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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

Can pelvic floor therapy help with constipation?

It's National IBS Month! We are continuing our bowel health series to help you achieve optimal pelvic health. Having bowel movements is something everyone must do, and sometimes it is difficult to have a bowel movement.  While the causes for constipation can vary, today I wanted to talk about a particular dysfunction that pelvic floor therapy can greatly help with:  dyssynergic defecation.

What is dyssynergic defecation and how common is it? 

Dyssynergic Defecation is a muscle coordination issue where you think you are relaxing your anal sphincter to defecate, but in reality you are actually contracting your muscles and closing off the sphincter. In short, your pelvic floor muscles are doing the opposite of what your brain is telling them to do. Dyssynergic defecation is common; an estimated 40% of patients with chronic constipation also have dyssynergic defecation, according to this study.

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Most people experience constipation from time to time. Constipation isn’t just the inability to have a bowel movement, it includes the difficulty associated with bowel movements. Travel, inactivity, illness, and certain over the counter medications taken “as needed” commonly result in short-term or acute constipation. Constipation lasting longer than three months is considered chronic constipation. Chronic constipation should be treated by a doctor to prevent health complications.

Clear communication is essential to working with doctors, but the general public often has only a rudimentary understanding of medical terms - including constipation. There is often a gap between the physician and the patient’s perception of constipation which can lead to confusion. (1, 2, 7, 10) A study of people who thought they had constipation showed that only a third actually fit the criteria for constipation, while the rest actually had Irritable Bowel Syndrome or other gastrointestinal disorders. (9) So what are the criteria for constipation? 

If you have two or more of these symptoms, you may have constipation: (Rome IV) 

  • Fewer than 3 bowel movements per week 
  • During at least 25% of bowel movements do you experience any:
  • Straining
  • Hard or lumpy stools
  • Sensation of incomplete evacuation
  • Sensation of blockage at the level of the anus and rectum
  • The need to use fingers or other manual maneuvers to have a bowel movement

If these symptoms last three consecutive months, your constipation may classified as chronic constipation

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A Conversation about Female Sexual Health & Pelvic Pain

with Screening of Animated Short Film "Tightly Wound"

Femina PT, the Pelvic Health and Rehabilitation Center, and the Milli, the first Expandable Dilator, are teaming up to bring Shelby Hadden and her animated short film about vaginismus, Tightly Wound, to Los Angeles on Saturday, May 19th! Many of you may know of Shelby and her past struggles with pelvic pain. Her journey getting diagnosed and treated combined with her skills as a filmmaker inspired her to create Tightly Wound to help raise awareness about vaginismus and pelvic pain, helping women get diagnosed and get the help they need.

As pelvic pain physical therapists, we understand all too well the challenges women face getting diagnosed and successfully treated for such personal issues. Every day we witness the emotional and physical drain pelvic pain syndromes have on our patients, threatening everything from one’s sexuality, daily comfort, relationships, and professional and personal lives.

Pelvic floor physical therapists are well-positioned to help women navigate the complicated medical system to get the help they need. A key to recovery is knowing you can and will get better. That’s why we teamed up with Shelby and three other patients to share their success stories, struggles, and how they ultimately recovered from pelvic pain.

May is Pelvic Pain Awareness Month, we want to do our part to help, so here are our plans and goals. We hope you join us!

Our Goals:

  1. Raise awareness about female pelvic pain
  2. Host a seminar for patients:
    1. To meet women who have recovered from pelvic pain & regained the ability to have pleasurable sex
    2. Learn tips about sexuality and intimacy while recovering from pelvic pain
    3. Tightly Wound Los Angeles screening with filmmaker Shelby Hadden (screening and Q and A!)
  3. Raise money for Tightly Wound’s distribution (Filmmaker’s Collaborative, 501c3)


Ladies recovering from pelvic pain, you are invited to our seminar!

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Endometriosis affects 1 in 10 women and girls. The delay for diagnosis averages 7 years! How early should you start the discussion about this debilitating condition? As a pelvic health physical therapist, I believe this conversation should start not long after your daughter begins menstruating. As moms, we need to be aware about what is “normal” versus “abnormal”. We only know if we ask them questions. It can be a scary time for girls when they first get their periods, and it can be devastating if there is a lot of pain. We need to be a strong support system for our daughters, but also educate them on the norms.

Is it normal to have cramping? Yes. It’s the uterus contracting to shed the lining of the uterus. Mild to moderate cramping can often be helped with Motrin, heating pads, gentle exercise and adequate hydration. Be careful to not dismiss her if she comes to you complaining of severe cramping during her cycle. If her pain is so severe she is vomiting, please do not accuse her of being “too dramatic”. I’ve heard these stories in my office from my patients as they relay their history and how long they complained of severe pain, only to be accused of playing up their pain too much. It only delayed their treatments and added psychological factors as they were made to feel that their pain wasn’t that bad or worse…not real at all.

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How Does Endometriosis Affect Fertility and Pregnancy?

As we continue our series about endometriosis, today we address how endo might affect fertility and pregnancy.

Endometriosis Does Not Equal Infertility

Having endometriosis does not automatically mean that you will never have children. What it does mean is that you might have more trouble getting pregnant. About 30% of those with endometriosis have trouble with fertility and struggle to get pregnant. Others with endometriosis have no difficulty getting pregnant, or eventually get pregnant after utilizing medical interventions including surgery to remove endometrial growths, or reproductive technologies like in vitro fertilization to help with conception.

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It’s Endometriosis Awareness Month

1 in 10 women have endometriosis and experience different forms of pain—pain with urination, pain with bowel movements, painful periods, pelvic pain, ovulation pain, painful sex, abdominal pain, and nerve pain. The Office on Women’s Health of the U.S. Department of Health and Human Services estimates 5 million American women are affected by endometriosis.

