We all know about the negative effects that stress has on our body and on our mental health, however can it actually make your pelvic floor symptoms worse?
As it relates to the pelvic floor, when we are stressed a few things happen:
The diaphragm is controlled by the Vagus nerve which when stimulated activates our rest and digest nervous system and therefore has a calming effect. Thus, diaphragmatic breathing is often one the of the first things that we try with patients to get their nervous system to calm down. Although breathing sounds like an easy exercise, it often is very challenging. Many times, if a patient has been dealing with long-standing stress, their body has adapted to it. This could result in tightness in certain muscles and joints, making proper diaphragmatic breathing a challenge.
There is a close relationship between diaphragm use and pelvic floor muscle use. So, when you inhale, your diaphragm goes down and your pelvic floor relaxes. One exhale, your diaphragm goes up and contracts (slightly). Without using the diaphragm to breathe, the pelvic floor doesn't move with each breath. This can create and contribute to a rigid, tight pelvic floor.
If you are struggling with pelvic pain or pelvic floor dysfunction, that is worse when you are stressed, there is good reason for it.
Running postpartum is a very a realistic goal, and it is totally attainable moms who are experienced runners, or are new to running. Just know that running postpartum often feels different than running in your pre-baby state.
Oftentimes, postpartum seasoned runners get back into running too fast. Typically, if there aren't any medical issues, moms will get clearance to slowly resume "normal activities” at their 6-week, follow-up appointment with the OB-GYN. But do these activities include running? And what about any instructions on how to run, or how much to run after having a baby?
Just because you got medical clearance to resume normal activities, doesn't necessarily mean you should return to running, even if it doesn’t hurt. In general, researching is showing that in order to allow for pelvic floor healing, you should wait until about 12 weeks until you begin running again after baby. I know that to a runner, this sounds crazy! As a runner myself, I know that running is more than a physical activity, it is a mental one too. Often, runners need that run in order to decompress.
Short term rest, to allow for prevention of long term problems.
The pelvic floor stretched 300% during vaginal births, and Cesareans are MAJOR abdominal surgery. You wouldn’t rush back into running after an ACL injury, so give your body time to heal so that you can prevent pelvic floor dysfunction later.
Just because running isn’t suggested, doesn’t mean walking is out. Typically you can start on a light walking program once you feel comfortable, at around 4 weeks postpartum. In addition to walking, strength training is one of the best things you can do to help your recovering postpartum body.
There are several things that we like to make sure that you can do before starting to run again postpartum. With all of these, you don’t want to have any pain, heaviness, incontinence or pressure symptoms.These include:
If you just had a baby, you endured pelvic tissue changes and injury. And, just like an athlete who sustained a sports injury, you should have a specialist by your side to help you return safely to running and an active lifestyle. If you are having difficulty with getting back into fitness, postpartum, don’t hesitate to reach out!
What does your morning routine look like? Does it involve you rushing around and trying to make breakfast for the kids, while drinking a quick cup of coffee, then taking a quick shower? What about breakfast? Do you usually eat it on the go or maybe skip it all together?
What if I told you that a key to a healthy pelvic floor involved a good solid morning routine? One which wasn’t too rushed, and one in which you had a nice, predictable schedule? Our bodies are creatures of habit, the more predictable and less stressed your morning, the better your body will function and thus the better you will feel.
One of the pieces of advice that I often give my clients is that it is important to take your time in the morning. Sometimes that means getting up a little earlier than you would have liked. I know that with little ones, that can often be hard. Especially if one (or more!) of your little ones decided they didn’t want to sleep at night. I encourage parents to try to avoid going to bed too late, so your chances of being able to wake up earlier, are better.
Trying to go to sleep and wake up at the same time everyday is a start. Try to get up at a time that is early enough so that it gives you plenty of time in the morning, but not too early that you feel sluggish for the rest of the day. This will differ for each person, depending on what your days look like.
The basic to do’s of your morning routine should include:
So, as hard as it is, it is very important that we give ourselves the time our bodies need in the morning. This will help you feel less bloated throughout the day, and will help you be on your way to a happy, healthy pelvic floor!
