What is Pelvic Floor Physical Therapy

marigold-2117436_960_720By Amy Stein, DPT and Fiona McMahon, DPT

As physical therapists who specialize in abdomino-pelvic pain disorders, one of the toughest parts of the job is meeting men and women who have suffered with pelvic pain for years, only to be told by their doctors/healthcare providers that there is no help for them. It is not uncommon to meet a patient who has suffered for 5- 10 years without help before finding us. Musculoskeletal causes of abdomino-pelvic pain are treatable conditions and often times we can start to improve a patient’s symptoms within just a few visits. Please read on to see how we can help you with your pain.

What do pelvic floor physical therapists actually do? Why do they do what they do? What can you expect from your first physical therapy visit?

Physical therapists (PTs) are experts in movement and function, which sounds like a pretty broad topic to be an expert in, and it is. After physical therapists graduate PT school (now-a-days at the doctoral level), they find their niche and specialize. You can find PTs working with high-level athletes, children, infants, people who are recovering from injuries, people with neurological conditions and many other types of clients.

Pelvic floor physical therapists specialize in the muscles, nerves and connective tissues that live between your legs, also known as the pelvic floor. They gain their expertise through a series of post-graduate continuing education classes, certifications, and training. Their training allows them to perform both internal and external pelvic exams, and broadens their knowledge of conditions which affect the pelvic floor. Sometimes, people who specialize in modalities like biofeedback or dilator therapy, advertise themselves as pelvic floor therapists, but don’t have any hands on experience treating the sensitive and often reactive muscles of the pelvic floor. If you are seeking pelvic floor physical therapy, it is important to enquire about the experience and level of training your potential physical therapist has had in this specialty.

What is the pelvic floor and what is pelvic floor dysfunction?

Who needs pelvic floor PT? The pelvis performs many important functions of the body. The muscles, nerves, connective tissues and skeletal structures of the pelvic floor help to keep us continent, aid in sexual performance and function, and assist in core stability.

When some or all of these structures of the pelvic floor are not functioning properly, they can cause a multitude of different symptoms. People who are suffering from bowel, bladder, and or sexual problems, as well as those who are suffering from pain in the pelvis, upper legs, abdomen or buttocks most likely have pelvic floor impairments contributing to their pain.

Issues with the pelvic floor can arise from a multitude of reasons. Infections, previous surgeries, childbirth, postural and lifting problems, and trips and falls can all bring on pelvic floor dysfunction. Pelvic floor pain can persist well after the cause of it has been removed. So it is entirely possible to feel the effects of an old infection, surgery or injury, days to years after they occur. Anyone who has had long standing abdomino-pelvic pain, or pain that they can’t seem to get rid of after seeking the help of medical doctors or other healthcare providers is a good candidate for a pelvic floor physical therapy evaluation and possible curative treatment.

What is Pelvic Floor Physical therapy?

Physical therapy is a practice of healing that restores function and reduces pain through the use of techniques to improve bony alignment, reduce trigger points, and improve muscle coordination and strength. Pelvic floor physical therapy is a branch of physical therapy and is built upon these same principles.

What sets pelvic floor physical therapists apart is their in depth understanding of the muscles and surrounding structures of the pelvic floor, beyond what was taught in physical therapy graduate school. What that means for a patient who is seeking the help of a pelvic floor physical therapist, is that his or her pelvic floor issues will be examined and treated comprehensively with both internal and external treatment, provide them with lifestyle modifications to help remove any triggers, and receive specific exercises and treatment to help prevent the reoccurrence of pain once he or she has been successfully treated.

What exactly do Pelvic Floor Physical Therapists Do?

The elephant in the room with pelvic floor physical therapy is the internal exam/ treatment. It can seem a little daunting, especially if you have pelvic floor pain, but pelvic floor therapists are trained to be as thorough as possible while minimizing discomfort.