As we covered in a previous blog post, endometriosis is a condition where endometrial-like tissue grows outside of the uterus (endometrial tissue is tissue that usually tissu grows inside of the uterus). Endometrial-like tissue can implant on the surface of organs and structures including the ovaries, bladder, rectum, and along the walls of the abdomen and pelvis. These tissues can cause inflammation and pain to develop throughout the abdomen and pelvic cavity.

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Pelvic Floor Muscles: What are they?

The inside of the pelvis is lined with muscles referred to as the pelvic floor muscles, these muscles are made of the same types of muscle tissue as other parts of the body, like the neck or shoulder. Similarly, the pelvis is home to ligaments, nerves, fascia, and bones, just like other parts of the body.

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We are starting an exciting new yoga therapy program at Femina/Fusion Wellness PT. To celebrate, there will be a series of blog posts highlighting how yoga can mesh well with issues like pelvic floor dysfunction, pelvic pain, and pregnancy.

Yoga and Pregnancy

Modified, gentle, and restorative yoga practices can be a fantastic addition to physical activity during pregnancy. Yoga can also give an opportunity for mamas to listen to their bodies, gain stamina and the courage needed for labor and motherhood. Whether you start practicing yoga after you get pregnant, or you already have a practice, yoga also helps you to consciously connect to the process of nature and your baby and prepare you for your birth.

With guidance, safe poses can be practiced during all three trimesters. Studies have found that a yoga practice during pregnancy can help improve health for both mothers and their newborn babies.

What is Yoga?

Yoga is a movement practice that incorporates movement for strength and flexibility with breath work and mindfulness for reduction of stress and tension. Yoga is used therapeutically for a variety of immunological, neuromuscular, psychological, and pain conditions.

Yoga increases comfort during pregnancy and makes for shorter and less painful labor.

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Happy National Condom Week!

Condoms are an effective barrier method of contraception (82% effective, according to the CDC) and reduce the spread of sexually transmitted diseases (STDs) including HIV, gonorrhea, and Chlamydia.

There are other benefits. Regular condom use with intercourse may also help the risk of recurrent Pelvic Inflammatory Disease (PID), Chronic Pelvic Pain (CPP), and Infertility. According to the 2004 study by Ness, Randall, Richter, et al., consistent condom users had 50% reduced risk for recurrence of PID, 30% reduced risk for chronic pelvic pain, and 60% reduced risk for infertility due to PID.

What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease is an infection-induced inflammation of the upper reproductive tract (the endometrium, fallopian tubes, ovaries, or pelvic peritoneum) of the female anatomy. In general, inflammation spreads from the vagina or cervix to the upper genital tract, endometritis is considered an intermediate stage of PID.

The way it presents can be different for different people. However, most clients with PID report pelvic tenderness and inflammation of the lower genital tract (vaginal canal, vaginal opening, and vulvar tissues).

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Does sex give you a backache?

Science based recommendations and how therapy can help you

Does sex give you a backache?
Do you avoid sex due to your low back pain?

If you are thinking “YES,” you are not alone. In a study by Bahouq et al. in 2013, 81% of clients with low back pain reported sexual problems and 66% of those clients reported never bringing the subject up with their doctor. As we all know, sex is an important activity for many. Today’s post will shine a light on the latest science based recommendations sex positions for those with low back pain and how the therapists at Fusion Wellness and Femina can help.

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Cervical Health Awareness Month:

Sexual Problems and Cancer Treatment

Sexual problems are a side effect of cancer treatment that oncologists don’t often talk about, but there are treatments to help, including the pelvic floor therapy that we do at Femina. Surgery, chemotherapy, radiation, hormonal therapy, stem cell transplantations, and other procedures can negatively affect quality of life, including sexual health and happiness. These side effects are not limited to cancers of the sexual organs either. Cancer treatment anywhere in the body (cervix, breast, throat, GI tract) can lead to changes in sexuality.

Up to 64% of women affected by cancer experience “altered sexuality”—their sex lives just feel different than they did before.  There are physical side effects like fatigue, nausea, dry, painful, itchy, and burning vaginal tissues, and hormonal changes which make sex unappealing and painful. Altered self-image, depression, and anxiety can make it hard to connect with others and feel intimacy. These effects can last years after cancer treatment. If you are currently experiencing these effects, you are not alone and there are treatments that can help.

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This information is for educational purposes only and is not intended to replace the advice of your doctor.

Is Pain with Penetration Preventing you from getting a Pap test?

January is a great time to make resolutions, fresh starts, and to start committing to self-care! It is also Cervical Health Awareness Month. Today we chat about the Pap test. If you are an adult with female anatomy living in the United States, chances are you have heard the term “Pap test” or “Pap smear.” But why they are important and what can you do if you can’t tolerate a gynecological exam with a speculum?

I can’t stand having a speculum placed in my vagina. What can I do?

Pelvic floor issues such as vaginismus, vulvodynia, and vulvar vestibulitis can make it hard to have anything inserted into the vagina. Be it a penis, tampon, or a speculum, commonly reported symptoms include intense burning and stinging, sharp pain, a feeling that you “will tear,” or like you are “hitting a wall.” These are all conditions that are treatable at Femina Physical Therapy.  Our therapy along with your healthcare team can help restore your ability to take care of your reproductive health as well as your sexual health and pleasure.

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What They Say About Us

  • Testimonials

    • Testimonial by S.B.

      As someone who suffered the debilitating physical and emotional effects of vaginismus (as well as a complicated history of back injuries) for more than 15 years, I thought a "normal" life was just a fantasy. Then I found Heather.

  • Testimonials

    • Testimonial by Julie T.

      Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going to doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to...

      Read more Testimonial by Julie T.

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