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

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Studies Find Connection Between Diet and Sexual Function

cooked food — Photo by Louis Hansel @shotsoflouis on Unsplash

A 2019 study by Towe et al., found that certain medical issues including metabolic syndrome, obesity, and eating disorders have an effect on female sexuality. The study also found evidence that incorporating of healthy dietary patterns into everyday life may positively influence female sexuality.

Metabolic Syndrome and Obesity May Cause Female Sexual Dysfunction

According to the Mayo Clinic, Metabolic Syndrome is a “cluster of conditions that increase the risk of heart disease, stroke, and diabetes. Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The syndrome increases a person's risk for heart attack and stroke.” Those with Metabolic Syndrome often have apple or pear shaped bodies.

Studies Show Mindfulness Can Help You Start and Stick with an Exercise Program

Man Meditating on a Dock — Photo by Simon Migaj (Unsplash)

Physical Activity has Psychological and Physical Benefits

Studies have shown that physical activity has many physical and psychological benefits. Staying physically active can increase happiness (Wang et al., 2012), improve health (Lee and Skerrett, 2001), and enhance quality of life (Penedo and Dahn, 2005).

Getting Started with a Problem Can Be Hard but Mindfulness Can Help

Dishman and Buckworth (1996) found that it is common for adults to quit an exercise program within the first 6 months of starting it, which decreases the chance for folks to fully receive the benefits of an exercise program. One factor that has been identified as helping people stick with an exercise program is satisfaction with physical activity.

In 2016 Tsafou et al. (2016) found that a mindfulness practice while you are exercising can increase

Can Mindfulness Help With Painful Sex? Part 1

Mindfulness Is More Than A Mindset

From bullet journals to hot yoga, and five minute breathing exercises to weekend meditation retreats, mindfulness is the hashtag-goals wellness buzzword of the moment… and rightly so. It’s hard to argue with all the documented health benefits of being fully present in your activities and relationships.

But is mindfulness a magic cure for painful sex? That’s what many of my patients have been told by well-meaning friends, partners, and even medical practitioners and professional counselors. And I’ll tell you what I tell them:

The pain isn’t in your head; it’s in your muscles. It’s in your nervous system. It’s a complex interplay of the two in many cases.

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

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?

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.

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.

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

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.

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.

User Rating: 5 / 5

Details: Written by Heather Jeffcoat, DPT; Published: 08 May 2018; Hits: 1789

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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Details: Written by Nancy Hoi Wong OTD, OTR/L, RYT200; Published: 02 May 2018; Hits: 4013

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

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.

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.

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.

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).

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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Testimonials
- I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment....
  
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Testimonials
- I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love. -- A.W., age 32(completed Post-partum Renewal...
  
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