During the internal exam, your physical therapist will place a gloved finger into your vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues. Internal exams and internal treatment are invaluable tools that are taught to pelvic floor physical therapists. It can tell us if there are trigger points (painful spots, with a referral pattern or local); muscle/tissue shortening; nerve irritation and/or bony malalignment that could be causing your pain directly or inhibiting the full function of your pelvic floor muscles. We can also determine if your pelvic floor has good coordination during the exam. A pelvic floor without good coordination, may not open and close appropriately for activities such as going to the bathroom, supporting our pelvis and trunk, sexual activity, and keeping us continent.

It is essential that we, as pelvic floor physical therapists, also include other assessments when we are examining our patients for the very first time. We employ the tried and true physical therapy exam practices to determine if there is an underlying condition elsewhere in your body, such as a strength deficit or alignment issue that could be affecting your pelvic floor. It’s wild to think of it, but something as seemingly unrelated as a flat foot or a hip injury can be enough to set off pelvic and abdominal pain!

Some pelvic floor physical therapists may have the opportunity of getting a lot of time to speak one-on-one with a patient to determine possible causes of his or her symptoms, educate the patient and to guide them to other practitioners who may optimize their physical therapy results if necessary. We truly can find out so much by just listening to what our patients have to say. A fall, or infection can be significant as well as a patient’s feelings and knowledge about their current condition.

Once we determine the cause of our patient’s pelvic floor dysfunction, we design a plan tailored to the patient’s needs. At Beyond Basics, we have a diverse crew of physical therapists who bring their own training and background into each treatment. What is really beautiful about that, is that all teach and help each other grow as practitioners. It will be difficult to go over every single type of treatment in one blog post, but we will review some of the main staples of pelvic floor rehab.

Manual Techniques

As physical therapists, are our hands are amazing gifts and phenomenal diagnostic tools that we can use to assess restrictions, tender points, swelling, muscle guarding, atrophy, nerve irritation and skeletal malalignment. We also use our hands to treat out these problems, provide feedback to the muscles, and facilitate the activation of certain muscle groups. There have been a great number of manual techniques that have evolved over the course of physical therapy’s history. Let’s go over a few.

Myofascial Release

Myofascial release was developed by John Barnes to evaluate and treat the myo-fascia throughout the body. The myofascial system is the connective tissue that coats our muscles, nerves, blood vessels, and bones, and runs throughout our bodies. Any tightness or dysfunction in the myofascial system can affect the aforementioned structures and result in pain and or movement dysfunction. By treating the fascia directly, therapists can improve their patient’s range of motion, reduce pain, and improve a patient’s structure and movement patterns.

Myofascial release is a more gentle technique that can be useful in cases where a patient is already experiencing a great deal of pain. The therapist will hold gentle pressure at the barrier of the tissue (the point where resistance is felt) for a short period of time, usually less than 2 minutes until the therapist feels the tissue release on its own. The therapist does not force the barrier.

Scar Tissue Manipulation

Scars are almost always a fact of life. From surgeries, to accidents, to conditions like endometriosis, or certain STI’s, almost everybody has one. What doesn’t have to be a fact of life are the muscle, nerve and skin restrictions and overactivity that they can cause. By releasing scar tissue in physical therapy, it has been shown that the surrounding restrictions also decrease their resistance and adherence to the deeper tissues and surrounding organs.

Myofascial Trigger Point Release

Discussed extensively in Travel and Simon’s two volume series, trigger points are taut (firm) points in the muscle that have a consistent referral pattern (they transmit pain to the another part of the body). Trigger points are not only important because they cause pain, they also can affect how the muscle works. This is one of the main reasons our therapists at Beyond Basics are fastidious about ensuring all trigger points are released in the abdomen, back, legs and pelvic floor before transitioning to any core stabiltiy or strengthening exercises that can re activate a trigger point.

People with trigger points in their pelvic floor and surrounding areas can experience pain in the rectum, anus, coccyx, sacrum, abdomen, groin and back and can cause bladder, bowel, and sexual dysfunction. When physical therapists find a trigger point they work to eliminate it and lengthen it through a myriad of techniques. Recent literature has found that trigger point release alone can achieve an 83% reduction in symptoms.

