Multi-Disciplinary Approach is best for relieving Chronic Pelvic Pain

Evelyn and her DPT staff traveled to Chicago for the International Pelvic Pain Society conference to learn about the evolving sciences and evidence based treatment for pelvic pain.

Pelvic pain is typically located in the lower part of your abdomen & pelvis and can stem from the reproductive, urinary or musculoskeletal systems. The cause of pelvic pain can be complicated, involving interactions between gastro-intestinal, genito-urinary, musculoskeletal, nervous, endocrine systems and can include socio-cultural factors.

So it’s important to have a medical team working with you. Your team can include a urologist, pelvic physical therapist, gynecologist, gastroenterologist, psychologist, radiologist acupuncturist and sex therapist.

In our experience we find that patients just need 2-3 team members such as a medical doctor well versed in pelvic pain to guide on medications and general health, an experienced pelvic physical therapist who provides education, manual and movement therapy, and a talk therapist to address underlying emotional traumas. 

UPOINT  helps MD’s find best treatments for Male pelvic pain

Most men with symptoms of chronic pelvic pain syndrome (CPPS), such as penile pain or discomfort, urinary urgency/frequency, inability to sit, testicular pain and/or ED, have been given a diagnosis of “Non Bacterial Prostatitis” and prescribed antibiotics. I often hear from my patients that the medicine didn’t help, as their prostate gland was not infected, which is what antibiotics target. Many men were not getting pain/symptom relief from antibiotics and doctors needed a better system to determine the cause of CPPS.  UPOINT was developed to help.

 

UPOINT is a classification system to determine the specific diagnosis and treatment for male CPPS. The white boxes below represent the cause of symptoms, which in the case of CPPS, can be multiple. The higher the number of causes, the more severe the symptoms.  The gray boxes show the appropriate treatment options depending on the cause(s).1

 

 

A study of 100 men assessed and treated with the UPOINT system saw an 84% reduction in pain and disability. 2 CPPS can have multiple classifications including Psychosocial, Neurologic/Systemic and Tenderness of Skeletal Muscles.  These men healed with a combination of pelvic floor physical therapy, medication that targets nerves and talk therapy. By using the UPOINT system doctors can prevent the natural increased anxiety and pain escalation that these patients experience the longer they experience pain.  

Women with Endometriosis benefit by a team of providers

The BC Women’s Centre for Pelvic Pain and Endometriosis utilizes an interdisciplinary approach to treat women with endometriosis which resulted in 45% of their patients feeling “much better” in regards to pain and quality of life. Twenty three percent (23%) reported feeing “somewhat better” and only 20% reported feeling the “same”. These results were seen at the completion and at the 1 year follow up of the program.3

 

What does this interdisciplinary approach look like?

BC’s approach included education in the recent science of pain – how the brain is involved in sending pain signals as a form of protecting the body and how the brain can be retrained to lower or stop sending those signals. BC clients received pelvic physical therapy which involved manual therapy to release adhesions of muscles, fascia & intestines and movement/exercise prescription. They were also assessed by a gynecologist, received counseling (stress management), nursing care management and  BC’s team would meet to discuss their patients to ensure great outcome.

Create Your Medical Team

Women may not have access to nor can afford an extensive program like BC’s, however they can use the same approach with their own care. An experienced pelvic physical therapist can be the liaison between the medical doctor and all other healthcare providers as we tend to spend dedicated 45 minutes to an hour of interrupted time with our patients.  Being open to explore other treatment options such as cognitive behavioral therapy, acupuncture and nutritional guidance as this can also lower symptoms of endometriosis.

 

 

Pelvic Physical Therapy helps Cervical Cancer Survivors

 After being diagnosed and successfully completing cervical cancer treatment, we learned that 66% of cervical cancer survivors suffer from urinary issues such as leaking. Thirty three (33)% percent have a “storage dysfunction” which means the bladder sends the “Gotta Go” signal when it is only a quarter or half full, making women go to the bathroom too many times a day. Fifty (50) % have voiding dysfunction, which means there is left over urine in the bladder or the time it takes to pee is markedly increased.4

Pelvic physical therapy is an accepted treatment option for these women. Gentle manual release of the lower abdominal, inner thigh and pelvic floor/perineal regions and pelvic floor muscle training using biofeedback can significantly improve urinary incontinence, sexual function and quality of life for women who survived cervical cancer. Progressive use of vaginal dilators can help promote optimal healing of vaginal tissues after radiation.5

We want all women to feel good and confident about their body after cancer treatments and are thrilled to see this research.

