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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

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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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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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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What They Say About Us

  • Testimonials

    • Testimonial by M.N., age 28

      A personal journey and testimonial from one of my patients: I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical...

      Read more Testimonial by M.N., age 28

  • 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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