Pelvic Health 101 is back!

Pelvis Drawing

***In light of current events, and in an effort to keep our community as healthy as possible, we have moved our Pelvic Health 101 (PH 101) seminars from in person to online.  Although we regret not being able to meet everyone in person, we are excited for the opportunity to broadcast information about pelvic floor disorders and how to treat them fair and wide. Please keep an eye on our social media as well as the blog to find out how you can learn more about the pelvic floor.****

Warmly,

The Team at Beyond Basics

 

On March 19th, at 7pm we will be kicking off our spring semester of pelvic health education class, we call Pelvic Health 101 (PH101). In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health and function of your bowel, bladder, and sexual functioning. We will also be covering how things such as alignment, posture, muscle tone and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.

 

New York, NY 10017
Register at: pelvichealth101.eventbrite.com

Here is our line up of this and future classes

ph101 sp 20

 

 

Endo Awareness Month: Understanding Endo

Amy Stein and Fiona McMahon

Beating Endo Cover

March Is Endometriosis Awareness Month. Treating endometriosis and improving the lives of people with endometriosis, has long been a passion of Dr. Amy Stein, founder of Beyond Basics Physical Therapy, so much so, that she teamed up with Dr. Iris Orbuch and wrote a book about it! This month we are reviewing some of the major talking points in their book, Beating Endo. Available here.  For more on endometriosis, check out our past blogs as well as Beating Endo.

Endometriosis is a condition that affects people born with female anatomy. It occurs when a tissue similar to that of lining of the uterus (known as the endometrium) grows outside of the uterus. Seems like a pretty simple definition, but it can cause a whole host of symptoms.

When something that doesn’t “belong” in the body is detected by the body, inflammation will occur. It is this inflammation that is believed to cause the myriad symptoms someone with endometriosis may experience. These symptoms can include

  • Irritable bowel syndrome (IBS)
  • Painful bladder syndrome
  • Pelvic floor dysfunction

One of the confusing things is, you don’t have to have all of these symptoms to have endo and the severity can range. This is Fiona writing, and I’m sure Amy would agree, no two endo patients are alike, and your pain is valid even if your symptoms do not necessarily look like someone else’s’ who is suffering with endo. It is this variability in presentation along with poor awareness within the medical field and public, leading to an average of 7 to 12 years to get a diagnosis.

Endometriosis can only be diagnosed by analyzing the suspected endometrial lesions removed during an excision surgery. There is no other test to confirm it, which can make diagnosis obviously, very difficult.

There is another condition that is called Adenomyosis. Similar to endo, adeno occurs when cells similar to the lining of the uterus occur within the muscular wall of the uterus. Most people with adeno have endo, but it is not always true that most people with endo have adeno. Adeno can show up as heavy periods, low back pain, and pelvic pressure.

Endometriosis is a chronic illness that affects millions of people. There is still a lot to figure out about endo and because of that fact there are many truths, half-truths, and myths floating around out there about endo. Check out some of the myths Amy and Iris busted together in Beating Endo.

Common Endo Myths

The abdominal and pelvic floor muscles are rarely affected by endometriosis.

False: Constipation, frequent urination or retention, pain with vaginal penetration from endometriosis causes tightening of the abdominal and pelvic floor muscles; So too does assuming the fetal position which is our go to pose when we are in pain. Both contribute to tight abdominal and pelvic floor muscles which causes pain.

The pelvic floor and abdominal muscles do not cause bladder, bowel, sexual dysfunction or abdominal-pelvic pain in patients with endometriosis.

False: Tight pelvic floor muscles caused by years of straining or reflexive tightening due to pain, often cause a severe amount of pain which results in further tightening and shortening of the pelvic floor muscles. Good news is that pelvic floor physical therapy benefits most people who have been experiencing abdomino-pelvic or sexual pain and/or are straining due to ongoing bladder and bowel symptoms.

Hysterectomy is a cure for endometriosis.

False: Hysterectomy is neither a treatment nor a cure. By definition endometriosis consists of cells similar to those in the lining of the uterus but found outside the uterus. Only surgical ‘excision’ removes endometriosis cells.

Medical menopause is a cure for endometriosis.

False: Just because your medicines give you hot flashes doesn’t mean your endometriosis is going away. The best treatment approach is to meet with an endo specialist to discuss options, and in most cases PT management. As well surgical excision has much better results than ablation of Endometriosis.

