PH101: I’m Pregnant – Help!

Having a baby is exciting, fascinating, and nerve wracking. If you have never been through the process before, chances are you have a lot of questions and concerns about what changes your body will go through during your pregnancy, what the birthing process entails, and how your recovery will go once you’ve had your baby.

Join us and childbirth specialist, Ashley Brichter, in our Pelvic Health class to discuss the ins and outs of having a child.

Register at pelvichealth101.eventbrite.com   today.

Location:

110 East 42nd Street, Suite 1504

New York, NY

10017

Time: 7pm on November 8th, 2017

Pelvic Health 101 Fall 2017

Building a strong foundation – Treating the pelvic floor in individuals with multiple sclerosis

By: Kaitlyn Parrotte, PT, DPT, OCS, CFMT

MS

What is Multiple Sclerosis?

Multiple Sclerosis (MS) is an “immune-mediated” disease, in which the body’s immune system attacks the central nervous system (1).  The cause is unknown. MS is characterized by injuries (plaques) of the myelin, which is a fatty substance that surrounds and insulates the nerve fibers; nerve fibers themselves may also be attacked. The damaged myelin forms scar tissue that is called “sclerosis,” which is how the disease was named (1,2).  When the myelin, or nerve fibers, are damaged or destroyed at any point on the neural pathway, nerve impulses that are traveling between the brain, spinal cord and the body are interrupted, and as a result, can create a variety of symptoms.(1)

Symptoms:

The more common symptoms seen in individuals with MS are:

  • Fatigue
  • Numbness or tingling
  • Weakness
  • Dizziness or Vertigo
  • Sexual Problems
  • Pain
  • Emotional changes
  • Walking difficulties
  • Spasticity
  • Vision problems
  • Bladder problems
  • Bowel problems
  • Cognitive changes
  • Depression(1)

Types of MS:

There are four disease courses that have been identified in multiple sclerosis:

  • Clinically Isolated Syndrome (CIS) – a first episode of neurologic symptoms in the central nervous system, which lasts at least 24 hours.(1)
  • Relapsing-remitting MS (RMSS) – the most common form of the disease, that is characterized by clearly defined episodes of new or increasing neurologic symptoms (relapses), followed by periods of partial or complete recovery (remissions).(1)
  • Primary progressive MS (PPMS) – characterized by a gradual worsening of neurologic function, from the onset of symptoms, without any relapses or remissions.(1)
  • Secondary progressive MS (SPMS) – follows a course of MS that is initially relapsing-remitting. Most people with RMSS will eventually transition into a secondary progressive course, which is when their neurologic function will gradually worsen over time.(1)

Treatment of MS:

Because of the complex nature of this condition, and because it is not a curable disease, the management of MS requires comprehensive care. One component of that care is physical therapy. A physical therapist will evaluate and address the body’s ability to move and function. Common physical therapy interventions frequently address walking and mobility, strength, balance, posture, fatigue, and pain. However, did you know that physical therapy can also treat issues with bowel, bladder, and sexual dysfunction(1)? These dysfunctions are addressed through treating the pelvic floor musculature and surrounding tissues, which is performed by specially trained clinicians, such as the physical therapists at Beyond Basics Physical Therapy.

 

Bowel Dysfunction:

As previously noted, patients with MS can have various symptoms, including symptoms related to pelvic floor dysfunction, such as bladder, bowel, and/or sexual dysfunction. According to one study from 2016, individuals with MS can have lower anal sphincter pressure (which limits their ability to control stool flow), as well as higher rectal sensitivity (which makes it more difficult for a person to appropriately recognize when they need to defecate). These can increase the occurrence of fecal incontinence (involuntary leakage of stool), as adequate muscle strength and tone are needed to prevent leakage, and appropriate urge is required to ensure a person can get to the bathroom when they actually need to go (3) Even in the constipated individual with MS, there is a decrease in anal sphincter tone, which results in poor muscle coordination, making the release of stool more challenging (3) With these individuals, pelvic floor relaxation is typically needed to allow for easier and complete emptying and to decrease symptoms of bowel urgency.

Several studies from the late 1990s and early 2000s have looked at using biofeedback to help retrain muscle coordination. Biofeedback was applied in two ways: through stick-on electrodes that measured the response of muscles surrounding the anus, and with feedback applied internally in the rectum, with a finger, rental sensor or balloon. With stick-on electrodes, individuals are typically connected to a machine that allows them to see the electrical activity of their muscles, so they can work on controlling them (contract or relax). With internal feedback through a therapist’s gloved finger, with a rectal sensor or balloon, individuals can improve muscle control through gaining better awareness of their pelvic floor muscles. Researchers found that the use of biofeedback yielded some improvement in patient reported disability for those experiencing either constipation or fecal incontinence (4,5).  Physical therapy treatments to address muscle coordination and sensitivity can be helpful to treat those experiencing constipation or fecal incontinence related to MS; however, more research is needed to help enhance care.

