PH101: Pain and Sexuality: Is it all in my head?

cute-couple-with-umbrella-in-blossom-field-web-header

By Fiona McMahon, DPT

Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if you walked into work complaining of pain in your elbow, but if you walk into work complaining about pain in you vagina or penis, you may end up having a meeting with HR.

On October 6th at 7pm, we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer session at the end. We will discuss the many causes of sexual pain and how physical therapy can help.  The event will be hosted by one of our therapists, Stephanie Stamas, DPT, ATC. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth-101.eventbrite.com

Here is our line up of this and future classes

Pelvic Health 101 Fall- (003)

Exercise, The Female Athlete, and the Pelvic Floor

active-image

Fiona McMahon PT, DPT

In honor of National Women’s Health and Fitness Day ,September  28, we are exploring the benefits of regular exercise for women as well as addressing some pitfalls (pelvic floor included), that female athletes can fall into too. It is far too often that women find themselves sidelined from their favorite sports and fitness routines secondary to issues like orthopedic or sports-related pain or incontinence. Although all the issues outlined in this blog can occur to both genders, many of these conditions are more likely to happen to females, secondary to their pelvic structure and physiology.

 

Exercise and Its Benefits

heart-health

 

The benefits of exercise are too numerous to discuss every single one here and span the physical to the emotional. There are a number of conditions that have profound effects on the health of women nationwide. Let’s explore some of exercise’s specific benefits for these conditions together.

Heart Disease

According to the American Heart Association, Heart disease is the number one killer of women in the US and is responsible for 1 in 3 female deaths.  Exercise and a healthy lifestyle have been shown to reduce the risk of heart disease by 80%. The American Heart Association recommends 150 minutes of moderate activity or 75 minutes of vigorous activity to stave off heart disease.

Osteoporosis

Osteoporosis is unfortunately a common affliction among white and asian urban dwelling females.  It is characterized by reduced bone density, which causes bones to be fragile and increases the risk of fracture in individuals that have osteoporosis. Exercise has been shown to be helpful in both reducing the risk of osteoporosis as well as improving the bone mineral density of those who already have osteoporosis.

Other benefits of regular exercise include:

  • Reduced risk of diabetes
  • Reduced risk of colon cancer
  • Improved psychological well being
  • Maintenance of healthy body weight

Remember, it is important to consult with a trained healthcare professional before commencing a new fitness routine.

 

The Female Athlete Triad- Aka the Downside

All things in moderation. Although exercise is beneficial it is easy to over do it. It becomes easier to slip into an unhealthy relationship with exercise, especially in women who are training at elite levels, have eating disorders, or body dysmorphia issues.

The  female athlete triad consists of three disorders that can have severe health consequences in both the near and long term. The three disorders that compose the female athlete triad are:femaletriad

  1. Disordered Eating
  2. Ammenorrhea (absent periods or periods that are irregular)
  3. Osteoporosis

The female athlete triad is often attributed to the expectation that women keep a slender appearance. Girls and women who have body image issues may be at greater risk. The female athlete triad is dangerous and has the potential to be deadly. Osteoporosis can result  in fractures and eating disorders can seriously impact fertility, or even throw off the delicate balance of electrolytes in their system, putting them at serious risk for a cardiac event.

Warning signs of the female athlete triad include:

  • Yellowing of skin
  • Stress fractures
  • Rapid fluctuations in weight
  • Development of baby hair over skin
  • Daily vigorous exercise to an excessive level

 

The female athlete triad requires a multidisciplinary approach from medical, to psychological to nutrition.  It is important for someone who is suffering from the female athlete triad to seek help in order to safeguard their health and emotional well being.

