Continuing the Continence Conversation

By Riva Preil

In honor of National Continence Week, I want to share a fantastic resource with you. Dustienne Miller, former Beyond Basics therapist and current owner and founder of Flourish Physical Therapy (Boston, Massachusetts) has created a yoga DVD to treat incontinence.

Dustienne has extensive experience both in pelvic floor physical therapy as well as in the practice of yoga. In fact, she fuses her knowledge and passion of both approaches into a course entitled Yoga for Pelvic Pain. She teaches this course to fellow practitioners on behalf of the Herman and Wallace Pelvic Rehabilitation Institute.

Not only does Dustienne share her wealth of knowledge with other therapists, she does so with patients worldwide through her wonderful DVDs, Your Pace Yoga: Relieving Pelvic Pain and Your Pace Yoga: Optimizing Bladder Control. I would like to focus on the latter of the two, because this DVD is an incredible tool for individuals experiencing incontinence. According to one satisfied individual, “I practiced the gravity eliminating flow on Sunday and I am so thrilled with your DVD! I’d wished for a DVD like this because I don’t always keep up with exercises on my own, and you had everything I needed all in one flow. Thank you so much!”

If you are jealous of that testimonial and want to be saying the same thing, check out a clip of the DVD for yourself!  While you are at it, please check out the website for Dustienne’s brand new clinic in Boston:

575 Boylston St, 4th fl, Boston MA 02116;


Committed to Continence

By Riva Preil

Join us at Beyond Basics Physical Therapy in celebrating the International Continence Society (ICS) World Continence Week (June 23-29)!  According to their mission statement, “The International Continence Society is a registered charity with a global health focus which strives to improve the quality of life for people affected by urinary, bowel and pelvic floor disorders by advancing basic and clinical science through education, research, and advocacy.”

According to the Continence Promotion Committee, the focus of World Continence Week 2014 is Bladder Diary Day.  This project involves individuals worldwide submitting an informational form about their personal bladder habits.  The ICS seeks to obtain as much information as possible about typical bladder habits as a basis of comparison for atypical patterns.

YOU can contribute to and help the ICS by submitting a response!  For more information, please refer to the following promotional YouTube video:

Continence is an attainable goal!  Don’t allow the commercials and advertisements for “adult pull-up diapers and protective underwear” to mislead you.  Leaking is not necessarily inevitable nor should it be expected as part and parcel of the aging process.

If you or someone you know experiences occasional (or frequent) involuntary losses of urine, pelvic floor physical therapy is probably an appropriate alternative for you.  Please speak to your doctor and request a prescription for pelvic floor physical therapy.  Let’s seek to make adult diapers an extinct species!

Celebrate Good Times

By Riva Preil

Wednesday night, the Beyond Basics team celebrated a monumental occasion- the release of Amy Stein’s new patient self-care  DVD entitled Healing Pelvic and Abdominal Pain!  In this new 2 hour home program for patients and guide for practitioners, Amy provides an explanation of pelvic and abdominal pain as well as self-care strategies (including massages and stretches).

The DVD is appropriate for patients with vulvodynia, endometriosis, non-bacterial prostatitis, pudendal neuralgia, pelvic pain, coccyx pain, interstitial cystitis, and bladder and or bowel dysfunction. The video provides information for men, women and children.

Amy also educates viewers on the proper performance of pelvic floor relaxation techniques, including diaphragmatic breathing, stretching, and dilator usage.  Bonus material includes behavioral modification suggestions.

The DVD is available for purchase at: ($49.95, free shipping).  It is included as a bonus for all out of town patients.

The release of this amazing DVD is an exciting opportunity for us to SHARE KNOWLEDGE about pelvic floor health. Too many individuals suffer in silence, and many are not aware their pelvic floor muscles may be the root of their symptoms and/or pain.  Heck, many people don’t even know what their pelvic floor IS to begin with!  Thanks to Amy and her new innovative DVD (as well as her book, Heal Pelvic Pain), the word is spreading and information is more accessible than ever before. That is truly reason to celebrate, and celebrate we did…in grand style!  A special thank you to Karen, Alexa, Yarissa, and Arianna for planning such a fabulous launch party!

Photo by Elyssa Goodman


Irritant Information

By Riva Preil

On June 9, we posted a fantastic YouTube video on our website entitled “Detox the Box”, a parody on a popular Justin Timberlake song from Saturday Night Live.  This entertaining and informative video encourages viewers to request that Tampax, Always, and Procter and Gamble remove irritants from their feminine hygiene products by signing a petition.

As a pelvic floor physical therapist, I STRONGLY AGREE with their message.  Vaginal irritants can cause vulvar and pelvic floor muscle irritation and pain. Natural-fiber pads and unscented products are healthier for the pelvic floor than scented products. Tampons appropriate for a particular menstrual flow should be used (rather than “playing it safe” with a larger than necessary tampon).

While on the topic of vaginal irritants, allow me to take this opportunity to mention several other DOs and DON’Ts


  1. Wear loose fitting underwear that does not restrict blood flow to the groin (due to tight fitting elastic)
  2. Sleep without underwear
  3. Use fragrant free detergents
  4. Use Dove bar soap, Neutrogena, or Basis
  5. Use soft, white, unscented toilet paper
  6. Wear loose/baggy sweatpants during exercise


  1. Don’t wear girdles or support stocking pantyhose– they restrict blood flow to the perineum and limit necessary circulation
  2. Don’t use a douche. EVER. Not pelvic floor friendly, to say the least
  3. Avoid extremely hot water on the vulva
  4. Never use a blow dryer on pubic hair
  5. Avoid toiletries with fragrances, propylene glycol, and sodium lauryl sulfate
  6. Avoid scrubbing the vulva while bathing
  7. Refrain from wearing Spandex, thongs, and wet bathing suits

A happy pelvic floor contributes to a happier YOU!  Have you discovered any unique or helpful products on your quest towards vaginal health?  Please feel free to comment and share any thoughts you have about products that have contributed your pelvic floor health.  The comment that receives the most “likes” on Facebook will receive a prize!  And on behalf of your fellow females, please sign the petition to “Detox the Box”!

