What Pelvic Floor PT is and What it is Not

 

PelvicTrigger Warning: This piece briefly discusses sexual assault.

Fiona McMahon PT, DPT

Last summer, a reporter came to our office. This is usually not a tremendously unusual circumstance at Beyond Basics Physical Therapy. We often have reporters come to our office to research conditions like dyspareunia (painful vaginal intercourse), endometriosis, painful bladder syndrome/interstitial cystitis, prostatitis, and the many other conditions we treat. This time was different. This reporter was researching legitimate medically necessary pelvic floor physical therapy to put into context what was currently happening in USA gymnastics and the Larry Nassar story.

The Larry Nassar story rocked the pelvic floor world to our core. Larry Nassar was a USA Gymnastics Team physician who sexually abused girls for decades, under the guise of providing “pelvic floor treatment”. For those of us who have spent our lives promoting, educating, and treating both men and women with pelvic floor dysfunction, to see pelvic floor treatment perverted into a way to systematically abuse women and girls, it was truly heartbreaking.

We at Beyond Basics PT feel it is imperative to ensure that every patient knows his or her own rights and what to do if they feel uncomfortable. Although we are writing this in the context of pelvic floor physical therapy. Keep in mind, that much of what we talk about applies to interactions with other healthcare professionals.

Before we get started, let’s discuss why one might need to have their genital region examined in the course of physical therapy treatment. Pelvic floor dysfunction refers to a whole host of symptoms mainly felt in the pelvis, although they may appear in other parts of the body. These symptoms may include and are not limited to both male and female pelvic pain, urinary, bowel and sexual issues. Treatment may include external manipulation of the pelvic floor and genital region as well as manipulation of the pelvic floor muscles by inserting a gloved finger into the anus or the vagina. These techniques are used in combination with other osteopathic techniques to improve muscle length and strength, as well as reducing spasm within the pelvic floor and surrounding areas. To read more about what pelvic floor physical therapy is, click here. Pelvic floor physical therapy can be life changing when performed appropriately. It can allow an individual to go back to work or back to school, or the tolerance to sit on a plane to visit family, when doing so would have been too painful prior to physical therapy. It can allow an individual to have painless sex (male and female, same sex or opposite sex sex), and it can allow someone to regain continence who before was socially isolated. Pelvic floor physical therapy is a legitimate means of improving the health and quality of life of an individual. We will include peer reviewed articles below if you would like to read more.

Given the intimate nature of the treatment as well as the power dynamic that sometimes may exist between patient and clinician, it is important to discuss what rights you have as a patient in order to make yourself feel more comfortable. The following outlines your rights as a patient receiving any type of medical treatment.

Consent

When you step through the door of any medical office for the first time, you get handed what feels like fistfuls of paperwork. In that paperwork, there should always be a consent form. This form must be signed before you are treated, the exception being in medically emergent situations, when you become unconscious and consent is implied for life saving medical intervention.

Remember, just because you signed the form before treatment, doesn’t mean you consent to any and all treatment. You may always revoke your consent by saying you don’t want to participate in a procedure or intervention by saying so.

We want you to feel comfortable. If a treatment course makes you uncomfortable, tell us. Gritting your teeth and tolerating an uncomfortable treatment can sometimes do more harm than good. It is also appropriate to revoke consent to be treated if you are unsure why a treatment is being done or suspect it may not be necessary. Our jobs as clinicians are not only to treat but to educate. If you don’t know why we are doing a certain technique, we need to take time to educate you in order to do our job correctly. Revoking consent can be as simple as telling your practitioner you do not want to engage in a certain activity. Practitioners may take time to explain why they feel that intervention is necessary; however they should never make you feel ashamed for revoking consent. Remember, you are not in the clinic to please us. You are there for yourself. To get better. That is it.

Even if you truly need a pelvic floor treatment, often times there are other parts of the body that should be addressed to aid in certain pelvic conditions. Skilled practitioners can delay pelvic floor treatment by treating other parts of the body until you are ready. This can often be done while still maintaining forward progress.

Chaperone

Chaperones are individuals who accompany you to medical and physical therapy exams and treatments. If having a chaperone attend a visit or visits would make you more comfortable, you should be allowed to bring one. You should be able to bring a family members, or a friend into treatment. If you don’t have someone to fill this role, you can ask the facility to supply you with one, (usually asking ahead of time will ensure a staff member is available). In very few cases, such as surgery or trauma interventions, is it appropriate for a patient to be denied a chaperone if he or she requests it.

Second Opinion

What if your clinician gives you a diagnosis or suggests a treatment that doesn’t sound right? This is where a second opinion really comes in handy. Getting a second opinion is not “cheating” on your doctor, it can allow you to explore other options or be more confident in your original provider’s course of action.

