
The Femina Physical Therapy Blog
Featuring original articles by our staff about current events and trends
Explore our insightful blog articles on pelvic health, where we delve into essential topics that empower and educate. From understanding pelvic floor disorders to strategies for conquering infertility, our content is designed for those seeking knowledge and support. We discuss the latest research, expert advice, and practical tips to enhance your well-being and foster a deeper connection to your body.
Featured From the Blog:
Why a Multidisciplinary Team is Best for Treatment of Bloating and Abdominal Distension

Bloating and Abdominal Distension Often Benefit Greatly from Multidisciplinary Treatment
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!
Bloating is the sensation of excess abdominal gas or a feeling of being distended without obvious visible abdominal distension. Some people have a feeling of fullness or discomfort in the upper abdominal area. Abdominal distension is the visible increase in abdominal girth. A multidisciplinary treatment team of primary care physicians (PCPs), gastroenterologists, dieticians/ nutritionists, and physical therapists is ideal to help manage these symptoms and find the root cause. For example, symptoms of bloating and abdominal distension affect 66 - 90% diagnosed with IBS. Getting the proper diagnosis can help direct the best treatment options for you.
Read more: Why a Multidisciplinary Team is Best for Treatment of...
Postpartum Sexuality & Mood Changes in Women with Pelvic Girdle Pain

Does my pelvic girdle pain have anything to do with my mood and sexuality?
Many of our patients experience sexual dysfunction and anxiety, depression and chronic pain. These conditions are known to coexist, and we unpack each component of pain, mood and one’s behaviors, desires and attitudes related to sex and physical intimacy.
Pelvic girdle pain is defined as “pain between the posterior iliac crests and gluteal folds particularly in the vicinity of the sacroiliac joint” (Simonds). More simply stated: in the very low area of your back and buttock. Pelvic girdle pain is common postpartum and may impact disability in the fourth trimester. Many are aware of peripartum symptoms such as low back pain, incontinence, pelvic organ prolapse, pain with intercourse, and postpartum depression. Knowing that many women experience pain during and after pregnancy - what can we learn about the effects of pelvic girdle pain? Specifically, what impact does pelvic girdle pain have on symptoms of mood and sexuality?
Read more: Postpartum Sexuality & Mood Changes in Women with Pelvic...
Understanding Relaxin: Why It Doesn’t Cause Pain in Pregnancy

Pregnancy is a time of significant physical and hormonal changes, and among the many hormones involved, Relaxin plays a crucial role. However, there’s a common misconception that Relaxin is responsible for pain during pregnancy. Let’s take a closer look at what Relaxin does and why it doesn’t directly cause pain.
What is Relaxin?
Relaxin is a regulatory hormone involved in growth, metabolism, and tissue remodeling after an injury to our bones, ligaments, muscles or tendons (Dehghan 2014). During pregnancy, Relaxin levels begin to increase in the first trimester to help the body prepare for childbirth by relaxing the ligaments in the pelvis and softening the cervix (Aldabe 2012, Daneau 2014). The ligaments of the pelvis will begin to relax around the 10th-12th week of pregnancy (Aldabe 2012). This process allows for greater flexibility in the pelvic area, facilitating delivery and accommodating the growing baby.
Read more: Understanding Relaxin: Why It Doesn’t Cause Pain in...
The Link Between Autoimmune Diseases and Sexual Dysfunction and How Pelvic Floor Physical Therapy Can Help
Unpublished- Details
- Written by: Kasia Gondek, PT, DPT, CLT, CSCS
- 116 Views

