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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:
Therapeutic Breast Massage in Lactation (TBML)
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!
Lightning Crotch in Pregnancy: How You Can Start Recovering from SPD
What is symphysis pubis dysfunction (Lightning Crotch)?
Symphysis pubis dysfunction (SPD), also known as pubic symphysis dysfunction, anterior pelvic girdle pain, or lightning crotch, is a common musculoskeletal condition that is experienced by pregnant women and can vary from minor discomfort to severely debilitating pain. It is typically characterized by discomfort in the front pelvic area that can radiate to the inner thighs and perineum (think where your pubic bone is).
Read more: Lightning Crotch in Pregnancy: How You Can Start...
Running Mechanics and Pelvic Floor Health: The Impact of Footwear
Did You Know That Proper Footwear Can Improve Your Running Mechanics and Pelvic Floor Health?
How Do My Feet Impact My Pelvic Floor When I Run?
If you are a runner, you tend to look for ways to improve your running. If you’re thinking about starting up or returning to running, it can feel intimidating particularly if you have any symptoms related to pelvic floor dysfunction. This only complicates an exercise that, on the surface, seems fairly straight forward. There are some studies that have looked at how your feet can play a part in your pelvic floor muscle function while you run. And if you are looking to return to running postpartum, read on and also check out this article by one of our pelvic floor physical therapists.
Read more: Running Mechanics and Pelvic Floor Health: The Impact of...
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- Written by: Debbie Dy, PT, DPT
- 76 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
- 880 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
- 882 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
- 2033 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...
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- Written by: Kasia Gondek, PT, DPT, CLT, CSCS
- 649 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
- 765 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
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- Written by: Stephany Tritt, PT, DPT
- 620 Views
What do Breastfeeding women need and want? Let's take a closer look.
You’ve had your bundle of joy and you’re working out the kinks of having a new baby in your life and feeding them the best you can. From breastfeeding to return to exercise, there are many challenges that new moms must navigate.
There are a wide range of feeding options, from exclusively breastfeeding to formula/food feeding or a combination of the two. Studies have tried to get a better understanding of what women need in this stage of motherhood, particularly determining what impacts breastfeeding may have on exercise and activity. We know that breastfeeding causes a depression in estrogen which in turn can cause pelvic floor dysfunction like the involuntary leakage of urine with activities such as sneezing, coughing, laughing or exercise defined as stress urinary incontinence. This type of incontinence has been linked to a longer duration of breastfeeding, however its effects are not lasting (Snyder). Breastfeeding people may also have breast-related discomforts such as nipple pain, mastitis, and over/under supply. Any of these symptoms may limit one’s motivation to exercise.
Read more: What do Breastfeeding Women Need and Want? - No One Told...
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- Written by: Debbie Dy, PT, DPT
- 725 Views
Exploring the clinical consequences of Levator Ani Muscle Avulsion
Including its risk factors and current management strategies, including the role of pelvic floor physical therapy
Levator ani muscle (LAM) avulsion is a significant concern in obstetric care, particularly for women undergoing vaginal delivery. This condition involves a tear in the levator ani muscle, which plays a crucial role in pelvic support and function. Avulsion of the levator ani muscle from its insertions has a significant impact on the function of the pelvic floor, often leading to symptoms such as pelvic organ prolapse, urinary and bowel incontinence, and sexual dysfunction.
The Clinical Consequences of Levator Ani Muscle Avulsion
According to Dietz (2012), levator ani avulsion can lead to a range of adverse outcomes, impacting a woman's quality of life. The levator ani muscle supports pelvic organs and maintains continence. When avulsion occurs, this support is compromised, increasing the risk of pelvic organ prolapse, urinary incontinence, and other functional disorders. The severity of these outcomes can vary, but they often necessitate further medical intervention.
Read more: Understanding Birth Injuries: Levator Ani Muscle Avulsion