In the era of coronavirus, people are doing everything from home and that includes working out. When it comes to workouts, people have been trying to “figure it out” on their own, or are utilizing online apps to help guide them through their workout. Peloton stock has skyrocketed and there is a 9+ week turn around time from purchase to delivery of the beloved peloton bike.
When it comes to working out and being physically active, I am a total advocate for doing whatever it is that make you feel good. I, like many of the clients I see get very set in my ways. I do the same workouts, I use the same equipment and working out from home has only made this worse. One of the many benefits of actually going to the gym, and/or having a trainer is the amount of variability that your workout can consist of. This variability is KEY to maximizing gains from your workout, as well as preventing overuse injuries.
Now don’t get me wrong, I LOVE doing indoor cycling. I love the fact that I can hop on my bike and do a workout in 30-45 minutes, sweat to the gills, shower and get back to my life. However, our bodies need variability. Do you ever notice how your butt is so sore after starting and increasing your indoor cycling (or outdoor cycling) routine?
This butt soreness is actually local inflammation and irritation to a bone called your ischial tuberosity (of sit bone). Around this bone, wraps a nerve called the pudendal nerve. Typically, irritation to the ischial tuberosity and pudendal nerve is brief, and goes away within a couple hours to days. However sometimes, this irritation is long lasting and only gets worse with the more cycling that one does.
The pudendal nerve gives muscle function and sensation pelvic floor and sphincters of the anus and urethra. Irritation of the pudendal nerve can cause a vast array of symptoms including:
If you have recently started increasing your indoor cycling frequency, or added it to your routine and are starting to develop the above symptoms, the best thing to do is to hold off on cycling until your symptoms subside. Remember, when it comes to working out, variability is key, in order to prevent injuries. If you are having trouble navigating your new workout routine, it’s okay to ask for help! Feel free to reach out to a physical therapist or certified personal trainer to make sure you are avoiding doing yourself more harm than good!
Pregnancy hormones result in increased flexibility of our joints and cartilage. Due to the complexity and high cartilage content of our pelvis, this increased flexibility is often most noticeable in our hips and pelvis. As a result, our body relies more on our muscles, in order to give us stability. If we have muscle imbalances prior to pregnancy, these imbalances might become more noticeable during pregnancy. If our body is unable to recruit muscles in order to give the joints more stability, pain often will occur.
The pubic symphysis is a cartilage plate that sits in the front of the pelvis and joins the two sides of our pelvis together (see picture below). Typically, this joint is very stable. However, due to its high cartilage content, during pregnancy, hormone changes can cause increased movement and thus pain, at this joint.
Often women will report pain is worse with any activity in which the legs are separated from one another. Activities that commonly will cause increased pain include:
Often, the pain is very transient and brief, however it can be extremely sharp. Many women become very cautious with moving due to fear that the pain will occur.
It is highly recommended that anyone experiencing pain in the pubic symphysis be evaluated by a pelvic floor physical therapist. It is important to assess muscle imbalances and joint restrictions that could be resulting in increased pain, as well as discuss activity modifications in order to decrease stress through the pubic symphysis. Sometimes, a therapist will recommend a stabilization belt which helps to give some compression to the two sides of the pelvis.
Remember, you shouldn’t have to live with the pain. Even if it is very common, pubic symphysis dysfunction can be managed and alleviated. If you are suffering with pubic symphysis pain and dysfunction, make an appointment with a pelvic floor physical therapist so that you can enjoy a happy, healthy and pain-free pregnancy!
Constipation could quite literally be, a pain in the butt. The inability to have a predictable bowel movement can cause a lot of angst and stress. This then creates a vicious cycle, and further inability to have a successful bowel movement. The first thing to combating constipation is to get yourself on a consistent schedule.
You want to start by having a consistent morning routine. I love my sleep, so I get the idea to stay in bed as long as you can and then rush around the morning like a maniac. However, if getting up earlier in the morning means that you can give yourself a little extra time to have a consistent morning routine, it might be necessary.
