During this time of "safer at home" orders, we have been having to find more creative ways to move at home.

If you are someone that experiences urinary incontinence and/or pelvic organ prolapse you may not be going out now to see a pelvic health physical therapist to guide you through a routine. In this blog post I’m going to go over a few mat pilates exercises I like to do with patients that experience urinary incontinence and/or pelvic organ prolapse (POP). A study done in 2018 by Lausen et al, found that in the group that did mat pilates with standard physical therapy had more positive outcomes with their urinary incontinence, as well as, quality of life. 

Babyboomers.com Says "Let’s Talk About Bladder Leaks", So Here We Go!

For many women, aging can present a variety of expected and unexpected hormonal and physical changes, including bladder leaks.

As a Doctor of Physical Therapy, I frequently see women come in with questions regarding bladder leaks and how to strengthen their pelvic floor. The pelvic floor is located between your tailbone and the pubic bone, and it plays an important role in supporting the bladder, bowel, uterus and vagina.

November is Bladder Health Month, Which Means Preventing Urinary Incontinence!

Urinary incontinence is very common, affecting up to 1 in 3 women. Despite some common beliefs, leaking urine is not a normal part of aging and can be treated,especially with the help of a pelvic floor therapist. Today we’ll cover some common contributing factors that you can be mindful of to prevent urinary incontinence.

What is Urinary Incontinence?

Questions You Are Too Embarrassed To Ask When it Comes to "Down There"

We asked the BuzzFeed Community if they ever had a question about ~down there~ that they might be too embarrassed or intimidated to ask, and they came through with lots of insightful questions! So, we reached out to Dr. Heather Jeffcoat, DPT, a licensed pelvic floor physical therapist and owner of Femina Physical Therapy in Los Angeles, to answer your pelvic health inquiries.

Here is a sampling of the questions you are too embarrassed to ask:

1. "Why do I have to pee so often? I barely drink any liquids throughout the day, because otherwise I’d be peeing even more than I already am."

What's the Link Between Urinary Incontinence and Postpartum Depression?

Postpartum Depression is a medical illness that negatively affects how you feel, the way you think, and how you act.

It typically arises due to a combination of hormonal changes, psychological adjustment to motherhood, and fatigue. Postpartum depression is said to affect between 5-20% of mothers depending on variable socioeconomic factors. Many people associate urinary incontinence as a common postpartum symptom. Prevalence of postpartum urinary incontinence figures vary due to diverse study formats, however it is predicted that bladder leakage is experienced in a quarter to half of all postpartum women.

In recent years, studies have concluded there is a strong link between both postpartum depression and urinary incontinence postpartum.

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. 

Worried About Exercise and Urinary Incontinence?

Don’t let your New Year's workout make you leaky!

With new year’s resolutions, a lot of us will be starting new workout routines to shape up. While exercise is a cornerstone of physical health, a little talked about side effect of increased athletic training, particularly for those with female anatomy, is urinary incontinence. A comprehensive literature review published March 2018 in International Urogynecology Journal found that female athletes have an increased the risk for urinary incontinence.

Discover the Ways Urinary Incontinence and Weight Are Linked

Today, let's delve into the intricacies of bladder leakage, commonly known as urinary incontinence (UI)

Balancing health and weight involves various factors, both intrinsic and extrinsic, making it a complex aspect of well-being. As a pivotal metric for assessing health, weight is not only a symptom but can also act as a causative factor for various health conditions.

According to the Centers for Disease Control and Prevention (CDC), in 2023, a staggering 41.9% of adults in the U.S. are affected by obesity, accounting for $173 billion in annual healthcare costs. While the implications of being overweight on cardiovascular and mental health are widely known, we explore whether it can also impact pelvic floor health, especially in the context of urinary incontinence.

Many people start like to start the new year off with exercise regimens and plans to lose weight.

Unfortunately, often times women who start exercise programs to lose weight also lose their ability to control of their bladders and experience urine leakage during physical activity, otherwise known as stress urinary incontinence (SUI).

So what makes certain exercises more leak-prone? Which exercises put less stress on your pelvic floor? Read on to find out.

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. 