Respect and Comfort

Feeling respected by your clinician is essential to healing . If you feel that you are not getting the respect you deserve or even if you are not connecting with clinician for whatever reason, you have the right to change clinicians. You don’t have to feel obligated to explain why you are changing clinicians if you don’t want to. Most healthcare providers realize that we might not have the right clinician for every person, and we are trained to not take it personally. It is okay to put yourself first.

Red Flags in Pelvic Floor Physical Therapy

  1. Feeling coerced, bullied, or shamed into a pelvic floor treatment
  2. Therapist does not wear gloves for treatment
  3. Therapist insists on not allowing chaperone
  4. Therapist fails to offer adequate reason for treating the pelvic floor
  5. Therapist is not licensed
  6. You therapist acts in a way to make you feel unsafe or uncomfortable

The truth is, there are so many wonderful physical therapists out there who treat the pelvic floor. Being a physical therapist is one of the greatest jobs in the world, because we get to help people do things that before were difficult or impossible. Pelvic floor physical therapy changes lives. We sincerely hope this article helps you feel empowered to go to physical therapy and know what your rights are and what to expect.

Further reading on pelvic pain:

Association

International Pelvic Pain Society: www.pelvicpain.org

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

 

Books

Heal Pelvic Pain

By: Amy Stein DPT

http://www.healpelvicpain.com/

Healing Pelvic and Abdominal Pain DVD

By: Amy Stein DPT

http://www.healpelvicpain.com/

When Sex Hurts

By: Andrew Goldstein, MD and Caroline Pukall, PhD

Healing Painful Sex

By: Deborah Coady, MD and Nancy Fish, PhD

 

Scholarly Articles

Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

Anderson R, Sawyer T, Wise D, Morey A. Painful myofascial trigger points and pain sites in men with chronic prostatitis/ chronic pelvis pain syndrome. The Journal of Urology, 182;6 2753-58

Fitzgerald M, Kotarinos R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. Int Urogynecol J 2003; 14:261-8

Fitzgerald M, Kotarinos R. Rehabilitation of the short pelvic floor. II: Treatment of patient with the short pelvic floor. Int Urogynecol J 2003;14: 269-72

King H. Manual Therapy May benefit women with interstitial cystitis and pelvic floor pain. J Am Osteopath Assoc. 2013;(113)4: 350-61

Morin M. Bergeron S. Pelvic floor rehabilitation in the treatment of dyspareunia in women. Sexologies. 2009; 18:91-4

Shafik A, Shafik I. Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol. 2003 May; 20(6):347-7. Epub. Apr 4

Wurn B, Wurn L, Patterson K. Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual therapy: results from two independent studies. 2011;3(4)

Beyond Basics is Visting Brooklyn!!!!

Brooklyn

 

Fiona McMahon PT, DPT

Have you got pelvic floor questions? Have you desperately wanted to go to one of our PH101 classes, but can’t swing 7pm in midtown in the middle of the week? Well, I have great news and GREATER news. I know, right… how much great news can you handle? The first bit of awesome, is that Beyond Basics’ Physical Therapists’, Dr. Fiona McMahon and Dr. Sarah Paplanus are hosting a forum and open discussion on pelvic floor health and treatment on Saturday, April 28th at The Floor on Atlantic (310 Atlantic Avenue in Brooklyn) at 12 noon. We will be there to explain the ins and outs of the pelvic floor, what can go wrong with it, and best yet, how you can heal it. It is a must go to event. RSVP here. Also, it’s FREE!

So what’s the other news, Fiona? Well, it’s that although we are not in Brooklyn, we have opened another office just across the river from Brooklyn, Beyond Basics Physical Therapy Downtown. In enlarging our footprint we hope to expand access and convenience to patients living downtown and in Brooklyn. We will be hosting a Grand Opening and 15 year anniversary celebration at our new location: 156 William St, Suite 800 New York, NY 10038 on Thursday, April, 26th from 4pm – 7pm. Come and enjoy food, drinks and meet our Physical Therapists. RSVP here.

 

 

Pelvic Health 101 is back and with BRAND NEW COURSES

Fiona McMahon PT, DPT

Our Pelvic Health 101 courses are back! For those of you not in the know about our courses, they are informational sessions provided by top experts in the field of pelvic pain and pelvic function. These courses allow you to dive more deeply into topics such as bowel, bladder and sexual function and dysfunction, pelvic and genital pain, childbirth, diet, issues with kiddos, and much more.

This year we added a Gent’s Only Session to be a companion to our Ladies only session to help answer some of the specific questions you may have about pelvic floor function as it relates to sexual health, bladder and bowel health, as well as pain.