Connective Tissue Manipulation

Skin rolling, ie. rolling of the skin over another layer helps to improve the movement of those two layers and reduce the tension and pulling between them. It feels like a scratch or ‘nails’, and in cases where a patient has more restrictions, the sensation may be more amplified.

One of the great benefits to skin rolling is it increases the circulation in the area to which it was applied. Often times, areas that are tight or restricted are receiving reduced blood flow and oxygen. By bringing blood flow to the area, toxins can be cleared and the healing contents of the blood are brought to the injured area. Skin rolling can also restore the mobility of surrounding joints and nerves, which can help to restore normal function. By allowing the skin to move more freely, pelvic congestion, heaviness and aching can be effectively treated.

Neural, Visceral, and Joint Mobilization

Nerves, organs, and joints can lose their natural mobility over time and cause a whole host of symptoms from pain, to loss of range of motion, and poor functioning of the bodily symptoms. Skilled and specialized therapists can use a variety of active techniques (patient assisted) and passive techniques to free up restrictions in these tissues and organs and improve overall function.

Neural mobilization as the name implies, involves the restoration of neural structures back to their normal mobility: to glide and slide. Neural structures that cannot move properly can cause pain that can radiate down an extremity or into the trunk and can give the sensation of burning, zinging, and stabbing. Some orthopedic therapists practice this type of mobilization; common examples include the sciatic nerve in the leg and the ulnar nerve in the arm. Pelvic floor PTs focus on these nerves when they cause issues, but they also pay attention to nerves that innervate the perineum and genital region (bicycle seat area), such as the pudendal, iliohypogastric, obturator, ilioinguinal, genitofemoral and the femoral cutaneous nerves. By allowing these nerves to move freely, symptoms such as vulvovaginal, penile, rectal, clitoral and testicular pain, itching and burning can be greatly improved.

Visceral mobilization restores movement to the viscera or organs. As elucidated earlier in our blog, the viscera can affect a host of things even including how well the abdominal muscles reunite following pregnancy or any abdominal surgery. Visceral mobilization aids in relieving constipation/IBS symptoms, bladder symptoms, digestive issues like reflux, as well as sexual pain. Visceral mobilization can facilitate blood supply to aid in their function, allow organs to do their job by ensuring they have the mobility to move in the way they are required to perform their function, and to allow them to reside in the correct place in their body cavity. Evidence is beginning to emerge to demonstrate how visceral mobilization can even aid in fertility problems.

Joint mobilization is a common and favorite tool of most orthopedic physical therapists. We love it so much because it can have so many different benefits depending on the type of technique used. Maitland describes types of joint mobilization on a scale between 1 and 5. Grade 1 and 2 mobilizations are applied to a joint to help to lessen pain and spasm. These types of mobilizations are typically used when a patient is in a lot of pain and to help break the pain cycle. On a non-painful joint, grade 3, 4, and 5 (grade 5 requires post graduate training) mobilizations can be used to help restore full range of motion. By restoring full range of motion within a restricted joint, it is possible to lessen the burden on that and surrounding joints, thereby alleviating pain and improving function.

Neuro-education of the Pelvic Floor and Surrounding Structures

The muscles of the pelvic floor must work together and in coordination to perform specific tasks. The pelvic floor has to contract, elongate and relax in very precise ways to perform basic functions like urination, defecation, support the pelvis and organs, and sexual function and pleasure. If your pelvic floor muscles and/or nerves fail to do what they are supposed to do at the right time, problems like painful sex, erectile dysfunction, constipation, and incontinence can occur.

Biofeedback is a modality that allows you to learn how to better control your muscles for optimal function. Biofeedback shows you what your muscles are doing in-real time. It is helpful to teach patients to lengthen and relax the pelvic floor for issues like general pelvic pain, painful sexual activity and constipation or to contract the pelvic floor in order to prevent leakage with activities like coughing, laughing, lifting, running or moving heavy objects. However, biofeedback does not demonstrate shortened muscles and tissues; therefore, in certain cases the biofeedback may seem to be within normal limits but yet the patient has 10/10 pain. In these incidences, manual palpation is more appropriate to identify restricted and shortened tissues and muscles, and myofascial trigger points.