It is not uncommon for patients with autoimmune diseases to come see us because of difficulties with arousal, pain with sex or orgasms, and/or erectile dysfunction. This is because the chronic inflammation that occurs with autoimmune conditions impacts how nerves function, alters blood flow, and can make it difficult to sustain an erection or can cause vaginal dryness.
Additionally, joint pain, muscle aches, and other pain symptoms associated with autoimmune diseases can make sexual activity uncomfortable or painful, and some autoimmune conditions can disrupt hormone balance, impacting sexual desire, arousal and overall sexual function. Autoimmune conditions like lupus, Sjogren’s syndrome, type 1 diabetes and rheumatoid arthritis are examples of systemic autoimmune diseases that can be associated with sexual dysfunction.
Are Autoimmune Conditions Linked to Sexual Dysfunction?: What the Research Says
One meta analysis and systematic review conducted by Minopoulou I, Pyrgidis N, Tishukov M, et al. in 2023 found that 63% of people with a systemic autoimmune rheumatic diseases (like lupus, Sjogren’s, and rheumatoid arthritis) have sexual dysfunction. They found that women with Sjögren's syndrome and systemic sclerosis reported the highest levels of sexual dysfunction.1
Additionally, “A 2024 meta-synthesis of 6 studies involving people with inflammatory arthritis conditions found that sexual function was impacted by pain, lower sexual desire, erectile dysfunction, fatigue, fluctuations in disease activity, altered self-image, and confidence in sexuality, with negative impacts on intimate relationships with partners.”2,3
What Can Pelvic Floor Therapy Do to Help My Autoimmune Condition?
If you have been diagnosed with an autoimmune disease and notice that you have any symptoms of sexual dysfunction, our pelvic health physical therapists can help you! When a person comes to us with sexual dysfunction and also has an autoimmune condition, we take a thorough history of their symptoms, previous treatments, current medications, and current providers. We then conduct an orthopedic assessment that includes screening the spine, hips, legs and feet, as well as any other body regions that may be impacted by the person’s condition.
This may include observation of day-to-day movements such as bending over, reaching, squatting, walking, and balance. Additionally, we check the range of motion and flexibility, muscle and soft tissue mobility and tender points, strength and muscle coordination. This is followed by a pelvic floor assessment, which entails observation of pelvic floor muscle function and tissue health and checking for any trigger points/tenderness in the person’s pelvic floor muscles externally and internally, depending upon the person’s comfort level at that time. The goal of these assessments is to determine what is driving the person’s sexual dysfunction and pain and then target physical therapy treatment toward these areas.
How Long Until I See Results in Physical Therapy?
Each person’s physical therapy treatment plan is unique because no two people are exactly alike! In general, people will begin to see improvements in their pain and functioning in about four sessions, however the complete treatment plan duration does vary from person to person depending upon their symptoms, areas of treatment, and how long symptoms have been going on.
Our Pelvic Health Physical Therapists Are Here to Support You!
All of our physical therapists at Femina have specialized training in treating and healing pelvic pain, sexual dysfunctions, and the associated difficulties with day-to-day functioning that can go along with an autoimmune disease. Our goal is to provide compassionate, evidence-based, and effective treatments to help you feel and function at your best. If you need pelvic floor physical therapy in Los Angeles, contact our office to start getting the care and support you deserve.
Sources:
- Minopoulou I, Pyrgidis N, Tishukov M, et al. Sexual dysfunction in women with systemic autoimmune rheumatic disorders: a systematic review and meta-analysis. Rheumatology (Oxford). 2023;62(3):1021-1030. doi:10.1093/rheumatology/keac457
- Ackerman IN, Restoux L, Dobo B, Slater H, Ross MH, Briggs AM. Holistic Care for People Living With Chronic Musculoskeletal Pain: The Relevance and Importance of Sexual Function. Phys Ther. 2024;104(8):pzae083. doi:10.1093/ptj/pzae083
- Restoux LJ, Dasariraju SR, Ackerman IN, Van Doornum S, Romero L, Briggs AM. Systematic review of the impact of inflammatory arthritis on intimate relationships and sexual function. Arthritis Care Res. 2020;72:41–62. doi: 10.1002/acr.23857.
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- Written by: Anna Larson, PT, DPT
- 104 Views