There is no correlation between quantity of endometriosis and severity of disease.

Truth: Even if you have a minimal amount of endometriosis, you can be in debilitating pain with lots of symptoms and in most cases dietary changes, physical therapy and mindfulness practices can help manage a lot of your symptoms.

Teenagers are too young to have endometriosis.

False: Teenagers can have endometriosis and their endometriosis can cause debilitating symptoms.

Pregnancy is a cure for endometriosis.

False: Just plain no. Pregnancy does not cure endometriosis.

Ablation surgery is the same as excision surgery.

False: Not even close. Excision surgery is the proper treatment for endometriosis. Ablation surgery, burns the surface of the endometriosis lesion but leaves the bulk of endometrial implants behind.

Surprising Endo Facts:

Fact: Physical therapy (pelvic PT) can help many suffering from the many pains and symptoms of Endo, including back, abdominal and pelvic pain, bladder, bowel and sexual function.

Fact: The majority of patients with Endometriosis require pelvic floor physical therapy. Pelvic floor PT can be instrumental in the healing process and can help abdominal-pelvic pain, bladder and bowel urgency, frequency, retention, incomplete emptying, and any sexual pain related to the musculoskeletal system.

Truth: Painful bowel movements, constipation, diarrhea and bloating are symptoms of endometriosis as well as symptoms of pelvic floor dysfunction .

Truth: Painful sex is a symptom of endometriosis as well as a symptom of pelvic floor dysfunction.

Truth: 40 to 50% of women with unexplained infertility is caused by Endometriosis.

Truth: Teens with endometriosis often have acyclic pain, that is, pain at other times of the month rather than only during their period, in addition to cyclic pain.

Truth: Back pain is a symptom of endometriosis.

Truth: If your ultrasound is normal you can still have endometriosis.

Truth: roughly 10% of women have endometriosis. That’s close to 200 million women worldwide. Endometriosis is much more than just bad period pain. 1 in 4 women have pelvic floor dysfunction.

Truth: Endometriosis commonly affects the musculoskeletal system, and in many cases can be a primary contributor to one’s pain and symptoms.

 

Orbuch I, Stein A. Beating Endo. New York. Harper Collins. 2019

What’s Neater Than Your Peter? Burning Urination

#3MalePelvicFloor_Nolabel_copyright
 copyright Amy Stein 2008

Fiona McMahon PT, DPT

It’s been a while since we’ve done a “What’s Neater than Your Peter” series so it’s definitely time for another addition! Today we will cover urethral burning. For people with penises, this can be an alarming symptom. By itself it can be a pretty non- specific symptom. Thus, for anyone experiencing urethral burning, it is important to visit your healthcare provider right away, to find out what is causing your symptoms. In this blog we review potential causes of urethral burning, which is by no means an exhaustive list, and discuss what can be done for urethral burning caused by musculoskeletal conditions as well as some food items that can irritate the urethra.

If you are saying “ureth- what?” you are not alone. Both people with male and female anatomy have a urethra. The urethra, or the “pee hole” as it is colloquially known, the passageway from the bladder to the outside of the body. In people with male anatomy, the urethra also transports ejaculate out during ejaculation. Nifty. For people with penises, your urethra is longer than those of us with female anatomy, which is somewhat protective against urinary tract infections(UTIs), you lucky duck, you.

Pain and stinging in your urethra could indicate a lot of things. Things that you definitely don’t want to wait on treating include; sexually transmitted infection (i.e herpes, chlamydia, and gonorrhea), bladder infection, which untreated can progress to kidney infection, reaction to personal care products, prostatitis, and pelvic floor dysfunction, which can cause non- bacterial prostatitis), amongst other conditions.

The thought of potentially having an STI can keep people away from the doctor secondary to embarrassment, cost barriers, etc. According to an up to date article cited in the sources, more than half of the United States population who is eligible for screening fails to do so. Don’t let it be you. The complications of untreated STIs can be much worse than the initial infection, not to mention the risk of harming your future partners. Also know that STI’s are fairly common and having one does not make you a “dirty” or “bad” person. It’s so common! Nearly 1 in 2 people will acquire an STI in their lifetime, so if you do have one, you aren’t alone and you deserve to feel better.

