Introducing Pelvic Floor Physical Therapy for Children!

Pediatric

We are pleased to announce that we will now be offering pelvic floor physical therapy for children in the Upstate area of South Carolina. We are very excited about this new offering and have worked hard over the past few months preparing our clinic space to accommodate children. Our PTs have also attended advanced training through Herman & Wallace Pelvic Rehabilitation Institute to learn about to apply our knowledge of treating adults with PFD to children! Our PTs are trained in working with children experiencing:

  • Urinary incontinence (loss of urine)
  • Enuresis (Night-time incontinence)
  • Urinary urgency and frequency
  • Urinary retention or voiding dysfunction (difficulty emptying)
  • Constipation (including pain with and/or difficulty emptying bowels)
  • Diarrhea (with and without leaking)
  • Constipation with fecal soiling
  • Chronic abdominal pain

We recognize that working with children requires unique considerations, and we strive to provide a comfortable setting where children and their parents can work together with their physical therapist to address their concerns. Our goal is to make Pelvic PT fun and interactive for children, and we use games, books, and prizes to help create the perfect environment for children to reach their goals.

Our physical therapy plans often will include:

  • Thorough evaluation of medical history, diet, sleeping patterns, etc.
  • Assessment of the hip and low back musculoskeletal structures
  • Visual (non-invasive) assessment of the pelvic floor muscles
  • Animated EMG biofeedback training
  • Extensive behavioral and dietary training
  • Appropriate stretching and strengthening as indicated
  • Specific individualized home program

Please feel free to contact our office at (864) 454 – 0952 with any particular concerns or questions. Pelvic Floor PTs treating children are located at our Patewood, Simpsonville, Greer and Spartanburg locations. Referrals can be faxed to (864) 454-0925.

Are you thirsty for more? Check out this post I wrote a year ago on tips for improving bathroom function in children!

Written by: Jessica Powley Reale PT, DPT, WCS

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Why everyone should see a Women’s Health Physical Therapist at least one time after having a baby:

pregnancy

Pregnancy and Childbirth ain’t for sissies! I once had a male colleague liken childbirth to a “motor vehicle accident of your pelvis”! Whether you have had a vaginal delivery or a planned c-section, your body goes through so many changes during pregnancy and the birth of your baby that, if not addressed, can put you at risk for injury in the future. Hormones are secreted that loosen up your joints and make you more prone to injury, your pelvic and abdominal muscles are stretched and weakened, making you more prone to issues such as low back pain, incontinence and prolapse later in life. Sometimes in a vaginal delivery muscles and tissues are torn. During a c-section tissues are stretched and cut to make room for the emerging baby. So, why, with all of this trauma and change do we expect our bodies to return to their “pre-pregnancy state” in a matter of weeks and why don’t we seek help to minimize the effects of this trauma and maximize our body’s healing potential?

I think, in my opinion it’s because

#1 new babies take a lot of time and what new mom has time for weekly visits to a PT?

#2 society considers these changes “normal” and for that reason, they almost becomes a badge that new moms must wear and deal with as just a result of pregnancy and birth

#3 access to physical therapy may be readily available, but unfortunately is not often recommended routinely for new moms by their physicians

In many countries in Europe it is standard for a woman to be referred to and receive several visits with a physical therapist following delivery in order to maximize their body’s recovery. In my opinion, this is one area where we are behind the 8-ball and missing the opportunity to help so many women and prevent dysfunction later in life.

So what can you gain from seeing a physical therapist post-partum?

First of all, a physical therapist can help with pelvic pain that may develop post- partum from muscle spasm. If you did have tearing during delivery (which can result in painful sex) they can teach you ways to minimize scar formation and eliminate the pain associated with it. They can address issues like urinary incontinence, which are common, but definitely NOT normal once you have a baby. The sooner you address these issues, the easier they are to take care of. Urinary incontinence usually suggests a weakening of the support structures to the bladder which can be improved with the correct exercises.

