March is Endometriosis Awareness Month

abstract-art-background-1020317Amy Stein BCB-PMD, IF (Pronouns: She, Her, Hers)

Fiona McMahon PT, DPT (Pronouns: She, Her, Hers)

 

We’ve written a lot of blogs over endometriosis (endo) over the years. It is a common diagnosis at Beyond Basics Physical Therapy, and frankly, out in the world. The current estimate is 1 in 10 people with female anatomy have endometriosis, and the average time for a proper diagnosis is 11 years. This number may be subject to change as currently laparoscopic surgery is the gold standard for diagnosis. We write extensively about what endometriosis is, and how it is thought to develop in this blog, But the cliff notes version is that endometriosis is the deposition of endometrial-like cells outside of the uterus. There actually was some degree of controversy about what the deposits actually are. It was originally thought that the deposits were endometrium (the lining of the uterus), but now the endo community is moving away from that thought. The deposits can cause a whole host of symptoms, or none at all. Symptoms severity is not related to the number/amount of endometrial deposits someone has.  We still don’t know why some people with large amounts of endometrial implants and or adhesions can experience little to no symptoms, while others who have a relatively small amount of endometrial deposits may experience debilitating pain.

For most people who know anything about endometriosis, they know it is associated with painful periods. Although this is true, if we look at painful periods, we may be missing a lot of other endometriosis-related symptoms.  Endo can affect the urinary system, resulting in urinary pain, hesitancy, frequency, urgency, and incomplete emptying. It can cause painful defecation and constipation, and it can affect your sex life causing pain with penetration and or orgasm. Endo can present itself in so many diverse ways and two people with endo may present completely differently.

For individuals with symptoms from endo, there is a lot that can be done to help minimize pain. But the same approach is not always effective for everyone. It is really important to look at your own goals when deciding on what to focus on so you can express them to your care team.

There is no magic pill or treatment that works on every endo patient. Oral medicines, surgery, physical therapy, nutrition, and lifestyle changes can all help with symptoms of endo. Often times treating endo requires some combination of all of these things and the frustrating part is what may have worked for someone else may not necessarily work for you. We will take a little look, (by no means exhaustive) at each one of these interventions with the intention of piquing your interest and hopefully facilitating a discussion about these options with your healthcare provider.

Endometriosis is thought to be an estrogen-driven condition. Some people with endo may find relief from medications that affect hormone levels. Oral contraceptive pills (OCPs)  are an example of medication used to affect hormone levels. There are other options beyond OCPs that work to alter hormone levels. For some people with endo, this approach can be helpful for symptom management, although hormone altering medication won’t cure endo.  You do have to consider the side effects of all the medication options however because some of the side effects can be worse than the medication’s positive effects.

Excision surgery is both treatment and the gold standard for diagnosis and treatment of endometriosis. Surgery works by cutting out the endometrial deposits. Performing biopsies on these deposits allows the practitioner to know if the deposit is Endo.  Ablation surgery has been shown to only clear part of the endometrial implants and is not nearly as comprehensive as excision surgery. As a result, repeat surgery is commonly required with ablation, and in many cases, multiple repeat surgeries.

So we’ve just explained to you that endo is an estrogen-dependent condition that causes deposits in the abdominal cavity. Logically it makes sense that getting rid of these deposits via surgery or slowing their growth with medication could help treat endo and the pain associated with it. But what does physical therapy have to do with the treatment of endometriosis? The answers range from simple to complex, with the complex delving into some pretty heady neuroscience. Why don’t we start with the simple first, and get more complex as we go.  

 

The deposits created in the abdominal cavity by endo can cause the tissues of the abdomen to get stuck and not slide and glide freely, we call those stuck areas, tissue restrictions or adhesions. The scars created by endo removal surgery cause adhesions. Sounds pretty bleak, but it’s not as bad as it sounds. Physical therapists have been treating scars for eons (actually since the start of the civil war, but we digress). Whether or not you have had surgery, chances are you will benefit from some myofascial release, which can help reduce endo and surgery related adhesions. Although most physical therapists know their way around scar massage, it is important to go to one who has been specially trained in pelvic floor conditions and ideally has been trained in visceral mobilization. This training will allow your PT to address adhesions of the viscera (your organs) as well as allow them to work on adhesions in the pelvic bowl by performing intravaginal and intrarectal release.