So what happens if you’ve ruled out STI, bladder infection, prostate infection, and reactions to personal care products? What in the actual heck could be causing your urethral discomfort? At this point it is important to look at your pelvic floor and your diet.

Let’s talk about diet first. There are some substances that can irritate the bladder and urethra, and give the feeling of burning in the urethra as well as increased urinary frequency and urgency. I write about bladder irritants in my recent blog and you can check out a list of bladder irritants here. (INSERT BOTH BLOG AND bladder irritant list). But if you are too busy to read the whole blog, the long and short of it is, not every irritant on this list will bother your symptoms. Be mindful when eating foods with these irritants. If your symptoms flare 2-3 hours following eating an irritant, consider eliminating it from your diet and see how you do. The most common irritants we see at BBPT are caffeine, citrus, alcohol and spicy food.

Now let’s talk about urethral burning and its relationship to the pelvic floor, shall we? The pelvic floor is the area of muscles that live between the pubic bone in front and the tailbone in back. Like an onion, the pelvic floor has layers: three to be precise. The outermost layer contains a muscle called the bulbospongiosus (bulbo), along with its buddy the ischiocavernosus, and the superficial transverse perineum. The bulbo surrounds the urethra and is at the base of the penis. If it is tight, it can make it harder to pee and also cause urethral burning with urination and ejaculation. In addition, the layer below: the urogenital diaphragm and the layer below that, which consist of a whole bunch of muscles called the levator ani, can contribute to these symptoms as well. In fact, dysfunction in these muscles causes almost 95% of non bacterial prostatitis cases. Wowzah, no? I discuss prostatitis in much more detail in this blog (INSERT). How can you tell if your muscles are tight? The best way to tell is getting yourself to a skilled pelvic floor physical therapist, who can accurately diagnose issues with the pelvic floor as well as provide you with a plan to start feeling better.

Sources:

American Sexual Health Association. Statistics. http://www.ashasexualhealth.org/stdsstis/statistics/ [ Accessed January 14, 2020]

Ghanem K, Tuddenham S. Screening for sexually transmitted infections. Up to Date. October 11, 2019

Mayo Clinic. Painful urination (dysuria). https://www.mayoclinic.org/symptoms/painful-urination/basics/causes/sym-20050772. [Accessed January 14, 2020]

Publications. Harvard Medical School. 2007. http://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome. Accessed December 11, 2016

Pelvic Floor MythBusters! Don’t eat lemon to avoid bladder pain, true or false?

alcoholic beverage bubble citrus
Photo by Pixabay on Pexels.com

Fiona McMahon PT, DPT

Hey guys!  If you have bladder pain, you probably have done some reading about bladder irritants. Lemon, dairy, spicy foods have all been rumored to spike bladder pain. But is this really the case? With everyone? Before you put down your lemon water, let’s dissect the truths, and kinda truths about bladder irritants in this month’s Pelvic Floor Mythbuster’s.

Truth be told there are a lot of different ways the bladder can go sideways. You can experience an urge to urinate that is so frequent it disrupts your everyday tasks. You can experience strong urge that feels impossible to repress. You may experience leaking. You may experience pain in your bladder while it fills, while you empty it, or immediately after emptying it. Can diet cure all these ills? In some cases, maybe. But in many cases, it’s a bit more complicated than that. Read on as I run through why we consider diet with bladder issues, what else may be at play, and some practical advice on how to manage an unruly bladder.

Common Bladder Conditions

Before we go over bladder irritants, lets go over some of the most common bladder ailments we see here at Beyond Basics Physical Therapy.

Urgency: Urgency can best be described as having a sudden need to urinate which is either extremely difficult or impossible to delay

Frequency: In most people, going to the bathroom every 2-3 hours is normal going more frequently is considered frequency. But keep in mind, you may experience more frequency after drinking a lot of water all at once or after having caffeine, alcoholic and carbonated beverages.

Hesitancy: Hesitancy is difficulty starting the stream of urine.

Pain: Pain seems pretty simple, but if you visit us at BBPT we usually will ask you more questions than “do you have pain? Yes or no?” We will ask where the pain is, and if you have pain with bladder filling, emptying, or urgency which can tell us a lot about what to do about the problem. We will ask what makes the pain better or worse?