HEP: Home Exercise Program

 

Home exercise programs are essential for each patient. In the case of weakness, a patient will require more pelvic floor, core and functional strengthening and stability exercises. For overactive and pain conditions, the HEP typically consists of relaxation techniques, self-massages (both external and internal), gentle stretching, cardiovascular fitness as tolerated, and eventually pain-free core stability exercises. Both require postural and behavioral modifications and self-care strategies. For more information and detail, check out the book: Heal Pelvic Pain, by Amy Stein or her DVD: Healing Pelvic and Abdominal Pain here.

Conclusion

As you can now see, there is so much out there that can be done for people suffering with pelvic floor dysfunction. This blog is by no means extensive, and there are even more options you and your physical therapist can explore to help manage your pain or other pelvic issues. Pelvic floor dysfunction requires a multidisciplinary approach for most of our patients. Hopefully, this blog helped to paint a picture of what you will experience with a pelvic floor physical therapist. We advise that you seek out an expert and experienced pelvic floor physical therapist in order to help better your life and improve your function.

Sources

FitzGerald M, Kotarinos R. Rehabilitation of the short pelvic floor I. Background and patient evaluation.

Padoa A, Rosenbaum T. The Overactive Pelvic Floor. Springer. 2016

Simons DG, Travell JG, Simons LS. Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1 Upper Half of Body. 2nd ed. Baltimore, MD: Williams & Wilkins; 1999.

Stein, Amy. Heal Pelvic Pain. McGraw-Hill. 2008

Stein, Amy. Healing Pelvic and Abdominal Pain. Video: www.healingpelvicandabdominalpain.com 2013

Travell, Janet G. and Simons, David G., MYOFASCIAL PAIN AND DYSFUNCTION. THE TRIGGER POINT MANUAL, Volume 2, The Lower Extremities, Williams & Wilkins, Baltimore, 1992.

Valovska A. Pelvic Pain Management. Oxford University Press. 2016

Weiss J. Chronic pelvic pain and myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001; 166(6) 2226-31

How to Start a New Exercise Program When You’re Feeling Intimidated

How to Start a New Exercise Program When You’re Feeling Intimidated

woman stretching on ground
Photo by Jonathan Borba on Pexels.com

Kierstin Elliott

Maybe you were an avid gym-goer, cross fitter, or yogi and then you got injured. Or maybe fitness has never been a part of your life, but now your doctor or PT has told you that a fitness regimen is necessary in order to help you feel like yourself again. Whatever the case may be, you just don’t know where to start, or you feel intimidated to return to what you were doing in the past because that is how you got injured in the first place. My advice is to start slowly. Educate yourself on how and why you got injured and what the next steps are on your road to recovery. Set goals on what you need to accomplish and build a plan to achieve them. Last but not least, train smartly. If you follow this check list, then you should definitely feel more confident moving forward!

It is imperative when you are transitioning from injury rehab to the fitness world, or starting a new exercise program for the first time, that you build a foundation. It is so crucial you stay true to your journey and not compare yourself to others. Trust that progress takes time. Resist the urge to jump right into something new if you’re unsure about form, alignment, and technique.

The first step would be to invest in private sessions. Educate yourself on what you’re getting into and find an expert in what you want to master. Having a coach who devotes the entire hour to your body and your needs will help you garner a deeper understanding of how your breath, body, and mind connect. Learning the proper form with a watchful eye on alignment, will ensure you have a strong foundation to move forward or join group classes.

Once you’ve gained confidence with your new (or old) exercise program, set some fitness goals. You’ve laid a strong foundation and now it’s time to build a skyscraper! Do you want to improve strength, flexibility, endurance? Once you have clear goals set, create a timeline. Establishing a realistic timeline will hold you accountable to sticking with your exercise program and crushing your goals!

