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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:
Treating Bloating and Abdominal Distension: a Multi-Disciplinary Team
Why a Multi-Disciplinary Team is Best for Treating Bloating and Abdominal Distension
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!
Hormonal Birth Control and Vulvodynia - Part 1: Combined Hormonal Methods
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...
Hormonal Birth Control and Vulvodynia Part 2: Hormonal Intrauterine Devices (IUD)
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...
- Details
- Written by: Debbie Dy, PT, DPT
- 108 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
- 162 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
- 125 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
- 94 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
- 98 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
- 102 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
- 103 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
- 159 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
- Details
- Written by: Anna Larson, PT, DPT
- 95 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...
- Details
- Written by: Anna Larson, PT, DPT
- 418 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...
- Details
- Written by: Anna Larson, PT, DPT
- 663 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...
- Details
- Written by: Anna Larson, PT, DPT
- 354 Views
The Relationship Between Hormonal Birth Control and Vulvodynia
Is the hormonal birth control mini pill better than the regular pill?
If you have been following along, this is the third part of our hormonal birth control and vulvodynia series. First, we covered how combination methods of birth control (containing synthetic forms of both estrogen and progesterone) could lead to vulvodynia. We then explored if there is a risk of developing vulvodynia after the insertion of a hormonal intrauterine device IUD). In this post, we will delve into the relationship between the progesterone only birth control pill, also called “the mini pill,” and vulvodynia. As a quick refresher, vulvodynia is pain on the vulva, or external genital tissue. For more information about vulvodynia, check out this post on our website.
Similar to the hormonal IUD, the mini pill works as a contraceptive by thickening cervical mucus and thinning the lining of the uterus to prevent a fertilized egg from implanting. Similar to the IUD, it is an expected side effect to experience spotting in the first few months of use1. Interestingly, some women will no longer ovulate, while some will continue to, about 4 in 10, according to the American College of Obstetricians and Gynecologists1.
Read more: Hormonal Birth Control and Vulvodynia Part 3: The Mini Pill
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- Written by: Iris Xu
- 2118 Views
Don't Let Paradoxical Diarrhea Ruin Your Day
Have you ever experienced a peculiar mix of constipation and diarrhea at the same time? This unusual phenomenon, known as paradoxical diarrhea or overflow diarrhea, can be both confusing and uncomfortable. Here’s what you need to know about this condition:
What is Paradoxical Diarrhea?
Paradoxical diarrhea occurs when liquid stool leaks around impacted, hardened stool in the colon. This leakage leads to symptoms of both constipation and diarrhea simultaneously. It’s often associated with conditions like mixed irritable bowel syndrome (IBS-M).1
Read more: Understanding Paradoxical Diarrhea: Symptoms, Causes, and...
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- Written by: Debbie Dy, PT, DPT
- 447 Views
In this article we’ll discuss how to assess if you may have a weak pelvic floor, what symptoms are and basic orientation to the pelvic floor.
What is the pelvic floor?
The pelvic floor is a very important group of muscles that live in the bottom of the pelvis. Both men and women have a pelvic floor. These muscles sit in the bottom of the pelvic floor like a hammock, and can move up and down like a trampoline to support your internal organs inside your body. They also help to control the openings and closures in the bottom of the pelvis, which is why they are so essential to urinary, bowel and sexual function. Just like any muscle, when they are weak, they can start to cause issues with any of these functions. Common signs of a weak pelvic floor include urinary incontinence, fecal (or bowel) incontinence, feeling of pelvic heaviness or pelvic organ prolapse, as well as low back or hip pain.
- Details
- Written by: Stephany Tritt, PT, DPT
- 344 Views
Does my pelvic girdle pain have anything to do with my mood and sexuality?
Many of our patients experience sexual dysfunction and anxiety, depression and chronic pain. These conditions are known to coexist, and we unpack each component of pain, mood and one’s behaviors, desires and attitudes related to sex and physical intimacy.
Pelvic girdle pain is defined as “pain between the posterior iliac crests and gluteal folds particularly in the vicinity of the sacroiliac joint” (Simonds). More simply stated: in the very low area of your back and buttock. Pelvic girdle pain is common postpartum and may impact disability in the fourth trimester. Many are aware of peripartum symptoms such as low back pain, incontinence, pelvic organ prolapse, pain with intercourse, and postpartum depression. Knowing that many women experience pain during and after pregnancy - what can we learn about the effects of pelvic girdle pain? Specifically, what impact does pelvic girdle pain have on symptoms of mood and sexuality?
Read more: Postpartum Sexuality & Mood Changes in Women with Pelvic...
- Details
- Written by: Anna Larson, PT, DPT
- 316 Views
Learn All About the Benefits of Yoga for Chronic Pelvic Pain
Chronic pelvic pain is a common debilitating condition that greatly impacts a person’s health and quality of life. Often, the origin of the pain can have one or several causes including: endometriosis, vulvodynia, interstitial cystitis, irritable bowel syndrome, chronic pelvic inflammatory disease, adenomyosis, fibroids, celiac disease, fibromyalgia, degenerative disc disease, and chronic urinary tract infections, to name a few5.
Sometimes, the exact origin of the pain is unknown, even stated as high as 61% of chronic pelvic pain cases5. To learn more about the interactions between these conditions and how they can cause chronic pain, see this previous blog post here.