Diet can be a major contributor of constipation. You want to make sure you are eating between 25-30 grams of fiber from fruits and vegetables, per day, as well as drinking 6-8, 6-8 ounce servings. You want to also make sure that you are maintaining a consistently active lifestyle: walking is a great activity that can help get things moving. Mental stress can also be a major contributor to constipation and managing stress is critical in managing constipation. Meditation (even for 5 minutes a day) has been shown to help decrease stress levels which can help your body relax to allow a successful bowel movement. The key is consistency. Remember, you are teaching and retraining your body. Even though we think having a bowel movement is a natural process, we often have to teach our body how to do it successfully. This takes time!
There are many over-the-counter medications on the market. However before trying a bunch of things that may actually disrupt the natural microbiome (good bacteria) in the gut, I strongly advise that you have a good team of practitioners on your side. A Registered Dietician or Nutritionist can play a big role in helping manage constipation from a diet perspective, a Pelvic Floor Physical Therapist can help patients with mechanics and muscle control and a psychologist might be necessary to help manage the angst and stress that might be playing a role in your symptoms.
Pelvic Organ Prolapse (POP) is a downward descent of pelvic organs into the bony pelvis. POP is extremely common after child birth and after menopause. The structures that are usually implicated with pelvic organ prolapse include the bladder, urethra, uterus, rectum and small intestine. The type of prolapse is named based on the structure that has shifted and graded based on how far the pelvic organs are dropping into the pelvis (Graded 0-4). See figure below.
Risk factors for developing POP include having children (increased risk with each subsequent pregnancy), chronic coughing, respiratory disease, repetitive heavy lifting, straining with constipation, increased BMI: specifically increased abdominal tissue.
It is estimated that about 50% of women have a prolapse (Beck, 1991). Some women are completely asymptomatic and some have symptoms. Women that have symptomatic prolapse will often report pelvic heaviness, pressure, bulging, inefficient toileting, and/or just a general feeling that something is right “down there”.
While a woman is breastfeeding and after menopause, estrogen levels in the vaginal tissue decrease, which decreases vaginal wall strength and support, and can thus give rise to symptoms. Evaluation of the prolapse will be performed by a physician or pelvic physical therapist. Assessment should be performed in a variety of positions to determine how the organs are shifting in response to different movements and postures.
Research shows that pelvic floor physical therapy is very effective at helping reduce symptoms and sometimes severity of prolapse. Some things that help women manage their symptoms include:
Sometimes depending on severity and symptoms, women may benefit from wearing a pessary, which is essentially an intra-vaginal support for your pelvic organs.
The goal with rehabilitating prolapse is always to reduce or abolish a patient’s symptoms and to discuss ways to prevent further progression of the prolapse. Symptoms should always guide what activities are safe to perform. A pelvic floor physical therapist is trained to help manage prolapse symptoms and can help guide you to what activities are safe, according to your specific prolapse.
Thanks to social media influencers like Kim Kardashian, waist trainers have gained popularity in recent times. Waist trainers are hard, rigid, corset-like binders (not to be confused with a soft binder that is sometimes worn for a week or so after birth). The goal of a waist trainer is to cinch the waist and narrow the waist line through prolonged use.
With every single client, we discuss ways to best control their abdominal wall and protect their pelvic floor. We sometimes spend an entire treatment session (if not more!) working on coordinating breathing, controlling rib position and improving recruitment of the abdominal muscles and pelvic floor to allow a client to handle increased load without increasing symptoms. We discuss bowel habits, bladder habits, lifting mechanics and more, all so that we can help the abdomen and pelvic floor can manage force. Overtime, increased downward pressure on the pelvic floor through a poorly coordinated core can cause muscle tightness, weakness, pain and other symptoms such as incontinence and prolapse.
Waist trainers provide constant inward pressure into the abdominal wall, increasing the pressure in the abdomen. This does not allow the diaphragm and ribs to participate in breathing, slows motility of the GI system, and puts a constant downward force on the pelvic floor. All of these things can make symptoms worse, and with continual use, can bring symptoms that might be at bay, to light.
