Mama’s 101: Strategies to Prepare for Birth

Hey Readers!

Our next installment of Mama’s 101 is coming your way on September 19th! Join Rachel Clausen PT, DPT as she details how to optimize your birth! The class will be held at our Downtown location register  here.

Details: 

Dates: September 19th, at 6pm

Location: 156  Williams Street Suite 800, NY, NY 10038

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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

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Back to school: A to Z with No problem with Pee!

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Fiona McMahon PT, DPT

It’s back to school time! Many of us look back at this time fondly. Reminiscing about the joy of picking out new notebooks, meeting new friends, and trying to put together a perfect back to school look (any 90’s kids remember the Delia*s catalog?) But if you are a kid or a parent dealing with a kid with urinary accidents, the idea of going back to school can be downright terrifying. In this blog, we will go through the causes of urinary incontinence as well as treatments. Here’s the thing, if you only have time to just skim this blog, I want you to know this: Urinary accidents are not your fault, nor your child’s and there are solutions out there to help improve accidents. So keep your and your kiddo’s heads up. It can get better.

In the spirit of back to school, we will start off this blog with some definitions. We can classify bladder accidents in many different ways, which can be helpful when it comes to selecting a course of treatment. Here are ways the medical community may classify your child’s incontinence

Intermittent versus Continuous: Intermittent applies to children who are having discrete individual episodes of incontinence, rather than continuous loss of urine from the bladder. The latter is more suggestive of neurological or anatomical impairment and does require a physician’s attention right away.

Intermittent incontinence can be further classified as primary or secondary. Primary incontinence occurs in children over 5 who have never achieved continence, whereas secondary incontinence occurs in kiddos who have had continence previously for a period of 6 months or more.

Urge Incontinence: Occurs when when a child has a sudden urge to urinate and cannot make it to the potty in time. It is a type of intermittent incontinence.

Stress Incontinence: Occurs when kiddos lose continence with activities like coughing, laughing, and sneezing. It is a type of intermittent incontinence.

Eneuresis or Nighttime Incontinence as the name would imply, this is intermittent urinary incontinence that occurs at night.

So here’s the thing, your child may experience just one type of incontinence or they may experience many types, (i.e. urge, stress, and bedwetting). Regardless of the type of incontinence your child is experiencing, they are not alone. Bedwetting is experienced in nearly 5%-10% of 7 year olds and daytime incontinence is experienced by 5-15 percent of kiddos between 5- 9 years old. It can be helpful to share this fact with your kiddo when they feel alone and isolated. Let them know that there may be several people in their class experiencing the exact same symptoms.

What Causes Incontinence in Kiddos?

In most kiddos, it is rarely one thing exclusively. One of the most common causes of incontinence at BBPT is constipation. The rectum and the bladder are neighbors sandwiched between two relatively immobile bones, the pubic bone in front and the sacrum in back. When a child, or an adult is constipated the rectum can become distended, like a big ol’ balloon. When the rectum is full of poo it squishes the poor little bladder leaving very little room for pee to collect before a child has to go. Furthermore, all that junk in the pelvic floor reduces the feeling that it’s time to go until it is much too late. Even a child that is pooping daily may be constipated. How can that be you may ask? Well, kiddos that are constipated may actually be incompletely evacuating resulting in a build up of stool in the abdomen. Signs besides bowel frequency that your child may be constipated include, abdominal pain, large painful bowel movements, itchy tushes, or even poo accidents. If you are still unsure, some doctors may do an abdominal x-ray to confirm the presence of large amounts of backed up poo in the abdomen

The pelvic floor is another huge player in urinary issues. The pelvic floor refers to the group of muscles between the pubic bone in front and the tailbone in the back. These muscles help regulate the flow of pee and poo out. Sometimes these muscles are too loose to hold everything in. Often times they actually may be too tight, which can lead to constipation, incomplete urination, and believe it or not, these muscles may also be too weak to hold in waste during play!

We see other factors linked to pediatric incontinence. Keep in mind these factors are correlated with incontinence and may not be necessarily causal. Kinda like a chicken and the egg situation. One may have caused the other or one may have no effect on the other. With correlations, it is often impossible to tell. Here are factors found in the research that have been linked with urinary incontinence in kiddos:

  • Younger age
  • Male sex
  • Black race
  • History of urinary tract infection (UTI)
  • Family history of bed wetting.
  • Difficult infant temperament
  • Early toilet training before 2 years
  • Late toilet training after 36 months
  • Attention-deficit Hyperactivity Disorder
  • Stressful life events

What to do About Pee Accidents

We have established that having urinary accidents as a child is pretty common. So the first thing to do, and I’m serious here, is remind yourself and your kiddo that you are not alone and that it is not your fault. Keep saying it until it sinks in. Potty issues can come with the extra burden of guilt and shame. Let it go. It is no longer serving you or your kiddo.