Here’s where it gets heady, bare with me. Let’s start with defining my subheading. Trigger points are taut bands of muscle that are extremely irritable. Trigger points can be described as “latent”, meaning they are painful when touched, or they may be an active myofascial trigger point, which is constantly angry and can refer pain elsewhere in the body. Trigger points in the abdominal-pelvic region can radiate to some funny places far away from where they actually are. Someone may feel the referred pain from a trigger point in their belly or back, near their bladder, or in their “ovary”, as well as other places.  Physical therapy can help relieve these trigger points by performing myofascial release as well as using techniques like biofeedback to help you learn how to relax your pelvic floor and prevent trigger points from reoccurring.

People who have been in pain for a long time may experience a phenomenon called central sensitization. What that means is the body, in an effort to protect you, starts perceiving things that wouldn’t necessarily be painful as painful. No one actively does this, and it is not in your head. It actually happens in the spinal cord and brain. This is what I mean by endo lowering pain thresholds. Physical therapy can be instrumental in improving pain thresholds through a process of desensitization.

What we just discussed are some of the most common things physical therapists address in patients with endometriosis. But let us not forget that everyone with endo experiences it differently. Pelvic floor physical therapists may address issues with urination, sex, and bowel movements directly as well as other issues like weakness, joint pain, and instability. It really is specific to the individual with endo.

Many people find relief in making adjustments to their lifestyle and diet. There have been numerous studies on the benefits of yoga on endo pain, as well as making changes in diet such as avoiding gluten, dairy, sugar, caffeine or committing to an IC and anti-inflammatory diet. In my experience, different things will work better for different people, but we have seen these changes be extremely helpful for some people. We write more about these changes in this blog.

We hope this blog was helpful to you. Having endo can really suck (we can’t think of a better word for it). If you think you may have endo, talk to a gyno who specializes in the treatment of endometriosis, because there is something you can do about your symptoms. Endo is a disease which requires much more research and awareness. Please take time this March to wear some yellow and do your part to spread endo awareness to physicians and other healthcare providers, to high schools and to your community.  

endo
This is the cover from Dr. Amy Stein and Iris Obruch’s latest book on endometriosis, available soon

 

Alimi Y, Iwanga J, Loukas M, et al. The clinical anatomy of endometriosis: A review. Cureus. 2108

 

Aredo J, Heyrana K, Karp B, et al. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin Reprod Med. 2017; 35(1):88-97

 

Mayo Clinic. “Endometriosis”.

. Accessed on February 19, 2019  

 

Mehedintu C, Plotogea MN, Ionescu S. Endometriosis is still a challenge. Journal of Medicine and Life. 2014. 7(3); 349-57

PH101: Running to the Bathroom Again?!

Fiona McMahon PT, DPT

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via Pexels

Bladder problems can be vexing, it may hurt for you to pee even though every test for infection you’ve taken has come back negative. You may find yourself incontinent after surgery or childbirth, or for no reason at all. You may find yourself waking up countless times to go, or needing to memorize every bathrooms’ location in the city because you go too often.

The bladder and the pelvic floor are intimately related and often times problems with the pelvic floor can cause real trouble with the bladder. Pelvic floor dysfunction can cause you to suffer from bladder frequency, urgency, incomplete emptying, slow stream, stream that stops and starts, bladder or urethral pain, or leaking.  By the way, it’s not just a female issue. Men and children can also have these symptoms. Learn from one of our experts, Sarah Paplanus, about how exactly the pelvic floor is related to bladder function and dysfunction, what you can do about it, and about common medical conditions affecting the bladder. Join us for this great seminar on March 26th at 7pm . Register here: pelvichealth101.eventbrite.com

And for those who can’t wait to learn about the bladder, check out our blog on bladder health here!

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Spring 2019

Navigating Life with Chronic Pain: Part II

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Fiona McMahon, PT, DPT

Welcome back to our discussion on chronic pain. In our last blog we discussed why one might experience chronic pain and some common missteps and pitfalls that have occurred in our understanding of chronic pain. If you haven’t yet read part one of this blog, I highly recommend checking it out first so you can get the most out of this post. Click here to read it now.