 

Athletics and The Pelvic Floor

d14e2-tipsforahappyandhealthyvaginaLike any muscle, the pelvic floor can get fatigued, strained, or even go into a painful muscle spasm. The thing about the pelvic floor muscles, is that they have to work in almost every athletic pursuit. They work in partnership with the multifidus of the back, the transverse abdominus of the belly, and the diaphragm to stabilize and protect your spine. They also contract with every step during running activities to prevent your pelvic organs from dropping down in your pelvic cavity and to prevent urinary and or fecal leakage. Things can go wrong when the pelvic floor or other core muscles don’t function properly. Athletes’ pelvic floors can become tight and restricted, preventing closure of sphincters and support of pelvic organs. They may go into spasm from working too hard to stabilize the spine, if one of the other core muscles is failing to pull its weight.

Recently there has been more work to investigate the link between athletes and pelvic floor dysfunction. A recent study found that self identified female triathletes suffer from urinary and fecal incontinence at rates as high as 37.4% and 28.0%, respectively. Similar results were also found on a group of runners. Of the triathletes studied, nearly a quarter of them fit the criteria for female athlete triad, discussed earlier in this post.

Does this mean you have to give up your penchant for running? NO! (hellooooooo the author of this post is a runner), but if you find yourself experiencing incontinence, pain, constipation, and or painful sex, something is wrong and you must intervene in order to protect your long term health and your ability to participate in your favorite sport. At Beyond Basics Physical Therapy we combine orthopedic and pelvic expertise to help return athletes to their sports in a more functional and less painful condition. We relax tight muscles of the pelvic floor, train the core, including the pelvic floor if needed, to do its fair share, and return normal postural and structural alignment to our patients. We work one on one with you to develop a home exercise plan to help you reach your goals and prevent a reoccurrence of your pelvic floor or core disorder.

 

Please come see us so you can return to your sport in a better and more optimal condition than when you started: http://www.beyondbasicsphysicaltherapy.com/

 

 

Sources

American College of Sports Medicine. Information on … the female athlete triad. https://www.acsm.org/docs/brochures/the-female-athlete-triad.pdf. Accessed September 19, 2016

 

American Heart Association. Facts About Heart Disease in Women.  2016. https://www.goredforwomen.org/home/about-heart-disease-in-women/facts-about-heart-disease/. Accessed: September 6, 2016

 

Bø, K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Medicine, 34(7), 451-464. 2004.

 

Illinois Department of Public Health: Women’s Health. Facts about  women’s wellness exercise . http://www.idph.state.il.us/about/womenshealth/factsheets/exer.htm Accessed: September 13 2016

 

Loyola University Health System. “Female triathletes at higher risk for pelvic floor disorders.” ScienceDaily. ScienceDaily, 23 August 2016. <www.sciencedaily.com/releases/2016/08/160823165743.htm>.

 

Stampfer M, Hu F, Manson J, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. The New England Journal of Medicine. 2000; 343(1). 16- 22
Todd J, Robinson R. Osteoporosis and exercise. Postgrad Med J. 2003; 79:320-23

Beyond Basics’s Pro-Bono Clinic for PT Day of Service!

201510_blog_globalptdayofservice

Victoria LaManna, DPT

October is around the corner! And a busy month for many. Whether you are getting back into the swing of school or work after summer vacation, preparing your Halloween costume or getting ready for all the upcoming holidays right around the corner – there is a lot going on!
This time of year is also an opportunity to do good and give back. October is National Physical Therapy Month, where physical therapists celebrate their amazing field of healing and getting people back to optimal function. In addition, many of the PT’s throughout the U.S. give back to their communities during this month. This year we are taking it up a notch. Physical therapists WORLDWIDE are getting involved for the second annual Global PT Day of Service Saturday, October 15th. Whether it is by hosting a pro-bono clinic, serving in a soup kitchen, participating in a 5k for a cause, or cleaning up a community garden – physical therapists globally as a profession are coming together to make a positive impact on the world around them.
At Beyond Basics, we have decided to host a pro-bono clinic Saturday, October 1st to give back to those in the New York City area who may not have insurance or access to physical therapy. We are providing 30 minute one-on-one evaluations and recommendations for home programs to up to 30 participants. For more information and to sign up please visit: http://signup.com/go/Nu1T4Q
You can also check out PT Day of Service here and follow on twitter (#PTDOS) to see how the day unfolds! http://ptdayofservice.com/
The American Physical Therapy Association (APTA) is also involved in hosting National Physical Therapy Month. This year the APTA’s focus is on it’s national public awareness campaign, #ChoosePT. This campaign lets consumers know about the risks of opioid use and that physical therapy is a safe, non-opioid alternative for managing pain.
I encourage you to check out educational resources provided by the APTA (www.apta.org) and Move Forward PT (http://www.moveforwardpt.com/Default.aspx). Learn all about how physical therapy can help you overcome pain without the use of opiods, improve mobility and maintain independence throughout your lifetime.