Physical therapy visits prior to childbirth, often referred to as birth preparation or "push prep" visits, play a crucial role in preparing expectant parents for delivery. These sessions are designed to equip pregnant individuals with the skills, strength, and knowledge necessary for a smoother birthing process. Whether planning for a natural delivery or a C-section, engaging in birth prep can significantly enhance overall birthing experiences and outcomes.
In this article, we will explore the concept of Birth Prep in detail, discussing what it entails and how it contributes to the childbirth process. We'll look into the various benefits of incorporating physical therapy into prenatal care and address the relevance of Birth Prep even for those anticipating a C-section.
What is Birth Prep (Push Prep), and What Can I Expect from my Visits?
Birth preparation with our physical therapists is a program that gets you more comfortable during pregnancy and works on issues that have been identified to optimize your birth experience.
During these classes for pregnant women, your physical therapist will:
- Provide education to the expecting patient about the birthing process
- Alleviate any discomfort related to pregnancy
- Teach you how to get in touch with your pelvic floor muscles
- Provide tools and practices to help prevent severe perineal tearing
- Help prepare the birthing person for a better postpartum recovery.
Why Should Birth Prep Be Included in My Prenatal Care?
The following are five key reasons why birth prep should be included in your prenatal care:
1. Education about Labor
Personally, this is one of my favorite parts of a push-prep visit. We get to take our time discussing what each of the stages of labor entail, helpful movements and positions for each stage of labor, and even how your birthing partner can help during this process.
2. Relieves Common Pregnancy Discomforts
Pregnancy can cause a variety of aches and pains due to hormonal changes, the growing weight of the baby, and changes in posture. Some common issues include:
- Back pain
- Pelvic pain and pelvic girdle pain (PGP)
- Sciatica
- Neck and shoulder tension
- Carpal tunnel syndrome
Get ahead of the pain when it begins, not when you are postpartum and have a whole new human to take care of! Many of my patients are told, “your pain will just go away when you deliver the baby”. Sometimes this is the case, but many times aches and pains can linger or even get worse, and it is best to assess and begin to improve your pain and function in the prenatal period. Techniques such as manual therapy, therapeutic exercises, and posture correction can be helpful.
3. Awareness of the Pelvic Floor
Labor and delivery requires significant physical effort, however, during actual labor, the pelvic floor just needs to get out of the way and let your uterus do its job! During our birth prep program, we teach you how to properly contract, and more importantly, relax your pelvic floor so that coordination of these muscles is automatic to you when the time comes! Physical therapy can also help you strengthen these muscles, as well as your core, back, and glutes to help through the rest of your pregnancy and with postpartum recovery.
- Pelvic floor exercises (like Kegels) can help prepare the muscles for the pressure of labor and delivery, reducing the risk of incontinence both during pregnancy and after childbirth.
- Core strengthening enhances your ability to maintain posture and stability during labor and supports your changing posture during pregnancy.
- Lower back and hip strengthening helps reduce discomfort and improve mobility as the baby grows.
4. Reduces the Risk of Severe Tears During Labor