For chronic pain, we have drugs, surgery, mental health therapy, physical therapy, and what is called complementary alternative medicine (CAM), which includes modalities like yoga, acupuncture, and mindfulness meditation. We discussed earlier how some opioids may actually be harmful in treating chronic pain. Unnecessary surgery can also have risks of actually increasing pain post-surgically, because it can change the brain’s sensitivity to pain. Because, for most musculoskeletal conditions, a course of conservative treatment is recommended for a period of time before turning to surgery, we will focus on non-surgical, and non-medical approaches to chronic pain.

Before we dive into specific treatments, let’s talk about what puts a person at risk for chronic pain. We can divide these risks into modifiable and non-modifiable risks. Nonmodifiable risks are situations or characteristics about ourselves that we can not change. They include socioeconomic status, where you live or have lived, cultural background and genetic factors. Unfortunately, we can’t change these things, but things like alcohol intake, nutrition, and obesity are all things we can change and have been generally understood as modifiable risk factors for chronic pain. Now that we have that in mind, let’s explore different approaches for the management of chronic pain.

 

Mindfulness Practice as Pain Management

Have you tried mindfulness practice? I ask this question a lot. When I ask it, I am careful to frame it in a way that does not give the patient the impression that I think their pain is all in their head, but rather, I try and present it as part of an adjunct to the current physical therapy treatment they are receiving from myself or any of the other PT’s at Beyond Basics Physical Therapy, and any other medical intervention they may be receiving.

Mindfulness and mindfulness meditation are somewhat based on eastern meditation practices.  Not all mindfulness programs are the same, but the basic premise is to allow the participant to observe their thoughts, feelings, sensations, and attitudes without judgment. Giving them the opportunity to reframe their thoughts in a positive manner.

It may sound like a small change, but research is really starting to bear out that changing your frame of mind about pain can have some very real results. In a meta-analysis done by Hilton and colleagues, mindfulness programs were found to have statistically significant positive results on pain, depression, and quality of life.

There are a lot of ways you can incorporate mindfulness into your day to day life. Apps for your phone are really helpful. I recommend both Calm and Headspace. I personally like Calm a bit better, but both are excellent. Headspace is a good starter because it breaks up meditation into more digestible nuggets, which can be a good way to start your meditation practice. Calm, as the name implies, is more soothing.  There are also guided classes you can attend in your area if that’s more up to your speed.

Be patient with mindfulness, I definitely suggest giving it the old college try. Stick with it for a week or two. If it isn’t for you, that’s perfectly okay. It’s not a moral failing, or a psychological one it’s definitely a case of different strokes for different folks.

Psychological Intervention

In a study performed by Macrae and colleagues, it was found that patients who engaged in catastrophizing type behaviors experience post-surgical pain at a significantly higher rate. Catastrophizing is envisioning a situation to be far worse than it actually is. A good example for this blog would be a patient with low back pain, jumping to the conclusion that her back pain will prevent her from being able to work and she would end up on the street, secondary to her lack of ability to secure an income. Although this is a possibility, it really isn’t a realistic one and it fails to entertain the possibility of the back pain remaining stable or getting better.

Mindfulness meditation can help with catastrophizing behaviors, but sometimes you need a little extra help. Psychological interventions, like talk therapy and cognitive behavioral therapy, can help you get a handle on these thoughts and address your current loss of function, secondary to pain in a more productive manner. Cognitive behavioral therapy as well as other forms of therapy have shown improvement in pain symptoms and quality of life in adults and has shown even more robust effects in children.

Acupuncture

Acupuncture is an ancient form of eastern medicine that is gaining a stronger and stronger foothold in the States. It has been shown to be effective in managing a number of conditions, and chronic pain is no different. Reviews of acupuncture in scientific literature have found that acupuncture can improve pain and function. The same review found that electroacupuncture had even more robust results for pain and stiffness.

Yoga

Yoga is super hip right now. In fact, it now has its own international day on June 21st of each year. It does for good reason. A consistent and solid yoga program has been shown to improve conditions such as low back pain, myofascial pain syndrome, fibromyalgia syndrome, osteo- and rheumatoid arthritis. It can be a great option to continue to add consistent exercise and pain management into your life.