Why Kegels Are Not the Only Option for Treating Incontinence

Femina Physical Therapy is rapidly becoming recognized as a leader in the field of physical therapy for women of all ages, and pelvic floor therapy in particular. As a result, Femina PT founder Heather Jeffcoat, DPT is finding herself in demand more than ever for her valuable insights into a number of pelvic floor related topics.

In this case the discussion centers around how kegels are not the only option for every pelvic floor issue that women often face.

In this article we’ll discuss how to assess if you may have a weak pelvic floor, what symptoms are and basic orientation to the pelvic floor.

What is the pelvic floor? 

The pelvic floor is a very important group of muscles that live in the bottom of the pelvis. Both men and women have a pelvic floor. These muscles sit in the bottom of the pelvic floor like a hammock, and can move up and down like a trampoline to support your internal organs inside your body. They also help to control the openings and closures in the bottom of the pelvis, which is why they are so essential to urinary, bowel and sexual function. Just like any muscle, when they are weak, they can start to cause issues with any of these functions. Common signs of a weak pelvic floor include urinary incontinence, fecal (or bowel) incontinence, feeling of pelvic heaviness or pelvic organ prolapse, as well as low back or hip pain.

Learn How Obesity Increases Urinary Incontinence and How Pelvic Floor Therapy Can Help

Urinary Incontinence is common, why suffer?

Urinary incontinence is the loss of bladder control.Urinary incontinence affects up to 1 in 3 women. The two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence (also called overactive bladder, or OAB). Incontinence affects twice as many women as men. This may be because pregnancy, childbirth, and menopause are contributing factors to urinary incontinence. Urinary incontinence should not be considered a normal part of aging, and it can be treated.

A new article published in September, 2018 by Lamerton, Torquati, & Brown found that being overweight (BMI 25-30) increased risk of urinary incontinence for young and middle aged by 35% and obesity (BMI ≥30) almost doubles the risk at 95%.

Did you know that when you sing you are not only using your vocal chords, but also the lungs, the diaphragm, the abdominal muscles, and also the pelvic floor?

It’s no surprise that the body is all connected, as in it’s one whole unit, but it’s easy to forget that an activity like singing is a dynamic and complex way we use our bodies. In a 2018 literature review, voice researchers Emerich Gordon & Reed refer to this YouTube video by osteopathic practitioner Roger Fiammetti which beautifully shows how the simple act of breathing involves not just the lungs, but the muscular system from the face and neck down to the bottom of our pelvic floor and the perineum, the video also outlines how the body has four diaphragms which help regulate air and fluid pressure throughout the body.

In fact, look at the structural similarities of the vocal chords and the pelvic floor:

Bladder Health Month and the Great American Smokeout - November 21st

In honor of both, today we are going to cover the damage that smoking nicotine products and tobacco use can do on the bladder.

Doctors have known for decades that smoking affects lung and heart health, greatly increasing risk of both lung cancer and heart disease. In recent research, they have been finding that smoking increases risk to various urologic diseases as well.

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. 

Incontinence is the inability to control bodily functions resulting in the loss of urine or feces.

Physical therapy treatments are important to restore the normal bladder and bowel functions through strengthening, use of behavioral modification strategies, correction of faulty patterns and habits and use of biofeedback and electrical stimulation as appropriate to enhance pelvic floor rehabilitation.

Types of incontinence include:

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

"Girls’ Night Out" Showcased InControl Medical's Fabulous Products

Hosted by Femina PT at LA's Big and Tiny

Three expert speakers chatted and answered questions on female pelvic and sexual health. One of our major sponsors was InControl Medical, the creators of one of my favorite product lines for urinary, bowel and sexual dysfunction. They have three different products that are focused on these basic necessities of female health and wellness.

“I do Kegels, but they don’t work”

International Journal of Childbirth Education, June 2009

Heather Jeffcoat, DPT

Post-partum urinary incontinence is a common problem. But is it normal to experience urinary incontinence after you've delivered a baby?

There is a typical history I encounter in my practice—“I’ve had two kids and now whenever I laugh or sneeze, I experience urine leakage”. But it’s normal, right? I always tell my clients that the problem may have arisen because of childbirth, and maybe all of their friends giggle about this unfortunate consequence of having a beautiful and perfect baby. But it is not NORMAL—there is something you can do (other than surgery or medication) to get your pelvic floor muscle function back to normal. And it’s more than doing just Kegels.