Urinary Dysfunction:

As MS impacts the nerve signal transmission along nerve channels, urinary dysfunction frequently occurs (6) The most common urinary disorder seen in this population is urinary incontinence, which is involuntary leakage of urine. Urinary incontinence is related to fatigue and uncoordinated muscle recruitment, which are characteristic of MS, and can have a significant impact on an individual’s quality of life(2) Another common diagnosis is overactive bladder, which interrupts bladder function and causes a sudden need to urinate(6). This may occur, at least in part, due to hyperactive muscles in the pelvic floor that have become too short and tight over time.

Many groups have looked at the impact of physical therapy to directly address weaknesses that develop in the pelvic floor, and are related to urinary dysfunction (6,7) Two separate articles published in 2016 looked at groups of women with MS, and split them into groups to undergo pelvic floor muscle training with and without some form of electrical stimulation. The emphasis of this intervention was to train the pelvic floor muscles how to activate without compensation from surrounding muscles, over the course of several months (6,7) By the end of one study, women in both groups demonstrated increased pelvic floor strength and endurance, decreased symptoms of overactive bladder, and decreased anxiety and depression (6). In the other study, all three groups exhibited a decrease in pad weight, which measured the amount of urinary leakage, as well as decreased frequency of urgency and urge incontinence episodes(7). This research is showing that direct treatment to the pelvic floor muscles help to decrease urinary symptoms in people with MS, as muscle strength and endurance are increased.

Sexual Dysfunction:

Sexual dysfunction is also common in individuals with MS (affecting 40%-80%)(8). Sexual arousal begins in the nervous system with the brain sending signals through the spinal cord and nerves to the sexual organs. These pathways can become damaged due to the effects of MS on the nervous system, which in turn impacts a person’s sexual response or sensation. Symptoms of this may manifest as difficulty achieving orgasm or loss of libido, as well as erectile dysfunction in men, and altered clitoral/vaginal sensation or vaginal dryness in women (9). Other symptoms of MS, such as fatigue, muscle weakness, and spasticity also negatively impact sexual response in this population (8).

Pelvic floor muscles are responsible for rhythmical involuntary contractions during orgasm. These contractions occur when sensory information travels through nerves to these muscles. Continued, uninterrupted stimulation may allow for sexual arousal to progress and build up to a maximum point. Once this point is reached, the pelvic floor muscles, which have been gradually becoming tighter and tighter, get even tighter, hold this tension momentarily, and then release all tension; this is an orgasm (10). Through various research, it has been shown that weak pelvic floor muscles can lead to a decrease in orgasm and arousal (8) and specific pelvic floor muscle strengthening can help improve sexual function, especially in females (11,12,13).

One study that looks at MS-related sexual dysfunction is a 2014 article published in the Multiple Sclerosis Journal. This article took 20 women diagnosed with relapsing-remitting MS, and divided them into three treatment groups: pelvic floor muscle training alone, pelvic floor muscle training with intravaginal electrical stimulation, and pelvic floor muscle training with electrical stimulation applied over a nerve in the leg. The pelvic floor muscle training in each group consisted of teaching each participant how to contract her pelvic floor without using surrounding muscles as a compensation, and then performing both fast and slow contractions, over twelve weeks of treatments. After the twelve weeks of treatment, individuals in all three groups demonstrated significant improvements in muscle power, endurance, and fast contractions of the pelvic floor. They also reported an increase in the total score, as well as the arousal, lubrication, and satisfaction subscores, of the Female Sexual Function Index.8 What this study has shown is, in women with MS, physical therapy can help to treat sexual dysfunction by enhancing muscle response and activity in the pelvic floor.

Conclusion:

All bowel, bladder, and sexual function rely in part on strong and flexible muscles in the pelvic floor. With Multiple Sclerosis, these muscles tend to lose either mobility and then strength, and/or muscle tone and coordination. Either way, the loss of efficient tissue tension, coordination, and strength, makes the performance of these important functions much more challenging. While various medications or other interventions, may also be necessary to help individuals with MS manage their symptoms, physical therapy has been proven to be an important part of the healthcare team. Here at Beyond Basics Physical Therapy, all our clinicians have specialized training to evaluate and treat the pelvic floor, so each one of us is in a strong position to help you manage these symptoms and improve function! Feel free to contact our office at 212-354-2622, or visit our website (www.beyondbasicsphysicaltherapy.com) for more information!

