Amy in London!

By Amy Stein, DPT

Yesterday, I was speaking in London with the well-known Fiona Lewis, vulvar dermatologist specialist, Peter Greenhouse, Maria Elliott and Fabrizio Bogliatto in London. It was a wonderful and informative seminar that Maria Elliott worked very hard at putting together, with an amazing group of people. Michelle Lyons and Jenny Burrell also attended.

My talk in London was well received with a mixed audience of beginner women’s health PTs and some physicians and also more advanced PFPTs like the host, Maria Elliott, Michelle Lyons and Andrea Dugan.

Peter Greenhouse was a very dynamic speaker and he disagrees with vestibulectomy, stating that there are other treatment options and the research of 61% is not strong enough to warrant a surgery. Other physicians may argue this.

Maria Elliott, the host, spoke on the importance of proper alignment and functional biomechanics.  She mentioned the importance of having a happy gut. We both mentioned the importance of a home program and we discussed lubricants like Yes, and massage tools like EZ Magic and EZ fit.

The commonality amongst all five of us was that vulvar and pelvic pain require a multidisciplinary approach and most of the time there is not a quick fix.

I also mentioned attending #ipps16 in Chicago, October 2016, and IPPS’s world congress on abdominal and pelvic pain in DC in October 2017!  I spoke to them about the Alliance for Pelvic Pain weekend patient retreat, as well, which is coming up in May 2016! I also discussed the importance of manual therapy both external and internal, and the need to assess and treat the rectal muscles. Even though it was a vulvar and pelvic pain seminar I did mention how male pelvic pain is also so prevalent and how necessary it is to help the male patients. Our practice is about 40% male pelvic floor dysfunction and pelvic pain.

Fiona Lewis discussed vi pat dermatoses and how you can have vaginal crones, lichens sclerosis, lichens planus and various other diagnoses. She   also discussed how some Vulvodynia is not “seen” and therefore can be moe challenging to diagnose. She praised me on my presentation, stating that physicians are not taught in most European medical schools on how to assess he musculoskeletal impairments that can cause pelvic and vulvar pain.  They are not taught how to palpate the pelvic floor muscles externally or internally, and she along with the other physicians are surprised by this because it is so important.

At the end of the evening, after an amazing job by Maria Elliott and Ilaina Brockman, of Icrelief.com, Maria took 12 of us to a lovely dinner in London and we celebrated her success over delicious food and wine!

See below for pictures!

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A Pelvic Health Weekend with Lila Abbate

By Amy Stein, DPT

This week, I assisted Lila Abbate at Touro College in New York in a Bowel Course through Herman and Wallace. The BBPT pelvic floor experts–Stephanie Stamas, Corey SIlbert and Melissa Stendhal–also attended, along with over 40 others from the U.S. and Canada.

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It’s exciting how the world of pelvic floor PT is advancing.  When I started only Holly Herman and Kathe Wallace were teaching separate classes and only one time per year.  Now there are over 100 classes taught between APTA Women’s Health and Herman and Wallace.

Lila discusses differentiating from bowel motility issues and pelvic floor muscle dysfunction. The biggest take-home messages are:

– none of the tests for PFMD replace palpation and findings with your expert finger
– the bowel is a slow learner and does not like change
– there’s a big link between the bowel and the nervous system.
-medications can effect bowel habits and the patient may have to adjust their lifestyle
– positioning on the toilet can help with the anorectal angle
– abdominal bracing can help
-the diaphragm assists with urination and defecation
-pelvic floor muscles are passive with defecation and abdominal muscles are active
– you need to set responsible expectations

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Even two years after a surgery or traumatic injury, bowels are still sensitive. Take a good history and do a bowel diary to help with your differential diagnosis.  Is the patient drinking enough water, drinking too much coffee, too much alcohol and dehydrating their system? Are they eating too much fiber or taking too many laxatives? Do they have constipation or bowel leakage because of this?  Do they need to bulk their stool vs. add more water and soluble or insoluble fiber? Almost all patients who have had a bowel surgery have difficulty with dairy and fatty foods, so eliminating this from their diet can help. Doing an p to two yeelimination diet can help. Lila also discussed how you can have the patient eat corn and see how long it takes to pass as a precursor to the Sitz marker test.