During a birth prep visit, we will teach you numerous techniques that have been proven in research to help decrease your risk of severe tearing – yay! Severe tears (grade 3 and 4) lead to more complications postpartum, and there is really no downside to incorporating these practices into your prenatal wellness routine. Some of these tools we will go through include:
- Optimal birthing positions to decrease your risk of tearing (Aasheim) through optimal labor positions.
- Breathing techniques both leading up to labor and during labor to decrease the strain on your pelvic floor
- Perineal massage, starting at 34 weeks pregnant have been shown to decrease the risk of severe tears (Beckman, Aasheim). While perineal massage is not a guarantee that you will not tear at all, it can help with the stretching sensation and discomfort of stretch of these tissues to help your body prepare for the sensation during vaginal child birth.
Your physical therapist can also provide instruction on specific birthing positions that will be best for you, depending on any injuries you are dealing with currently. For example, if you have labral tears in your hips, you would be advised on avoiding the classic lithotomy position (on your back with your hips and knees flexed past 90 degrees).
5. Prepares You for Postpartum Recovery
While the focus during pregnancy is often on preparing for labor, physical therapy also plays an important role in preparing for postpartum recovery. Many women experience significant physical changes after childbirth, including pelvic floor dysfunction (such as incontinence of bowel and bladder), abdominal weakness, and poor posture due to the stress of pregnancy and delivery.
By strengthening key muscle groups and maintaining flexibility before delivery, physical therapy can reduce recovery time after birth, improve your strength, and decrease your chances of developing pelvic floor dysfunction, including incontinence. Additionally, it can aid in diastasis recti recovery, a condition where the abdominal muscles separate during pregnancy.
Will Birth Prep Help Me If I’m Having a C-section?
Absolutely! As we discussed above, pelvic floor dysfunction can be identified while you are still pregnant. These issues can be addressed during pregnancy and lay down a better foundation for postpartum recovery. You can learn more about postpartum recovery after a c-section here.
Get Started with Our Birth Prep Program
Pregnancy is a time of immense change, and taking care of your body is crucial for both your well-being and that of your baby. Birth prep offers a range of benefits, from relieving common pregnancy discomforts to preparing your body for labor and helping you recover more quickly postpartum. If you’re expecting, consider adding a birth prep visit or two before your delivery. Your body—and your baby—will thank you! All of our therapists at Femina Physical Therapy are specialized to help you during your pregnancy and beyond. Reach out to get started with our classes for pregnant women!
Resources
Aasheim V, Nilsen ABV, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev. 2017;6(6):CD006672. Published 2017 Jun 13. doi:10.1002/14651858.CD006672.pub3
Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2006;(1):CD005123. Published 2006 Jan 25. doi:10.1002/14651858.CD005123.pub2
Neta JN, Amorim MM, Guendler J, Delgado A, Lemos A, Katz L. Vocalization during the second stage of labor to prevent perineal trauma: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2022;275:46-53. doi:10.1016/j.ejogrb.2022.06.007
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- Written by: Debbie Dy, PT, DPT
- 98 Views

