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The Femina Physical Therapy Blog

Featuring original articles by our staff about current events and trends

With emphasis on vaginismus, pregnancy and postpartum best practices, treatments for incontinence, and other topics related to the health of your pelvic floor.

Featured From the Blog:

Introducing The Origin Fund - Helping Women in Need

Helping Women in Need With Our Community in Mind

The Origin Fund is dedicated to facilitating access to services that address a person’s physical, emotional and medical needs. Our focus is on individuals with pelvic health dysfunctions, and we are dedicated to improving the biopsychosocial aspects of each person as a whole. Through education, outreach and providing access to these services, we can support individuals on their journey to address their pain and dysfunction—linking patients to our network of referrals that provide these services.

Therapeutic Breast Massage in Lactation (TBML)

Therapeutic Breast Massage in Lactation | Image Courtesy of Mehmet Turgut Kirkgoz via Unsplash

Therapeutic Breast Massage in Lactation Can Help Make Breastfeeding Less Painful

Breastfeeding is widely accepted as the normal standard for providing nutrition to newborns, however, many women who do not reach their breastfeeding goals. US national data stated that breast pain was a commonly reported reason for women weaning less than 1 month postpartum. Within that segment, 29% of women who participated in the study stated that “breastfeeding was too painful” to continue.

In the same study, 24% of women reported “breasts feel(ing) too full or engorged” as another reason to discontinue breastfeeding prior to 1 month postpartum.¹ Currently, The American Academy of Pediatrics recommends exclusive breastfeeding of infants for the first six months of life. As physical therapists who treat patients with postpartum conditions, we are well positioned to make a big impact on patients with breastfeeding related pain and reduce barriers to continued breastfeeding!

Treating Bloating and Abdominal Distension: a Multi-Disciplinary Team

Why a Multi-Disciplinary Team is Best for Treating Bloating and Abdominal Distension

Bloating, abdominal distension, loose stools, constipation, abdominal or pelvic pain, fatigue, brain fog, weakness, nutritional deficiencies… these symptoms may be caused by a variety of gastrointestinal or pelvic conditions. If you are experiencing any of these symptoms, this article is a good place to start when deciding who to have on your care team, and what treatments can help!

All About the Importance of Pelvic Floor Stretches for Childbirth

**Talk to your physical therapist and healthcare team about specific guidelines for you**

Are you ready for the big day? Have you thought about how you will prep for your upcoming delivery? In this article, we’ll review four pelvic floor stretches for childbirth that may be appropriate, but recommend you consult with your childbirth healthcare professional to confirm if these are right for you.

Details: Written by: Staff; Published: 19 April 2022; Last Updated: 13 July 2022; 3963 Views

Let's Talk Pilates for Urinary Incontinence and Low Back Pain

"Physical Therapy is the first line of treatment for any type of urinary incontinence."

Incontinence, or unwanted urinary leakage, is commonly experienced by women, especially during pregnancy and postpartum. Experts often state, and research supports, it occurs in 1 in 3 women. While this may be common, it is not normal, and it is treatable! Physical therapy is the first line of treatment for any type of urinary incontinence. In fact, pelvic floor muscle training for women with stress urinary incontinence is six times more likely to result in a cure or a significant improvement. For all other types, women are twice as likely to report significant improvement or completely resolve their urinary incontinence. As you can imagine, getting help can dramatically improve their quality of life.

Details: Written by: Kasia Gondek, PT, DPT, CSCS; Published: 13 April 2022; Last Updated: 17 July 2023; 3448 Views

Building a Recovery Routine | Kasia Gondek's Road to the Boston Marathon

A very important component of any running program, ranging from a 5 km (3.1 miles) race to an ultra-marathon (anything more than a marathon which is 26.2 miles), is adequate recovery.

Many people neglect this portion of their training because it doesn’t involve getting sweaty or doing high intensity intervals or weights. However, building in a solid recovery routine is crucial to helping your body bounce back after training as quickly as possible. A good recovery routine also helps prevent injury, decreased immune system function, and muscle mass loss. A recovery routine encompasses a cool-down activity, nutrition, and exercises like hatha-based yoga, foam rolling, and/or stretching the major muscle groups used during your workout. Although not discussed here, getting good quality sleep is critical to recovery as well!

My Post-run Recovery Routine:

Details: Written by: Staff; Published: 12 April 2022; Last Updated: 18 May 2022; 3532 Views

Lower Urinary Tract Symptoms and Toileting Behaviors | Image Courtesy of Mick Haupt via Unsplash

How do you know if you have lower urinary tract symptoms and an overactive bladder?

