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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!

A Pelvic Floor PT Can Assist With Cervical Cancer and Recovery

Cervical cancer is the fourth most common cancer affecting women worldwide.

Luckily there are many wonderful treatments that can stop the cancer, either completely or from progressing further. However, the treatments do come with some unwanted side effects. But there is help and having a pelvic floor physical therapist added to your ervical cancer support team can truly guide you along the way.

Common Cervical Cancer Treatments

Some common treatments are pelvic external beam radiotherapy and/or brachytherapy, which unfortunately can adversely affect women’s sexual functioning and quality of life. Radiotherapy especially can cause vaginal stenosis, which is narrowing of the vaginal canal. This is due to radiation effects of collagen deposition, loss of elasticity in the vaginal tissue, and atrophic changes of the mucosa. Unfortunately, 88% of women after radiation will develop vaginal stenosis. As you can imagine, narrowing of the vaginal canal can impede women’s ability to tolerate penetrative sexual intercourse or gynecologic exams, for example.

Details: Written by: Staff; Published: 17 January 2022; Last Updated: 06 February 2023; 6635 Views

Coping with Restless Leg Syndrome | Image Courtesy of Yuris Alhumaydy via Unsplash

Restless Legs Syndrome (or RLS)

Restless legs syndrome (or RLS) is a condition where there are uncontrollable urges to move limbs (mostly in the legs, but sometimes in the arms) that follows a circadian pattern, namely evenings/overnight when resting.

The urges usually come with unpleasant sensations such as tingling, burning, itching, or otherwise pain. Usually, it can be alleviated by movement, but as you can imagine, it can be debilitating and impair sleep, and thus the quality of life. It is common to experience mood swings, anxiety, and depression.

It is estimated that about 3.9-14.3% of the general population suffers from RLS. It is the most common movement disorder in pregnant women. There is either primary (idiopathic) RLS, or secondary (acquired) RLS due to pregnancy, renal pathologies, diabetes, hypertension, and other metabolic conditions. The two most common risk factors for RLS are iron deficiency and kidney disease.

What is DRA?

Diastasis rectus abdominis (DRA, sometimes referred to as Diastasis Recti) is a distortion or thinning of the linea alba which is the midline of the abdomen that connects left and right rectus abdominis muscles together.

Although DRA can be found in both genders, it is more commonly found in females, and more common during pregnancy (66-100% of women have DRA during their third trimester) and can persist through their postpartum periods. About 33% of women continue to have a DRA a year postpartum. It can look like a gap in the midline, “doming” in the midline, or it can even appear as a “pooch,” in the lower abdomen.

Why Do We Care?

The abdominal muscles and linea alba assist in trunk movement, posture, lumbopelvic stability, breathing, and abdominal organ support. As you can imagine, it can affect those functions when a DRA is present. As movement specialists, we want to make sure you are engaging the muscles and tensing up the fascia of the linea alba appropriately to help prevent low back pain, pelvic girdle pain, and activity-related injuries.

Details: Written by: Staff; Published: 03 January 2022; Last Updated: 15 March 2022; 3133 Views

Safely Returning to Activity and Sport Postpartum

Postpartum Recovery Part 1

Most women get the clearance after their 6 week check-up for sex and exercise, YAY! But, really? How? What does that mean? There are no guidelines on how to return to activity in a safe, leak-free and pain-free manner.

Between 6 and 31% of postpartum women experience urinary incontinence. In addition, 66% of those who experience urinary incontinence during pregnancy and/or their first 3 months of postpartum continued to experience incontinence even at 12 years after birth! As you can see, it may be common, but it is certainly not normal!

