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The Femina Physical Therapy Blog
Featuring original articles by our staff about current events and trends
Explore our insightful blog articles on pelvic health, where we delve into essential topics that empower and educate. From understanding pelvic floor disorders to strategies for conquering infertility, our content is designed for those seeking knowledge and support. We discuss the latest research, expert advice, and practical tips to enhance your well-being and foster a deeper connection to your body.
Featured From the Blog:
Running Mechanics and Pelvic Floor Health: The Impact of Footwear
Did You Know That Proper Footwear Can Improve Your Running Mechanics and Pelvic Floor Health?
How Do My Feet Impact My Pelvic Floor When I Run?
If you are a runner, you tend to look for ways to improve your running. If you’re thinking about starting up or returning to running, it can feel intimidating particularly if you have any symptoms related to pelvic floor dysfunction. This only complicates an exercise that, on the surface, seems fairly straight forward. There are some studies that have looked at how your feet can play a part in your pelvic floor muscle function while you run. And if you are looking to return to running postpartum, read on and also check out this article by one of our pelvic floor physical therapists.
Read more: Running Mechanics and Pelvic Floor Health: The Impact of...
Understanding Relaxin: Why It Doesn’t Cause Pain in Pregnancy
Pregnancy is a time of significant physical and hormonal changes, and among the many hormones involved, Relaxin plays a crucial role. However, there’s a common misconception that Relaxin is responsible for pain during pregnancy. Let’s take a closer look at what Relaxin does and why it doesn’t directly cause pain.
What is Relaxin?
Relaxin is a regulatory hormone involved in growth, metabolism, and tissue remodeling after an injury to our bones, ligaments, muscles or tendons (Dehghan 2014). During pregnancy, Relaxin levels begin to increase in the first trimester to help the body prepare for childbirth by relaxing the ligaments in the pelvis and softening the cervix (Aldabe 2012, Daneau 2014). The ligaments of the pelvis will begin to relax around the 10th-12th week of pregnancy (Aldabe 2012). This process allows for greater flexibility in the pelvic area, facilitating delivery and accommodating the growing baby.
Read more: Understanding Relaxin: Why It Doesn’t Cause Pain in...
Participate in a High Quality Study Using Shockwave Therapy for Painful Intercourse
Learn about low intensity shockwave therapy for painful intercourse (dyspareunia)
Our team at Femina Physical Therapy is committed to providing the highest level of evidence-based care. That is why we are conducting a research study to determine the effectiveness of low intensity shockwave therapy for painful intercourse, or dyspareunia as it is known clinically. We are searching for volunteers to participate in this high quality study. Those who qualify to participate will receive a significantly reduced rate on all visits related to the study + will receive our world-class physical therapy program for treating painful sex!
Read more: Participate in a High Quality Study Using Shockwave...
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- Written by: Anna Larson, PT, DPT
- 55 Views
Learn How Orgasm Improves Postpartum Pelvic Floor Function
Try a naturally occurring strengthening method
Many factors come into play when considering resuming to sexual activity postpartum. Individuals who have just given birth are not only faced with potentially new physical aches and pains, but also shifting family and partner dynamics, which all play a role in painful sex and lowered sexual desire.
One study reported both of these common postpartum conditions as prevalent as 22% experiencing painful sex and 86% experiencing loss of desire2. It is common in postpartum rehabilitation to be prescribed specific pelvic floor exercises in order to help strengthen the pelvic floor.
Read more: How Orgasm Improves Postpartum Pelvic Floor Function
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- Written by: Kasia Gondek, PT, DPT, CLT, CSCS
- 68 Views
Bloating and Abdominal Distension Often Benefit Greatly from Multidisciplinary Treatment
Bloating, abdominal distension, loose stools, constipation, abdominal or pelvic pain, fatigue, brain fog, weakness, nutritional deficiencies…
These symptoms may be caused by a variety of gastrointestinal or pelvic conditions. If you are experiencing any of these symptoms, this article is a good place to start when deciding who to have on your care team, and what treatments can help!