Now, it’s time to get the ball rolling. Although childhood incontinence has a 15% spontaneous cure rate every year after age 7, it leaves out a whopping 85% of kiddos who deserve being able to play and go to fun activities like sleepovers without fear of accidents.

First, get yourself a proactive doctor who will screen for UTI’s. They often don’t show up the same way in kiddos as they do for adults. UTIs can cause incontinence and left untreated, they can be dangerous.

Then get yourself to a qualified pelvic floor physical therapist who has experience working with kids. A qualified pelvic floor physical therapist has the ability to assess the muscles of the pelvic floor in a non-invasive manner to see if weakness or tightness could be a potential culprit. They also are qualified to assess the abdomen to determine if backed up poo from constipation is worsening accidents. Based on what they find, they will taylor a program to help fix any potential barriers your child could be facing on their way to continence.

Things to do now:

  1. Explore Irritants: Certain foods can irritate the bladder and cause accidents. Check out this list {HERE} to explore potential bladder irritants. Keep in mind, not everything irritates everyone. What I would suggest is a blander day followed by a day where you add back in a potential offender. Bladder irritants usually cause irritation within 2 hours, so if you don’t see anything in that timeframe, that item is most likely off the hook.
  2. Schedule the Potty: Kids are so scheduled these days but we need to add potty breaks to the agenda. Having your child attempt to urinate, whether she wants to or not can help. I suggest starting at once every hour during the day and gradually increasing the interval as they succeed. There are watches like the WOBL watch that can help kiddos out, but I also find teachers to be extremely helpful getting a kiddo to visit the bathroom regularly.
  3. Pee at the transition times: This one is from my clinical experience. Make sure your kiddo goes to the bathroom immediately before leaving camp or school. The on the way home accidents are usually the last to clear up . So nip it in the bud ahead of time.
  4. Drink water! But not to close to bed: Your child should be drinking enough water to keep his stool soft and his urine dilute. Dehydration can worsen bladder irritation and constipation, which can in turn worsen incontinence. Just stop water intake 2 hours before bed.
  5. Manage Constipation: Give your kiddo enough time to poo and make sure her diet is varied so her stools are formed but not pellets. If you struggle with this, come see us.

Wrapping it up:

One more time for the people in the back. You are working so hard. I never met a family who is not trying everything for their kiddo. Incontinence is tough, but with PT and support it can get better. If trying these steps is not working for you, come see us.

 

Check out Amy’s book Heal Pelvic Painwhich includes a chapter on the pediatric pelvic floor.

Baird D, Seehusen D, Bode D. Enuresis in children: a case based approach. American Family Physician. 90(8) 2015

Maternik M, Krzeminska K, Zurowska A. The management of childhood urinary incontinence. Pediatr Nephrol (2015) 30:41-50

Vasconcelos M, East P, Blanco et al. Early behavioral risks for childhood and adolescent daytime urinary incontinence and nocturnal enuresis. J Behav Pediatric. 2017; 38 (9): 736-42

Von Gontard A, Kutwertz-Bröking. The diagnosis and treatment of enuresis and functional daytime incontinence. Dtsch Arztebl Int 2019; 116 279-85

Mama’s 101 is here! Optimize your Pregnancy and Post-Partum period

Beyond Basics Physical Therapy Downtown is hosting a brand spankin’ new series of classes focusing on pregnancy and post-partum health. Our first class is September 12th. Feeling Good While Pregnant will cover how you can optimize your function during the many pregnancy related changes your body will experience during your pregnancy. It is not to be missed! Register here!

Check out the upcoming Mama’s 101 classes:

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Mama’s 101 is a FREE educational series for mamas focused on how to improve pain-free function during pregnancy and the post-partum period.

Mama’s 101 will be held at our downtown location

Date: September 12th 6pm

Address: 156 Williams Street, Suite 800, NY, NY 10038

 

Physical Therapy and the Prostate

By Fiona McMahon

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We hear a lot about prostate cancer nowadays, as we should. Prostate cancer is an extremely common form of cancer, which affects 1 in 7 men in the United States, according to the American Cancer Society. Over the years, the approach to the treatment of prostate cancer has evolved from a more surgery and radiation focused treatment, to more of a philosophy of watchful waiting. The driving factor behind this decision is that prostate cancer is usually a slow growing cancer that is discovered late in life, and therefore  a diagnosis of prostate cancer in a 65 year old man is not as likely as other cancers to have a significant impact on his lifespan.