  1. Nickel JC. C. Paul Perry Memorial Lecture “Clinical Approach to Male CPPS”. 2016.
  2. Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. J Urol. 2010;75(6).
  3. Allaire C. Innovations in the Evaluation and Care of Women with Endometriosis. 2016.
  4. Katepratoom C, Manchana T, Amornwichet N. Lower urinary tract dysfunction and quality of life in cervical cancer survivors after concurrent chemoradiation versus radical hysterectomy. Int Urogyn J. 2014;5(1).
  5. Lyons M. Women, Cancer and Pelvic Pain. 2016.

 

 

 

Chronic Pain and sexuality: How Eva Margot Kant, LCSW-R helps people navigate these issues

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(Image courtesy of Eva Margo Kant, LCSW-R)

The National Institute of Health (NIH) defines chronic pain as pain lasting more than 3 months and it affects more than 100 million Americans today.  As a pelvic floor physical therapist, I help patients with both acute and chronic pain, more specifically pelvic pain, on a daily basis. Due to the private nature of pelvic floor issues, sexual dysfunction, or bowel and bladder complaints it can be difficult for patients to feel comfortable talking about their symptoms.

The famous quote, “no man is an island,” rings true for healthcare providers who treat chronic pain as multiple specialists working together is more effective than one. I recently met with Eva Margot Kant, LCSW-R  with 12+ years of experience helping people deepen their self-esteem, navigate life’s transitions, and address fears and questions about chronic illness/pain which includes topics of sexuality and sensuality. Eva taught me some great perspectives on how she helps people heal their emotional/sexual wounds and how they can be a source of chronic pain.

Eva runs workshops about sex and disability, sex and aging and trains medical students how to talk about sex with their patients. Her goal is to help people “unpack their feelings” that are attached to physical pain and anxiety. Anxiety increases the output of the limbic system, the emotional flight or fight, and memory areas of our brain which results in pain.

Eva believes that “understanding how the body works is the key to understanding you”.  Her job is to help people understand what their sexuality is to them and to own how they view and understand it.  Eva believes that “the body always remembers.” She likened the reflexive blink of an eye that’s about to be poked to the feeling a woman with sexual pain feels if her partner demonstrates affection. The woman may fear that any show of affection may lead to sex which is painful for her, so she avoids this.

Eva’s goal is to help patients learn if some physical reflexive tightening may be due to thoughts involving shame, guilt, or embarrassment.  She helps clients decide when to disclose to a new partner about their chronic condition. She stressed the importance of self-care with their partner and to feel emotionally safe. People who have chronic pain/illness may go thru life as if they are “holding their breath.” Often times Eva finds that partners want to help, they just don’t know how. Demystifying chronic pain/illness allows partners to be supportive and an active participant in healing.

Eva’s upcoming book and course work, called “The Holy Trilogy of Sex (c),” guides patients and their partners in sensuality, sexuality, and intimacy; none of which are possible without communication, sensation, and connection. She encourages partners to engage in body mapping: offering each other a “menu” of intimate ideas that can promote togetherness without causing more pain.

As a Pelvic Physical Therapist, I invite my patient’s partner to a session to observe, learn, and understand what my patient is experiencing and teach the partner ways they can help. I work on the physical aspect of pain with my manual, movement and exercise therapies while Eva addresses on the mental and emotional aspects of chronic pain which leads to a more efficient outcome.

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EMH Team; Jennifer Jurewicz, Tova Laufer & Charissa Morrisroe with Eva Margot Kant, LCSW-R

If you have chronic pelvic pain consider receiving both physical and talk therapy to get your life back on track.  Consider visiting us at EMH Physical Therapy and Eva Margot Kant, LCSW-R if you are in the NYC area. Your pelvic floor with thank you!

Resources:
http://evamkantlcsw.com/
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

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EMH Physical Therapy Goes To Chicago for The International Pelvic Pain Society (IPPS) Conference on Chronic Pelvic Pain

                                     

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screen-shot-2016-10-07-at-11-40-39-amAt EMH Physical Therapy, we support an interdisciplinary approach to treating our patients. We are in constant communication with primary care physicians, urologists, psychologists, gynecologists and other healthcare providers to make sure all our patients have a strong team working for them

A team based approach to medical care has been shown to prevent medical errors (1), improve patient-centered outcomes and chronic disease management (2-4). 