Over ¾ of women report that they have experienced one or more Lower Urinary Tract Symptoms (LUTS)¹. More than ½ of American women report urinary incontinence (UI), and approximately 17% of women over the age of 18 years report symptoms of overactive bladder (OAB)^{2, 3}. It is also believed that most women underreport their bladder symptoms due to embarrassment and false notions that it is a normal part of aging^{4, 5, 6}.

Lower urinary tract symptoms include incomplete bladder emptying, urine dribbling after you finish urination, persistent drip of urine after completion of urination and/or urinary incontinence. Overactive bladder symptoms consist of urinary urgency (the need to get to a restroom quickly), with or without incontinence, urinary frequency, and frequent nighttime urination (waking more than 1x/night). These symptoms can negatively impact a woman's life. One study found that women with Lower Urinary Tract Symptoms reported several impacts on quality of life including decreased sleep, work productivity, and physical/sexual activity⁷.

Details: Written by: Kasia Gondek, PT, DPT, CSCS; Published: 10 April 2022; Last Updated: 06 May 2023; 3529 Views

Image credit: Kasia Gondek - Selfie taken on one of my 18-mile long runs leading up to Boston Marathon, sporting my Boston Marathon running hat from the last time I did the race in 2014!

Road to Boston Marathon Part 2: Exercising at Home or in the Gym

10 Exercises to Improve Strength, Conditioning, and Balance

Leading up to the Boston Marathon, I have been incorporating these 10 key exercises into my weekly routine (3x/week) to keep my body strong and balanced. Videos of these exercises are posted below. These exercises target the key muscle groups used by runners. These are for educational purposes, not meant to treat medical conditions nor supplement medical advice.

Details: Written by: Kasia Gondek, PT, DPT, CSCS; Published: 29 March 2022; Last Updated: 04 October 2023; 4585 Views

Self-Care to Combat Endometriosis Symptoms — Self Care for Endometriosis | Image Courtesy of Callum Shaw via Unsplash

Self-Care and Self-Management Strategies to Combat Endometriosis Symptoms During the COVID-19 Pandemic

Since March of 2020, people living with endometriosis symptoms are facing tough challenges and barriers due to the Covid-19 pandemic: canceled surgeries, canceled appointments with family physicians, gynecologists, fertility specialists and/or other allied healthcare providers, postponed in-office assessments and visits, and changes in overall work environment and social activities. This can worsen feelings of isolation, depression, anxiety, hopelessness, and have a negative impact on self-reported pain and disability levels during this time.

Endometriosis and Sexual Function Require a Specialized Approach

Endometriosis is a global disease affecting 5-15% of women during their reproductive years. It is characterized by the presence of endometrial-like tissue outside of the uterus which can trigger a local inflammatory response and can have a significant impact on patients’ quality of life.

One such domain of quality of life that is often affected is the correlation between endometriosis and sexual function. The DSM-V defines sexual dysfunction as a clinically significant disturbance in a person’s ability to respond sexually or to experience pleasure and includes pelvic pain, penetration disorders, lack of sexual interest, and/or arousal and orgasm disorders. Unfortunately, it is common, as approximately 40% of women with endometriosis and chronic pelvic pain suffer from sexual dysfunction.

Road to Boston Marathon Part 1

A Tribute to the First Female Runners

On April 18, 2022 I am excited and grateful to be able to run the historic and prestigious Boston Marathon! As a physical therapist at Fusion Wellness /Femina Physical Therapy and avid long-distance runner for over 20 years, I’m excited to share my training journey with you leading up to the race. This race holds a special place in the hearts of long-distance runners because you must run a qualifying race with a qualifying time. Females ages 18-34 must run 3 hours 30 minutes or better, and males ages 18-34 must run 3 hours flat or better.

Details: Written by: Staff; Published: 15 March 2022; Last Updated: 07 April 2022; 3045 Views

How to Manage Urinary Incontinence After Childbirth | Image Courtesy of Engin Aykurt via Unsplash

Postpartum Recovery Series Part 5

Managing Urinary Incontinence After Childbirth

Urinary incontinence is the unwanted leakage of urine, also known as accidental bladder leakage. There are a few main types. Stress urinary incontinence is leakage associated with activities, such as lifting, exercising, coughing, sneezing, or laughing. Urge urinary incontinence is leakage associated with the urge and people often experience leaking on the way to the toilet. There is also mixed incontinence which is a combination of the two types. Continence is managed by the complex interaction of bladder physiology, central nervous system, and the pelvic floor muscles. When there is dysfunction in any part of the three systems, incontinence may occur.

Did You Know Physical Therapy Can Help Endometriosis?

What is the link between endometriosis and painful sex?

