The Things We Put “Up There”, Part I

By Fiona McMahon, DPT

This might seem like an odd topic to post about, but when you think about it, there seem to be more and more products on the market for you to use on or in your vagina. These products promise a range of different benefits from pelvic pain relief, to making your vagina smell like a spring meadow in bloom. For any woman, especially one with pelvic pain, it can be difficult to navigate this marketplace and find products that are not only safe, but deliver on their promises. This post will serve as a brief introduction to vaginal products and their respective risks and benefits.

When I first started this blog post I thought it would be a brief blow by blow of different products, their intended uses, and their side effects. Little did I know that the politics, history, and business interests surrounding vaginal and intrauterine devices could fill a whole book, let alone a measly little blog post. I opened Pandora’s Box. In an effort to highlight the story behind these objects, beyond the what and how, I will be making this blog a multipart series. So, if you don’t see your favorite device, despair not, dear reader. It may be coming in a future post. So for now let’s explore the first two devices in our line up: pessaries and tampons. Onward.

Source: http://www.aafp.org

Pessaries are devices that are inserted into the vagina that provide mechanical support for the pelvic organs when the muscles of the pelvic floor are not strong enough to support them. They basically do the work of the pelvic floor and can be used to treat stress incontinence (urinary leakage with increased abdominal pressure, like coughing laughing or sneezing), pelvic organ prolapse, ( a condition where the bladder, uterus, or rectum drops down in the pelvic cavity and causes increased pressure and discomfort).

Pessaries are a good option for women who do not want surgery. Women who have short vaginas, large vaginal openings, or prior repair of hernias may not be successful with finding an appropriately fitting pessary.

Pessaries acts like a little a buttress to hold up the organs of your pelvic floor to improve continence. Because we all come in different shapes and sizes, pessaries must be fitted by a trained professional to do their job correctly.

Pessaries are taking on an amazing new role in developing countries with reduced health care infrastructure. Pessaries can be used to prevent pre-term birth in mothers who may not have access to advanced Western-style neonatal intensive care units. In a study published in the Lancet, the use of pessaries spontaneously reduced the rate of preterm delivery. The implication of this finding is profound and far reaching. With the use of a $50 device,  women who do not have access to proper medical care are more likely to carry their infants to term and deliver healthier babies. It’s really amazing.

As amazing as pessaries can be, they aren’t correct for all people. If you suffer from pelvic pain, the pressure from the pessary can increase pressure on the pelvic floor muscles (usually culprit for pelvic pain), and make your pain worse. Although this is disappointing, pelvic floor physical therapy is helpful to help reduce your painful trigger points in your pelvic floor as well as strengthening your pelvic floor muscles to reduce your degree of prolapse.

Tampons are familiar to most of us. They are thin cylinders that are inserted into your body to capture menstrual blood before it escapes the body. But, oh boy, are tampons and the social politics surrounding them complex.

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Source: Pinterest

Tampons come from the rather crude French word, tampion meaning plug or stopper. Tampons have been around in some form or another since well before the common era. Things such as rolled papyrus, and ferns have been used since ancient times to staunch the flow of menstrual blood.

The first modern tampon appeared in the US around 1933 by the Tampax corporation. It is estimated the American women use approximately 11,400 tampons in their lifetime and spends 6 to 7 years of their life menstruating (total bummer).

With that kind of use and ubiquity the safety of tampons is certainly a concern for women and parents of adolescent girls who have begun their cycle. In the United States, tampons are considered a grade II medical device, meaning they a subject to regulation by the food and drug association to ensure they are not only effective, but safe. Prior to 1976 tampons were not classified the way they are today and were not as rigorously tested to ensure that they were safe to use.

Anyone who has opened a box of tampons is probably aware of the little slip of paper that contains information on how to use tampons as well as Toxic Shock Syndrome (TSS). TSS is usually a result of the overgrowth of a nasty little bug, who goes by the name Staphylococcus aureus (S. aureus). S. aureus is carried in about 20% of people. These little microbes can cause a multitude of ailments from pimples, rashes, and food poisoning.

TSS is characterized by high fever, a drop in blood pressure, flaky skin, rash and muscle pain. It was first classified in 1978 and received a more precise definition in 1980. What is really fascinating about TSS is that it was found across the population at the time of its classification, in men and children (clearly, not regular tampon users).

The link between TSS and tampons came to light during the late 1970’s and early 1980’s. The tampon market ( an extremely lucrative and competitive industry) was entering a phase known as the “absorbancy wars”. In the mid 70’s and 80’s there were huge market pressures to produce a tampon that was not only cheaper to make, but also highly absorbent to compete with a market already saturated (sorry), with inexpensive and highly effective products.