This week the EMH team are packing our bags and headed to Chicago to attend the International Pain Societys annual fall meeting on chronic pelvic pain where well hear practitioners of various disciplines discuss advances and techniques in treating pelvic pain. Some topics were excited about exploring include the mind-body” connection, psychosocial aspects of pelvic pain, cancer and pelvic pain, cystitis, hormone treatments, vulvodynia and more. 

The International Pelvic Pain Society (IPPS) was established in 1996 with the goals of educating health professionals on how to diagnose and manage chronic pelvic pain and to bring hope to men and women who suffer from this pain by raising public awareness (5). 

Their website, pelvicpain.org, contains articles which can help to educate patients on a wide variety of conditions and find healthcare providersWe are excited to share the information we learn at IPPS conference with all of you when we return to New York City next week! Stay tuned.

P.S. Well be active on Instagram, @emhpysicaltherapy, and Twitter, @EMHPH, while were away, so keep up with us there!

Resources:

1. IOM (Institute of Medicine) To err is human. Washington, DC: National Academy Press; 1999.

2. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: The chronic care model, part 2. Journal of the American Medical Association.2002;288(15):19091914.

3. Ponte P, Conlin G, Conway J, et al. Making patient-centered care come alive: Achieving full integration of the patients perspective. Journal of Nursing Administration. 2003;33(2):8290.

4. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: Translating evidence into action. Health Affairs. 2001;20(6):6478.

5. International Pelvic Pain Society. Pelvicpain.org

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PelviCorFit™ by EMH Physical Therapy Grand Opening

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Have you been working out for years, but neglecting a crucial muscle group??

At EMH Physical Therapy we recently launched our brand new PelviCoreFit™ program designed to whip your pelvic floor muscles into shape. Proper firing of pelvic floor muscles is not only essential for pelvic health but is also a key factor in overall core strength and fitness.

Visualize this:

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The pelvic floor muscles form a sling that transmit forces from the ground up and from your head down. If pelvic floor muscles are weak and unaccustomed to firing during exercise, you could be promoting a faulty movement pattern in the chain. Neglecting the Pelvic floor muscles can potentially lead to more serious conditions such as chronic hip, back or pelvic pain, urinary or fecal incontinence, GI and bowel disorders, and erectile or sexual dysfunction. At EMH Physical Therapy we will help you identify and strengthen the pelvic muscles during your general workouts to help prevent future dysfunction!

Additionally, did you know that the pelvic floor muscles play a fundamental role in breathing through connections to the diaphragm?  Think about doing cardio, executing a heavy lift, or performing a Vinyasa flow with a sub optimal breathing pattern. Strengthening the pelvic floor muscles can improve breathing which will help to optimize your workout efficiency.

Come try out our discounted  PelviCoreFit™ program, learn about proper activation of the pelvic floor muscles and bring your workouts to the next level!

We offer 2 options:

“PelviCorFit™ #1” – One fifty minute session with a DPT + Fitness Guru that includes 15 minute pelvic floor/core education followed by a 30 minute PelviCorFit™ workout, then Q&A. Regular price is $200. New Client price is $50

“PelviCorFit™ Pack” – Three (3) fifty minute sessions with your DPT + Fitness Guru. The first session is similar to the description above. The 2 follow up sessions include 45 minute PelviCorFit™ workouts plus instruction on how to implement pelvic floor awareness into your fitness program. Regular price is $500 for 3 sessions. New Client price is $130

To register call 212-288-2242

or

email info@emhphysicaltherapy.com

For more information click here

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How to Foam Roll Most Major Muscle Groups in 5-10 Minutes

Don’t you wish you could get a deep tissue massage every day? If you said “yes!” then I highly recommend you make a small investment in your own foam roller.

I foam roll every time I go to the gym because it’s the easiest way to self-release all of the major muscle groups. Foam rollers act on the fascia, or connective tissue, that lies above all muscles and organs of your body. When you use a foam roller, you’re making the fascia mobile, which ensures all structures underneath will function without restrictions.

When ordering remember: darker colors usually mean a firmer roller. If you are a beginner try white or a light color. If you want a deeper, firmer tissue massage go with dark grey or black.

Check out my quick video that hits most major muscle groups in just a few minutes. Happy rolling!