Bloating is the sensation of excess abdominal gas or a feeling of being distended without obvious visible abdominal distension. Some people have a feeling of fullness or discomfort in the upper abdominal area. Abdominal distension is the visible increase in abdominal girth. A multidisciplinary treatment team of primary care physicians (PCPs), gastroenterologists, dieticians/ nutritionists, and physical therapists is ideal to help manage these symptoms and find the root cause. For example, symptoms of bloating and abdominal distension affect 66 - 90% diagnosed with IBS. Getting the proper diagnosis can help direct the best treatment options for you.
Read more: Why a Multidisciplinary Team is Best for Treatment of...
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- Written by: Kasia Gondek, PT, DPT, CLT, CSCS
- 67 Views
Learn These Simple Exercises For Pregnancy Related Carpal Tunnel Relief
During pregnancy, swelling is a common occurrence.
Swelling of the legs, feet, and ankles is common, but also the wrists and hands! Over time, this can cause compression, inflammation, and irritation of the median nerve that passes through the carpal tunnel of the wrist (which is on the palm-side of the wrist). This compression and irritation is called carpal tunnel syndrome (CTS). Carpal tunnel syndrome (CTS) is common in pregnancy due to the extra fluids retained in the body, as well as hormonal changes causing increased flexibility of ligaments and joints in the body. It is estimated that between 19 to 70% of pregnant people experience carpal tunnel syndrome, and 47.5% of those people have carpal tunnel syndrome in both wrists. It is more common in the third trimester, accounting for 63% of cases.1
Read more: Pregnancy Related Carpal Tunnel Relief - Exercises for...
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- Written by: Kasia Gondek, PT, DPT, CLT, CSCS
- 70 Views
What to Know if You're Experiencing Lower Abdominal Pain with Orgasm
Read on for Common Causes and Solutions
Pain with orgasm or climax is called dysorgasmia, and it can be caused by physical, emotional and/ or psychological factors. Typically dysorgasmia is felt as pain with climax in or around the lower abdomen or clitoris, but symptoms can feel different from one person to the next. Due to a lack of research on female dysorgasmia, it is unknown how many vulva-owners experience pain with orgasm. However, around 3 in 4 people with a vulva have experienced pain with vaginal penetration (called dyspareunia) at some point in their life, according the American College of Obstetricians and Gynecologists (ACOG).
Read more: Lower Abdominal Pain with Orgasm - Female Dysorgasmia
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- Written by: Stephany Tritt, PT, DPT
- 75 Views
What do Breastfeeding women need and want? Let's take a closer look.
You’ve had your bundle of joy and you’re working out the kinks of having a new baby in your life and feeding them the best you can. From breastfeeding to return to exercise, there are many challenges that new moms must navigate.
There are a wide range of feeding options, from exclusively breastfeeding to formula/food feeding or a combination of the two. Studies have tried to get a better understanding of what women need in this stage of motherhood, particularly determining what impacts breastfeeding may have on exercise and activity. We know that breastfeeding causes a depression in estrogen which in turn can cause pelvic floor dysfunction like the involuntary leakage of urine with activities such as sneezing, coughing, laughing or exercise defined as stress urinary incontinence. This type of incontinence has been linked to a longer duration of breastfeeding, however its effects are not lasting (Snyder). Breastfeeding people may also have breast-related discomforts such as nipple pain, mastitis, and over/under supply. Any of these symptoms may limit one’s motivation to exercise.
Read more: What do Breastfeeding Women Need and Want? - No One Told...
