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

Happy Pride Month! Femina Physical Therapy is proud to be a supportive and inclusive orthopaedic and pelvic health center. Earlier this month, I had the privilege to attend the first ever physical therapist-specific course for LGBTQ in the US, with an emphasis on transgender care. The course covered, amongst many things, pre-operative, intra-operative and postoperative recovery guidelines. While this is the second course I have taken on transgender care (with a third coming up in a few months), it was the first that was held primarily for the benefit of training physical therapists.

This course was led by Holly Herman, and supported by other physical therapists, nurses and physicians.

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Rectal Prolapse or Hemorrhoids?

We continue Pelvic Organ Prolapse Awareness Month by talking about Rectal Prolapse and hemorrhoids, two conditions that are commonly mistaken for one another. 

Rectal prolapse and hemorrhoids can both cause irritation, discomfort, and pain in the anal region. However the causes and treatment can be different for both conditions.

Hemorrhoids

Hemorrhoids are veins in the lower rectum that become swollen or stretched. They are similar to varicose veins in the lower legs. There are two types of hemorrhoids: internal and external.

Internal hemorrhoids are swollen veins inside the rectum. Sometimes these swollen veins begin to descend and come out through the anal sphincter.

External hemorrhoids: are swollen veins that can be seen and often felt under the skin outside around the anal sphincter. Usually they look like a small bulge and are the same color as the skin.

Hemorrhoid Symptoms

The most common signs of hemorrhoids are:

  • Bright red blood on toilet paper
  • Drops of blood in the stool
  • Pain at the anus
  • Burning, pressure, or intense itchiness at the anus

About 75% of adults in America will have hemorrhoids at some point in their lives.

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Yoga for Incontinence

A study presented at the annual meeting of the American Urological Association this past May of 2018 shows that a 3-month yoga intervention can reduce the frequency of urinary incontinence (UI) in women aged 50 years or older.

In the randomized trial completed by Dr. Alison Huang, MD and colleagues, a 3 month yoga therapy program was conducted with a group of 56 ambulatory women aged 50 years or older. These women had previously reported daily leaks and were not using any other clinical UI treatments.

The yoga program consisted of classes twice a week and one session of home practice weekly for three months. The therapeutic yoga classes were based out of the BKS Iyengar style of yoga.

After the three month trial, researchers saw a 74% decrease in daily leakage reported by the women in the yoga class. The women reported no negative outcomes related to the yoga practice. 

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Body Mechanics and Posture for Prolapse Management

Do you feel a bulge or feel like you are sitting on a ball in the pelvic area?  What should you do? Don’t freak out, there is help for you! Here are some things to get you started:

See your gynecologist

Not all prolapses are the same. They can vary based on which organ is descending and how far it has descended (grade).

Prolapse will be diagnosed based on which organ is descending:

  • Cystocele: The bladder falls backward into the front (anterior) vaginal wall, the most common type of prolapse
  • Urethrocele: A prolapse of the urethra (the tube that carries urine)
  • Uterine prolapse: A prolapse of the uterus
  • Vaginal vault prolapse: prolapse of the vagina
  • Enterocele: Small bowel prolapse
  • Rectocele: 
    the rectum falls forward into the back (or posterior) vaginal wall

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It’s Pelvic Organ Prolapse Awarenesss Month. Today we talk about something that’s often not talked about and lay out ways prolapse can be avoided and treated with proper pelvic floor physical/occupational therapy.

What Is Pelvic Organ Prolapse?

"Prolapse" refers to a descending or drooping of organs. Pelvic Organ Prolapse (POP) refers to the prolapse or drooping of any of the pelvic floor organs, including:  the bladder, uterus, vagina, small bowel, or rectum. These organs are said to prolapse if they descend into or outside of the vaginal canal or anus.

Prolapse is sometimes given these specific names to describe which organ is descending:

Cystocele: The bladder falls backward into the front (anterior) vaginal wall
Urethrocele: A prolapse of the urethra (the tube that carries urine) into the vaginal wall
Uterine prolapse: prolapse of the uterus
Vaginal vault prolapse: prolapse of the vagina
Enterocele: Small bowel prolapse
Rectocele: the rectum falls forward into the back (or posterior) vaginal wall.

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On May 6, communities across the country including downtown LA gathered to march for changes to improve the health of mothers and birthing families in the United States. Femina Physical Therapy was there to join the national movement to address the maternal health crisis in our country.  It was a wonderful day connecting with the community of concerned parents, community members, and health practitioners.

Together, we were able to call attention to issues affecting moms in Los Angeles.

Maternal Death

Maternal mortality rates in the U.S. surpass those of any other industrialized nation and continue to rise, unlike any other industrialized nation. According to the CDC, there are considerable racial disparities in pregnancy-related mortality. Black women have a maternal death rate that is nearly four times the rate of white women. During 2011–2013, the pregnancy-related mortality ratios were–

  • 12.7 deaths per 100,000 live births for white women.
  • 43.5 deaths per 100,000 live births for black women.
  • 14.4 deaths per 100,000 live births for women of other races.

Over 50% of maternal deaths are considered preventable.