Prolapse: My Organs are Dropping- What Now?

Pelvic Organ ProlapseWhat is it?

Pelvic organ prolapse is a common condition that occurs most often in women following childbirth or menopause. The muscles inside the pelvis become weakened and lack the endurance or strength to support the body’s internal organs. This can result in a descent of the bladder, uterus, rectum, or even the vagina itself into the vaginal canal. The degree to which the pelvic structures descend can vary greatly. Some women with pelvic organ prolapse may have no signs at all and be completely unaware of their condition, while other women may have a larger grade of loss of support to their pelvic organs and develop more significant symptoms.

How might you know if you have a prolapse?

Some symptoms of pelvic organ prolapse include:

  • Sensation of a bulge/protrusion- feeling like something is coming out of the vaginal canal
  • Pressure and/or heaviness in the vagina
  • Urinary leakage, frequency, or urgency
  • Weak urinary stream, hesitancy with urination, incomplete bladder emptying
  • Painful sexual intercourse
  • Feeling of incomplete bowel emptying
  • Fecal incontinence or leakage
  • Low backache
  • Vaginal bleeding or discharge

What are the risk factors for pelvic organ prolapse?

While women who have been pregnant or given birth vaginally are the most at risk, especially in cases where the mother has given birth to a large baby or experienced prolonged pushing during labor, there are many other causes of pelvic organ prolapse.  Some are work or lifestyle related, such as heavy and frequent lifting.  Others stem from other medical symptoms such as chronic coughing, chronic constipation and/or straining with bowel movements, connective tissue disorders, prior pelvic surgery, or obesity.  Pelvic organ prolapse may also occur as a result of a genetic predisposition or from increasing age.

How can physical therapy help?

A healthy pelvic floor is vital in preventing pelvic organ prolapse, inhibiting further descent of organs that have already begun to fall, decreasing symptoms of pelvic organ prolapse, and as an effective conservative measure to avoid or delay surgery. A study performed by the American College of Obstetricians and Gynecologists in 2007ⁱ found that women with prolapse were found to have defects in the pelvic floor muscles, specifically the levator ani, and were found to produce less power in closing of the vagina with muscular contractions. Pelvic floor physical therapy will directly assess the strength and endurance of pelvic floor and core muscles, look for trigger points within the muscles themselves, help restore shortened muscles of the pelvic floor to their optimal length, and improve awareness of control of pelvic floor muscles with daily activities.

Pelvic floor physical therapy treatment of pelvic organ prolapse includes:

  • strengthening the pelvic floor and core muscles
  • biofeedback to help with improved awareness in using the muscles correctly and effectively
  • education in how to protect from further descent of pelvic organs
  • education in activities to avoid or modify

Women with symptoms of prolapse or who are at risk for pelvic organ prolapse should seek a consultation with a licensed pelvic floor physical therapist to have the best results in long-term pelvic health, function, prevention and management of pelvic organ prolapse.

How Can I Get Started?

Here is one exercise to begin:

Exercise for to help prolapsed organsLie flat on the back with feet propped up and supported on a wall. Place a pillow beneath the pelvis so that the hips are slightly elevated. This will put your pelvic floor in a gravity-reduced position to improve the ease of contractions and encourage an upward movement of the pelvic organs. Next try a pelvic floor contraction by exhaling and drawing the pelvic floor in and upward.  Hold this contraction for 5 seconds and then fully release, allowing the muscles to rest for 5-10 seconds. Repeat 10-20 times.

 

 

 

 

For more information, please go to: http://www.pelvicorganprolapsesupport.org

ⁱDeLancey JOL, Morgan DM, Fenner DE, et al. Comparison of Levator Ani Muscle Defects and Function in Women With and Without Pelvic Organ Prolapse. Obstetrics & Gynecology. 2007; 109: 295-302.

Six Ways to Help Manage Constipation

Constipation[Photo credit: PracticalCures.com]

Constipation is a common condition that affects up to 42 million Americans which is usually caused by:

  • Dysfunction with the nerves, muscles, or hormones in the body
  • Pelvic floor dysfunction leading to an outlet dysfunction
  • Delayed transit through the colon
  • Lifestyle and dietary habits

Specific factors such as medications, lack of physical activity, dehydration, lack of fiber in the diet, pregnancy, aging, travel, laxative overuse, diseases, and IBS form the majority of reasons a person develops constipation.