day-of-service

Amy is Live with Integrated Pelvic Health!

Fiona McMahon DPT

amy2016What would you ask a pelvic floor physical therapy expert about exercise, or about the pelvic health as an athlete, if you had the chance? Don’t miss Amy Stein, founder of Beyond Basics Physical Therapy and author of Heal Pelvic Pain answer some commonly asked questions in a webinar hosted by well-renowned Jessica Drummond of Integrated Women’s Health Institute. Jessica is a nutritionist specializing in abdomino-pelvic health and dysfunction.  She will be interviewing Amy on the athlete and pelvic floor dysfunction, treatment paradigms, and practical tips for relieving the under active and the overactive pelvic floor.

Details:

Time: Friday, Sept 23, from 12-1pm EST.

Place: www.facebook.com/IntegrativePelvicHealth

Remember this interview can be replayed later if you cannot view it live.

 

 

Resources for Pelvic Pain:

Beyond Basics Physical Therapy: http://www.beyondbasicsphysicaltherapy.com/

 

Heal Pelvic Pain: http://www.healpelvicpain.com/

 

Integrated Women’s Health Institute: http://integrativewomenshealthinstitute.com/

 

Link to hear Amy and many other wonderful pelvic health experts speak in December about the female athlete and pelvic floor dysfunction:

https://km132.isrefer.com/go/WIWH/AStein/

 

September is Sexual Health Awareness Month

sexual health

Fiona McMahon DPT, PT

September is here and we at Beyond Basics are taking some time to observe sexual health awareness month. We take pride in our role of providing our patients with treatments to make sex comfortable and pleasurable as well as in our role as sexual health educators. Sexual health is comprised of many factors beyond just your ability to have sex. This article, by no means, exhausts all factors but is a good starting point to learn more about increasing your health as well as your enjoyment when it comes to sex. We will be expanding on some of the conditions featured in this blog in future posts, so stay tuned.

What is Sex

Sex is not a one-size fits all activity and can come in many different forms. Even between straight couples penetrative sex may not be the standard. In fact there are many couples that can not engage in penetrative intercourse for a variety of reasons. This may be because of an injury, medical condition, or simply because intercourse is not gratifying for the couple or there is some other act that is more gratifying. It’s really up to the couple’s choice and preference. A term for sexual activity that is not penetrative is called outercourse. Communication with your partner is essential at all stages of sexual health.

Emotional Health and Sex

Sex is more than how it makes you feel physically, it is about how it makes you feel emotionally. Many things can influence how we feel about sex and how sex makes us feel about ourselves. If sex is making you feel unhappy or anxious it is important to get to the root of the cause, in order to maximize not only your pleasure but also, your well being. Common issues, to name a few, that can negatively affect sexual experiences are listed here:

 

  • Trauma
  • Mismatch between your sexuality and culture
  • Issues with your partner
  • Issues with consent: Consent is a hot button issue in today’s media and on college campuses. Although consent is a broad and important topic, it can be boiled down to a few key points:
  1. Consent can never be assumed, regardless of dating status or previous sexual activity. For consent to be given, it must be given with an affirmative “yes” answer.
  2. Consent can not be given if someone is high on drugs, underage, or drunk
  3. Consent must be given with every sexual encounter and can be withdrawn at any time.

If emotional issues are contributing to a lack of enjoyment with sex, it may be time to reach out to a certified sex therapist.