Physical Therapy and Exercise

Exercise is good for you, even if you have chronic pain. The old way of thinking was to put someone on days of bedrest when they have chronic pain. No more. Evidence has shown gentle movement progressing into more functional training can really help with chronic pain. In fact, the National Institute for Healthcare Excellence’s (NICE) osteoarthritis guideline is  “exercise should be a core treatment… irrespective of age, comorbidity, pain severity and disability. Exercise should include local muscle strengthening [and] general aerobic fitness”(NICE 2014) . Geneen and colleagues found in their review and meta-analysis of the current literature that just receiving the advice to exercise alone is not sufficient to produce improvements in pain scales. That’s where the professionals like physical therapists come in, PTs have the knowledge and expertise to prescribe exercise that is not only safe and functional but hopefully kind of fun. PTs also can diagnose and treat issues such as tissues with reduced mobility and poor alignment to ensure you get the most out of your exercise.

Data show that a prescribed and monitored exercise program by a physical therapist can have good effects on pain symptoms and can help facilitate the production of your body’s own natural painkillers.  Additionally, exercise can help individuals lose weight, which can reduce the pressure on one ’s joints and further improve pain.

Aside from exercise and hands-on work, we can use modalities like Kinesio tape at physical therapy. Kinesiotape has been shown to improve not only pain but decrease trigger points, improve range of motion and improve disability rates in individuals suffering from myofascial pain syndrome.

Conclusion

Chronic pain is complex. Rarely is there a silver bullet that will cure it. Treatment requires a multidisciplinary approach, which has been shown to be more effective than traditional treatment alone. Start small, where you feel comfortable when adding something new into your treatment approach. You will find what works best for you. A good place to start is here at Beyond Basics. Our staff not only has the expertise to treat you from a physical therapy perspective, but they also have the ability to guide you towards other traditional and complementary treatments/practitioners that can help you reach your goal. Your treatment for chronic pain does not have to be and should not be passive, please call and make an appointment today to start your journey.  

 

Sources:

 

Achilefu A, Joshi K, Meier M. et al. Yoga and other meditative movement therapies to reduce chronic pain. J Okla State Med Assoc. 2017;110(1):14-16

 

Andersen T, Vægter H. A 13-Weeks Mindfulness Based Pain Management Program Improves Psychological Distress in Patients with Chronic Pain Compared with Waiting List Controls. Clin Pract Epidemiol Ment Health. 2016;12: 49-58

 

Ay S, Konak H, Evick D, et al. The effectiveness of kinesio taping on pain and disability in cervical myofascial pain syndrome. Rev Bras Reumatol. 2017; 57(2) 93-9

 

Eccleston C, Crombez G. Advancing psychological therapies for chronic pain [version 1]; referees: 2 approved]. F1000 Faculty Rev. 2017

 

Geneen L, Moore R, Clarke C, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews ( Review).  Cochrane Database Syst Rev 2017; 4

 

Hilton, L, Hempe; S, Ewing B. Mindfulness Meditation for Chronic Pain: Systematic review and meta-analysis. Ann Behav Med. 2017. 51:199-213

 

Kamper S, Apeldoorn A, Chiarotto A, et Al. Multidisciplinary biopsychosocial rehabilitation for chronic pain ( review). Cochrane Database Syst Rev. 2014; 9.

 

Macrae W. Chronic post-surgical pain: 10 years on. Br J Anaesth 2008;101: 77-86

 

Mayer F, Scharhag-Rosenberger F, Carlsohn A. The intensity and effects of strength training in the elderly.  Dtsch Arztebl Int 2011; 108(21):359-64

 

Neira S, Marques A, Pérez I. Effectiveness of aquatic therapy vs land based therapy for balance and pain in women with fibromyalgia: a study protocol for a randomized trial. BMC Musculoskelet Disord. 2017; 18(22)

 

Perry R, Leach V, Davies P, et al. An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools. Sytematic Reviews. 2017. 6(97)

 

Saxena R, Gupta M, Shankar N, et al. Effect of yogic intervention on pain scores and quality of life in females with chronic pelvic pain. Int J Yoga. 2017. 10(1): 9-15

 

Singh P, Chaturvedi A. Complementary and Alternative Medicine in Cancer Pain Management: A Systematic Review. Indian J Palliat Care. 2015. 21(1): 105-15

 

     

 

PH 101 Something’s Wrong with my What?