 

Constipation is currently diagnosed through a cluster of symptoms, which include hard stools that are difficult to pass, straining for 25% of defecation, a sensation of incomplete evacuation for at least 25% of bowel movements, and fewer than 3 bowel movements per week.  If your constipation results from a dysfunction of the nerves, muscles, or hormones in the body, you will need to consult your doctor and may need to seek out a physical therapist specializing in pelvic floor dysfunction; they can also assist you in making the necessary changes if your constipation results from lifestyle and dietary habits.

 

However, here are some simple lifestyle changes to help manage constipation:

 1.) Diet modifications

Certain types of foods can increase constipation (processed foods, cheese, white rice, red meat, bananas, dairy products).

Increasing fiber intake is important for the health of the digestive system and can help alleviate constipation. There are two types of fiber: soluble and insoluble. Soluble fiber helps to soften and bulk stool, while insoluble helps to promote movement through the colon.

  • Soluble fiber examples: fruits, vegetables, legumes, nuts, seeds, oats.
  • Insoluble fiber examples: whole grains, brown rice, oat and corn bran, some vegetables and root vegetable skins.

 2.) Anxiety and stress management

Stress is a common cause of constipation. Increased anxiety and stress triggers the sympathetic nervous system (our “fight or flight” response) and deactivates the parasympathetic nervous system (the “rest and digest” system).  This not only decreases the activity of the digestive system, slowing transit through the colon, but also decreases the body’s ability to relax the muscles of the pelvic floor to allow for defecation.

3.) Daily aerobic exercise

Moderate levels of aerobic exercise increases blood flow to the digestive system and improves function. Any form of exercise is beneficial, and can be as little as a 10-20 minute walk.

 4.) Toilet posture/positioning

Proper toilet posture can help assist in relaxation of pelvic floor muscles to allow for improved ease of bowel movement and decreased straining. Modern toilets typically create a sitting posture that does not allow the anorectal angle to straighten, which may increase difficulty with voiding.

For improved ease of bowel movement, the best toileting position is one that mimics a squatting posture. Placing the feet on a stool to increase the amount of hip flexion while sitting is a simple solution to create a better toilet posture.

 5.) Drink water, plenty of it

Dehydration is a common cause of chronic constipation. Decreased fluid intake can lead to firmer, harder stools that are more difficult to pass. Current recommendations for fluid intake vary depending on activity level, health status, and the environment. Generally, a good rule is to aim for around 2 liters of water intake per day.

 6.) Sleep!

Sleep deprivation can slow the intestinal slowdown and decrease bowel regularity. Sleep recommendations vary based on individual needs, however most resources continue to suggest aiming for 7-9 hours per night.

Leaking is More Common Than You Think

Hmmm…. How to put this delicatelyWoman jogging on a track

Do you often find yourself leaking urine while exercising?  Squat… leak a little, overhead press… leak a little more, jump… forget about it, pants are soaked!

If this describes YOU, know that you are not alone. You likely fall into the 25% of women between the ages of 18-44, or the 44% of seniors, or the 33% of female athletes who experience varying levels of incontinence. These astounding statistics represent only those who have come forward to report symptoms. If you are skeptical, just take a look at YouTube (search “girl peeing while lifting weights”). You will find solidarity; everything from women admitting to leaking during exercise, to videos of complete loss of bladder control while executing a heavy lift. Today, there are even T-shirts glorifying urinary leakage during workouts in order to empower women and banish feelings of shame.

It is wonderful that women are finally coming forward to bring this previously taboo topic out into the open.  Just last week, Kate Winslet explained that she no longer jumps on trampolines for this very reason.  Leaking when exercising, sneezing, or coughing is so normal that Winslet’s admission was received with more “it’s nice to know she’s normal” reactions than surprised ones.  Yet, shockingly, statistics show that women will wait, on average, 6.5 years before reporting incontinence, because as normal is it may be, women rarely speak of it, even to their medical providers.  It’s no wonder urinary (and fecal) leakage has generated a $28 Billion dollar industry in the US alone.

If you are leaking while exercising, it is likely that your pelvic floor muscles are just not firing properly in order to withstand the load. We call this Stress Urinary Incontinence (SUI) which describes urinary leakage that occurs particularly with physical activity or exertion. While this issue is extremely common, it is not something you want to leave untreated. Whether you are losing a few drops or outright “peeing your pants”, help is out there, in some cases, right around the corner.