 

Sexually Transmitted Infections (STIs/STDs) and Safer Sex

Sexually transmitted infections also known as sexually transmitted diseases can have a huge impact on your well being. Up until recently, sexually transmitted infections (STI’s) have been known as sexually transmitted diseases. There was a change in the nomenclature of these infections, because many of them can be asymptomatic and a person may carry and transmit them without knowing they have been infected.

STI’s unfortunately sometimes carry a moral connotation, in that blame is often put on the person who has it. STIs are simply an infection with a bacterial, fungal, or viral pathogen and have absolutely no bearing on the moral character of those infected. They can be transmitted sexually but they can also be spread through the childbirth process, dirty needles, or a tainted blood infusion.

All STI’s are not created equal. For some there are excellent screening tests and treatment, yet for others, treatment or screening or both may not be fully effective yet. Some may be obvious to those infected, while others may go undetected for years. Common symptoms of symptomatic STI’s include:

  • Sores and bumps around the genital and rectal area
  • Painful urination
  • Penile discharge
  • Irregular vaginal bleeding
  • Foul vaginal odor
  • Painful sex
  • Fever
  • Swollen lymph nodes in and around the lower extremities, which may also be present in the upper body as well.
  • It is important to remember these symptoms are non-specific and can be related to a number of other conditions that are not solely related to STI.

STI Complications

  • Pelvic pain
  • Eye inflammation
  • Pregnancy complication
  • Infertility
  • Pelvic Inflammatory Disease
  • Certain types of cancers associated with Human Papilloma Virus (HPV)

Risk Reduction

Because not all STI’s can be cured, (although many can be effectively managed) and the impact to one’s health can be so large, it is imperative to safeguard your health and fertility. Steps you can take to reduce your risk of STI infection include:

  • Abstaining from sex: abstinence is the most effective way to reduce your risk of STI; however, with most adults, this is not an acceptable option.
  • Using a barrier to reduce contact with bodily fluids. Using condoms for penetrative sex (vaginal, oral, and anal) or a dental dam for vaginal oral sex, can help to reduce your risk.
  • Keeping your number of sexual partners low: long term monogamous coupling is associated with a lower incidence of STI
  • Regular screening: Because many STI’s can be asymptomatic, regular screening is key to catching an STI early, treating the infection, and preventing damage to your own body as well as transmission to others,
    • Herpes: Recommended for those at risk for herpes (people having unprotected sex, have had sex with someone who is infected, or people experiencing symptoms such as sores)
    • Chlamydia:  men who have sex with men, as well as women who are under 25 have a greater risk of contracting chlamydia and should be tested for it
    • Gonorrhea: men who have sex with men, as well as women who are under 25 have a greater risk of contracting gonnorrhea and should be tested for it
    • Human Immunodeficiency Virus (HIV): It is suggested that everyone between the ages of 13 and 64 be tested for HIV. If you do have HIV, it is imperative to be regularly screened for other STI’s as it is easier to contract them with an HIV infection
    • People born between 1945-1965: should be tested for hepatitis C as there is a high incidence in this population.
    • New Partners: Before having sex with a new partner, both people should be tested for STI to prevent transmission of new infections
    • HPV: Females should be screened for HPV at least every 3 years if they are 21 to 30.  It is recommended to be tested at least every 5 years for sexually active women over 30. There is currently no HPV screening for males.
      • Two vaccines are now available to help prevent two types of HPV associated cancer. The current recommendation is that both boys and girls receive the vaccine between the ages of 11 and 12 years old. Boys can receive that vaccine between 13 and 21 and girls between 13 and 26 as a catch up period.
    • Truvada: Truvada is a drug that is now available to help prevent transmission of HIV and indicated for use in high-risk populations.

