when histamines are present. This activation occurs in the bladder membrane, the detrusor muscles, as well as the afferent nerves of the bladder.

Read more: Histamines and Interstitial...

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Yoga for sciatica pain

Simple Tips for Using Yoga for Sciatica Pain

Sciatic nerve pain can be uncomfortable and may affect your quality of life and your activities.

Flares in sciatic pain can be debilitating, and yoga for sciatica pain can help immensly. Often times the lower back and hips can contribute to sciatic pain. Try these yoga stretches for some relief.

This article is for informational purposes only and should not be considered medical advice. Please consult with your doctor or a physical therapist for an individualized session and exercises.

Here are some stretches you can do at home, at the gym, or at the park to keep your sciatic nerve pain at bay and enjoy your day pain-free.

Read more: Yoga for Sciatica Pain

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Photo by Matteo Vistocco on Unsplash

Dealing with tension headaches? Try these yoga poses.

Headaches can be caused by tension in the jaw, face, neck, shoulders, and back.

Headaches can be caused by tight and restricted neck muscles, and a seated neck release will stretch the scalene muscles on the neck. Sometimes headaches are caused by back pain that’s radiating up the spine.

Try these simple poses to release tension that may be givign you a headache.

Read more: Yoga to Relieve Your Headache

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woman with red laser beams around her

A Breakdown of common Energy Based Devices Marketed for your Vagina

Risks and Possible Benefits

*This article is intended NOT intended to be used as medical advice. Please talk to your doctor about what treatments may be right for you.*

In the past decade, nonsurgical devices using radio-frequencies, lasers, and infrared light have been marketed as non-invasive treatments for “vaginal rejuvenation.” However, there has been conflicting opinion among the medical community as to what the lasers have evidence of treating. The rampant use of the lasers to treat conditions they have not been approved to treat has also caused the Food and Drug Administration to warn the public about these devices in 2018.

Read more: Lasers... And My Vagina?

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We wanted to share this article that we found published by the New England Journal of Medicine. We all have a lot of ongoing questions about the ongoing COVID-19 pandemic, and this is a great resource that answers nearly every question we’ve had regarding testing, vaccines and more.

Covid-19 Vaccine — Frequently Asked Questions

Image courtesy of NEJM

A collection of resources on Covid-19 vaccines, including frequently asked questions, continuing medical education, published research, and commentary.


Read more: New England Journal of...

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Couple embracing in a pink sunset

Involving your partner in your pelvic floor therapy may improve your outcomes and your relationship.

Here are some ways you can involve your partner in your pelvic floor physical therapy:

Start Talking About Your Experience.

Both studies and clinical experience have shown that talking to your partner about your sexuality, pelvic floor issues, and sharing the progress you’re making in pelvic floor therapy can improve anxiety, reduce pain levels, and bring more intimacy to your relationship. As you transition to sex with your partner, sexual assertiveness will also help you find activities, angles, and positions that feel pleasurable, not painful to you and your partner.

Read more: How to Involve Your Partner...

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Occupational Therapist Nancy stretching hamstring with yoga strap

Stretching for health

Studies have foune that stretching improves joint range of motion (flexibility), decreases muscle tension, improves circulation, relieves muscle pain, prevents injury, and improves athletic performance (Nakaruma et al., 2015; Avela et al., 1999; Suzuki, 2005). Stretching the legs can allieviate low back, hip, and pelvic pain. 

Here's a New Year's Stretching routine to get started. Please consult with your doctor or a rehabilitation therapist before beginning any exercise routines. 

Tools Needed

  • Yoga strap, dog leash, or robe strap
  • A comfortable place to lay down (yoga mat or blanket)

Read more: Leg Stretching Routine for...

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      I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be. It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally...

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      No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.To know why I was...

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