The point I’ll end with is to train smartly. No matter what discipline you train in, if you are not focused on form, alignment, and breath control, you are only setting yourself up for future injuries. If you are in a group class, don’t be afraid to ask questions if something is unclear, doesn’t feel quite right, or if you know you need a modification. If you are doing an at home workout on your own, try to do it in front of a mirror to check out your form. If there’s no mirror accessible, simply take it slow and use the knowledge you’ve acquired from a trainer, coach, or PT. Take notes. Practice. Your exercises won’t be perfect the first time you attempt them. Be patient and mindful. It’s all about the journey 🙂

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

 

Pelvic Health 101 is back! Come to Our First Class on September 18th

 

On September 18th, at 7pm we will be kicking off our fall 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.

Please join us at our office at:

110 East 42nd Street, Suite 1504

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

Here is our line up of this and future classes

Pelvic Health 101 Flyer-jpeg

 

Saggy Jeans and Tailfeathers: How Your Pelvic Positioning Affects Your Body

animal bird blue bright
Photo by Pixabay on Pexels.com

Joanna Hess PT, DPT, PRC, WCS

Wait! Marie Kondo has you throwing out your favorite jeans because the joyless saggy bottoms that your tushy cannot manage to fill out? We are seeing an epidemic flat butt among mamas, plumbers, barre fanatics, and office workers—all with strangely similar symptoms—pelvic floor dysfunction, low back and sacroiliac pain, and a tucked under pelvis. In this blog we will explore why the position of the pelvis, the maker of flat butts and the maker of less flat booties, is important and how to more easily move out of this position for benefit beyond your behind.

Besides needing a new wardrobe, why should I care about my flat bum?

The flat bum or preference towards posterior pelvic tilting shrinks the distance between the front and back of pelvic outlet which changes pelvic floor muscle tension. The body needs access to the full range of the pelvis and pelvic floor muscles. Over time, this position could cause excessive pelvic floor activity to compensate for the loss of resting tension. Think of the pelvic floor muscles simplified as a rubber band between two points, the pubic bone and tailbone. When the distance between the two points decreases, the rubber band loses its stability from resting tension. Changes in pelvic position alters stability from the pelvic floor muscles. This posterior pelvic tilt position also decreases the accessibility for hip extension and therefore the upper glute muscles get sleepy. As the top of the pelvis moves back, the sacroiliac joint in the low back opens and decreases its bony stability. Translated into everyday life, the flat butt position increases the potential for incontinence, pelvic floor muscle tension, sacroiliac pain, and decreased efficiency in movement.

The Flat Bottom. Only in the eye of the beholder?

Pelvic floor and tilt

The disagreement of the “neutral pelvis” or zero-point causes confusion when describing pelvic tilt—anterior pelvic tilt, posterior pelvic tilt, and neutral pelvis. Some argue that the neutral pelvis is when the ASIS’s (front hip bones) are level to the PSIS (back butt dimples). Others say that the pelvis is neutral when ASIS’s are in the same plane as the pubic bone. Or for those with X-ray vision, pelvic tilt is the vector of the sacral angle at S2 in relation to the vertical axis. But often, neutral pelvic position is subjective to the observer and relative to other parts of the body—namely the spine/rib cage and thigh bone. Clinically, this “neutral pelvis” is hard to find because 1) pelvis’ are shaped very differently, 2) left and right pelvis on the same person can also be quite different, 3) feeling these bony landmarks have been shown to be remarkably unreliable, 4) the neutral pelvis should be on top of vertical thigh bones. See how the eyes can be tricked confusing spinal curve focusing on pelvic tilt without also including rib position.

Rib pelvic alignmentThe inability to move in and out of posterior pelvic tilt and anterior pelvic tilt decreases efficiency and possibly results in pain and instability. Anterior pelvic tilt is when the front part of the pelvis moves forward/down. Posterior pelvic tilt is when the front part of the pelvis moves back/up. A neutral pelvis on top of vertical femurs and happy rib cage should correlate with better muscle performance.

Do I have a flat butt?

Aside from the saggy jeans, the flat butts of the world have a few other correlations.