 

When Genital Pain Limits Sex

Both men and women can have pain that is so severe that it limits their enjoyment of sex, or prevents sexual pleasure completely. There are many syndromes and diseases that can cause pain with sex. As we covered earlier, STI’s can influence pain, as well as other conditions such as non-bacterial prostatitis, vulvodynia, vaginismus, pudendal neuralgia, as well as many more. These diseases and conditions can be influenced by poorly functioning pelvic floor muscles and vice versa. Keep an eye out for future blog posts devoted entirely to these conditions.  It is possible to have tight and tender pelvic floor muscles as a result of an infective process, injury, or they may arise on their own idiopathically.

 

What to do if you have pain

First off, don’t panic.  Pelvic pain is relatively common, some studies estimate chronic pelvic pain rates being higher than 25%. You are not alone. It is important, though, to act swiftly to identify the culprit. The majority of pelvic pain is treatable, but the process is much easier when started earlier on in the pain cycle.

Go to your doctor to rule out any infective or disease process that may be causing your pain. The best case scenario is that a short course of treatment will do the trick. Unfortunately, often times the root cause is not identified on the first trip to the doctor and your results may come back negative for any infectious agent or systemic condition. This is common for many of the patients we see at Beyond Basics. If this happens to you, consider going to a pelvic pain specialist, whether physician or pelvic floor physical therapist, for more precise testing.

It is important to remember not all physicians are trained to recognize dysfunction of the musculoskeletal system, although the number of those who are trained is growing. Indications of musculoskeletal dysfunction are: pain that changes with changes in activity or position, pain that does not go away once the original disease or infection is treated or cured, or pain that can not be correlated to a specific systemic dysfunction. It is important to remember that musculoskeletal dysfunction in the pelvis can mimic, or be the cause of, bladder, bowel and sexual dysfunction.

If you believe your pain is musculoskeletal in nature or even think it might be, it is important to be examined by a skilled pelvic floor physical therapist and not all pelvic floor physical therapists are well trained. Pelvic floor physical therapists can determine if muscles and/or nerves are playing a role in your pain, and then treat the dysfunctional muscles and tissues to allow you to return to your old activities. When looking for a pelvic floor physical therapist, it is important to inquire whether or not they do internal work, both vaginally and rectally, and to ask about their training and experience.

At Beyond Basics we are experts at treating sexual pain as well as screening our patients and referring them on to the correct physicians to help treat any systemic causes of pain. We value a holistic approach to treating sexual pain, and strive to provide our patients with the best care possible. If you are in the New York area, another state, or even abroad and are suffering from sexual pain, please consider starting your healing journey with us.  We have an extensive ‘out of town’ program:  URL for program.

 

Resources:

STI Awareness and Counselling Services

American Sexual Health Association: http://www.ashasexualhealth.org/

Planned Parenthood: www.plannedparenthood.org

 

  • Services provided
    • STI screening/counseling
    • HPV vaccine
    • Male reproductive health exams
    • Pregnancy tests and counseling
    • Health insurance screening and enrollment

NYC STI Clinics and Services: http://www1.nyc.gov/site/doh/services/clinics.page

 

Sexual Assault Counseling:

 

RAINN: Rape Assault Incest National Network: https://centers.rainn.org/

-800.656.HOPE

  • Services provided (free or low cost):
    • Counseling
    • Medical Attention/ Hospital Accompaniment
    • Victim assistance/ advocacy
    • Legal/ Justice System advocacy
    • Emergency Shelter

Pelvic Pain Resources:

International Pelvic Pain Society: www.pelvicpain.org

 

International Society of the Study of Women’s Sexual Health: www.isswsh.org

www.pelvicpain.org

 

Heal Pelvic Pain

By: Amy Stein DPT

http://www.healpelvicpain.com/

Healing Pelvic and Abdominal Pain DVD

By: Amy Stein DPT

http://www.healingpelvicandabdominalpain.com/

 

Explain Pain

By: David Butler

https://www.amazon.com/Explain-Pain-David-Butler/dp/0987342665?ie=UTF8&hvadid=49868747328&hvdev=c&hvexid=&hvnetw=g&hvpone=&hvpos=1t1&hvptwo=&hvqmt=b&hvrand=9859257768995611935&ref=pd_sl_1tz644lwle_b&tag=googhydr-20