A physical therapist can help address low back pain, hip pain, pubic joint pain and also instruct you in proper body mechanics and breathing to minimize stress to your already loosened joints and optimize healing. They can also check for a diastasis recti ( a separation of the abdominal muscles that is common during pregnancy) or other muscle weaknesses that may exist and help you get back into a safe exercise routine that will help to optimize your core strength and stability.

So…the take home message…if you have had a baby recently, or whether it has been several years, ask your physician to send you to a physical therapist that specializes in the pelvic floor or in working with pregnant women for at least 1 visit to make sure your healing is on the right track! If your only obstacle is finding childcare, don’t worry, most physical therapists will love the opportunity to meet you AND your baby, and don’t mind you bringing them along for your visits! (In fact, it helps us to get our baby fix!) Your body will thank you for it later…especially if you plan on becoming pregnant again in the future!

Written by: Kim Osler PT, DPT, WCS

Sexuality during Pregnancy, Part 2: When will I be in the mood while I’m pregnant?

 

We’ve all heard that at some point during pregnancy women can have heightened sexual desire (Remember that scene from the movie Knocked Up?). Interestingly enough, this does tend to vary per person and is based on everything from hormones, to stressors, pain, and other pregnancy symptoms. For some women, pregnancy creates a new “spark” in their sexual relationships and for other women, the mood totally disappears.

Today’s post is Part 2 in a 3 Part Series on Sexuality during Pregnancy written by our awesome intern, Kerry McLaughlin, SPT. Please stay tuned next week for Part 3 on Sex during the Postpartum period.

Pregnant mother
 

Going along with our conversation last week on common questions regarding sex during pregnancy, many women find huge variances in sexual desire and arousal during pregnancy. These fluctuations vary during each trimester, but here are some great general things to know:

First Trimester: Most women experience a decrease in desire during the 1st trimester because of their primary symptoms of nausea and fatigue. Let’s be honest, it’s difficult to be “in the mood” when you’re constipated and about to vomit.

Second Trimester: The second trimester is where desire varies the most from woman to woman. Women can experience any of the three: increase, maintenance, or decrease (all of which are normal) during the second trimester. This is often attributed to increased blood flow to the pelvic region, increased sensitivity to the genitals and breasts, and increased vaginal discharge and moistness, all of which could add to pleasure during sex. Plus, this is the time when most of that nausea from the first trimester is decreasing, which would make anyone feel a little more ready for sexual intimacy.

Third Trimester: Women most often experience a decrease in both desire and function during the 3rd trimester. This is attributed to symptoms such as back pain, fatigue, hemorrhoids, decreased clitoral sensation, difficulty achieving orgasm, ligamentous laxity, and general discomfort that women feel towards the end of their pregnancy. At this point, the baby is growing significantly and those bellies are getting bigger each day. These changes can often play a huge role in comfort during sexual activity.

Emotional factors also take a toll on sex drive. Concerns about a woman’s pregnancy, the future with the new addition to your family, and changes in self-image all may weigh heavily on the minds of expecting women and may contribute to decreasing sex drive.

So, what about you? Did you find these changes occurring during your pregnancy?

Stay tuned next week as we continue this discussion with sexuality postpartum! Have a great week!

RESEARCH UPDATE: Exercise may reduce perception of pain

New post published by the New York Times this week highlights how exercise may reduce perception of pain. The post focuses on a new study published this month in Medicine & Science in Sports & Exercise. In this study, researchers found that people who exercised had less perception of pain when a stimulus was applied to their arm compared to people who did not exercise. See the full article in the New York Times Here!

Aerobic exercise is often something we recommend here at Proaxis Pelvic PT for men and women struggling with chronic pelvic pain, and many do find it to be helpful. What do you think? Have you found exercise helpful in reducing your pain? Let us know in the comments!

exercise Exercise is the Best Preventive Drug (Study)

 
 

Sex during Pregnancy- Your top questions answered!