Lasers And My Vagina - Do They Really Belong Together?

A Breakdown of common Energy Based Devices Marketed for your Vagina

Risks and Possible Benefits

In the past decade, nonsurgical devices using radio-frequencies, lasers, and infrared light have been marketed as non-invasive treatments for “vaginal rejuvenation.” However, there has been conflicting opinion among the medical community as to what the lasers have evidence of treating. The rampant use of the lasers to treat conditions they have not been approved to treat has also caused the Food and Drug Administration to warn the public about these devices in 2018.

Everyone Has to Pee... Should You Use a Squatty Potty?

A squatty potty or toilet stool can make it easier to have a bowel movement, particularly if you're dealing with constipation. But is it worth sitting on one just for peeing too?

The answer is yes.

A deep squat position or feet on a toilet stool is preferred for both urinating and bowel movements,"

says Heather Jeffcoat, DPT, owner of Femina Physical Therapy in Los Angeles and President of the Academy of Pelvic Health Physical Therapy.

Here's why it helps, and how to know if you need one.

First some facts about pelvic floor dysfunction:

• Nearly one in two women experience painful sex.
• One in three women suffers from urinary incontinence.
• 40% of all women and 50% of childbearing women have pelvic organ prolapse.

Because I’m a fan of scientific data, this isn’t the first time you’ve seen the truth by the numbers in this space.

Rarely, though, do I get to talk about a ‘study of many studies’ like the one published in Sexual Medicine Reviews.

Involuntary loss of urine during athletics is more common than you thought

Athletic incontinence is a type of stress incontinence that happens during an athletic event. Stress incontinence is an involuntary loss of urine due to a pressure or force like coughing, sneezing or jumping. When most people think of urinary incontinence they do not usually picture young athletes, however it is surprisingly common.

A study of young, elite athletes found 43% experienced urinary leakage while participating in their sport. The study also investigated which sports had higher incidences of incontinence:

September is Healthy Aging Month!

Curious about pelvic floor physical therapy for menopause? Read on.

You’ve probably already considered a visit to your primary care doctor and your gynecologist. But what about pelvic floor physical therapy for menopause?

About 6,000 women enter menopause every day in the US, usually between the ages of 45 and 55; and as life expectancy increases, so does the number of years most women will spend on the other side of it. Approximately half of all women can expect to live 40% of their lives in the post-menopausal stage. It makes sense to develop a solid strategy for optimal health, the earlier the better – and regular physical therapy can be an important component of that plan.

Can pelvic floor therapy for bowel urgency and incontinence help you?

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.

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. 

What are Pelvic Organ Prolapse and Urinary Incontinence?

What is the biggest risk factor for both conditions? And how can you tell if you have them?

Not sure? You’re not alone. In fact, one research study found women actually know more about erectile dysfunction than they do about pelvic organ prolapse! While pharmaceutical company advertising bias may be to blame for part of that equation, one of the largest surveys of pregnant women and new moms ever conducted on the subject (by a team of medical experts in New England) reveals women’s healthcare providers consistently miss their biggest window of opportunity to educate patients about these conditions and offer treatment strategies that work.

Learn Why Peeing Just In Case Isn't Such a Great Idea After All

We make lots of ridiculous choices regarding sleep. As a kid, we might have snuck under our covers with a flashlight and read Powerpuff Girls chapter books, and later we went to slumber parties and competed to see which seventh grader could keep their eyes open til morning. As youngish adults we had many (maybe too many) late-night/early-morning study sessions or drunk-fests. And as a parent, you (like me) may have stayed up well past bedtime to be blissfully alone, curled up with a pint of Cherry Garcia and a book of sudoku puzzles. We definitely needed more hours to snooze—but there was no way we were trading our *bedazzled* nightlife in favor of practicing smart sleep hygiene.

You feel it coming, but you can’t stop it; that twitch in your pelvic floor perfectly timed to your sudden cough or sneeze, or the confirmation you’ve pushed that pigeon pose a little too far. Stress Urinary Incontinence (SUI) – involuntary leakage that occurs with increases in intra-abdominal pressure – is one of the more frustrating and embarrassing hallmarks of womanhood, the inescapable tradeoff for motherhood or a satisfying workout.