Healing Painful Sex

By:   Deborah Coady, MD and Nancy Fish, PhD

 

The Pain No One Wants to Talk About

https://beyondbasicsptblog.com/2015/05/13/the-pain-no-one-wants-to-talk-about/ When

When Sex Hurts

By: Andrew Goldstein, MD and Caroline Pukall, PhD

 

Sources:

 

International Pelvic Pain Society:  www.pelvicpain.org

 

International Society of the Study of Women’s Sexual Health:  www.isswsh.org (confirm url)

 

Ahangari A. Prevalence of Chronic Pelvic Pain Among Women: An Updated Review. Pain Physician. 2014;17(2) E141-7

 

Barrow R, Berkel C, Brooks L. Traditionally Sexually Transmitted Disease Prevention and Control Strategies: Tailoring for African American Communities.  Sex Transm Dis. 2008 Dec; 35 (12 sUPPL): s30-9

 

Katz A, Lee M, Wasserman G, et al. Sexually Transmitted Disease (STD): A Review of the CDC 2010 STD Treatment Guidlines and Epidemiologic Trends of Commone STDs in Hawai’i. Hawaii J Med Public Health. 2012 Mar; 71(3): 68-73

Mayo Clinci Staff. Sexually Transmitted Diseases (STDs). http://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/home/ovc-20180594. [Accesses August 17, 2016]

 

 

 

Pelvic Health 101: Pain & Sexuality: Is it all in My Head?

Fiona McMahon, DPT

Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if you walked into work complaining of pain in your elbow, but if you walk into work complaining about pain in you vagina or penis, you may end up having a meeting with HR.

On October 20th at 7pm, we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer at the end.  The event will be hosted by one of our therapists, Stephanie Stamas, DPT, ATC. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.

PelvicHealth

We sincerely hope that if you are experiencing pain with sex, that you will come visit us to learn more. Our Pelvic Health courses are free and open to the public. If you are interested please register at: Pelvichealth101.eventbrite.com. We hope to see you soon!

The Pain of Falling

By Fiona McMahon

I want to talk about a health risk that is seldom thought of when we think about health, falls. According to the CDC, elderly men are the most likely to pass away from a fall. White men in particular, are at risk for falls and are 2.7 times more likely to fall than their black men. Falls are the leading cause of both fatal and non fatal injuries in older women and men.

Image via Pinterest

There are simple steps you can take to limit your fall risk. A good first step is having your primary care provider review your current medications, both prescription and over the counter. You may find you are on many medications that treat the same thing. Your doctor can help determine if this is the case. Some medications, for example those that cause dizziness, can increase your risk of falls and your doctor may want to adjust them.

Another important step to minimize your fall risk is to have regular eye exams. Vision is an important part of our balance system and as we age, we may grow increasingly reliant on it. The CDC also advises seniors to get single distance lenses for outside activities like walking.

Modifications can also be added to your home to make it safer.  Adding additional handrails to your stairs, removing area rugs, adding non slip mats to your bathtub, and keeping your home neat and free of debris are all great steps to improving your overall safety.

One of the most important components in reducing your fall risk is remaining active. The old adages, “a body in motion, tends to stay in motion” and “use it or lose it” could not ring more true. Sarcopenia is the term that’s given to the gradual loss of muscle one experiences as he or she ages. We can begin slowly losing muscle fibers as early as 30 years old! With the gradual loss of muscle tissue we gradually lose strength and it becomes much more difficult to do things that were once previously easy.  Weaker muscles will make it harder to keep your balance. Remaining active and making sure you are eating enough of the right food can go a really long way towards slowing your rate of muscle loss as you age.

Even if you are not very active now, there are simple steps you can take toward reducing the rate of age-related muscle loss and maintaining your functional independence. Adding in more walking is a relatively easy thing to do. If you live in the city, get off the bus or subway a station early and walk the extra distance. You can also do your shopping at a bodega further away from your apartment. If you are a suburban or country guy or gal, park your car a little further away from the grocery store.