Details: Written by: Staff; Published: 21 December 2021; Last Updated: 28 March 2022; 4027 Views

Breast Cancer Surgery and Physical Therapy - An Overview

There are an estimated 2 million breast cancer survivors in the United States and it is the most common form of cancer among women.^{2, 3}Following breast cancer surgery many patients experience neck, arm, and shoulder impairments. The most common complaints after surgery are restrictions in shoulder range of motion, pain, or a change in sensations of the arm and lymphedema.¹

Common Side Effects After Breast Cancer Surgery

Restricted Arm Mobility

Women that experience restrictions in arm mobility following surgery report a lower quality of life and higher psychological distress.⁶ It is estimated that anywhere between 3.8–73% of women will have restricted arm motion following surgery.¹⁰

What is IC or Interstitial cystitis?

IC is also known as bladder pain syndrome or painful bladder syndrome and is a debilitating condition that significantly affects the quality of life of patients living with it.

Many patients with IC have other overlapping pain conditions such as Dyspareunia (pain with intercourse). 88% of patients with IC had at least one symptoms of sexual dysfunction (lack of sexual interest, can’t relax and enjoy sex, difficulty becoming sexually aroused and difficulty reaching orgasm)¹. Women with IC rated their sexual dysfunction as moderate to severe when compared to controls and reported increased pain with intercourse, decreased desire and decreased frequency of orgasm^5,6.

Details: Written by: Heather Jeffcoat, DPT; Published: 22 November 2021; Last Updated: 06 January 2022; 14048 Views

Endometriosis Laparoscopic Road to Recovery | Image Courtesy of Unsplash

Postoperative Care for Endometriosis Laparoscopic Procedures

Recovering from an endometriosis laparoscopic procedure requires proper care for a full and timely recovery. During this time there are some important steps to follow in order for everything to go smoothly. Here is a guide that will help ensure that you return to full health as soon as possible.

The First 48 Hours After Endometriosis Laparoscopic Surgery:

Arrange for a partner, family member, or friend to drive you home and stay with you after your procedure. General anesthesia can cause nausea and vomiting. Having a bag or bin ready for the car ride home is a good idea.
It can also be helpful to have a small pillow or cushion to put between your abdomen and seat belt for the ride home.
Each surgery has unique guidelines specific to your case and what was done during surgery. Follow the guidance of your surgeon and pelvic health physical therapist. As this is a general guideline It is always a good idea to speak with your health care team prior to initiating any new exercise or protocol.
Take it easy and rest for the first 24 hours.
Finding a position of comfort: During the initial stage of recovery it is important to find a position that is comfortable to allow your body to rest and recover.

Details: Written by: Staff; Published: 20 November 2021; Last Updated: 06 January 2022; 6323 Views

Mental Health and Sexual Pain | Image Courtesy of Anthony Tran via Unsplash — Mental Health & Sexual Pain | Image Courtesy of Anthony Tran via Unsplash

Mental Health and Sexual Pain: Sexual Dysfunction is Not “In Your Head”.

We have seen that experiencing sexual pain CAN affect your mental health, and pre-existing mental health conditions can amplify sexual dysfunction.

This article will review the research related to these, but in reading, know that we believe your pain is real and should be addressed from all relevant contributing factors.

A very large range, about 7-46% of Americans may experience painful sex. For some, it may be a one-time painful experience, and for others, it may be every single time. This can have a huge effect on mental health and overall quality of life.

You may have heard that chronic stress takes a toll on your body. But did you know how chronic stress affects your sex life?

What is chronic stress?

Chronic psychosocial stress is defined as either a major life event that takes place over a long period of time (ie. death of a family member) or small stressors that are constant and often accumulate (ie. traffic, financial worries, work deadlines).^1,2 A study by Allen Kanner, Ph.D, published in the National Library of Medicine, found that these small stressors can have more of a negative effect on health than the more severe but less common stressors.¹

How does chronic stress inhibit sexual arousal?

Details: Written by: Staff; Published: 08 November 2021; Last Updated: 18 May 2022; 4176 Views

Are You Thinking of Returning to Running Postpartum?

There is not a magic time frame as each person recovers differently and the most important thing is to listen to your body.

For healthy uncomplicated pregnancies and deliveries the American College of Obstetricians and Gynecologists (ACOG) recommends women return to low-moderate intensity exercise at six weeks postpartum and eight weeks postpartum for cesarean.