Our first class is “PH101: Something’s Wrong with my What?”, where our own Stephanie Stamas,will be going through the basics of anatomy of the pelvic floor, what can go wrong and how we can fix it. Our first class is on March 7th at 7pm. Register here: pelvichealth101.eventbrite.com, to reserve your spot. Our classes are extremely popular so make sure you register well ahead of time.

Check out

Location:

110 East 42nd St, Suite 1504

New York, NY

10017

Check out all the upcoming classes here:

Pelvic Health 101 Spring 2018 (2)

Pediatric Bowel Part II: How to Make Pooping Easier for your Kiddo

poop

Fiona L McMahon, PT, DPT

Hey everyone! We are resuming our conversation about potty issues with kiddos. In our last blog, we discussed how issues with pooping can occur with kiddos and how often times it is easy to overlook long standing constipation in kiddos with fecal and urinary accidents. We learned that although it can seem like someone is doing something wrong, potty issues are no one’s fault. Even though poo problems are no ones fault, they are problems that families can work on together to be solved.

In this blog, we are going to discuss right here and right now what you can do today to help your child poop easier. Some of the changes are astonishingly simple while some may require a bit more work and change from the whole family. Keep in mind in order for anyone’s bowel to change ( not just kids), you must be consistent, and these changes may take a very long time to occur. Be patient, you and your child will get there. Let’s go over ways to get back on the right track now.

STEPS to help with bowel issues:

Step 1: Allow your kiddo enough time to poop

Ever have to catch an early morning flight and noticed that you skip pooping that day, or even worse, you get a little bound up in the following week? Getting up early and rushing in the morning can constipate anyone and the thing is that’s what most kids are having to do. Many children have between half an hour to an hour to scarf down their food, dress, and brush their teeth before rolling out to school, leaving very little time to sit on the toilet and have an effective bowel movement. Kids then often find themselves at school with public bathrooms or single bathrooms within the classroom that don’t lock, making it hard to be comfortable enough to have a bowel movement. Then they usually must rush to extracurriculars and complete homework before bed. There simply is not enough time to poop.

Allowing your child 10-15 minutes to sit on the toilet 10-20 minutes after they eat can allow them to use what’s called the gastrocolic reflex. Basically what that means is when you eat, the body makes room for the new food by moving everything down further in the digestive canal. Therefore, after meals is the time when we are most likely to have a poop.

Allowing more time in the morning is the most easily modifiable part of your routine to start with when trying to improve your kiddos pooping habits. Get up about 30 minutes earlier to allow your child time to eat and to sit on the toilet. Follow with sitting on the toilet after lunch and after dinner.

Step 2: Fit the toilet to you child; don’t fit your child to the toilet

Studies show that toilet posture is imperative to good poops. My colleague, Sarah Paplanus, DPT, explains in detail the importance of having your knees above your hips while pooping in her blog on the squatty potty. Step stools will help your child get their knees above their hips, just remember to make sure that they keep their legs somewhat separated. Also, for the little littles, a child size toilet seat will help make sitting on the toilet more comfortable for kiddos with little tushes.

Also, check out this video on potty posture, with fellow peds therapist, Victoria LaManna PT, DPT, CLT

Step 3: Improve Diet

Most adults are aware that diet is important, but diet is equally as important with children. Making sure your child is getting enough fruits and veggies (approximately 5 servings daily), skipping sugary and refined foods like white bread, pastries, candy, and chips, and getting enough water (about half their weight in ounces) is so important to keep their stool soft and moving.

Step 3: Recognize Progress and Hard Work

Bowel issues are hard work for all involved. Make a sticker chart to track how often your child is compliant at sitting on the toilet, eating well, and having bowel movements. Make a goal for how many stickers your child will earn and celebrate when they achieve their goal. It is a long process so make sure to recognize even the smallest of victories.

Step 4: Get Help from Professionals

There is help out there. Make sure you go to a knowledgeable doctor and physical therapist to ensure your child gets the best chance at improving their bowel issues as quickly as possible. Do not accept any medical professional telling you it is normal for children to have accidents past potty training age, (age 5), or that it is your fault as a parent, or it is the child’s fault. It’s not. A knowledgeable doctor will run appropriate tests to rule out dietary allergies that could be contributing as well as starting your child on medicine or supplements to help improve bowel movements.

Pelvic floor physical therapy is a mainstay of care for kids with bowel issues, Skilled pediatric physical therapists will help your child re-learn how to use their pelvic muscles to better hold in waste as well as eliminate it when appropriate. We will teach you how to use techniques to help stool move more effectively, and we can perform hands on work to reduce pain and discomfort associated with bowel dysfunction. In addition to our clinical skills, we will help you to find doctors to help compliment the treatment your child is receiving in PT. If your child is suffering from bowel problems, don’t waste another day, call our front desk to make an appointment today!

BBPT Health Tip: Eat your Fiber

breakfast-1804457_1920

Fiona McMahon, DPT, PT

What is fiber?