In the mid 1970’s Proctor and Gamble released a highly absorbent tampon called “Rely”. This tampon was extraordinarily absorbent and distinct in its design from its competitors. The tampon contained synthetic gelling materials that absorbed  massive quantities of menstrual blood. While this designed allowed the wearer security and protection from unintentional menstrual leaking, the gelling substance provided a great environment for bacteria to grow and flourish. Furthermore, the gelling substance was manufactured in cube shape which increased the surface area for S. aureus to multiply.

A new tampon put on the market today would qualify as a class II medical device and would be under much stricter regulation by the Food and Drug Association (FDA). Rely, however, debuted on the market before such regulation was in place, and therefore was under less rigorous testing.

All tampons on the market today have won approval by the FDA and should be considered safe, but there are a few common sense recommendations to keep in mind when using these convenient little pieces of cotton. Always make sure you are inserting your tampons with clean hands, whether or not you are using tampons with applicators, or digital (applicator-less tampons). Use the lowest absorbency to do the trick. Tampons that are too absorbent  for your flow can dry and irritate the vagina, (not to mention a dry tampon is never a pleasant experience to remove). Change tampons regularly, and remove old tampons before inserting new ones. Remember tampons are only meant to be used during your period, if you feel like you are having discharge that needs to be absorbed, see your doctor as it may be a sign of infection.

That will do it for “Thing we put up there: Part 1”. Stayed tuned for our next edition. Ever hear of a pelvic wand or wonder what is the deal with douches? Well, put on your scuba gear, dear reader, we will be diving into those topics and more in future editions.

Sources:

Lamers, B.H., Broekman B.M., et al; Pessary treatment of pelvic organ prolapse and health-related quality of life: a review. International Urogynecology Review. 2011. 22(6), 637-44

Goya M, Pratocorona L, Merced C, et al. Cerivical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. The Lancet. 2012. 379(9828): 1800-06

Viera A, Larkins-Pettigrew. Practical Use of the Pessary. Am Fam Physician. 2000 1;61(9):2719-26

Tampons for menstrual hygiene: modern products with ancient roots. October 28,2014

Vostral S. Rely and toxic shock syndrome: A technological health crisis. Yale Journal of Biology and Medicine. 2011. 84: 447-59

Evaluating and Treating Neck Dysfunctions

By Amy Stein

Corey Silbert, who has her CFMT (certified manual therapy certification) and is an OCS (orthopedic certified specialist) led our staff on how to evaluate and treat neck dysfunctions, including those that result in headaches, dizziness, vertigo, pain and radicular symptoms. She evaluated and treated the upper cervical spine and down to upper thoracic area, assessing for decreased mobility in the spinous processes, lateral and rotational movement of the individual vertebrae, any soft tissue restrictions and decreased mobility in the ribs. She then followed the assessment with soft tissue and gentle joint mobilization, as well as neuromuscular re-education and postural training techniques.

We each assessed each other and gave each other a treatment.  If there is a musculoskeletal dysfunction in the cervical, thoracic and rib area, it can result in pain and radicular symptoms down the arm/s, back, and pelvic region as well as cause headaches and dizziness. Physical therapy, which is non invasive is the first line of treatment for these conditions and if you are experiencing any of the above symptoms you should seek out a physical therapist specializing in Manual and orthopedic therapy.

See below for some snaps of our session with Corey!

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After the Sirius XM Doctor Radio Show!

By Amy Stein

TjkWnIrQFyHXDiv2yQ4B8MyiZ6FenznTUdVxQzm8iSus_WHxS2hWmCJGGqjZnm4nZXtvWgkhQDBgIj1uQIKJIIEAahIZNhEGWSQWtkbx1zXyLWibELQNMv2B8EoQSNKuM5r3NAgWgkSGb9-lkBL1newaHVSVRrZdDy_mg5_2zo_kWGuul-_nmDYlcIqjvQhUqJN1k5V9grXF0SoFzMEPSkn0IePgLast Wednesday evening, I did a Sirius XM Doctor Radio show at NYU Medical Center on male pelvic pain conditions. There is still such a lack of understanding of female and male pelvic and sexual pain disorders, so it was wonderful to have this opportunity!  The show was well received with lots of phone calls and email questions during the show.

I went over how to identify possible musculoskeletal signs and symptoms and for the healthcare providers and how to palate the external and internal pelvic floor muscles. I explained that if there is pain with the palpation then it most likely is contributing and possibly the cause of their bladder, bowel and/or sexual dysfunction and pain.