1. The Tailfeather Test: Stand comfortably and squeeze the gluts.

a. Neutral pelvis: Thigh bones rotate.

b. Posterior tilt-ing pelvis: The butt will further tuck under and mainly access the lower glutes.

c. Anterior tilt-ing pelvis: The pelvic floor muscles will do most of the work.

2. You bear weight more in the heels

3. Back of your rib cage is behind your pelvis

4. Your Thigh bones are angled so that your pelvis is front of your knees

5. Your lower belly pooch

6. You Sit with pressure more on the sacrum/tailbone vs. sit bone

7. You have Overactive and possibly overworking pelvic floor muscles—the front to back pelvic distance decreases with your posterior tilted pelvis and loses the resting tension from length. As described earlier, this is similar to tensile strength of a slightly stretched rubber band vs. rubber band without pull/tension. Therefore, your pelvic floor muscles have to work harder to keep some type of tension for purposes like continence, stability, etc. The inability for the pelvic floor muscles to work optimally can lead to incontinence, pain, and constipation.

9. You have Breathing and abdominal pressure problems

10. You have Sacroiliac joint pain. As the pelvis tips back, the sacrum moves away from the ilium decreasing the bony stability. The hip muscles have to work harder, but as felt in the Tailfeather Test, the glut muscles aren’t in a good place to work.

Is there a better fix than butt implants?

Bodies have and love variability for posterior, anterior and “neutral” pelvic positioning. The brain likes positions where muscles and nerves work with ease and stability—life shouldn’t be so difficult—but it needs the chance to choose and learn it. Folks working with bodies have traditionally “corrected” spinal curves by changing pelvic position. From what has already been discussed, spinal and pelvic position can be altered many different ways—from the changing weight-bearing area in the feet, to position of ribs and range of breath, and even head angles with visual and vestibular input. Consider these hacks into pelvic stability until the brain learns how to access this stability in many situations and positions.

1. Standing. Bring your chin down to your neck and keep looking down until you see the front of your ankles. You’ve just untucked your pelvis and brought your ribs over your pelvis. This one is courtesy of my colleague, Stephanie Stamas. Or check in to feel where the weight is going through your feet. The front to middle of the foot is a good place to start and then do the Tailfeather Test. You might have to toggle other parts of the body because of how the body will compensate in the chain.

2. Sitting. Get your hips as far back as possible. Or put a pillow in the back of the chair so that your hips can find the pillow and you are sitting on top of your sit bones. Then, relax the trunk into the seat back/pillow. Again, you’ve untucked your pelvis and brought your ribs over the pelvis.

3. Better squats/lunges/burpees/stairs/ab work. You can do 5 sets of 20 squats, but still no junk? Take care to see if your pelvis is tucking under in the movement. If so, use an inhale to keep the pelvic floor lengthening as your hips bend in movement. Later, the movement should be dissociated with breath pattern (as long as you are breathing.)

4. See a physical therapist. Often times, the habits of pelvic tucking are a little more complicated because it is a protective and compensatory mechanism for stability. A physical therapist can help with seeing the bigger picture and how different parts of the body relate to each other. They can also help facilitate better movement through manual therapy and specialized movement.

Good luck with the joy sparking!

How to Travel with Pelvic Floor Dysfunction

Fiona McMahon PT, DPT (She, her, hers)

airplane-backlit-clouds-1262304

It’s that magical time of year in New York City, that I call “Goldie Locks Time”. It is that brief stretch of one to two weeks right after the cold of winter has left us and right before the sweltering hot gritty city summer descends upon us. It is the time of year that the weather is so supremely pleasant, that the hustle and bustle of the city slows and usually frenetic New Yorkers actually take time to stop and smell the roses, literally. My pediatric patients begin to grow giddy as school is wrapping up in a couple weeks. It is a time when many New Yorkers start looking forward to their summer escapes back to their home towns across the country or vacations to new and familiar locales alike. Having the time and resources to travel is a luxury, but for those with chronic pelvic pain, it can seem like a really daunting task. People often wonder, “how can I fly across the country if sitting for more than 20 minutes causes my pain?”, “how will I keep from flaring?”, “How do I negotiate the demands of travel so I can actually enjoy my time away?”. Although travel can be really daunting, there are steps that you can take to ease your journey and help you enjoy your time at your destination. Below are some considerations for travel I hope that you will find helpful.