First you must understand that the pelvic floor muscles are just that: muscles. Therefore, you can strengthen them like any other muscle. We spend hours in the gym attempting to perfect every muscle in the body, but somehow forget the pelvic floor, a keystone to our overall health and fitness.

The tricky part is that you can’t easily see these muscles. As a matter of fact, you may not even be able to feel them. That is where Pelvic floor rehabilitation comes to the rescue. At EMH, we teach you how to identify, isolate and strengthen the pelvic floor muscles to restore normal function. We then help you integrate pelvic floor techniques back into your exercise routine so that you can squat, overhead press, and jump “leak free”.

So at your next holiday party, just think to yourself — 1 in 4 of the women in this room are currently peeing in their pants. Luckily, you don’t have to be one of them.

When Kegels Do More Harm Than Good

Sit forward, slight inward curving back to prevent a short pelvic floor

Strength Training for healthy muscle is generally good – it thickens the muscle tissue (hypertrophy), increases motor neurons activity for better awareness and reaction time, and improves muscle tone.  Kegels, a specific exercise for the pelvic floor, may help in reversing incontinence, preventing prolapse, increasing sexual pleasure, and stabilizing our core, but they don’t do the full job by itself and can be harmful.   As a pelvic physical therapist treating men and women with pelvic floor dysfunction and pain for 18+ years, I’ve found that the regular performance of Kegel exercises, especially if self-taught, may aggravate or even lead to dysfunction and pain.

How can Kegels do Harm?

Most people who experience leaking, urgency, prolapse, sexual dysfunction and pain in pelvis/groin/hip have short, or “non-relaxing” pelvic floor muscles. A short pelvic floor means just that – instead of returning to a lengthened state at rest, the muscle stays chronically short. Performing repetitive Kegel exercises to these already shortened muscles can further shorten and weaken those muscles leading to pain.  At EMH Physical Therapy, we advocate learning how to relax and lengthen the pelvic floor while recruiting other external muscles to work more effectively for best outcome.

What is the function of the Pelvic Floor?

The pelvic floor muscles attach from the pubic bone in front of the pelvis to the coccyx bone in back. During pelvic floor contraction, the muscle gently pulls the coccyx slightly forward.  The pelvic floor squeezes the urethra shut when not at the bathroom (no leaking), relaxes during urination (no hesitation) and bowel movement (no constipation), and works with the deep lower abdominal and lower back muscles to stabilize our body in preparation for movement (preventing back/hip pain).

A chronically short pelvic floor keeps the coccyx tucked forward, cannot fully relax during urination and bowel movements and because it is weak, can lead to leaking.   Research shows that pregnancy is not the main cause of pelvic floor issues, as teenaged girls, women athletes who have not been pregnant and men suffer from pelvic floor issues.

How does the Pelvic Floor become Short and How to Reverse this Habit?

Think about how you position and use your body during your day.

At the office: are you placing weight backward on the single small coccyx bone (not good) or on your two larger ischial tuberosities (good)?

Is your lower back rounded or flat (not good) or have an inward curve (good)?

At home: Avoid slouching on couches – use back pillows and support your feet.

Here are some Tips to Reverse a Short Pelvic Floor

  • Sit with your spine against the back of your chair, placing a roll or pillow in the lower back.
  • Stand up regularly.
  • Keep your gluteal muscles toned with regular squats, bridging or hip extensor exercises. Gluteal activation helps to lengthen the pelvic floor to prevent chronic shortening
  • Keep your hamstrings and inner thigh muscles flexible. STRETCH or foam roll these muscles. Tight hamstrings and adductors directly refers tension into the pelvic floor.
  • Check your pelvic floor tension throughout the day- gently squeeze this muscle first and then completely release. Feel this release for a few seconds and see if you can relax a bit further.
  • Take a deep slow inhale – allow your abdomen to expand and think of the pelvic floor widening as you inhale. Exhale as you keep the pelvic floor open.
  • Yoga positions such as Childs Pose, Happy Baby and Pigeon Pose help to open the pelvic floor and hips as you slowly breathe.  Maintain each position for 30 seconds.
  • Consult with a pelvic physical therapist for tailored therapy and home exercise program

Pelvic Physical Therapy helps Children Overcome Bedwetting and “Accidents”

April Any parent will tell you, the potty training years are stressful! There are millions of resources that tell you different information, and on top of that, work and school schedules make it almost impossible to stick to a solid routine. Every day on the streets of New York City I see frantic parents running to the nearest restroom dragging their child who is doing “the pee dance” because 10 minutes ago at home they “didn’t have to go.” At some point, the chaos ends, and children have a better awareness of their needs, but what about those children who don’t?