This post comes to you from our current student intern, Kerry McLaughlin, who is completing her final year of her Doctor of Physical Therapy degree at Duke University. Sex during pregnancy often is filled with lots of questions- and this will be part 1 of a 3 part post to help you better understand how you can still have a healthy sex life throughout your pregnancy!

There are so many misconceptions women and men have regarding sexual activity during pregnancy! Our hope is that this post will help to answer some of the questions you may be having. As always, remember that all women experience different pregnancies and there may be circumstances where couples must modify their activity or abstain altogether. Make sure to discuss any specific concerns you may have with your health care practitioner to make sure you are safe throughout your pregnancy.

Is it safe to have sex during pregnancy?

YES! For normal progressing pregnancies engaging in sexual activity is safe. However, there are circumstances where sex should be avoided. These include if the mother: 

  • Is at risk for premature delivery (has a history of preterm labor or premature birth)
  • Has cervical incompetence (cervix begins to open prematurely)
  • Has placenta previa (placenta partly or completely covers cervical opening)
  • Has unexplained vaginal bleeding
  • Has leaking amniotic fluid 
  • Has a partner that is positive for an STI (HIV, Syphillis, Chlamydia, Gonorrhea, and Herpes simplex virus are some of the STIs that can be transmitted either in utero, during delivery or breast-feeding). **This may vary per person, so please be sure to consult with your OB if this effects you.

Will we hurt the baby?

NO! The baby is protected by amniotic fluid and the strong musculature of the uterus so vaginal penetration will not harm the baby. The baby is also protected against infection by the thick mucus plug that seals the cervix. 

Can sex cause a miscarriage?

Engaging in sex generally isn’t a concern. Early miscarriages are most often caused by chromosomal abnormalities or developmental dysfunctions.

Can sex cause preterm labor?

Very unlikely. Many couples think that sexual orgasms may induce labor, but female orgasms, which can be caused by sex, nipple stimulation and prostaglandins in semen, are just mild non-labor uterine contractions. 

Is there anything my partner and I should avoid?

Although sexual activity is typically safe, there are a few things to be cautious about:

  • Blowing air into the vagina during oral sex could potentially block a blood vessel (air embolism) that could be fatal to the mother and the baby. 
  • It is not safe for your partner to give you oral sex if he has or ever had oral herpes (especially concerning during the third trimester)
  • Anal sex isn’t recommended during pregnancy because it could potentially allow infection-causing bacteria to spread from the rectum to the vagina. Most women generally aren’t interested in anal sex during pregnancy anyways because of pregnancy-related hormonal side effects and physical discomfort. 

What other questions do you have about sex during pregnancy? Were you scared to have sex when you were pregnant?

Stay tuned for Part 2 coming next week, titled, “When will I be in the mood while I’m pregnant?”

Written by: Kerry McLaughlin, SPT

Yes, you have incontinence. No, I do not necessarily want you to do Kegel Exercises.

This past week, I was fortunate to evaluate a nice middle-aged woman referred to me by her urogynecologist for urinary incontinence. When we first sat down, she looked at me and said, “I’m not sure why I am here. My doctor specifically told me that I have a strong pelvic floor. I really don’t think you can help me.” I smiled. I hear this same thought process on a weekly basis (See my previous article on common misconceptions of pelvic physical therapy) You see, at some point the world became convinced that from a musculoskeletal perspective, urinary leakage is always due to a weak muscle. And the best way to fix a failed muscle is to strengthen, strengthen, strengthen. But, if that’s the case, then why do I have so many patients walking into my office telling me that they have done “Kegel” exercises and still leak? Why would a patient like the one above have a “strong” pelvic floor that cannot hold back urine? Why is urinary leakage associated with low back pain and pelvic pain- disorders that we know can often include tight and irritated pelvic floor muscles?