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- Written by: Debbie Dy, PT, DPT
- 182 Views
Exploring the clinical consequences of Levator Ani Muscle Avulsion
Including its risk factors and current management strategies, including the role of pelvic floor physical therapy
Levator ani muscle (LAM) avulsion is a significant concern in obstetric care, particularly for women undergoing vaginal delivery. This condition involves a tear in the levator ani muscle, which plays a crucial role in pelvic support and function. Avulsion of the levator ani muscle from its insertions has a significant impact on the function of the pelvic floor, often leading to symptoms such as pelvic organ prolapse, urinary and bowel incontinence, and sexual dysfunction.
The Clinical Consequences of Levator Ani Muscle Avulsion
According to Dietz (2012), levator ani avulsion can lead to a range of adverse outcomes, impacting a woman's quality of life. The levator ani muscle supports pelvic organs and maintains continence. When avulsion occurs, this support is compromised, increasing the risk of pelvic organ prolapse, urinary incontinence, and other functional disorders. The severity of these outcomes can vary, but they often necessitate further medical intervention.
Read more: Understanding Birth Injuries: Levator Ani Muscle Avulsion
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- Written by: Anna Larson, PT, DPT
- 288 Views
Pregnancy is a time of significant physical and hormonal changes, and among the many hormones involved, Relaxin plays a crucial role. However, there’s a common misconception that Relaxin is responsible for pain during pregnancy. Let’s take a closer look at what Relaxin does and why it doesn’t directly cause pain.
What is Relaxin?
Relaxin is a regulatory hormone involved in growth, metabolism, and tissue remodeling after an injury to our bones, ligaments, muscles or tendons (Dehghan 2014). During pregnancy, Relaxin levels begin to increase in the first trimester to help the body prepare for childbirth by relaxing the ligaments in the pelvis and softening the cervix (Aldabe 2012, Daneau 2014). The ligaments of the pelvis will begin to relax around the 10th-12th week of pregnancy (Aldabe 2012). This process allows for greater flexibility in the pelvic area, facilitating delivery and accommodating the growing baby.
Read more: Understanding Relaxin: Why It Doesn’t Cause Pain in...
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- Written by: Anna Larson, PT, DPT
- 184 Views
The pelvic floor is a crucial yet often overlooked part of our anatomy. It is a group of muscles akin to a hammock, starting from the pubic bone to the tailbone, which help to support our pelvic organs and contribute to overall core strength and stability. These muscles also act to control the opening and closing of our urethra and anus to allow urine and feces to eliminate, and stay continent (Raizada 2008). Last but certainly not least, the pelvic floor also plays a role in sexual function. For women, the pelvic floor assists with arousal and orgasm as it is in close proximity with the clitoris (Rosenbaum 2007). The pelvic floor undergoes remarkable changes during and after pregnancy, impacting both physical health and daily life.
Pelvic Floor Changes During Pregnancy
During pregnancy, the pelvic floor undergoes several significant changes:
- Increased Pressure: As the baby grows, it exerts additional pressure on the pelvic floor muscles. This pressure can lead to stretching and potential weakening of the muscles.
- Hormonal Effects: Pregnancy hormones, such as relaxin, help loosen the ligaments and muscles in preparation for childbirth, which includes the muscles of the pelvic floor (Aldabe 2012)
- Weight Gain: The added weight from the baby and amniotic fluid increases the load on the pelvic floor, requiring it to work harder to maintain support.
Read more: What is the Pelvic Floor and What Happens After Giving...
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- Written by: Anna Larson, PT, DPT
- 164 Views
Negotiating Physical Activity for Perinatal Mental Health
Exercise is commonly prescribed as one method to help improve one’s mental health (Ekkekakis 2013, Hu et al 2020, Heissel et al., 2023, Stubbs et al 2018, Vella et al 2023). However, a major barrier to begin an exercise routine can often be lack of motivation and fatigue, which is experienced by those suffering from depression (Faulkner and Biddle 2004, Glowacki et al 2017). Postpartum depression and other mental health illness is quite common, with research suggesting a prevalence of up to 20% in new mothers (Bauer et al 2014). Many new moms are told by health care providers to exercise during pregnancy and postpartum. However, advice and guidance on how to overcome barriers to exercising, including mental health barriers, is not addressed often enough.