Almost all children experience wetting or soiling accidents for various reasons during these training years. By age 5, a child’s neuromuscular system is developed to have bowel and bladder control; however 10% of children from age 5 to 7 continue to have regular day and night time accidents. This trend continues with 3% of children age 12, and 1% of children age 18 .

Persistent wetting has emotional and psychological effects on both children and their parents. Parents report feeling frustrated, stressed, bothered, sad, and helpless when their children are not as physically capable as their peers to remain continent. Children can reports feelings of anxiety, embarrassment, and generally become less sociable . So, why does persistent wetting occur?

Children experiencing persistent wetting should be evaluated by a doctor for the following causes:
• A “Twitchy” or “overactive” bladder that signals frequent urgency sensations and premature voiding
• A weak outlet system that is unable to hold back urine during laughing, coughing, or straining
• Urinary tract infection
• Chronic constipation
• Structural abnormalities within the urinary system
• Neurological issues effecting the lower half of the body
• Psychological or emotional trauma

April2      Regardless of the cause, a root issue seen with most of the conditions above is “dysfunctional voiding” from weak, over active, or non-coordinated pelvic floor muscles. In addition to the immediate psychological effects, dysfunctional pelvic floor muscles can lead to improper development of the urogenital system with connections to chronic pelvic pain in their adolescent and adult life. So what can be done to improve the functioning of these muscles?

Pelvic floor physical therapy is a specialty within physical therapy that focuses on the strength and coordination of this vastly important muscle group. When working with pediatrics, the whole family is considered, and involved as a unit. It is NOT just about kegel exercises! Therapy is focused on creating a better awareness of this area of the body, improving the child’s interpretation of the various sensations experienced at different points in the voiding cycle, and developing the strength and coordination to allow more effective voiding habits. To accomplish this, first, keep a bladder diary to keep track of every time your child uses the bathroom, or has an accident, to find any patterns in their bladder symptoms, such as time of day and frequency. After that, “timed voiding” helps retrain the bladder to void only when in the bathroom by having your child use the bathroom every hour, then slowly increasing the time until it is more optimal.

Rewards and praise are excellent motivation for children to want to use the bathroom and let you know when they have to use it. Avoid negative feedback such as reprimands or “time outs” when an accident does occur, this is very discouraging and does not help improve confidence or self-esteem. Exercise consisting of leg and abdominal stretches help keep your child’s muscles more calm rather than tense, which applies added stress and compression to the bladder. And finally, educating your child about their pelvic muscles is key! Many parents find this topic taboo, or uncomfortable to talk about. This sends a message to children that they should dissociate themselves from feelings or sensations in this area rather than really paying attention and developing that complete mind body awareness. If you find this topic uncomfortable, remember, your pelvic muscles are not solely for sexual function, and that part of the conversation does not need be discussed until your child comes closer to puberty. Educate your child on the fact that they have control over this area of their body, they can squeeze those muscles, release those muscles, and push those muscles downward (this maneuver is referred to as “bearing down” and is done during bowel movements). Most of the time, children feel excited to learn they are in control of something since this is usually a rare occurrence in childhood. The more they are taking notice of these muscles and practicing using them, the stronger they will become. In physical therapy, their strength gains are monitored using biofeedback which uses external surface electrodes to quantify the strength of the muscle contractions.

For strengthening when the muscles have significant weakness, pelvic physical therapists engage the child in play activities that facilitate the use of these muscles. Activities include bouncing on therapy balls, negotiating obstacle courses, creating dances, and other full body physical activity that is fun for the child, all the while incorporating pelvic floor contractions in a safe and supportive environment. Training and educating children is more successful when it is fun and engaging. Parents are also instructed in activities they can perform at home as a family to further increase the child’s engagement, and provide effective parent involvement.

If your child is experiencing any of the symptoms discussed, there is hope. In a matter of 2 to 3 months, muscles can be trained to work at their full potential, and you, and your child can develop the confidence and peace of mind to overcome the struggle of persistent incontinence.