It is important for the abdominal wall to move in order to dissipate forces put on the body! Failure to have the abdominal wall, diaphragm and ribs move is detrimental to core stability and resiliency and can have serious implications to the pelvic floor! So, just say no to waist trainers!
“Just do your Kegels”. This is often a statement told to my clients at some point, whether it be from their Doctor, or from a close friend.
A lot of clients coming to see me report urine leakage: often with activities such as coughing, laughing or higher impact activities like running or jumping jacks. I often hear: “I am doing my Kegels but they aren’t working!”.
Kegels are voluntary, isolated contractions of the pelvic floor muscles, and are named after Arnold Kegel, a gynecologist who invented a device used for measuring strength of the pelvic floor muscles. Research shows that many women incorrectly perform pelvic floor muscle contractions (Talasz et. al 2008, Thompson and O’Sullivan 2003). The most common compensations include: tightening the abdomen, squeezing the gluteals and tensing the inner thighs.
A Kegel contraction is one way to strengthen the pelvic floor and can be a starting point for a patient with an under-active pelvic floor. Sometimes in therapy, we will combine a Kegel contraction with a functional movement (such as a squat) in order to help manage their symptoms. However, isolated pelvic floor muscle contractions do not address why someone is having their symptoms. If the pelvic floor is “weak”, it is likely that there are other muscles that are not functioning properly, and thus need to be addressed. Therefore, Kegel contractions are a start, but should not be the only exercise that a person performs. We must recruit other muscles and tie the pelvic floor in with the rest of the body, in order for the patient to have success at abolishing their symptoms.
There are cases in which Kegels can actually make a patient’s pain or symptoms worse. In cases of pelvic pain, and an over-active, or excessively tight pelvic floor, doing repetitive Kegel contractions will likely worsen the symptoms. If you are performing Kegel contractions and they are making your symptoms worse, then do not perform them and definitely consult with a pelvic floor physical therapist.
The pelvic floor is a delicate area that can be easily affected by other areas of the body. It is important that the pelvic floor is strong, but also flexible. It is very important that before someone routinely does isolated Kegel contractions, they are evaluated by a pelvic PT to ensure that they are doing them correctly, that Kegels are in fact an appropriate exercise for them, and that they are instructed on other ways to strengthen the pelvic floor.
Many people are nervous for their first visit with a pelvic floor physical therapist. Your therapist will ensure that you are very comfortable and will explain all tests and procedures that she is doing.
Our evaluations take 90 minutes to complete. This is because we want to get a thorough history and hear your story regarding your symptoms so that we can best help you manage them!
During the first part of you evaluation, your therapist will thoroughly review your medical history. She will ask you questions about when your symptoms started, contributing factors, what makes your symptoms worse/better, and more. Your therapist will also ask about bowel, bladder and sexual function and likely ask that you keep a thorough bowel and bladder diary.
Once your therapist has taken a thorough history she will examine how you are moving and may ask you to perform functional movements such as squatting, walking, lunging and more. She will look at how some of the larger muscles in the abdomen, back, hips and legs are functioning.
With your permission, your therapist will then ask you to undress from the waist down and will perform an examination of the muscles that sit inside the pelvis. This is very similar to a gynecological examination. Your therapist will be assessing how the muscles in the pelvis are functioning and may be playing a role in your symptoms. Often, dysfunction in these muscles can cause radiating pain, and bowel, bladder and sexual dysfunction.
After your internal examination, your therapist will discuss her findings with you and come up with a treatment plan that is agreeable between you and her. Your therapist will throughly discuss your goals for therapy and will make sure that they are being addressed at each visit.
Your therapist will give you specific exercises and education to address your symptoms and will ask you to complete them in between your treatment sessions with her.
We understand that pelvic floor physical therapy deals with private issues and ensure that you, the patient, is most comfortable prior to performing any assessment or treatment.