Yoga for Urinary Incontinence is a Thing

By Kasia Gondek PT, DPT, CSCS, certification in Yoga for Pelvic Pain through the Herman and Wallace Pelvic Rehabilitation Institute

When I am working with fitness or physical therapy clients, I often incorporate mindfulness, breathwork, and yoga postures (asanas) into our sessions together to cue pelvic floor muscle awareness. For thousands of years, yoga has been practiced daily as a discipline for the mind, body, and community to restore balance and overall health. Yoga has been shown to be useful in reducing anxiety, perceived stress, and autonomic nervous system imbalances that are risk factors for urinary incontinence. Yoga postures can improve and maintain general lower extremity and core muscle strength, balance, and conditioning, which has been shown to protect against incontinence in older females.¹ An estimated 15 - 40% of females in their 40s to 60s experience some form of urinary incontinence.²

The latest literature review conducted by Mazur-Bialy et al. (2020) shows the most modern methods of pelvic floor physical therapy that can help with urinary incontinence.

Here at Femina PT, we pride ourselves in keeping up with the current best practices and latest techniques. Here’s a breakdown of the latest techniques and how we utilize them at the clinic.

What is urinary incontinence?

Urinary incontinence refers to the involuntary loss of urine, which can range from a few drops (also called light bladder leakage) to complete loss that wets the floor. There is actually more than one kind of urinary incontinence: the two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence (also called overactive bladder, or OAB).

There really is an app for everything… even pelvic floor exercises!

And research proves supervised pelvic floor home exercise programs can reduce treatment time and result in significant improvement over in-office therapy alone.

So why don’t all my patients have pelvic floor apps? Especially at the beginning of treatment, those exercises can be difficult enough to squeeze into a daily schedule without the added anxiety of scrolling through hundreds of options to find an affordable and reliable one; and no one wants to base sensitive healthcare decisions on anonymous user reviews.

Wouldn’t it be great if a medical expert could cut through all the clutter?

Yes, Physical Therapy for Urinary Incontinence is a Thing

Urinary Incontinence Under the Radar: Part 1

November is Bladder Health Awareness month, and Femina PT would like to shine light on something that tends to go understated, unaddressed, brushed off as “normal”: urinary incontinence. This blog series focuses on the various effects that urinary incontinence (or UI) leaves on an individual’s life, and how conservative physical therapy treatment can help combat them. Lucky for you, reader, we love to talk about it.

The story goes like this - urinary incontinence is thought to be something expected with getting older, or something that occurs during pregnancy or as a result of delivery. Because of the embarrassment and shame that surrounds such issues, patients often don’t share these problems with their provider. Or worse, if they do share, they may be dismissed as their symptoms being a normal consequence of their stage of life. There is also a lack of awareness for conservative treatments such as pelvic floor physical therapy for these issues. Patients may fear surgery, medication, routine visits, and avoid talking about it all together. However, pelvic floor physical therapy for urinary incontinence can save patients time, money, and psychological distress. The numbers speak for themselves. Up to 45% of adults with bladder control problems fail to seek care.

More About Urinary Incontinence and Physical Therapy

Urinary Incontinence Under the Radar: Part 2

Welcome back for Part 2! November is Bladder Health Awareness month, and Femina PT would like to shine light on something that tends to go understated, unaddressed, brushed off as “normal”: urinary incontinence. In this blog series we’ve been addressing the various effects that urinary incontinence has on an individual’s life, and how conservative physical therapy treatment can help combat them. If you missed last week’s article, you can find it here.

Last week, we went over a lot of statistics. Urinary incontinence is without a doubt a healthcare crisis and places an enormous burden on the individual and their family members. Urinary incontinence, and the related sequelae, is expensive, isolating, and poses the risk of delirium, falls, pressure ulcers, and abuse.

A recent study connects anxiety, urinary incontinence and depression in women

What is urinary incontinence?

Urinary incontinence refers to the loss of urine, out of your control. There is actually more than one kind of urinary incontinence: the two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence (also called overactive bladder, or OAB).