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Updating Standards of Care

Last month the American College of Obstetricians and Gynecologists (ACOG) updated their position on postpartum care and the “fourth trimester”.--the first 12 weeks after your baby is born. This is such a huge step for better healthcare and support for women after delivery. In other countries (France, Belgium, Northern Ireland and other European countries), postpartum physical therapy is a routine referral for women both in the hospital and for ongoing support when they are discharged.

The statement updates the previous recommendation of a 6 week visit, and instead supports a paradigm shift of postpartum care that not only adds contact with their Ob-Gyns within the first 3 weeks of delivery, but also address the need for ongoing care:

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After delivery via cesarean section, hysterectomy or other laproscopic procedure, there will be an incision site that you will have to manage according to the directions of your doctors and nurses to keep the site from becoming infected. Although the incision site will close after about 2-3 weeks, scar tissue will continue to form. It is important to begin scar massage and desensitization techniques to help prevent scar tissue build up, puckering, and ongoing pain.

Managing Scar Tissue

A trained physical or occupational therapist can perform soft tissue mobilization and other modalities such as cold laser over the scar site. As a part of your treatment, your therapist will teach you skills to manage the scars at home for the following benefits:

  • Prevent scar tissue build up and puckering of scar site
  • Soften and flatten scar tissue by promoting collagen remodeling
  • Decrease itching
  • Provide moisture and flexibility to the scar
  • Desensitize the scar tissue, reducing pain

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Physical and occupational therapy can help you in your recovery after a C-section by giving you skills to regain optimal body function and help you get back on your feet, doing the activities you value in addition to taking care of your new little one. In this article we review some ways that a therapist at Femina Physical Therapy can help you through your recovery. You can see a trained therapist as soon as you have the energy to do so.

Scar management and desensitization

Physical and occupational therapists are trained in soft tissue mobilization techniques to help soften and flatten scar tissue after your cesarean incision is healed. As a part of your treatment, your therapist will teach you techniques such as scar massage to help prevent scar tissue build up and puckering. Check out our full article on scar tissue management here.

Additional benefits of scar tissue management:

  • Soften and flatten scar tissue by promoting collagen remodeling
  • Decrease itching
  • Provide moisture and flexibility to the scar
  • Desensitize the scar tissue

Diastasis recti recovery

Diastasis recti, or diastasis rectus abdominis (DRA) is a condition in which the 2 sides of the “six-pack” muscle (A.K.A. rectus abdominis) separate.

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Today we talk about ergonomics with baby care after a cesarean section. It’s important for all new parents to conserve energy and protect their own bodies while adjusting to the care of a new baby, especially those who have had a cesarean. Today we will discuss body mechanics of picking up a baby, breastfeeding, and the like after a C-Section.

Lifting Restrictions

As a cesarean section is an abdominal surgery, your doctor will likely advise you to not lift anything over 8-10 lbs, depending on the doctor as well as the details regarding your cesarean and your personal health. Lifting restrictions typically last anywhere from 6-8 weeks. This may prevent you from lifting household items heavier than a gallon of milk… That means no carrying baskets of laundry or heavy bags of groceries. This will also mean that you won’t be able to lift and carry an older sibling during this time. If possible, encourage the older sibling to climb onto your lap, into bed, into the car, etc. Also, get help around the house and with chores such as grocery shopping, lifting heavy loads of laundry, and other activities that require moderate to heavy lifting.

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It’s Cesarean Section Awareness Month! Trauma to the body is something all who give birth to a baby experience. With those who deliver via cesarean (c-section), there is the added trauma of an abdominal surgery in addition to the trauma of labor and delivery.

Today we will talk about post-delivery rehabilitation, with an emphasis for those who have had a cesarean. This information is all about self care to recover birth and is useful for ALL new mothers, whether delivering via the vaginal canal or a cesarean section.

In an upcoming blog post this month, we will discuss body mechanics of picking up a baby, breastfeeding, and the like after a C-Section.

Taking it Easy

The first 6 weeks after the birth of the baby will be a period of lots of change. The body will feel tired and worn out, with low energy. Labor scars (tears, episiotomy, cesarean section) may feel painful. Giving birth to a baby is no joke, so allow your self time to heal. Do not over-exert your body and try to involve members of your support system for help. Avoid stairs for the first two weeks unless necessary. Gradually add activities every day once your strength and endurance improves.

Avoid strenuous activity such as weight training, jogging and running until after 12 weeks following a C-section, or when cleared by your doctor or licensed pelvic health therapist.

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Can pelvic floor therapy help with bowel (fecal) urgency and incontinence?

It's National IBS Month and our series on bowel health continues. Today’s article is for those with irritable bowel syndrome that tends towards softer stools and diarrhea (IBS-D). Most people have experienced fecal urgency at least once in their lives- the experience of rushing to the bathroom to have a bowel movement or having an accident.

Although management of conditions like irritable bowel syndrome should be multidisciplinary, pelvic floor therapy can play a role in regaining control of your bowel movements instead of allowing them control you. 

Bowel incontinence (also referred to as fecal incontinence, or FI) is defined as the involuntary loss of liquid or solid stool that affects quality of life or hygiene. Between 2 to 24% of the adult population suffer from bowel incontinence in a year, with 1 to 2% experiencing significant impact on daily activities (Scott, 2014).

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    • Testimonial by Alexandra B.

      Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying...

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    • Testimonial by T.H.

      I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse.  I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing...

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