Hydrate- Even if You Have Bladder Problems

Recirculated air is the worst and is inevitable when flying, but is also something you should consider with bus, car, and train trips. Long and even short haul flights can leave you feeling parched and dry which can cause issues with many pelvic floor symptoms. It is really important to not get on the plane dehydrated. In the week or so preceding your trip, be extra mindful of trying to get enough water. A popular guideline we use at BBPT with to try and consume at least one half your body weight in water in ounces. For example, if you weigh 150 pounds, drink 75 ounces of water. Being properly hydrated will decrease irritation within the bladder and can even reduce frequency, reduce your chances of constipation, and ensure the tissues of your body have good mobility. Also be sure to hydrate on the plane and in the airport. Water sold at airports is usually overpriced and has the downside of being packaged in environmentally unfriendly plastic. To save money and the planet, I suggest bringing an empty reusable water bottle through security. Once you are through security you can fill it up and keep on your hydration game. One thing to remember is to take your water bottle out of your bag and place it in the screening bin, so you won’t lose time having security check inside your bag to verify that your bottle is indeed empty.

Prioritize Pooping

In my world, it’s all about poop. Traveling can lead to some gnarly cases of constipation, which makes virtually every pelvic floor complaint worse. We talked about keeping up with your hydration, which is a really good first step. Making sure that you have a enough time to eat, chill, and have a solid BM before rushing off to the airport is really important. So when possible, Try and carve out at least an hour of pre-travel chill time before heading out the door.

Food

Eating well is so important. Many of our patients have diets that make them feel better. When travelling, food can be a wild card. With the change in routine associated with travel, it can be all too easy to throw a diet that is working to the wind. A huge change in dietary routines is one of the top reasons I see people flare. Although indulging in margaritas and other treats can be so much fun, be aware of how it will affect your symptoms and overall enjoyment of your trip. It is good to come prepared if possible. Packing snacks that you know don’t make you feel like garbage if you are going to place where you are unsure of what the food situation will be like, will help.

Choose your Seat

The idea of sitting on a long haul flight is daunting especially for those who have pelvic and or sitting pain or bladder issues. There are travel cushions you can bring with you to ease your symptoms. If you don’t typically use a travel cushion, check out my cushion hack bellow using a jacket.

seat.jpg
The cushion hack: If you find you have sitting pain but no cushion, use your coat or sweatshirt to fashion a cushion

Choosing seats next to the bathroom when possible can go a long way towards reducing stress for folks with bladder issues. Additionally ,opting for an aisle seat can also be helpful. To the extent possible, try to get up and move to reduce the pressure on your pelvic area.

Manage Travel Stress

Travel is a stressful thing for most of us. There is so much out of our control and there’s no amount meditation or mindfulness that can change that. That being said, meditation and mindfulness practice can help how you deal with how you react to  cancelled flights, lost baggage, the works. Allowing yourself a quiet moment to breathe before and during your travels can help you re center and get back to enjoying the journey. Both Calm and Headspace make really awesome guided meditation apps that you can use while waiting for your flights.

 

Get out There!

This world is so big and beautiful. It can be really hard if pelvic pain is holding you back. Try these tips out on smaller trips to see if they help you! If you find that you are still having pain that holds you back, see a pelvic floor physical therapist who can help you get out there!

Beyond Basics Physical Therapy offers intensive week or weeks long treatment to those who live out of town and do not have regular access to pelvic floor physical therapy. If you are feeling like taking a trip to the Big Apple, NYC, check out more about our out of town services here.

 

The Special Care Needs of the LGBTQ+ Community

Happy Pride Month!!!!

We are reposting an old post broadly discussing the LGBTQ+ community, with special focus on transgender individuals. Please keep checking back as we continue to discuss specific issues relating to the care of the LGBTQ+ community.  