• Stress Incontinence: urine leaking with physical activity - sneezing, coughing, laughing, lifting, pushing/pulling, jumping.
• Urge Incontinence: urine leakage that is coupled with urgency to go- leaking while you’re in line for the toilet, leaking/urgency when you’re parking your car in the driveway, putting the key in the door, fumbling with your pants, etc.
• Mixed UI: a combination of stress and urge symptoms

5 Ways That Enduring the Pandemic and Bladder Health Are Related

It has taken a toll, but here are a few tips on what you can do about it

As pelvic health specialists, bladder health is one of our main areas of focus here at Femina PT and Fusion Wellness PT, and as this article at Well + Good states:

Our society has finally started to show some improvement in acknowledging the importance of having open, public conversations about bladder health—including the many ways that your urinary system impacts your lifestyle on a day-to-day basis—over the last several years."

The article touches on the root causes of bladder issues, how these causes were exacerbated by the fears that arose from the pandemic, and even disposable underwear for those dealing with urinary incontinence. It also asks the question "Has something changed for the worst in the broader scope of people's bladder health?" The answer to this is multi-faceted, and Hannah Schneider does a great job of analyzing each one of these facets.

‘I’m a Pelvic-Floor Therapist, and This Is Why You Should Not Stop Your Flow Mid-Pee’

There's a strong chance someone in your life has either done or suggested Kegel exercises to you. You may have stumbled on Kegel advice through platforms like this TikTok. Or maybe you've googled Kegel exercises because you're dealing with bladder leakage. It can seem like Kegel exercise advice is everywhere, but there's a lot about this seemingly simple exercise that people do wrong. So, if you've heard you should do Kegels while peeing to assess your pelvic floor prowess, it is not the sagest advice.

What are Kegels?

Kegels are a contraction of the pelvic floor muscles, sometimes referred to as “PC Contraction”. PC is short for “pubococcygeus”, the name of one of the many pelvic floor muscles.

However, after over a decade of practice, I have found that simply telling a patient to “Do Kegels” is usually not enough. Often, women perform pelvic floor exercises incorrectly, or do not do an amount appropriate for their strength levels. This finding has been confirmed by Bump et alin an August 1991 article from the American Journal of Obstetrics & Gynecology, “Assessment of Kegel pelvic muscles exercise performance after brief verbal instruction”.

Every person with a uterus will experience menopause during their lifetime.

Genitourinary syndrome of menopause (GSM) is a term that describes the different genital, sexual, and urinary signs and symptoms that can occur during menopause.

The symptoms of GSM can greatly affect quality of life, so it is important to be aware the signs so that you can seek out appropriate care and support from your healthcare team.

What is pelvic floor physical therapy?

When you are suffering from neck or shoulder pain, it is common to go see a physical therapist to help correct any issues with like alignment, movement, strength, and flexibility to reduce pain and improve function. Pelvic floor physical therapy is performed by physical therapists with advanced training to help correct those same issues in the pelvis, lower extremities, spine, and abdomen.

Pelvic floor muscles: What are they?

The inside of the pelvis is lined with muscles referred to as the pelvic floor muscles, these muscles are made of the same types of muscle tissue as other parts of the body, like the neck or shoulder. Similarly, the pelvis is home to ligaments, nerves, fascia, and bones, just like other parts of the body. Pelvic floor physical therapy utilizes an inegrative approach to get all of these functions working together as they should.

Have You Ever Asked "What's Up Down There, Doc?"

Pelvic floor physical therapy is one of the best kept secrets in medicine.

I was on a recent plane flight and sat next to two women that were very chatty with one another. They quickly swept me up into their conversation. Inevitably, in situations like this, everyone asks “So what do you do for a living?”. My answer used to be “I’m a physical therapist”. The past couple of years, my standard response is “I’m a physical therapist, but let me tell you about what kind of physical therapist I am”. Then I go into the diagnoses I treat related to bowel, bladder and sexual health and, in general, how I treat them. Across the board, their reaction is a mix of astonishment and genuine interest. The follow up dialogue is always eye-opening for them, and more often than not, they will report either knowing someone close to them as having one of these pelvic floor issues, or they have it themselves.

Learn How Yoga Reduces Urinary Incontinence in Older Women 

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.