Regardless of this new approach to the treatment, there are still many men whose cases require medical and surgical intervention. Prostate cancer is often treated surgically by removing the prostate either through a laparoscopic procedure or an open procedure. Men may prefer the laparoscopic removal of the prostate because it has been shown to cause less bleeding and it allows the surgeon to better be able to visualize the nerves responsible for erections. Other treatments for prostate cancer include cryotherapy, hormonal therapy, radiation, and chemotherapy.

Surgery carries side effects, which can have a profound effect on your life but usually these side effects will go away over time. Side effects that generally go away include urinary incontinence and erectile dysfunction. Some permanent effects from prostatectomy surgery are dry orgasm (orgasm without ejaculate) and loss of fertility. This is because when the prostate is removed, the surgeon must cut the connection between the testicles and the urethra. Because this connection is removed, the sperm that is produced has no way to exit the penis to fertilize an egg.  Some men may chose to cryopreserve or “bank” their sperm prior to surgery.

The ability to achieve an erection and control your bladder returns spontaneously for many men after they undergo treatment for prostate cancer. The return of these abilities can take anywhere from 6 to 12 months. Many men find that waiting for half a year to a year for these functions to return is simply too long. They also often struggle when they compare themselves to other men who have recovered faster. Recently, there have been many studies looking at ways to expedite the return of urinary and sexual function in men who have been treated for prostate cancer.

Urinary incontinence is a frequent side effect of surgery for prostate cancer. In a 2010 study Centemero and colleagues found that participants who completed a pelvic floor muscle strengthening program before and after their prostate removal surgery experienced urinary incontinence for a significantly shorter period of time post-operatively than those who began pelvic floor muscle training after they had had their prostate removal surgery. These results were also reinforced by the work of Hischhorn and colleagues, who found that men who had received pelvic floor training prior to their prostatectomy reported significantly fewer issues with urinary incontinence.

Men have many of the same pelvic floor muscles as females do. Male pelvic floor muscle strength has also found to be an important factor in the ability to have an erection, remain continent, and avoid dribbling urine after one voids his bladder. These muscles can be trained to be stronger, relax better, and behave more effectively to help alleviate urinary and sexual symptoms following prostate cancer treatment. It is possible that strengthening your pelvic floor muscles may expedite your recovery. In a 2004 article by Siegal, pelvic floor muscle strength was found to be stronger in men without issues of erectile dysfunction, urinary dribbling, and incontinence.

The research shows that men can take an active role in speeding up their recovery from prostate cancer by participating in a pelvic floor rehab program with a qualified pelvic floor practitioner. We offer these services at Beyond Basics, so feel free to learn more about them here. By strengthening weakened muscles, stretching tight muscles, allowing for better coordination through biofeedback, pelvic floor physical therapy can help you feel like you sooner.

Sources

American Cancer Society

www.americancancersociety.org/prostatecancer. Accessed: March 10, 2015

Centemero A, Rigatti L, Giraudo D. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: A randomised controlled study. Eur Urol. 2010 Jun;57(6):1039-43

Hirschhorn A, Kolt G, Brooks A.

A multicomponent theory-based intervention improves uptake of pelvic floor muscle training before radical prostatectomy: a ‘before and after’ cohort study. BJU Int. 2014;113:383-392

Siegal A. Pelvic floor muscle training in males: practical applications. Urology. 2014 Jul;84(1):1-7

Pilates with Kierstin! Abdominal Bracing

Kierstin Elliott, Pilates Instructor

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What is it? Abdominal bracing is an activation of the core muscles that help provide support and stability for your trunk. This brace is commonly called upon in almost every single Pilates exercise and is essential for building tone within the deep and superficial layers of the core. Let me take you through two different scenarios where the core should naturally brace on its own.

Scenario one: Imagine kneeling on the floor with one foot forward and back toes tucked. Now if you were to lift the back knee two inches off the floor, how do you prep for that movement? I bet you would find yourself naturally bracing your core as a response to your body calling for additional stability to lift the back knee. Try it. If you do not feel the core engage naturally, it may take some deliberate asking from the brain to activate the core.

Scenario two: Imagine you tripped, but caught yourself! Chances are your whole body tenses up and your abs engage. Your body has to instinctively muster up as much stability as it can manage to prevent you from falling. This is another example of abdominal bracing.