Most research is focused on the benefits of exercise for mental health support in the general population and postpartum, but rarely addresses the barriers the postpartum population experiences related to mental health. An online survey by Goncalves et al recently set out to fill this gap in knowledge, exploring how women negotiate physical activity for their mental health and the barriers to participating in physical activity associated with mental health illness. 186 mothers were included in the study, from 6 weeks postpartum up until 4 years postpartum, three main themes were found in this qualitative study: barriers to physical activity associated with mental illness, strategies to negotiate being active for perinatal mental health, and guilt associated with not being active enough.
Read more: Negotiating Physical Activity for Perinatal Mental Health
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- Written by: Anna Larson, PT, DPT
- 159 Views
Sexuality Changes Postpartum Are Common
Sexual Function After Childbirth Can Be Restored With These Tips
In my last blog post, we explored the barriers many women face during the postpartum period regarding return to their sexual lives. Several physical, emotional, and relational components can delay the return to sexual activity, and the enjoyment of it as well. If you missed that post, check it out here.
A qualitative study of over 1000 women was performed in interview style to collect coping mechanisms new moms adapted to deal with all of the changes that come with the postpartum period that impact their sexuality. The women were found to have three different categories of coping mechanisms: emotional, relational, and physical. Summarized below are the common strategies used by women to recover their sexuality postpartum:
Read more: Coping Mechanisms for Sexuality Changes Postpartum
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- Written by: Debbie Dy, PT, DPT
- 176 Views
What are the “deep core muscles”?
The “deep core” is a muscle group that acts to stabilize your spine. This muscle group consists of the diaphragm, the pelvic floor muscles, the transverse abdominis and the multifidi muscles. When properly engaged, your intra-abdominal pressure increases and improves stability in the core. Due to the connection to your diaphragm, breath control is essential to core stability.
How are your deep core muscles affected by pregnancy?
These muscles are essential to stabilize your spine and create a solid foundation in order for you to move well and efficiently. During pregnancy, as your baby bump grows, the pressure in your abdomen increases. This means that the deep core structures have to work overtime in order to maintain core stability. The abdominal wall stretches to create space for a growing baby and this can affect the integrity and strength of the transverse abdominis. The increased weight of a growing baby can also put increased pressure on the pelvic floor and may cause pain or other pelvic health symptoms such as urinary leakage.
Read more: What are deep core muscles and how does pregnancy affect...
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- Written by: Iris Xu
- 192 Views
As the popularity of medications like semiglutides rises for weight management, many people may unknowingly exacerbate underlying conditions such as gastroparesis, making it essential to explore the interconnectedness of digestive health and pelvic function. Gastroparesis is a chronic digestive disorder characterized by delayed gastric emptying. This condition occurs when the muscles in the stomach are unable to contract properly, preventing the efficient movement of food into the small intestine. Common symptoms include nausea, vomiting, bloating, early satiety, and abdominal pain. Gastroparesis can significantly impact a person's quality of life, causing discomfort and nutritional deficiencies.
Causes and Risk Factors of Gastroparesis:
The causes of gastroparesis are varied and can include diabetes, nerve damage, connective tissue disorders, and certain medications. For instance, weight loss medications such as Ozempic (semaglutide) and Mounjaro (terzepatide) have been associated with gastrointestinal side effects, including gastroparesis. Diabetes is a major risk factor, as high blood sugar levels can damage the vagus nerve, which controls stomach muscles. Other risk factors include abdominal surgery, viral infections, hypothyroidism, and eating disorders.
Read more: Understanding Gastroparesis and the Role of Pelvic Floor...