Pelvic Organ Prolapse Awareness Month

By Riva Preil

June marks Pelvic Organ Prolapse Awareness Month.  Pelvic organ prolapse (POP) is a descent of the uterus, bladder, and/or rectum.  It is often associated with stress urinary incontinence or bowel dysfunction.  Patients often report a feeling of fullness in the vagina or the feeling of a tampon falling out.

Multiple factors affect the development of POP, including genetic predisposition, number of previous pregnancies and deliveries, age (ex. post-menopause), and ethnicity.  Furthermore, women who have worked in professions that involve heavy lifting and increased intra-abdominal pressures (ex. flight attendants) are at a greater risk of developing prolapse.

A woman’s chances of developing prolapse increase significantly with her third child’s pregnancy and delivery.  Furthermore, women with a connective tissue disorder (ex. Ehlers-Danlos or Marfans Syndrome) are at increased risk of developing POP.

Research has shown that pelvic floor physical therapy targeted at STRENGTHENING the pelvic floor muscles can help reduce the severity of prolapse.  Therefore, pelvic floor physical therapy is an appropriate and minimally invasive treatment.  The best position for Kegel exercises is with hips elevated (ex. on a wedge or stacked pillows- refer to picture).  This position takes advantage of the gravitational pull which naturally reduces organ descent.  It sure beats having to do your Kegels standing on your head!

Screen Shot 2014-06-13 at 8.41.35 AM
Should physical therapy  alone not suffice, a pessary may be an appropriate device to help provide additional support to the system’s laxity.  In more severe cases, surgery may be the appropriate intervention.  One should speak to their doctor if they think that either of these options may be appropriate.

Heavy Weight Cancer Research

By Riva Preil

Obesity has been associated with various health risks, including cardiovascular disease.  Furthermore, recent research has linked obesity with increased risk of developing colorectal cancer.

A study which appeared online in the journal Cell Metabolism (April 1) performed by Dr. Paul Wade and Dr. Thomas Eling at the National Institute of Environmental Health Sciences (NIEHS) explored the connection between obesity and colorectal cancer.  Their work was based on findings from previous rodent research that has shown that the NAG-1 gene is correlated with decreased risk of colorectal cancer.

In the current study, Wade and Eling worked with two groups of mice.  One group of mice contained the NAG-1 gene and the other group did not.  Both groups of mice were fed high fat diets- 60% of calories consumed were obtained through lard.

Two interesting finding emerged from the research:

  • The mice with the NAG-1 gene did not gain weight, whereas the NAG-1 deficient mice gained weight
  • According to Ellis, “The obese mice exhibited molecular signals in their gut that led to the progression of cancer, but the NAG-1 mice didn’t have those same indicators.”

Wade proposed that the reason behind the second difference is that fat cells in the large intestine, or colon, may trigger tumor growth.  Whatever the reason, further research is warranted to gain more knowledge about this important connection.  Better understanding of the chemical pathways can allow for better treatment and development of targeted medications to interrupt the faulty mechanism.

Detox the Box!

Women’s Voices for the Earth is an organization seeking to eliminate toxic chemicals from female health products. They recently released “Detox the Box,” a hilarious yet  informative video parody of SNL’s “D*ck in a Box”, asking women to reach out to companies like Procter & Gamble in hopes of eliminating toxic chemicals in feminine hygiene products. Take a look at it below, and follow the instructions for reaching out to P&G here.

Aspirin Advantages

By Riva Preil

It is estimated that approximately 20,000 women will develop ovarian cancer in 2014. The prognosis for approximately 75% of those women is very poor because the disease is often only first detected during its late stages. The reason for this is that during the initial stages, ovarian cancer mimics gastrointestinal upset and bladder disorders, and the disease is often misdiagnosed (or altogether undiagnosed) for a significant amount of time. One of the risk factors associated with the development of cancer is chronic inflammation. Therefore, much research has focused on the connection between anti-inflammatory medications and cancer risk. The proposed theory is that if chronic inflammation is correlated with the development of the disease, perhaps anti-inflammatory medication is correlated with prevention of cancer.

Aspirin is classically known as a salicylate drug, an analgesic used to relieve minor aches and pains and to reduce inflammation. It has also become accepted in the medical field as a prophylactic approach to prevent heart attack, and it has additionally been linked with decreased risk of colorectal cancer and other malignancies. And if that wasn’t enough, the most recent research suggests that routine aspirin usage may decrease the risk of developing ovarian cancer.

The Journal of National Cancer Institute published this research on February 6, 2014. The study analyzed data that was collected from 12 other studies, and it compared individuals who regularly used aspirin (18% of participants), non-aspirin NSAIDS (non-steroidal anti-inflammatory drugs, 24% of participants), and acetaminophen (16% of participants). The researchers concluded that individuals who used aspirin daily had a 20% decreased risk of developing ovarian cancer than those who used aspirin less than once a week. There was no statistically significant finding amongst the non-aspirin NSAID users. Acetaminophen, a non-anti-inflammatory medication, is not associated with decreased risk of developing ovarian cancer. While the findings of this study point positively towards promoting aspirin usage, please bear in mind that adverse side effects of daily aspirin include hemorrhagic stroke and upper gastrointestinal bleeding! Therefore, make sure to discuss using this medication (as any other medication) with your doctor to determine whether or not it is appropriate for you.