After your OBGYN or midwife has cleared you to return to exercise, if you haven’t started with a Pelvic Floor Physical Therapist yet, now is a good time.

November is Bladder Health Awareness Month.

At Fusion Wellness & Physical Therapy, we take pride in understanding and applying how your whole body affects your pelvic health. In this article, we explore the links between grip strength and urinary incontinence.

A study conducted at the Jeju National University measured grip strength in patients and found statistically significant differences in patients with incontinence, overactive bladder and nocturia⁴. They found these patients had a weaker grip strength (less than 18kg) using a hand dynamometer.

Symptoms & Causes of Clogged Milk Ducts and Mastitis

Breastfeeding can be a joyous time for some, but unfortunately it can be painful for others. Clogged milk ducts can be extremely uncomfortable and painful. It often arises due to not being able to drain fully, causing a back-up of milk along the mammillary ducts. It can occur when feeding sessions are interrupted or skipped, as well as when mom is under stress. One may experience symptoms such as a painful lump in the breast tissue, pain during breastfeeding that subsides after, and/or decreased milk supply from the blockage. Sometimes if unresolved, it can lead to mastitis, or infection of the breast tissue. Monitor for symptoms such as fever, swelling of breast tissue, redness of breast tissue, and escalation of pain/breast tenderness. If you start to experience these aforementioned symptoms, give your doctor a call as soon as possible.

Third Stage of Childbirth: Delivery of the Placenta

You made it!

Now, at this point you have delivered your baby and your body’s hormones have shifted tremendously! You may feel overwhelming emotions of joy and exhaustion at the same time. Oxytocin, the bonding hormone, rises sharply to compensate for the drastic drop in estrogen and progesterone. You may find yourself shivering, and this is normal immediately post-giving birth and can last up to one hour.

Delivery of the Placenta

Upright Labor Positions for the Second Stage of Labor

If you missed part 1 in the vaginal childbirth positioning series, go back and read it here.

Childbirth/labor is quite an experience, and it can be scary waiting for the unknown. Being prepared, knowing, and being familiar with different options and labor positions is the best way to approach childbirth to help decrease as much anxiety should surprises arise.

This article will go over specific labor positions that help progress labor, and prevent perineal trauma.

As mentioned in Part 1: Pre-Birth article, it’s important to keep changing labor positions to help progress, preferably in different upright labor positions. As a reminder, the first stage is all about increasing the pelvic inlet to help guide the baby through the mid pelvis and finally towards the pelvic outlet/vaginal canal.

Positioning for the Pre-Birth Stage of Labor

What to Expect and What to Focus On:

If you have been pregnant for many months now, it is time to get ready for your upcoming birth! Similar to a marathon, we need to train for childbirth to prepare the muscles and body for the big event. For this reason, it is a good idea to start practicing being in different positions either with movement or holding a position for a long time. The pre-birth stage of labor involves contractions to dilate and open the cervix. Once the cervix is fully dilated, the second stage includes the passive and active phases of the baby crowning and coming out of the vaginal canal. The third stage involves the delivery of the placenta. We will go over how to best support our bodies throughout your childbirth journey.

Positioning for the Stages of Labor

Practicing and knowing different positions during this first stage can be helpful when pain may escalate. Upright positioning such as: walking, standing, rocking back and forth, kneeling over birthing ball, leaning against wall, holding onto partner are just some of the many, many positions that can be helpful.

Postpartum Pelvic Health Recovery Should Start Day 1.

Here are some tips to help you get your postpartum pelvic health (and general health) back on track:

This article focuses on 5 key techniques you can use to improve postpartum pelvic health. It covers diaphragmatic breathing to activate core muscles and kickstart lymphatic drainage, pelvic floor muscle coordination, posture, and the benefits of a pelvic floor evaluation by a physical therapist to begin improving postpartum pelvic health on day 1. It also provides detailed instructions and references scientific studies to provide further research.