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- Written by: Anna Larson, PT, DPT
- 224 Views
Why Sexual Function After Childbirth Can Be a Challenge
Disclaimer: This blog post is based on research performed on cis-gendered women
Many women are told at their 6 week postpartum follow-up, that they are cleared for sexual intercourse, however, most women do not return to sexual intercourse at this time frame, for several reasons1,2. If this is you, you are not alone, and you are actually in the vast majority. During this unique time in a woman’s life, she is experiencing physical, emotional, and relational changes that all influence a woman’s sexuality. Physically, many women experience pain with sex, lack of desire, and decreased lubrication2.
One of the biggest causes found to contribute to these symptoms was hormonal changes related to whether a woman is breastfeeding during the postpartum period or not. While breastfeeding can offer a host of benefits, for mom and baby, it can be a cause of pain with sex because of the decreased sex hormones impacting the tissue of the vagina and vulva2,3, leading to a condition called vulvodynia. For more information about this condition, and if this sounds like you, check out this blog post to learn more.
Read more: Barriers to Restoring Sexual Function After Childbirth
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- Written by: Anna Larson, PT, DPT
- 153 Views
Yoga Practice For Chronic Pelvic Pain Can Be a Very Helpful Routine
As stated in my last blog post, yoga can be so beneficial as a pain management tool due to its ability to modulate the sympathetic nervous system3,4 which plays a large role in chronic pain. The exact mechanism of how yoga helps with chronic pain is still being studied, however, it is reasonable to believe the full body relaxation promoted by a yoga practice helps to decrease tension in key muscle groups- including the hips and pelvic floor which are often tight in people with chronic pelvic pain.
Currently, evidence has mostly focused on one hour long practices as an intervention, although there are some studies that report improvements in pain with shorter practices, such as the routine below. As with any mobility/stretching routine, benefits will be seen with more frequent practice, however even twice weekly can help decrease pain.
Read more: Restorative 20 Minute Home Yoga Practice For Chronic...
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- Written by: Anna Larson, PT, DPT
- 596 Views
We Take a Look at Combined Methods of Hormonal Birth Control and Vulvodynia
In this three part series, we will explore the effects of hormonal contraceptive methods and their relationship with vulvodynia.
What is Hormonal Birth Control?
Hormonal birth control methods, such as birth control pills, patches, injections, rings and hormonal intrauterine devices (IUDs), work by altering hormone levels in the body to prevent pregnancy. Hormonal contraceptives fall into two categories: combined, meaning they contain both estrogen and progestin (think the pill, patch, or ring), or contain progestin only (think progestin only pill or “POP”, arm implant, IUDs, or injections). While the primary intent of these drugs are for contraception, they are also widely prescribed for other common issues such as: mood imbalance related to periods, skin issues, irregular periods, and painful periods.
Read more: Hormonal Birth Control and Vulvodynia - Part 1: Combined...
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- Written by: Anna Larson, PT, DPT
- 854 Views
Hormonal Birth Control and Vulvodynia - Part 2: Hormonal Intrauterine Devices (IUD)
This article takes a looks at intrauterine devices (IUDs) and it’s potential effect on vulvodynia, or vulvar pain.
Intrauterine devices, also called long-acting reversible contraceptives (LARC), have become more and more popular as a birth control method in the United States due to high efficacy, less side effects and higher continuation compared to other hormonal contraceptive methods1,2,6. They are offered in two forms; hormonal (common brand names are Mirena, Kyleena, Skyla, Liletta) and copper IUDs. For this blog, we will be exploring the effects of the hormonal IUD only. This type of IUD releases progestin into the body which suppresses endometrial cell growth (called proliferation) and thickens the cervical mucus to prevent pregnancy4.
I consider myself to be a case study when it comes to the topic of hormonal birth control and pelvic pain. I have tried several variations of the combo pill, progestin only pill, the Mirena IUD and most recently, the Nuvaring. When taking the combination methods, I definitely noticed the side effects previously mentioned in my last blog post. However, in my early twenties, when I was on the Mirena (hormonal IUD), I didn’t notice any of these side effects.
Read more: Hormonal Birth Control and Vulvodynia Part 2: Hormonal...