One common question I get when introducing abdominal bracing to clients is, “How do I breathe when I’m bracing?” Don’t expect to get a full belly breath while under an abdominal brace, but do allow your abdomen to stretch and fluctuate a bit to accommodate to the task at hand. If the task is strenuous, strive to find a three-dimensional breath. Expand through the back of the ribs on your inhale. On the exhale while you exert the most force, start to knit your ribs together, draw your pubic bone up and gently pull navel toward spine (finding your brace). This will provide adequate support for your system. If you need prolonged stability throughout an exercise, your breath pattern may feel a bit short and more shallow than a full expansive breath.

Note from a PT

An abdominal brace is a useful tool for you to support your spine and pelvis during moments where you may have to lift something heavy, stabilize yourself from a jossle or bump, or to allow you the stability through your body for explosive athletic movements. That said, it is important not to grip constantly, that can invite a whole host of issues including pelvic floor dysfunction! A good abdominal brace is really like a seasoning. Think cilantro, it may be tasty in small doses on top of a burrito, but you certainly don’t want to eat a salad of it! We are often taught to grip because it pulls in our flab and men and women alike have been taught that “fluffiness” around the waste line is icky for some reason. But it is truly important for your health to let go when you are at rest.

Breathing under an abdominal brace directly impacts our intra-abdominal pressure which leads me to another common question I often get when asking clients to brace, “Is it safe for my pelvic floor?” Yes, bracing but not gripping is safe for your pelvic floor. In fact, not bracing for certain movements could lead to hernias, prolonged diastasis, or more severe pelvic floor issues. Learning the proper way to activate the various layers of your core and then coordinating that activation with proper breathing techniques will take you far; not only in functional daily movement, but in all of your active fitness dreams! If this peaks your interest, or you find it hard to find an abdominal brace on your own, schedule a session with me at Beyond Basics Physical Therapy, and we’ll have some fun exploring abdominal bracing!

Marathoning with Molly: Training Update

Molly Caughlan, PT DPT

Hello blog readers! I am writing this blog a good three or so months into my marathon training and wanted to give an update on how it has been going. Things started off rough: when just two weeks in, I rolled my ankle. Unfortunately, this story is not one of cool athletic prowess where I rolled it sprinting to save a child from a burning building. Rather, I was doing an silly move of “texting while walking the dog” maneuver that lead to a mis-step off the curb. I did a full tuck-and-roll, landed on the ground covered in dirt, and very much freaked out my doggo. I wish someone had caught this trip on camera, because I’m sure it was amazing. I took a minute to sit on a bench and assess the damage. Luckily, the grand theatrics of my trip did not equate to the severity of my injury and I was still able to put weight on it enough to walk home.

Two days later, I had a PT session with Tina Cardenia, where she worked to reduce the swelling and improve the mobility in my ankle. This helped tremendously to accelerate my healing and allowed me to return quickly to my running program. I was back on the pavement in under two weeks! Even though the sprain itself has fully healed, it continues to occasionally feel stiff during and after runs along with a little bit of swelling. Tina continues to focus on my right ankle mobility and stability to prevent future sprains. Pictured in this video below, Tina is performing what’s called a “thrust manipulation” that gives a quick stretch to my ankle joint to help it move more freely.

Disclaimer: This technique should be performed by a licensed professional and is not intended to be reproduced at home.

In addition to my right ankle, I will occasionally have left sided hip crease/groin pain and discomfort. This has come and gone even before marathon training. Based on Tina’s assessment, my left pelvic bone does not move well into extension and this causes some pinching in that area. Treatments have focused on releasing tight muscles and connective tissue in the front of my hip as well as building stability by strengthening my glutes and core.

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Another challenge with training is trying to beat out this summer heat! Compared to Atlanta’s summers (where I trained for my first marathon), this season started out pretty mild. I had been doing well and progressing mileage, but once the end of June hit I knew things needed to change. I remember the tipping point when I set out on a 12 mile run and my poor little leggies could only carry me 10. I recognized afterward my mistakes in that I woke up too late, chose a trail with little shade, and that I wasn’t properly supplementing myself in restoring electrolytes. Since this weekend, I’ve added SaltStick Chews to my regimen and they have really made a big difference. I’ve also been more diligent about really planning ahead when I can get in my long runs.

I’m sponsored by an organization called Team Tisch MS​ that performs groundbreaking research to discover the cause of Multiple Scelrosis, understand disease mechanisms, optimize therapies, and repair the damage caused by MS, as well as offering patient access to the best and most advanced treatment possible. So far I’ve raised $555 and I’m only 11% towards my $5000 goal with just 3 and a half months left to go. Support Team Tisch MS by donating to my fundraiser here.

 

Beyond Basics will be offering matching donations throughout the marathon, so keep your eyes peeled on social media to see how you can make your donation go TWICE as far!