Now, as a caveat to this article, let me say now that it is sometimes totally appropriate for a person to start a pelvic floor strengthening program. In fact, the person with a truly weak, overstretched, poorly-timing pelvic floor will likely be prescribed a strengthening program. With that being said, the truth is that the majority of patients referred to my clinic for evaluation of urinary incontinence are not issued a traditional kegel exercise program. Jenna and I actually tend to be surprised when we evaluate a new patient who truly needs to start a strengthening program for their pelvic floor at the first visit. The reason behind this is that Incontinence is not simply a failed muscle, but a failed system.

The urethra is supported within the continence system by fascia, ligaments, as well as muscular structures. When a downward force is applied to this system as occurs with coughing, sneezing, lifting, bending, etc, these structures function in a coordinated way to compress the urethra and prevent urine from leaking. In fact, Hodges et. al. in 2007 examined musculoskeletal activation occurring when a person performed an arm movement and found that the pelvic floor muscles pre-activated to prepare the body for movement. But, from a muscular standpoint, stability of the lumbopelvic structures (organs included!) requires optimal function of the diaphragm, the deep abdominal muscles, the deep low back muscles as well as the pelvic floor muscles.

When any of these structures are not functioning well, leakage can occur. Now, the tricky part here is that optimal functioning requires both strength, flexibility and proper timing. A tight irritated muscle then becomes equally as dysfunctional as a weak over-stretched muscle. And, a strong, flexible muscle that doesn’t have the right timing contributes to a very dysfunctional system.

So, treatment for incontinence then must include retraining and reconditioning the system to ensure its proper functioning—which for me includes a bit of detective work to truly identify the faulty structures. And, when it comes down to it, typically does not include doing 100 kegel exercises a day. More often, it includes learning to relax the pelvic floor, learning to coordinate the pelvic floor with the diaphragm, eliminating trigger points and restrictions, and then retraining the motor control of the lumbopelvic girdle as a system.

So, for now, take a deep breath and relax. We’ll save Kegels for another day.

For more information, check out the following:

Written by: Jessica Powley Reale, PT, DPT, WCS

Got Prolapse? Here are a Few Tips to Minimize Pelvic Pressure!

POP

First of all, some of you might be wondering, “What is prolapse anyways”? Well, according to pelvichealthsource.com “Pelvic Organ Prolapse (POP) occurs when the tissues that hold the pelvic organs in place become weak or stretched, resulting in the drop (prolapse) of the pelvic organs from their normal position”. In other words, things down below aren’t supported as they should be! You may feel a sensation of heaviness or pressure vaginally, as well as complain of difficulty emptying your bladder or bowels, report discomfort during intercourse,  or feel a bulge in the vagina (and the list goes on….)

The good news is, Physical Therapy is highly effective for POP. In a recent randomized control study (March 2014), researchers found that women in the intervention group reported fewer prolapse symptoms (ie, a significantly greater reduction in the pelvic organ prolapse symptom score [POP-SS] at 12 months than those in the control group.

If you think you may be experiencing POP, consult your doctor or gynecologist and look for a local Pelvic Floor PT. In the meantime, here are a few tips to minimize strain and pressure on the pelvic floor:

  • Avoid breath holding during strenuous activities, such as lifting, pushing, pulling, or bending. (I always tell my patients, if it’s not coming out your mouth in the form of air, it’s coming out down below worsening POP or making you leak 😉  )
  • Manage any constipation or straining issues you may have. Pushing, especially while holding your breath places a large amount of pressure downwards and can worsen POP.
  • NO CRUNCHES, enough said. (Check out www.pelvicexercises.com.au for a great post on abdominal exercises to avoid)
  • Utilize a “functional brace” by engaging your deep abdominals and pelvic floor BEFORE lifting, bending, twisting, etc. Don’t forget to breath.
  • If you do start to feel worsening pressure, lie down with pillows under your bottom to elevate your hips.

Feel free to leave any other tips you may utilize to decrease symptoms of prolapse!

 

 

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