If you’re curious, some symptoms of male pelvic pain are erectile dysfunction or postcoital pain, as well as prostatodynia or nonbacterial prostatitis, which is pain in or around the prostate.

I also discussed the research that supports musculoskeletal causes of male pelvic pain disorders, and suggested to the listeners that if they are unsure of their diagnosis then my book, Heal Pelvic Pain, may help guide them to a proper diagnosis and can also start their self-care program; however they also should seek out a skilled pelvic floor physical therapist (PFPT) that does hands-on, manual therapy to the external and internal muscles. I mentioned how in 2012, the AUA (American Urological Associaton) guidelines support that Kegels (pelvic floor muscle training) are not effective and most of the time contraindicated for overactive pelvic floor muscles and if they are seeing a PT that is only doing biofeedback and gave them Kegels, then they should seek another PFPT.

I reiterated that the same guidelines should be followed for female sexual pain disorders.  We still have a long way to go with regard to male and female pelvic and sexual pain; however we are making strides.

If you have any comments or questions, please comment here on our blog! Thank you Sirius XM radio and NYU medical center for spreading and for sharing the knowledge!

The Pain of Falling

By Fiona McMahon

I want to talk about a health risk that is seldom thought of when we think about health, falls. According to the CDC, elderly men are the most likely to pass away from a fall. White men in particular, are at risk for falls and are 2.7 times more likely to fall than their black men. Falls are the leading cause of both fatal and non fatal injuries in older women and men.

Image via Pinterest

There are simple steps you can take to limit your fall risk. A good first step is having your primary care provider review your current medications, both prescription and over the counter. You may find you are on many medications that treat the same thing. Your doctor can help determine if this is the case. Some medications, for example those that cause dizziness, can increase your risk of falls and your doctor may want to adjust them.

Another important step to minimize your fall risk is to have regular eye exams. Vision is an important part of our balance system and as we age, we may grow increasingly reliant on it. The CDC also advises seniors to get single distance lenses for outside activities like walking.

Modifications can also be added to your home to make it safer.  Adding additional handrails to your stairs, removing area rugs, adding non slip mats to your bathtub, and keeping your home neat and free of debris are all great steps to improving your overall safety.

One of the most important components in reducing your fall risk is remaining active. The old adages, “a body in motion, tends to stay in motion” and “use it or lose it” could not ring more true. Sarcopenia is the term that’s given to the gradual loss of muscle one experiences as he or she ages. We can begin slowly losing muscle fibers as early as 30 years old! With the gradual loss of muscle tissue we gradually lose strength and it becomes much more difficult to do things that were once previously easy.  Weaker muscles will make it harder to keep your balance. Remaining active and making sure you are eating enough of the right food can go a really long way towards slowing your rate of muscle loss as you age.

Even if you are not very active now, there are simple steps you can take toward reducing the rate of age-related muscle loss and maintaining your functional independence. Adding in more walking is a relatively easy thing to do. If you live in the city, get off the bus or subway a station early and walk the extra distance. You can also do your shopping at a bodega further away from your apartment. If you are a suburban or country guy or gal, park your car a little further away from the grocery store.

Another great idea is doing a little extra work when you get up out of a chair. Being able to get out of your chair by yourself is an important skill to maintain your independence. When you get up out of your chair, sit back down and get up a couple of extra times. This is like doing a mini-squat. “Sit-to-stands” as they’re called, are lovely exercises that strengthen all of your thigh muscles without having to go to the gym!

If you have fallen in the past year you are at risk for future falls. Medicare requires physical therapists to incorporate fall training into your plan of care if you have had a fall in the past year or demonstrate a risk for falls as determined by your physical therapy examination.  Physical therapy doesn’t just teach you skills that improve balance, it can also teach you potentially lifesaving skills like being able to get up from the floor independently. PTs will also strengthen the key muscles used for balance and give you exercise that gradually train your balance.

Beyond Basics can offer a little something extra to complete your fall training program. If you have incontinence either urinary or fecal, you are at an increased risk for falls. People with incontinence can fall for a multitude of different reasons. They may fall because of slippery floors that occur as a result of an episode of incontinence, or they may trip while rushing to the bathroom. Whatever the reason is, our therapists are specially trained to determine the reason for incontinence and implement a program to correct it.

You don’t have to accept falling, or incontinence, as a natural part of getting older. Whether you decide to start on your own, join a Tai Chi or balance training class at the gym, or whether you decide to seek help from a skilled physical therapist, act now, your health and independence depends on it.
Centers for Disease Control and Prevention. Falls among older adults: an overview. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.  Last reviewed March 19. 2015. Assessed June 18,2015.