Anorectal symptoms such as hemorrhoids, anal fissures, and anal pain are common during pregnancy and the postpartum period and can have a negative impact on one’s quality of life. They can be one cause of uncomfortable pain in the butt and anal area, but read on—there is hope!
This article will go over:
- Statistics related to hemorrhoids, anal and rectal pain during pregnancy
- Contributing factors to hemorrhoids, anal and rectal pain
- Birth Prep to improve your delivery experience
- How pelvic floor physical therapy can help!
How Common Are Hemorrhoids During Pregnancy?
The incidence of symptomatic hemorrhoids during pregnancy varies between 24-38%, increasing to 85% in the last trimester. Hemorrhoids are also very prevalent in the first 3 months postpartum, with the prevalence increasing with age and parity (the number of times you’ve delivered).
How Did I Get Hemorrhoids?
Many factors contribute to the development of hemorrhoids, including various musculoskeletal, hormonal and circulatory changes that occur during pregnancy.
- Increased intra-abdominal pressure compresses the pelvic veins, the inferior vena cava, and results in venous dilation (swelling or widening of the veins)
- Increased progesterone levels also lead to venous dilation and swelling
- Increased tension at symphysis pubis caused by high progesterone levels
- Physiological changes in blood volume that increases by 25-50% during the third trimester
Constipation increases the risk of hemorrhoids during pregnancy and prevalence of constipation in pregnancy by 11 to 38%.
Sex hormones are a large factor contributing to high rates of constipation in pregnancy, especially in the first trimester.
- Rising levels of progesterone cause relaxation of smooth muscle which leads to decrease in bowel motility.
- This, combined with growth of the fetus prevents movement of feces through the bowel, making defecation mechanically difficult.
- Prolonged straining during defecation due to constipation leads to an increase in intra-abdominal pressure, contributing to hemorrhoids.
Other factors that contribute to the development of hemorrhoids:
- High body mass index (BMI)
- Iron supplementation
- Hypermobility associated with connective tissue disorders
- Low fiber and water intake
- Sedentary lifestyle
- Higher number of pregnancies
- Increased anxiety and/or depression (due to nervous system effects)
Previous prolonged delivery, higher birth weight of more than 8.5 pounds, traumatic second stage of labor all additionally contribute to increased risk of postnatal hemorrhoids and anal fissures.
The Role Of Pelvic Floor Physical Therapy (PFPT)
Pelvic floor physical therapy for hemorrhoids, anal fissures and rectal pain focuses on relaxation of tight (or hypertonic/overactive) muscles, education on proper bowel mechanics and strategies to improve bowel movements, nervous system downtraining exercises (include Vagus nerve activation), restoring postural alignments, strengthening weak muscles and rehabilitating other aspects of the pelvic floor muscles. The pelvic floor muscles support the uterus, bladder, and rectum and when dysfunctional, can lead to developing hemorrhoids, anal or rectal pain. Pelvic Floor Physical Therapy can be instrumental in managing and alleviating hemorrhoid and other symptoms during and after pregnancy.
Benefits of Pelvic Floor Physical Therapy for Hemorrhoids
- Improved Circulation: Pelvic floor exercises can enhance blood flow in the pelvic region, reducing swelling and discomfort associated with hemorrhoids.
- Strengthening Pelvic Muscles: A stronger pelvic floor can improve management of intra-abdominal pressure, potentially preventing the development or worsening of hemorrhoids.
- Enhanced Bowel Function: PFPT can address constipation by promoting better bowel habits and reducing straining during defecation.
Teaching Optimal Labor and Delivery Positions
An often-overlooked benefit of pelvic floor physical therapy is the education it provides regarding labor and delivery positions. Prolonged labor can increase the risk of hemorrhoids due to sustained pressure on the pelvic floor region. Our physical therapists can teach positions that:
- Reduce the risk of prolonged labor by promoting effective pushing strategies.
- Minimize strain on the pelvic floor muscles, thereby decreasing the likelihood of developing or worsening hemorrhoids during delivery.
- Encourage proper alignment and relaxation to facilitate a smoother birthing process.
- Reduce risk of perineal tearing
Conclusion
Hemorrhoids and anal and rectal pain are a prevalent issue during pregnancy and the postpartum period, influenced by factors such as age, multiple pregnancies, and constipation. Pelvic floor physical therapy offers a non-invasive, comprehensive approach to manage symptoms, prepare for labor, and protect pelvic health.
If you're pregnant or postpartum, consulting with a pelvic floor physical therapist can provide personalized strategies for symptom relief, improved bowel habits, and labor preparation, ultimately enhancing your comfort and quality of life. Contact us at Femina to get the pelvic health solutions you deserve!
References:
- Gülören, Gülbala PT, PhD, Çınar, Gamze Nalan PT, MSc, et al. Hemorrhoids, Anorectal Symptoms, and Related Risk Factors in Pregnancy and the Postpartum Period: A Follow-up Study. Journal of Women’s & Pelvic Health Physical Therapy 48(3):p 184-193, July/September 2024. | DOI: 10.1097/JWH.0000000000000308
- Longo SA, Moore RC, Canzoneri BJ, Robichaux A. Gastrointestinal conditions during pregnancy. Clin Colon Rectal Surg. 2010;23(2):80–89. doi:10. 1055/s-0030-1254294.
- Bužinskiene D, Sabonyte-Balšaitienė Ž, Poškus T. Perianal diseases in pregnancy and after childbirth: frequency, risk factors, impact on women’s quality of life and treatment methods. Front Surg. 2022;9:788823. doi:10. 3389/fsurg.2022.788823
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- Written by: Anna Larson, PT, DPT
- 956 Views