Nocturia (nighttime bathroom trips): Unless you have had a ton of water right before bed, it is generally accepted that getting up 1 or more times a night to pee if you are under 65 and more than 1 time a night to pee if you are over 65 is considered nocturia.

Stress incontinence: Stress incontinence refers to the involuntary loss of urine usually associated with activity, like running, lifting, coughing, laughing and sneezing.

Urge Incontinence: Urge incontinence is the loss of urine with a strong urge to pee.

Mixed Incontinence: As the name would imply, mixed incontinence is a combination of both urge and stress incontinence.

How Can What We Eat Affect our Bladders?

The science community isn’t really sure yet what causes certain foods to irritate certain people’s bladders, but they have some good hypotheses. In the case of pain, some scientists have proposed that people who are affected by food may have linings of the bladder that are less protective from the irritating material found in pee, especially pee that contains irritants from certain foods. Some evidence supports “cross talk” between different organs in that things that irritate the bowel, may irritate the bladder. Also it is believed in cases where the nerves are more sensitive, which can happen in cases of chronic pain, diet can more easily cause symptoms to spike.

So What to do About Irritants?

There is a saying I say a lot. Everybody is different and every body is different. This saying could not be more true when it comes to bladder irritants. Not everyone’s bladder is irritated by the same thing. You can find a list of common bladder irritants here . Did you click it? Totally overwhelming, am I right? The thing is my bladder irritant may not be your bladder irritant. The best way to find out what is your irritant, is to eliminate items you may suspect as being irritants for three to four days and add them back in to see if they bother you. If you find that you are really unsure what is bothering you or you have a history of disordered or restrictive eating. I would highly recommend doing this with the guidance of a trained nutritionist. Not only can a good nutritionist help you detect irritants more efficiently, they also can provide you alternatives, so you have plenty of yummy things to eat during your quest to determine if your diet is bothering your bladder as well as keep you safe if you have had or are currently struggling with disordered eating.

The Bladder and The Pelvic Floor

All of the conditions listed earlier in this blog can be caused entirely or in part by the pelvic floor. Hopefully experimenting with eliminating bladder irritants improved your symptoms at least somewhat. But if it hasn’t, it may be time to consider the pelvic floor. Both pelvic floors that are weak and tight and weak and loose can contribute to the symptoms outlined above. Often times combining dietary changes with pelvic floor rehab can provide the right synergy to get over the hump and to start feeling better again.

Practical Bladder Tips

  • Normal voiding frequency is once every 2-3 hours. If you find you can not make it that long and don’t have pain, try lengthening the time between “goes” 10-15 minutes at a time and practice deep diaphragmatic breathing in the interim.
  • If you experience sudden urge, DON’T PANIC! Rushing often makes it worse. Breath slowly and calmly make your way to the toilet.
  • When hesitancy strikes, breath deeply. If you have male reproductive organs, try sitting on the toilet to relax the pelvic floor and make peeing easier.
  • Avoid drinking water 2 hours before bedtime if you are experiencing nocturia.
  • If you are constipated, work on managing that problem. The bladder lives right in front of the rectum. A large backup of stool will press on the bladder, irritating it and reducing its holding capacity.

Conclusions

Are bladder irritants really a thing, yes for some people and we are still trying to figure out why. If you are having trouble tackling your bladder problems. Come give us a visit at BBPT so we can get you feeling better! Also check out Amy Stein’s book for more ways you can deal with bladder pain.

Friedlander J, Shorter B, Moldwin R. Diet and its role in interstitial cystitis/ bladder pain syndrome (IC/BPS) and comorbid conditions. BJUI. 109. 1584-91

Pelvic Floor Mythbusters: Is kegeling the one true way to a healthy pelvic floor?

Pelvis Drawing

Fiona McMahon PT, DPT.

Is kegeling the one true way to a healthy pelvic floor? Not always. We can end the blog here. Just kidding, of course there is nuance to be considered here. But as pelvic floor physical therapists, nothing is more cringe inducing than hearing the phrase “just do your kegels” thrown around for myriads of ailments from low libido, to pain, incontinence, and erectile dysfunction. While it is true the pelvic floor muscles can be involved in all of these conditions and in some cases kegels may help, there are many cases where kegels are the EXACT opposite of how you should be treating these muscles.