Another great idea is doing a little extra work when you get up out of a chair. Being able to get out of your chair by yourself is an important skill to maintain your independence. When you get up out of your chair, sit back down and get up a couple of extra times. This is like doing a mini-squat. “Sit-to-stands” as they’re called, are lovely exercises that strengthen all of your thigh muscles without having to go to the gym!

If you have fallen in the past year you are at risk for future falls. Medicare requires physical therapists to incorporate fall training into your plan of care if you have had a fall in the past year or demonstrate a risk for falls as determined by your physical therapy examination.  Physical therapy doesn’t just teach you skills that improve balance, it can also teach you potentially lifesaving skills like being able to get up from the floor independently. PTs will also strengthen the key muscles used for balance and give you exercise that gradually train your balance.

Beyond Basics can offer a little something extra to complete your fall training program. If you have incontinence either urinary or fecal, you are at an increased risk for falls. People with incontinence can fall for a multitude of different reasons. They may fall because of slippery floors that occur as a result of an episode of incontinence, or they may trip while rushing to the bathroom. Whatever the reason is, our therapists are specially trained to determine the reason for incontinence and implement a program to correct it.

You don’t have to accept falling, or incontinence, as a natural part of getting older. Whether you decide to start on your own, join a Tai Chi or balance training class at the gym, or whether you decide to seek help from a skilled physical therapist, act now, your health and independence depends on it.
Centers for Disease Control and Prevention. Falls among older adults: an overview. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.  Last reviewed March 19. 2015. Assessed June 18,2015.

The Pain No One Wants to Talk About

By Fiona McMahon and Amy Stein

Imagine if you will, Sheila. Sheila is an active 30-something who has just come into her own. She is moving up the ranks at work, she is in a stable and loving relationship, and is even thinking about having kids one day. Imagine Sheila begins developing pain in and around her vagina that makes it painful for her to have sex with her partner, sit for long periods of time, or even wear tight pants. Sheila begins missing work because she can’t bear to sit for eight hours a day, she stops working out, and her relationship with her partner has become increasingly strained. Sheila feels increasing shame that she is not the sexual person she once was and is hesitant to bring her pain up to her doctor because she fears there is nothing he can do, or even worse, he might think her pain was all in her head.

Now imagine Sheila’s pain isn’t in her vagina, but rather it is in her back. You could imagine that the version of Sheila, with the back pain ends up faring much better than the version of Sheila with the vaginal pain. Sheila with the back pain isn’t embarrassed to bring her pain up to her doctor. She may even talk to her friends about their back pain and treatments and practitioners that have helped them.  Sheila is given all the tools, resources, and support of the healthcare community and her friends to help treat her back pain and return to the person she was before. The version of Sheila with the vaginal pain remains unsure of where to start. She is embarrassed and feels alone in her journey. She has bounced back and forth to doctors, urologists, gynecologists and even psychologists but has found no cause or relief in her pain.

We at Beyond Basics see it as one of our key missions to open a dialogue about the millions of women (and men!) who suffer with pelvic pain and provide them with treatment options to help them return to their former selves. We recognize for many women and men, pelvic pain is a profoundly sensitive subject that can be difficult to talk about. We also recognize that the consequences of letting pelvic pain go unchecked can deeply affect an individual’s, and their family, friends and colleagues’ quality of life.

Let’s start our conversation with the type of pain Sheila was experiencing. Someone like Sheila might start her journey thinking she has a urinary tract infection or a sexually transmitted disease, but when the results of her medical tests come back negative, she and her healthcare practitioner may not be aware that her pain could be caused by musculoskeletal dysfunction, which can be treated by a trained pelvic floor physical therapist.

Patients who lack a clear cause of their pelvic pain may have muscle spasm or nerve irritation, in their pelvic floor muscles, weakness, or bony misalignments. We refer to these problems in the pelvic floor as pelvic floor muscle dysfunction (PFMD).  PFMD can occur from a variety of different causes, a fall while skiing, stress, chronic illness, or previous acute infection.