 

You’ve waited and waited, now finally Pelvic Health 101 is BACK!

On March 19, 2019 at 7pm we will be kicking off our fall semester of pelvic health education classes. We have a lot planned this year, so get pumped. 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 as well as the function of your bowel, bladder, and sexual muscles and organs. 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 Spring 2019

 

Pilates with Kierstin! Bridges with Stability Ball

Kierstin Elliot

Exercise: Bridges with Stability Ball

Set Up: Lie on your back with knees bent, with left foot flat on the mat, and stability ball under the right foot. Arms resting by your sides. Neutral pelvis.

Execution: Inhale to prep. Exhale to lift pelvis off the mat into bridge position while pressing left foot firmly into the mat and right foot firmly into the stability ball. Hold bridge for one breath, then lower with control maintaining a neutral pelvis. Repeat 5-10 times on this side and then switch to the other leg.

Focus: Keep pelvis completely level throughout the entire exercise. Be sure to not overuse or arch the lower back. Ribs should be flush with abdomen and the knees should be reaching over the toes.

Importance: Key muscles targeted in this exercise are the glutes and hamstrings! Pelvic and core stability are also challenged due to the stability ball. If you feel only your hamstrings engaging as you bridge, move heels closer to sits bones. This should help the glutes turn on.

Modifications: If you find adding the stability ball too challenging, don’t continue using it with faulty form. Try marching slowly in a bridge position- hold the right leg up for 5 counts, then slowly transfer to left leg lifting for five counts. Keep alternating legs being sure the pelvis stays level and glutes and hamstrings are engaged. If you find you pelvis dropping on one side as you do this, then do fewer repetitions to start.

What To Do About Scars from Childbirth?

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Photo by freestocks.org on Pexels.com

Joanna Hess PT, DPT, PRC, WCS

No one told you that the pain of childbirth doesn’t end with that final push and it doesn’t matter if you had a vaginal or belly birth. If you are the roughly 10% of demigoddesses who delivered without a tear, bless you and your fairy child.* If you are a mere mortal, here are some secrets for post-partum “battle wound” care.

For many mamas, the scars from delivery heal without any intervention. However, in our clinic, we often see hypersensitive or immobile perineal and cesarean scars that affect other parts of the body and can be a reason for the loss of core stability mechanisms, pain with intercourse, and urinary and fecal incontinence.

Scars are the body’s glue and use a complex set of proteins. While scars are never as strong as the original (70% of the original strength), it usually doesn’t cause a problem. The healing process after cutting your finger on that dull knife is the same for a cesarean incision and perineal tear/cut. Immediately after the injury, lots of good inflammation comes into the area to clot and start a loose frame for new tissue to develop. In the first days, collagen and other healing buddies come in to pull the wound together. It’s not particularly organized, but that’s okay because really, priorities are to keep things from getting in. In the next weeks, the collagen fibers will start organizing according to the demands of that particular tissue resulting in a pinkish or red color to the scar. It’s about this time that you can tell if things aren’t going well, namely, the scar shouldn’t be painful. We don’t know for sure why some scars cause problems and others don’t. The best guesses have to do with genetics, tissue tension, hormonal glands, and blood supply. Within 7-12 weeks, not only should the scar not be painful, but it also should move as freely as the tissue around it—without tugging at other places. The scar should be flat and slightly lighter than skin color.

MOVEMENT AND ICE

In the first days, keep good blood flow to the area while managing the pain. For perineal scars, you can work by breathing gently into your pelvic floor and changing your position regularly so that blood doesn’t stagnate in the area. For cesarean scars, working on deep breathing is a safe way to gently move the area without disrupting the healing. You want to keep big movements limited (but really, you’re a mom and movements are a part of life). Use the pain meds as needed so that your muscles continue to function normally. Things like vagsicles (frozen maxi-pads) and support belts can also help with the pain. A regular ice pack for the c-section scar is also a good option. Make sure to place a thin towel between the ice or vagiscles and the skin.