Sources:

  1. National Multiple Sclerosis Society. https://www.nationalmssociety.org
  2. de Abreu Pereira CM, Castiglione M, Kasawara KT. “Effects of Physiotherapy Treatment for Urinary Incontinence in Patient with Multiple Sclerosis.” Journal of Physical Therapy Science 2017; 29(7): 1259–1263.
  3. Marola S, Ferrarese A, Gibin E, et al. “Anal Sphincter Dysfunction in Multiple Sclerosis: An Observation Manometric Study.” Open Medicine 2016; 11(1): 509–517.
  4. Chiotakakou-Faliakou E, Kamm MA, Roy AJ, et al. Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Gut 1998;42:517–21.
  5. Wiesel PH, Norton C, Roy AJ, et al. Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. J Neurol Neurosurg Psychiatry 2000;69:240–243.
  6. Ferreira, Ana Paula Silva, et al. “Impact of a Pelvic Floor Training Program Among Women with Multiple Sclerosis.” American Journal of Physical Medicine & Rehabilitation 2016; 95(1): 1–8.
  7. Lúcio A, Dʼancona CA, Perissinotto MC, et al. “Pelvic Floor Muscle Training With and Without Electrical Stimulation in the Treatment of Lower Urinary Tract Symptoms in Women With Multiple Sclerosis.”Journal of Wound, Ostomy and Continence Nursing 2016; 43(4): 414–419.
  8. Lúcio AC, D’Ancona CA, Lopes MH, et al. “The Effect of Pelvic Floor Muscle Training Alone or in Combination with Electrostimulation in the Treatment of Sexual Dysfunction in Women with Multiple Sclerosis.” Multiple Sclerosis Journal 2014; 2 (13): 1761–1768.
  9. “Sexual Problems.” National Multiple Sclerosis Society, http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Sexual-Dysfunction.
  10. Lowentein L, Gruenwald I, Gartman I, et al. Can stronger pelvic muscle floor improve secual function? Int Urogynecol J 2010; 21: 553-556.
  11. Bo K, Talseth T, Vinsnes A (2000) Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand 79(7):598–603
  12. Beji NK, Yalcin O, Erkan HA (2003) The effect of pelvic floor training on sexual function of treated patients. International urogynecology journal and pelvic floor dysfunction 14(4):234–238
  13. Zahariou AG, Karamouti MV, Papaioannou PD (2008) Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. International urogynecology journal and pelvic floor dysfunction 19(3):401–406.

PH101: Ladies Only Session

By: Fiona McMahon, DPT
Hey Ladies!!! In our next installment of our Pelvic Health 101 course, 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 one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Hear more about it in her video below! Join us at 7pm on October 25, 2017  Please register at pelvichealth101.eventbrite.com

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Spring 2018 (2)

How a Birth Doula Can Help Make Labor a More Intimate Experience

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Chantal Traub, CD, CCCE, LCCE,

Pregnant mothers may be unsure if they want to work with a doula because they would like their labor and birth to be an intimate experience between them and their partners and wonder whether having a doula would encroach on their intimacy.

The role of the doula is to help ensure a healthier, safe and positive birth experience for the whole family. She will provide emotional support, physical comfort and the information needed to make informed decisions as they arise in labor at home or at the hospital. She will present reassurance and perspective to the birthing woman and her partner, offering various positional ideas for relaxation and labor progression and hands-on comfort measures like touch, massage, counter pressure and breathing techniques.

One may wonder how an intimate experience can be enhanced with the presence of a doula and the medical staff. Intimacy refers to the feeling of being in a close personal association and belonging together. It is the familiar and very close affective connection with a bond that is formed through knowledge and experience of the other. This intimate experience can be created by having the partner taking a role in the birthing process. The experienced doula will include the partner.

The doula’s presence offers a great sense of relief for both of you, especially for your partner who may begin to feel concerned with the responsibility of supporting you and may not know what normal is in this situation. If you’re having an intimate moment with your partner, an experienced doula will know when to step in and when to step back. She will encourage and allow you both to have that moment. In fact, she will look out for and suggest opportunities for you to be together. She will gently pull your partner back if your partner is feeling overwhelmed or feels worried seeing you in pain and give your partner the tools to help support you. If your partner needs a break or a breath of fresh air, the doula will be there, so that the partner can take care of themselves knowing the doula will take care of you.

The role your partner takes depends on the two of you. If your partner would like to roll up their sleeves and offer physical support or prefers to remain emotionally present from a distance, your doula will guide you. The doula may suggest ways for your partner to hold you or breathe with you. She can show your partner ways to massage and apply pressure while you are laboring. If a partner cannot participate physically for various reasons, they may choose to assist in other ways like getting ice and water while the doula manages the physical part, or merely remain emotionally present in the room. The intimacy is in the experience, allowing your partner to remain confident and emotionally present with you.