PFMD can occur in men, women and children, of whom may experience pelvic, abdominal, hip, back and/or lower extremity pain.  In addition, men may experience pain in their testicles, groin, tip of the penis, or perineum. Women, like Sheila, may experience vaginal pain with penetration (superficial or deep), burning in the vulvar area, or pain in their clitoris. PFMD can significantly impair one’s ability to enjoy sex, causing painful penetration in women, and post ejaculatory pain, premature ejaculation, difficulty reaching climax, and erectile dysfunction in men. Patients with PFMD may also experience urinary and gastrointestinal issues and/or incontinence.

A pelvic floor physical therapist can diagnose PFMD by performing a specialized pelvic exam, where the therapist will test the strength of the pelvic floor muscles, their ability to relax, and whether or not the pelvic floor muscles are in spasm or are shortened. A pelvic floor physical therapist will also examine the skeletal alignment, the strength and range of motion of the hip and core muscles, and the muscles and fascia of the abdomen, back, lower extremities and perineum to assess for other possible biomechanical contributors to the patient’s pain and symptoms.

Based on what the physical therapist finds, he or she will develop a specialized course of treatment for the patient. Sometimes scarring is the culprit in PFD. Conditions like endometriosis, episiotomies, and abdominal and pelvic surgeries can all cause scarring. Scarring can lead to tissue adhesions, which don’t allow the tissues of the abdomen, trunk and pelvic area to move freely. Tissues that can’t move freely, whether from shortened muscles or from scarring, can impair motor control, visceral function (i.e. intestines) and contribute to pain. Tissue restrictions and shortening can be effectively treated in physical therapy by using manual techniques to mobilize the restrictions both internally and externally. In addition, the pelvic floor physical therapist will correct bony misalignments that may be found upon exam.

Weakness is a common contributor in PFMD. Weakness can cause the organs of the pelvic cavity to drop lower in the pelvis due to a lack of muscular and connective tissue support. The dropping of these organs can cause discomfort that worsens over the course of the day. A patient with weak pelvic floor muscles can be guided through an exercise program to strengthen his or her pelvic floor.

Pelvic floor physical therapists may also use different tools besides their manual skills to address PFMD. Some women experience pain during penetration because the skin and muscles of their vagina and/or perineum are too tight. In this case, a physical therapist may use vaginal dilators to gently stretch these tissues allowing the patient to comfortably be able to accommodate her partner’s penis or a sex toy during penetration.

Biofeedback is a tool that can help improve a patient’s awareness of his or her pelvic floor muscles. Biofeedback is used to show the muscle activity of a patient’s pelvic floor as a display on a computer, allowing the patient to see the action of his or her pelvic floor in real time. For a patient who is experiencing pain, a physical therapist can use biofeedback to teach a patient how to properly relax his or her pelvic floor muscles allowing for better pelvic floor function.

Having pain is hard. Having pelvic pain is arguably even harder. We as a society attach so much shame to this area of our body that sometimes we end up closing ourselves off from possible treatments when something goes wrong with our pelvic floor. We at Beyond Basics hope you have found this article helpful and encourage you to seek help from a pelvic floor physical therapist if Sheila’s problems seemed at all similar to your own. We hope this post has helped you to reconsider pelvic pain and the options that exist to help you return to your old self.

Holiday Traveling? Pain-Free’s the Way to Be!

Are you constantly on the road, or traveling a lot this holiday season? Whether you know it or not, your body  is talking to you and it may not be super psyched to see yet another seatback in the upright position. Take a look at these tips from About.com to make sure your travel this holiday season (and your travel from now on!) is pain-free.

Tablet Takeover?

Though there’s a continuing presence of mobile devices like iPhones and iPads, we’re not really paying attention to the way our bodies our responding to them. In reality, they can hurt our necks and our backs if we don’t use them properly. Here’s an article in the Harvard Health Blog offering some tips so you can get your mobile on pain-free!