Bowel issues can arise uI highly recommend this class and all of the Herman and Wallace and APTA Women’s Health classes to advance your learning in pelvic health. Also, for more information on nutrition for PTs, Jessica Drummond teaches and has a certification for PTs and nutrition.

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Ooo La La, La! Rééducation Périnéale: Pelvic Floor En France

Fiona McMahon, DPTpregnant en frnace

Bonjour les femmes et les hommes! Did you know that in France, after you have a baby, you get government sponsored pelvic floor physical therapy? That’s right, the French send their new mothers to pelvic floor reeducation, La Rééducation Périnéale. It is free of charge and this type of physical therapy has become the standard of care for postpartum mothers.

We all know childbirth can cause things “down there” to need a little TLC and that after childbirth, things like sex and maintaining continence may become more difficult. Women in France as well as in all countries, including the US, regularly benefit from programs of pelvic floor physical therapy, to address restrictions and areas of tightness in the vagina, vaginal muscle tone changes, and teach the muscles of the vagina to work properly again. What makes France standout is that for women in France, these postpartum physical therapy sessions are free.

The French healthcare system is a little different than ours. The people of France receive government insurance (which draws its financing from a 5.25% of earned income, paid into social security by every French worker), but they also may pay for private insurance to cover any costs that fall outside of what is covered insurance. In France the entire cost of pelvic floor physical therapy is covered by the government.

For new mothers, 10 weeks of pelvic floor physical therapy are provided after giving birth. There are a bevy of think pieces (many cited below), that recount the experience of American- expats’ feeling like they had been magically gifted some strange and exotic European vagina personal training. In these pieces, the explanations for why France foots the bill to rehab your pelvic floor are varied and not all in agreement. Some of the authors cite that because of the European Union’s already dwindling population, and that rehabbing their pelvic floors allows mothers to return to baby-making more quickly than they would have had they only received the 6 week post-partum OBGYN checkup, which is common practice in the United States.

Another more practical explanation is, that because France’s healthcare system is largely funded by the French state. It behooves the French to foot the relatively small bill of pelvic floor physical therapy, versus paying for more expensive problems like incontinence and prolapse, which can occur if pelvic floor issues are ignored. It really is a wise investment for both the French government as well the new mothers, who are investing their time in treatment.

Regardless of the rationale, French women are given a great service. The benefit of Pelvic floor physical therapy has been shown over and over again in many different studies. Rehabbing your pelvic floor after a traumatic event like childbirth, both cesarean and vaginal, can help relieve troublesome symptoms like pain, incontinence, and symptoms of prolapse. It is important that if you feel you need some extra help after your birth, that you seek out a pelvic floor physical therapist. The rewards can be great, and they are much easier to obtain the sooner you enroll in physical therapy! To read more about the benefits of pelvic floor physical therapy, check out these blogs from our archives!

Sex After Pregnancy

https://beyondbasicspt.wordpress.com/2015/06/10/sex-after-pregnancy/

The Pain No One Wants to Talk About

https://beyondbasicspt.wordpress.com/2015/05/13/the-pain-no-one-wants-to-talk-about/

Sources

Giovanni J. We will teach you to make love again. The Guardian.  Wednesday 25, March 2009

Lundberg C. “The French Government Wants to Tone my Vagina”. Slate. Accessed October 14, 2015. http://www.slate.com/articles/life/family/2012/02/postnatal_care_in_france_vagina_exercises_and_video_games.2.html

Rochman B. “Why France pays for postpartum women to “re-educate” their vagina. Time. Feb 22, 2012

Pelvic Health 101: Women’s Only Session November 10th

By: Fiona McMahon, DPT

Hey ladies! For our next installment of our Pelvic Health 101 course, on Tuesday, November 10 at 7pm, we are hosting a women’s only session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class is one of Stephanie Stamas’s, (the founder of PH101) favorites and is definitely not to be missed.

As always, first-time attendees will receive FREE copies of Amy’s DVD, Healing Pelvic and Abdominal Pain, and we provide snacks. We will also be tweeting the highlights of the seminars at @beyondbasicspt!

Pelvic Health courses are free to the public, but space is limited. Please register at: pelvichealth101.eventbrite.com.

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