Amy Stein PT, DPT and Fiona McMahon PT, DPT

rainbow flag

Who are LGBTQ+ individuals?

At Beyond Basics Physical Therapy, we have been meeting and studying with experts about the LGBTQ + community. LGBTQ+ refers to individuals who do not identify as heterosexual or do not identify as cis- gendered (although these two categories are not mutually exclusive). Cis-gender means you identify with the genital anatomy you were born with. People who belong to the LGBTQ+ community can be cis-gendered (meaning they identify with the genital anatomy that they were born with) and be gay/lesbian/ bisexual/ questioning etc.  They can be trans-gender and heterosexual or some combination thereof. Basically LGBTQ+ is a term that includes people who are not both cis-gender and heterosexual. LGBTQ+ is an acronym for lesbian, gay, bisexual, transgender, queer/questioning, and other individuals.  

Never Assume. Listen, Ask.

We were excited to understand and learn more about how we can help, specifically with patients experiencing pain or weakness in the pelvic floor. We met with an LGBTQ + advocate and he recommended the following when it comes to treating patients both within and outside the LGBTQ+ community.  First rule of thumb:  with all patients, don’t assume and be open to any questions or discussion. Ask if your patient would like you to stay away from certain terms regarding their anatomy, as well as their preferred gender pronoun. Use language that they want us to use.

 As with all patients, we need to use a biopsychosocial approach. With any patient, Richard Green at Bellevue hospital says that we always want to know exactly what is going on with our patient. We must subjectively understand why they are visiting us.  Has there been trauma, surgery, complications, or anything that has worsened their symptoms? What hormones and medications are they on? Don’t single anyone out. These questions are important for every patient.  

We want to get the medical and surgical history during or prior to the visit. There is no standard one surgical procedure or hormonal protocol in trans care. Hormones, either testosterone, estrogen, lupron, puberty blocking, testosterone suppressing can be used in many patients, but are also used specifically to aid in transition in transgender patients. Many hormones have consequences or side effects and our patients need be educated on the various options.  There is research on hormones and bodily changes, however there is no good research on how the hormones affect the pelvic region. Anti-estrogen hormones may result in vaginal drying and atrophy, more tissue tearing, and pain with penetration.  Hormones can be administered via injection, pellets, patches, creams, gels, and pill form.  It’s important to realize side effects and risks of hormones for each patient. Dosage depends on body type, weight, previous surgeries, etc.  Hormone therapy can be given by a primary care provider or endocrinologist; however, many are not familiar with a specific protocol but at the same time each person may have different goals.  Progression of hormones can be monitored for each patient and according to patients wants and needs.  

For those who opt for surgical transition, it can result in pelvic pain and or weakness as organs are moved and or removed. Like we mentioned before, there is no one surgical protocol and it will vary from surgeon to surgeon, from changes in hormones from the removal of certain organs.  Knowing what tissues have been removed or moved and or where scar tissue could have been formed, is important to addressing a patient’s complaints. Also, it’s important to ask if the patient was having these symptoms or pain prior to any of the surgeries or hormonal medications. Surgical transition can take a long time with various surgeries and various symptoms that arise throughout. Some issues that  can occur are fistulas or fissures and when dealing with nerve implants there could be nerve damage and restrictions.

How is care for the LGBTQ+ community funded and regulated?

Medical coverage for the LGBTQ + community is non-regulated and different in each state. The Affordable Care Act, (ACA) covers some therapies and surgeries. You can try to appeal with each insurance which have their own policies on gender affirming care.

How can physical therapy help?

At Beyond Basics Physical Therapy, we specialize in abdomino-pelvic disorders, including pain, weakness, bladder, bowel and sexual dysfunction.  We also specialize in orthopedics and functional manual therapy.  We treat the LGBTQ+ community and we welcome any questions at desk@beyondbasicspt.com or call 212-354-2622. We are happy to help and look forward to hearing from you!
Resources: Center of excellence for transgender health.

WPATH center for care Endocrine Society

  • speaks on hormone therapy (however some information may be out of date).

 Adolescent Health Center