Physiology

To understand kegels we must first understand the pelvic floor. To understand the pelvic floor we must also explain the muscles at a very basic level. Bare with me readers, this will help us as we bust through this myth. Muscles, all muscles do what they do, by contracting and getting shorter to produce force. This is easy to see on a bodybuilder doing a bicep curl. As she curls her hand up you can see these muscles shortening into a little ball. Not only is this a great way to show off your gains in the gym, the shortening of these muscles are providing the strength to perform this task. We call this shortening a concentric contraction. Kegels are concentric contractions too! A good kegel will cause the pelvic floor to shorten and provide strength. Let’s go back to our body builder for a second. She has done her lift now she needs to lower her dumbbell back to the floor. In order to lower that dumbbell back to the floor in a controlled way, she needs what’s called an eccentric contraction, which is the controlled lengthening of the muscle. If she did not have a good eccentric contraction she may not be able to lower that weight effectively after she curled it. What if she couldn’t lower her bicep at all or just very slowly after her bicep curl? Maybe her weightlifting wouldn’t be as effective, she’d tire more easily, or she could develop pain. Would you tell this woman that more bicep curls would help? Or might you suggest a program of stretching first? Telling someone to do kegels, when you don’t know the status of their pelvic floor and how well it can relax is similar to telling the bodybuilder with the non relaxing bicep to just do more bicep curls. At best it certainly won’t help the situation and at worst it could cause more pain and dysfunction.

“But Fiona, I have incontinence, so that definitely means I have weaknesses, so it’s good for me to do kegels, right?”. Maybe… but in my experience, probably not. Let’s agree on one thing, it’s completely intuitive that people would think that kegels would help incontinence. The muscles of the pelvic floor are responsible for continence… so they must be weak if one is experiencing incontinence. You are right! When we think weak with muscles, we often think weak and loose, which is one form of weakness, but we rarely think weak and tight. Let’s go back to our body builder lady. She deserves a name at this point. Let’s call her Kendra. If Kendra has a tough time moving her lifting her arm from fully straight to a full bicep curl, we could guess she is weak and loose. But if Kendra could not fully straighten her arm out she would be considered weak and tight. Both of these versions of Kendra would have trouble curling heavy weight. One Kendra due to frank weakness another Kendra because she simply does not have enough room or range of motion to generate enough force to curl that dumbell.

Tight and weak pelvic floors are a lot like second Kendra with the poor ability to lengthen her arm. Tight pelvic floors have less range of motion to generate force. You need a good amount of force from the pelvic floor to counteract the pressure of activities like lifting, coughing, laughing and sneezing and stay continent. Over loose and over tight pelvic floors can’t really do that.

If you have pain in your pelvis not from a medical condition, (although tight pelvic floors present with many medical conditions), your pelvic floor is probably tight. A tight pelvic floor may also have trigger points which can send pain to various locations in your genitals, back, legs, and abdomen. Continuing to tighten can cause this pain to get worse.

Treatments

So how do you know what to do? This is where a skilled pelvic floor physical therapist can come in handy. They can assess the muscles by touching them either externally or internally to determine what course of action is right for you. If you are loose and weak, HAPPY DAYS! Strengthening can help them get better. If you have tight and weak muscles, HAPPY DAYS again! Gentle lengthening, stretching and down training of the muscles can help them get better. Did you know, because a tight pelvic floor can cause weakness itself, returning the proper length to the muscles can restore strength, without actually needing to kegel?! Wild! Regardless of the situation happy days can be ahead.

Skilled PT

Really knowing the pelvic floor is a skill and requires advanced expertise.  Kegels should not be initiated, unless the physical therapist has carefully examined your pelvic floor. Not all therapists are trained to do that technique so it is important to inquire about their background before starting pelvic floor PT. There are a lot of different ways to treat the pelvic floor, to read more What is Pelvic Floor Physical Therapy . If you are interested in learning more give us a call at 212- 354-2622 for a free consult if you live in the greater NY/NJ/CT area.

PH101: Ladies Session

By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a ladies’ 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 30th . Please register at pelvichealth101.eventbrite.com

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Flyer-jpeg

Ph101 Men’s Only Seminar

Fiona McMahon PT, DPT

On October 23rd at 7pm we will be hosting our  “Men’s Only Seminar”. Join us as we 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 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 male 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

Location:

110 East 42nd Street

Suite 1504

NY NY

10017

Pelvic Health 101 Flyer-jpeg