Are Crunches for Diastasis Recti Abdominus a Good Idea? Let's Discuss.
What does the most recent evidence say about the best exercises to rehab from DRA?
Diastasis recti abdominis, more commonly seen as DRA, is an extremely common condition that occurs in almost 100% of pregnant women, and is still present in about 32% of women 12 months postpartum (Theodorsen et al).
This article covers:
- The definition of a Diastasis Recti Abdominus (DRA)
- How to know if you have a DRA
- Dispelling myths about abdominal exercises during pregnancy and postpartum
Read more: Crunches for Diastasis Recti Abdominus (DRA): To Crunch Or...
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- Written by: Anna Larson, PT, DPT
- 958 Views

Learn How Orgasm Improves Postpartum Pelvic Floor Function
Try a naturally occurring strengthening method
Many factors come into play when considering resuming to sexual activity postpartum. Individuals who have just given birth are not only faced with potentially new physical aches and pains, but also shifting family and partner dynamics, which all play a role in painful sex and lowered sexual desire.
One study reported both of these common postpartum conditions as prevalent as 22% experiencing painful sex and 86% experiencing loss of desire2. It is common in postpartum rehabilitation to be prescribed specific pelvic floor exercises in order to help strengthen the pelvic floor.
Read more: How Orgasm Improves Postpartum Pelvic Floor Function
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- Written by: Kasia Gondek, PT, DPT, CLT, CSCS
- 2093 Views

Bloating and Abdominal Distension Often Benefit Greatly from Multidisciplinary Treatment
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!
Bloating is the sensation of excess abdominal gas or a feeling of being distended without obvious visible abdominal distension. Some people have a feeling of fullness or discomfort in the upper abdominal area. Abdominal distension is the visible increase in abdominal girth. A multidisciplinary treatment team of primary care physicians (PCPs), gastroenterologists, dieticians/ nutritionists, and physical therapists is ideal to help manage these symptoms and find the root cause. For example, symptoms of bloating and abdominal distension affect 66 - 90% diagnosed with IBS. Getting the proper diagnosis can help direct the best treatment options for you.
Read more: Why a Multidisciplinary Team is Best for Treatment of...
- Details
- Written by: Kasia Gondek, PT, DPT, CLT, CSCS
- 683 Views

Learn These Simple Exercises For Pregnancy Related Carpal Tunnel Relief
During pregnancy, swelling is a common occurrence.
Swelling of the legs, feet, and ankles is common, but also the wrists and hands! Over time, this can cause compression, inflammation, and irritation of the median nerve that passes through the carpal tunnel of the wrist (which is on the palm-side of the wrist). This compression and irritation is called carpal tunnel syndrome (CTS). Carpal tunnel syndrome (CTS) is common in pregnancy due to the extra fluids retained in the body, as well as hormonal changes causing increased flexibility of ligaments and joints in the body. It is estimated that between 19 to 70% of pregnant people experience carpal tunnel syndrome, and 47.5% of those people have carpal tunnel syndrome in both wrists. It is more common in the third trimester, accounting for 63% of cases.1
Read more: Pregnancy Related Carpal Tunnel Relief - Exercises for...
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- Written by: Kasia Gondek, PT, DPT, CLT, CSCS
- 820 Views

What to Know if You're Experiencing Lower Abdominal Pain with Orgasm
Read on for Common Causes and Solutions
Pain with orgasm or climax is called dysorgasmia, and it can be caused by physical, emotional and/ or psychological factors. Typically dysorgasmia is felt as pain with climax in or around the lower abdomen or clitoris, but symptoms can feel different from one person to the next. Due to a lack of research on female dysorgasmia, it is unknown how many vulva-owners experience pain with orgasm. However, around 3 in 4 people with a vulva have experienced pain with vaginal penetration (called dyspareunia) at some point in their life, according the American College of Obstetricians and Gynecologists (ACOG).
Read more: Lower Abdominal Pain with Orgasm - Female Dysorgasmia