Whether your birth is unmedicated or medically complex, every family can benefit from the guidance and support of a doula at this often vulnerable and overwhelming time in their lives.

Chantal is originally from Cape Town and after years of working in film she began teaching yoga in 1996 and in 2003 she became a Certified Doula and has been assisting women in labor ever since. She is also a Certified International Childbirth Educator and a Certified Pre/Postnatal Yoga teacher. Her Prenatal classes are informative and educational and are designed for Labor and Delivery. Chantal has been teaching and assisting families in the New York Metro area for over 15 years and she combines her wisdom and knowledge to help families prepare for a positive birth experience

Chantal Traub, CD, LCCE, CCCE

 www.chantaldoula.com

Certified Doula (CD)

Lamaze International Certified Childbirth Educator (LCCE)

Certified Cooperative Childbirth Educator (CCCE)

Chantal Traub is a certified doula with over 15 years of experience and is a board member for the Childbirth Education Association of Metro New York. Originally from Cape Town, South Africa, Chantal received her BA of Fine Arts and after working for many years in film as an art director, she began teaching Yoga in 1996. Chantal is a White Lotus Foundation Certified Yoga Teacher, Pre/Postnatal certified Yoga teacher and Certified Traditional Ayurvedic Bodyworker. Chantal started her Birth Doula practice in 2003 after receiving her certification from A.L.A.C.E. In 2007 She became a Certified Childbirth Educator by Lamaze International and by the Childbirth Education Association of Metropolitan NY. Chantal is trained with Kate Jordan Pregnancy and Postpartum Massage Therapy and with The Julie Tupler Maternal Fitness Technique. She’s also Certified Kangaroula by Dr Nils and Jill Bergman. She lives in Brooklyn with her husband and two children, Naomi and Noah.

Ph101 Men’s Only Seminar

Fiona McMahon PT, DPT

Guess what?! The next class in Beyond Basics Physical Therapy’s Pelvic Health 101 series is ALL NEW! On April 11th at 7pm we will be hosting our very first ever “Men’s Only Seminar”. Join Sarah Paplanus, DPT and Dr. Seth Cohen as they discuss how pelvic floor dysfunction affects the male pelvic floor. Learn how your sex life can be improved by pelvic floor treatment, how to regain function after a prostatectomy, and how to rid yourself of the pain of prostatitis, and avoid antibiotics for the most common type of prostatitis. This seminar is not to be missed!

For more reading on men’s pelvic health topics, check out:

All About Testicles

Navigating Life with Chronic Pain: Part 1

Navigating Life with Chronic Pain: Part II

Prostatitis What it is and What to do About it

Read more about our hosts here:

Sarah Paplanus PT, DPT

Sarah graduated with a Bachelor of Science in Exercise Science from Manhattan College and a Doctorate in Physical Therapy from Hunter College. Her clinical studies included advanced training in manual therapy at Functional Physical Therapy in Denver, Colorado. She has continued her training as a functional manual therapist with the Institute of Physical Art and is pursuing certification in Functional Manual Therapy (CFMT).

Prior to joining Beyond Basics, Sarah spent over five years specializing in orthopedics. Her interest in pelvic floor physical therapy grew through working alongside talented pelvic floor physical therapists and seeing the connections between orthopedics and pelvic floor dysfunction. Sarah has continued her training in pelvic health through the Herman and Wallace Pelvic Floor Rehabilitation Institute.

Sarah is a member of the International Pelvic Pain Society (IPPS).

Seth Cohen, MD, MPH 

Dr. Cohen treats erectile dysfunction, male sexual dysfunction, low testosterone, benign prostatic hyperplasia, enlarged prostate,  and kidney stones and other conditions including male and female pelvic pain. 

Credentials

Positions
  • Assistant Professor, Department of Urology
  • Assistant Professor, Department of Obstetrics and Gynecology
Board Certifications
  • American Board of Urology – Urology, 2016
Education and Training
  • Fellowship, Univ of CA San Diego Med Ctr, Sexual Medicine, 2014
  • Residency, Lenox Hill Hospital, Urology, 2012
  • MD from Tulane University, 2007
  • MPH from Tulane University, 2003
Departments
  • Urology, 
  • Obstetrics and Gynecology

Register here: pelvichealth101.eventbrite.com

Location:

110 East 42nd street

Suite 1504

NY NY

10017

Pelvic Health 101 Spring 2018 (2)