Sexual Function

One such domain of quality of life that is often affected is sexual function. The DSM-V¹ defines sexual dysfunction as a clinically siginifcant disturbance in a person’s ability to respond sexually or to experience pleasure and includes: pelvic pain, penetration disorders, lack of sexual interest and/or arousal and orgasm disorders. Unfortunately, it is common, as approximately 40% of women with endometriosis and chronic pelvic pain suffer from sexual dysfunction.

What's the Link Between Endometriosis and Central Sensitization?

Endometriosis affects roughly about 10% of reproductive-age women, and is characterized by endometrial-like lesions that grow outside of the endometrium (the lining of the uterine wall). Women with endometriosis have symptoms such as: chronic pelvic pain, dysmenorrhea, abdominal pain, infertility, constipation, interstitial cystitis/painful bladder syndrome, and more.

Often endometriosis is treated through hormonal management and/or surgically. However, 18-27% of patients with endometriosis treated via hormonal medications reported no relief from symptoms. About 20% of patients with endometriosis treated through surgical excision or ablation continued to experience chronic pelvic pain and other endometriosis symptoms. Moreover, 70 to 80% of women with chronic pelvic pain with confirmed endometriosis lesions do not have lesions in the areas where they experience symptoms.

What causes incontinence during pregnancy?

There are many causes for incontinence during pregnancy and postpartum. Some of the proposed factors are:

hormonal changes,
pelvic floor muscle and connective tissue modifications,
bladder neck widening (due to the weight of both the uterus and the growing fetus),
anatomical injuries during delivery.^{1, 2}

A hormone called relaxin is produced during pregnancy to help soften the muscles and ligaments in preparation for delivery. As the uterus and baby grow throughout pregnancy more load is placed on the pelvic floor muscles causing the pelvic floor muscles to become weaker.³ Also constipation, which is commonly seen in pregnancy, puts an additional load on the pelvic floor.⁴ Furthermore, the pelvic floor has additional strain placed on it during labor; the pelvic floor muscle is stretched five times its original length.⁵

What Are The Connections Between Endometriosis and Sleep?

March is Endometriosis Awareness Month.

The endometrium is the lining of the uterus. When there is tissue similar to the endometrial lining that is growing outside of the uterus, it is called endometriosis. Endometrial lesions can be on the ovaries, vaginal walls, bladder, colon, and more. Endometriosis affects up to 10% of the general population and can be quite debilitating as common symptoms include dysmenorrhea, dyspareunia (pain with sex), infertility, bloating, gastrointestinal symptoms, and chronic pelvic pain.

Pelvic Floor Rehabilitation for Prolapse Surgeries

Including both Pre and Post Operative Situations

Suffering from symptoms of pelvic heaviness? Experiencing a feeling that there is a bulge down there or something is falling out of your vagina? Have trouble having a bowel movement or experiencing incontinence? These are all common symptoms of pelvic organ prolapse (POP). Unfortunately, 2-48% of women may experience symptoms of POP.

Pelvic Floor Rehabilitation Treatment Options

There are treatment options such as pelvic floor rehabilitation through physical therapy techniques including lifestyle modifications such as managing intraabdominal pressure, promoting healthy bowel/bladder habits, as well as physical therapy, manual therapy, and strengthening exercises to decrease pelvic heaviness.

Details: Written by: Staff; Published: 22 February 2022; Last Updated: 07 April 2022; 18029 Views

Eating Disorders and Pelvic Floor Dysfunction | Image Courtesy of Niklas Hamann via Unsplash

What's the Connection Bewteen Eating Disorders and Pelvic Floor Dysfunction?

Read on for some answers.

Eating disorders are unfortunately common, with at least 9% of people worldwide suffering from an eating disorder. This translates to 28.8 million Americans will have an eating disorder in their lifetime. There are different types of eating disorders (ED) including anorexia nervosa, bulimia nervosa, and binge eating disorder. Other than the typical psychological and social implications that these eating disorders may cause, they also can affect our pelvic health and lead to pelvic floor dysfunction. It can lead to incontinence (either urine or feces), prolapse, increased urinary urge, pelvic pain (possibly associated with polycystic ovarian syndrome or PCOS), constipation, and sexual dysfunction.

Details: Written by: Staff; Published: 18 February 2022; Last Updated: 17 July 2023; 5616 Views

contraceptives and sexual function | Image Courtesy of Reproductive Health Supplies Coalition via Unsplash — Contraceptives & Sexual Function | Image Courtesy of Reproductive Health Supplies Coalition via Unsplash

Contraceptives and Sexual Function Considered

As pelvic floor physical therapists, we work with a lot of women who have some type of female sexual dysfunction, whether it may be pain with initial penetration, pain with deep thrusting/deep penetration, pain with orgasms, or decreased sexual arousal, desire, libido. Unfortunately, about 30-50% of women may suffer from these symptoms.