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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

Painful periods are common.

According to the American College of Obstetricians and Gynecologists, more than half of those who have periods suffer from “dysmenorrhea” (pain associated with their cycles) 1-2 days each month.

What causes the pain?

There are two main causes of the pain associated with menstruation:

  • Primary dysmenorrhea is pain caused by the related to menstruation and starts shortly before or after bleeding begins
  • Secondary dysmenorrhea is period pain that is tied to another condition, usually endometriosis or fibroids

Although period pain is a commonly shared experience, your pain shouldn’t be keeping you from doing things like resting comfortably, going to school, going to work, or being active.

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Tightly Wound recently released on Iris!

Tightly Wound has been released, watch it today and share it with your loved ones and anyone else who may need more education on vaginismus and pain with sex.

Tightly Wound is a 15-minute animated short by Shelby Hadden. Our very own Heather Jeffcoat, DPT is one of the producers of film. Check out the video here.

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Pilates Can Strengthen the Pelvic Floor

A modified Pilates program can be a fantastic way to improve the strength of the pelvic floor muscles. A 2018 study by Lausen et al.  had clients attend weekly one-hour Pilates classes over the course of six weeks. These classes used a type of Modified Pilates which consisted of Pilates exercises which had been modified and led by a physical therapist to specifically target the pelvic floor for the management of urinary incontinence. Those who attended the Pilates classes reported less leakage, improved self-esteem, decreased social embarrassment and lower impact of incontinence. Some of the women also reported improvement in their personal relationships after attending the classes.

In another 2011 study by Phrompaet et al., researchers found Pilates to be an effective treatment for instability in the low back and

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Yoga can help manage pelvic organ prolapse, but there are also some poses, movements and breathing methods that could make the condition worse.

What is a 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.

Read our previous blog for more information on prolapse and how pelvic floor therapy can help.

Which yoga poses will help and which poses will make it worse?

Yoga has been found to help women with urinary incontinence, but will it help with prolapse?

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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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What They Say About Us

  • Testimonials

    • Testimonial by T.C.

      While pregnant with my twins, Heather took care with keeping me on my feet and pain free. She saved my back, my sanity and the holidays! I would recommend her to every “mom” looking to stay on her feet during pregnancy and post-partum. -- T.C.

  • Testimonials

    • Testimonial by M.M.

      My husband and I were married for 5 years and unable to have intercourse, but I never knew why. After numerous awful experiences at doctor’s offices (where many doctors told me I “just needed to relax”), a surgery that didn’t fix the problem, and a year of owning dilators that didn’t get me anywhere, someone finally referred me to Heather for Physical Therapy. I finally had answers and information from someone who knew exactly what I was dealing with!

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