Login
Register

Home

About Us

Diagnoses

Treatments

Classes

Resources

Media

Testimonials

Blog

Account

Blog
Register

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

Pelvic floor physical therapy is one of the best kept secrets in medicine.

I was on a recent plane flight and sat next to two women that were very chatty with one another. They quickly swept me up into their conversation. Inevitably, in situations like this, everyone asks “So what do you do for a living?”. My answer used to be “I’m a physical therapist”. The past couple of years, my standard response is “I’m a physical therapist, but let me tell you about what kind of physical therapist I am”. Then I go into the diagnoses I treat related to bowel, bladder and sexual health and, in general, how I treat them. Across the board, their reaction is a mix of astonishment and genuine interest. The follow up dialogue is always eye-opening for them, and more often than not, they will report either knowing someone close to them as having one of these pelvic floor issues, or they have it themselves.

User Rating: 5 / 5

Star ActiveStar ActiveStar ActiveStar ActiveStar Active

I came across an article that came out last month and it brought up an old question I often muse over--Does Vaginismus create the fear and anxiety in women, or does an underlying fear or anxiety create Vaginismus? As we often say in physical therapy "It depends".

With some of my patients, there is a specific injury or infection that is at the root of their pain. The story is similar whether they were diagnosed with Vaginismus, Vulvodynia, Vestibulitis, Dyspareunia, or a host of many other diagnoses that lead to painful intercourse. For example, a young girl that always wore bathing suits and developed recurrent yeast infections, only to find out that over a decade later she had developed vaginismus. She had no fear or anxiety going in to first sexual encounter, yet she had severe pain. Now, she presents with what I perceive as fear and anxiety. Should she be treated for fear and anxiety? Or just the pain? Or both?

User Rating: 5 / 5

Star ActiveStar ActiveStar ActiveStar ActiveStar Active

In my last post, “Why You Should Be Doing Kegels NOW”, I went over the specific diagnoses that tend to benefit most from doing pelvic floor muscle exercises. However, not all issues related to the pelvic floor are appropriate to prescribe pelvic floor muscle exercises for. In fact, doing Kegels can actually be harmful and counterproductive to your symptoms if you have certain diagnoses. In physical therapy, there are proper and improper times to strengthen a muscle. When speaking about the pelvic floor, you should only strengthen a muscle that is weak and overly lengthened. If a muscle in a high state of rest (guarded, hypertonic, or with limited flexibility), the LAST thing you should do is continually contract it. This will only further shorten/tighten an already short/tight muscle and likely make your problem worse, or at the very least, prevent if from getting better.

Here are the primary diagnoses that I generally recommend avoiding Kegel exercises (and even core strengthening) with, at least in the early stages of treatment:

User Rating: 5 / 5

Star ActiveStar ActiveStar ActiveStar ActiveStar Active

I am proud to announce the official book release today of Sex Without Pain: A Self-Treatment Guide To The Sex Life You Deserve. It is available on Amazon.com, iBooks and other retailers.

43% of women will experience pain during sex or other sexual problems – why isn’t this a public health concern?  http://www.prweb.com/releases/2014/09/prweb12156888.htm

Join us in helping to increase the awareness of female sexual dysfunction, including vaginismus, vulvodynia, vulvar vestibulitis, overactive pelvic floor and more. You are not alone if you or your loved one are experiencing painful intercourse. There is help!

 

User Rating: 5 / 5

Star ActiveStar ActiveStar ActiveStar ActiveStar Active

In my early days of being a pelvic floor PT, I was convinced I had the answer to all the woes of the pelvic floor. One word – Kegels. As I’ve developed professionally, I certainly realized Kegels have their place. However, they do not have their place with all things related to the pelvic floor. There are specific instances when Kegels (also known as PC or pelvic floor muscle contractions) are the answer. I’m a firm believer in doing a Kegel program combined with a core strengthening program that will address the bigger picture. Here’s who should be doing Kegels and why:

1) Most women that experience urinary incontinence

a.     A thorough physical exam can identify if postural dysfunction and weakness in your pelvic floor and what I call “pelvic floor accessory muscles” that are contributing to your incontinence.

b.     There are 3 primary types of urinary incontinence that physical therapy can treat:  

                                               i.     Stress Urinary Incontinence (SUI)

1.     Involuntary urine leakage with coughing, laughing, sneezing, exercise

                                              ii.     Urge Urinary Incontinence (UUI)  

User Rating: 5 / 5

Star ActiveStar ActiveStar ActiveStar ActiveStar Active

What are Kegels?

Kegels are a contraction of the pelvic floor muscles, sometimes referred to as “PC Contraction”. PC is short for “pubococcygeus”, the name of one of the many pelvic floor muscles.

However, after over a decade of practice, I have found that simply telling a patient to “Do Kegels” is usually not enough. Often, women perform pelvic floor exercises incorrectly, or do not do an amount appropriate for their strength levels. This finding has been confirmed by Bump et al in an August 1991 article from the American Journal of Obstetrics & Gynecology, Assessment of Kegel pelvic muscles exercise performance after brief verbal instruction”.  The results of verbal instruction were 60/40 (60% could/40% could not perform a pelvic floor contraction or, Kegel, correctly). This article also stated that a very high percentage of women that were doing Kegels incorrectly were not only doing them wrong, but doing them in such a way that they were actually making their incontinence WORSE. I have seen this initial frustration with many of my own patients over the year, not realizing before they started physical therapy why they were getting worse. I continue to site this study, as despite it’s age, it was really revolutionary in identifying why so many women think Kegels do not work.

How do I know if I am doing Kegels correctly?

Chances are if you have basic stress, urge or mixed incontinence, and see no improvement in your symptoms, you may not be doing your Kegels appropriately. This is not to say that you don’t know how to do a Kegel, but you many not be doing the proper routine based on your strength levels.

How many do I do? How long should I hold them for? There are different types of Kegels?!

User Rating: 5 / 5

Star ActiveStar ActiveStar ActiveStar ActiveStar Active

Newsletter

  • 2.png3.png1.png5.png4.png2.png
  • Visitors:
  • Today 160
  • |
  • Yesterday 164
  • |
  • This week 1635
  • |
  • This month 3407
  • |
  • Total 231542
Our site uses cookies to implement some of its features. We encourage you to visit our Terms of Use page for more information.