SCAR MASSAGE

At the postpartum six-week appointment, have your physician or midwife check the mobility of the scar. If it is painful or stuck, ask if the scar healed enough to start gentle scar massage. The idea of the scar massage is to give a non-threatening stimulus for desensitizing the area and re-orienting fibers so that the tissue moves freely.

For both the perineal and cesarean scar, if the movement of the scar exceeds pain 2-3/10, start with just desensitization. This can be as simple as tapping the scar or rubbing the scar gently with a towel for 3-5 minutes/day.

For a perineal scar, use a clean finger to slightly push the scar along perineal body up towards the body to create some slack. Then, move the scar away from the center in all directions (north, south, east, west, and in between) to find out which direction is the least mobile. Hold the scar in the restricted direction for 30 seconds. The pain should not exceed more than 2-3/10. Repeat 3-5 more times. You should be able to steadily tolerate more movement within a month.

For a cesarean section scar before 3 months, lift the tissue around the scar in a generous pinch and move the scar up and down, then side to side. Continue along the length of the scar until you find an area of pain or restriction. At this point, spend a little more time and move that area of the scar 10-30 times and keep moving. Again, the pain should not exceed 2-3/10. For a cesarean section scar older than 3 months, you can mobilize the scar in the same movements by direct pressure or skin rolling—up and down, side to side, clockwise and counterclockwise and lifting with skin rolling.

For the new mama, this is easy to incorporate in the precious quiet moments in the shower.

SILICONE

The gold standard of stubborn scars is silicone with or without compression. For hypertrophic scars and keloids in other parts of the body, silicone sheets and gels are the primary non-invasive prevention and treatment. Silicone strips and gels are easily used over a cesarean scar. Silicone is used daily for 12-24 hours for 2-4 months to soften and decreases the height of the scar. The sheets and compression can also help with the hypersensitivity. Because of the proximity to the body cavities, silicone is not advised for perineal scars.

*If you want to try to avoid perineal tearing altogether, ask your birth team to help birth baby’s head slowly and use warm compresses during pushing, stay active during labor, deliver in a side-lying or upright position, and perineal massage in late pregnancy can all help reduce the risk of perineal tearing.

PHYSICAL THERAPY

If you have tried these simple interventions and still find your scar problematic or think your scar is related to pain in neighboring areas, find a women’s health physical therapist to help manage your care. Recent studies show that in 4-8 sessions, skilled physical therapy changes the mobility and thickness of old scars to decrease pain and improve function.

Scar management is widely promoted in post-operative care in orthopedics, plastics, and dermatology—we hope that scar care will soon be standard of care in post-partum care.

 

Joanna practices at our Downtown location

Joanna Lee Hess

REFERENCES

Aarabi S, Bhatt KA, Shi Y, Paterno J, Chang EI, Loh SA, Holmes JW, Longaker MT, Yee H, Gurtner GC. Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis. The FASEB Journal. 2007 Oct;21(12):3250-61.

Agha R, Ogawa R, Pietramaggiori G, Orgill DP. A review of the role of mechanical forces in cutaneous wound healing. Journal of Surgical Research. 2011 Dec 1;171(2):700-8.

Comesaña AC, Vicente MD, Ferreira TD, del Mar Pérez-La Fuente M, Quintáns MM, Pilat A. Effect of myofascial induction therapy on post-c-section scars, more than one and a half years old. Pilot study. Journal of bodywork and movement therapies. 2017 Jan 1;21(1):197-204.

Huang C, Murphy GF, Akaishi S, Ogawa R. Keloids and hypertrophic scars: update and future directions. Plastic and Reconstructive Surgery Global Open. 2013 Jul;1(4).

Lewit K, Olsanska S. Clinical importance of active scars: abnormal scars as a cause of myofascial pain. Journal of manipulative and physiological therapeutics. 2004 Jul 1;27(6):399-402.

Marshall CD, Hu MS, Leavitt T, Barnes LA, Lorenz HP, Longaker MT. Cutaneous scarring: Basic science, current treatments, and future directions. Advances in wound care. 2018 Feb 1;7(2):29-45.

Meaume S, Le Pillouer-Prost A, Richert B, Roseeuw D, Vadoud J. Management of scars: updated practical guidelines and use of silicones. European Journal of Dermatology. 2014 Jul 1;24(4):435-43.

Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound in Obstetrics and Gynecology. 2004 Mar 1;23(3):247-53.

Son D, Harijan A. Overview of surgical scar prevention and management. Journal of Korean medical science. 2014 Jun 1;29(6):751-7.

Wasserman JB, Abraham K, Massery M, Chu J, Farrow A, Marcoux BC. Soft Tissue Mobilization Techniques Are Effective in Treating Chronic Pain Following Cesarean Section: A Multicenter Randomized Clinical Trial. Journal of Women’s Health Physical Therapy. 2018 Sep 1;42(3):111-9.

Wurn LJ, Wurn BF, Roscow AS, King CR, Scharf ES, Shuster JJ. Increasing orgasm and decreasing dyspareunia by a manual physical therapy technique. Medscape General Medicine. 2004;6(4).

Do You Speak Pelvic Floor? Guide to Antatomy Part 2: Male Genital Anatomy

woman wearing white high top shoes
Photo by Du01b0u01a1ng Nhu00e2n on Pexels.com

Fiona McMahon PT, DPT (Pronouns: She, Her, Hers)

Hello again and welcome to part two of the “Do you Speak Pelvic Floor Series”. In the first part, we described the most common clinical language we use to describe the genitalia of those with female anatomy. In part two we will look a little more closely at the male anatomy. The male anatomy goes beyond the ‘ol twig and berries and there are specific names for the specific parts. Many folks, when they think of about pelvic floor physical therapy, think of it only as a women’s specialty. Beyond Basics Physical Therapy has been treating male pelvic disorders since 2003! In this blog, we will discuss the structures of the male external genitalia as well as some of the conditions that can affect this anatomy. Let’s read on!

Penis– The penis is one of the male sex organs and it has some pretty cool capabilities. The penis has individual compartments in it called the corpus cavernosus which fills with blood to keep the penis hard during erection. The corpus spongiousus helps to keep the urethra from collapsing upon itself during erection. We can see many issues concerning the pelvic floor muscles, surrounding tissues, and nerves that can affect the penis. Peyronies disease occurs when the penis bends, which can be uncomfortable and painful. We have a whole blog which takes a deep dive into the causes of Peyronie’s as well as treatments. You can read more about it here.

Glans- The glans is also known as the head of the penis. The glans is highly sensitive and provides a good deal of sexual sensation during sexual activities. The glans resembles an acorn. The word glans actually means acorn in Latin. The glans is often a place that will be painful with pelvic floor dysfunction. Tight and restricted muscles of the pelvic floor often refer to this area.

Foreskin- Foreskin is a really interesting structure, (stay with me, folks). Foreskin has cultural and religious importance. Many Abrahamic religions, (Jews, Muslims, and some but not all Christians) may practice circumcision as part of their faith tradition. Whether or not someone has had a circumcision is also linked to where someone lives. In the USA circumcision is extremely common, however in many countries across the pond in Europe, circumcision is much less commonly practiced. Whether or not to circumcise is a deeply personal choice that can be affected by your religion and your nationality. There are trade-offs to being circumcised and being uncircumcised and many doctors recommend that the decision is made by the family of the child.

Urethra- The urethra transports semen and urine to the outside world. Did you know that when the penis is fully erect, only semen can travel through the urethra? This prevents urination during intercourse. Men with poor pelvic floor function may experience leakage secondary to poor closure of the urinary tract into the urethra.

Testes- I have a blog all about testicles. In fact, that’s what it is called, All About Testicles. You can read about it here. Testicles create sperm. Did you know problems with muscles and nerve irritation can cause pain in the testicles, as well other serious and non-serious conditions? Read more about testicular conditions in the blog I linked above..

Scrotum- The scrotum is the sack that contains the testicles. The skin on the scrotum can get tight and restricted and sometimes cause pain in the scrotum and penis. Skilled physical therapists can teach you how to gently mobilize this tissue to treat your pain.

 

If you are having pain in any one of these areas, physical therapy may help.

Give us a call at 212-354-2622 to schedule a free consult for those living in the Tri-State Area to find out if PT is right for you.

Fiona McMahon PT, DPT practices at our Midtown Location

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