Fiber, it’s the hot ticket. It is being marketed to us like crazy. But why is fiber is so important? What fiber is best? Should you get more fiber with supplements? Let’s take a closer look into the benefits of fiber in this edition of BBPT’s Health tips.

Fiber is the part of food that we cannot digest. It is separated into two types, soluble and insoluble. Both bulk up the contents of your stomach and colon, which can help you feel more full but after that, the similarities end.

As the name implies, soluble fiber dissolves in water but insoluble does not. Insoluble fiber increases the mass of the stool and helps to get things moving, in terms of passing feces. Soluble fiber absorbs water. The truth is, most people are not getting enough fiber. Less than half of people in the United States consume the recommended amount of fiber. Let’s discuss the benefits of fiber and how to make sure you are getting enough.

 

So what if you don’t have issues going number 2? What else can fiber help you with?

 

Fiber has been shown to help with reducing the risk of the following conditions:

  • Coronary artery disease
  • Stroke
  • High blood pressure
  • Diabetes
  • Obesity

Fiber has also been shown to:

  • Improve insulin sensitivity in people who have diabetes
  • Enhance weight loss
  • Improve GI conditions like acid reflux, duodenal ulcers, diverticulitis, constipation, and hemorrhoids
  • Enhance the function of the immune system

 

How much to eat and where to get it?

Men under 50 years and under should consume at least 38 grams of fiber daily, Women under 50 should consume at least 25 grams of fiber daily. Women over 50 should eat at least 21 grams and men over 50 should get 30. Those who suffer from constipation may add more to your diet. We suggest contacting a nutritionist for proper amounts of soluble versus insoluble in these cases and anyone with a history of GI issues. Also, please discuss with your doctor before making any drastic changes to your diet.

Adding fiber to your diet when you are not used to it can sometimes be a little difficult. If you add too much too quickly, you may experience gas and bloating. Start slow and work your way up. Also, drink plenty of water.

Start by adding in whole wheat items (unless you have a gluten sensitivity), legumes, fruits, and vegetables slowly to your diet. Check out the Mayo Clinic’s full list of fiber rich foods here http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948

Sources

 

Anderson J, Baird P, Davis R, et al. Health benefits of dietary fiber. Nutr Rev. 2009. 67(4)188-205

Family Doctor.org Decermber 2010: http://familydoctor.org/familydoctor/en/prevention-wellness/food-nutrition/nutrients/fiber-how-to-increase-the-amount-in-your-diet.printerview.all.html. Accessed November 11, 2016.

Medlineplus. Soluble vs. insoluble fiber.https://medlineplus.gov/ency/article/002136.htm. Accessed November 17,2016.

The Scoop When Kids Have Trouble with Poop

 

Kiddo

Fiona McMahon PT, DPT

I spend a lot of my time at work talking about poop. In fact, poop discussions run in my family. My great grandmother, a nurse in the 1920’s, would always inquire about her charges and her children’s movements when they’d complain of any ailment. This scatological interest was passed to my grandfather, a civil engineer, designing and working in wastewater treatment plants, to my mother who was a nurse practitioner, who dealt with digestive issues and famously asked a guest at her parents’ dinner party when she was a child, “how are your bowel movements, lately?” This familial interest in the distal end of the alimentary canal was bequeathed unto me and I now spend much of my working life trying to help people of all ages with issues defecating to live more comfortable and full lives when it comes to bowel movements.

Anyone who has had any issues concerning their ability to poop, or to hold it, can attest to how much havoc issues with bowel movements can cause in one’s life. This is especially true when it comes to children. Children often have continence requirements to attend school, camp, and other activities. Not to mention other children may not always be very kind to another child who is experiencing difficulty with their bowels. Aside from the obvious issues of constipation and incontinence, kids with bowel issues can experience other symptoms like pain in their belly or with defecation, foul body odor, problems with their bladder, including incontinence, as well as skidmarks in their underwear or itchy bums. It really does all come down to poop.

The largest driver of bowel problems in kids is constipation. Constipation is surprisingly common and occurs in 4-36% of children. It accounts for 3% of visits to the pediatrician and 30% of visits to pediatric gastroenterologists. Constipation can be tricky to diagnose and many people who have children who are constipated, do not identify constipation as the culprit for issues like bowel and urinary incontinence, and pain. According to Afzar and colleagues, constipation would be missed nearly 50% of the time in children, if infrequent bowel movements was the only criteria used in assessing constipation in children.

So what criteria do we use to assess constipation in kiddos? We obviously look at how often a child is defecating. Two or less bowel movements a week is considered constipation, but it is important to keep in mind that a child with difficulty evacuating may move one or two small pellets multiple times a day and still be severely constipated.  Check out the Bristol Stool Chart here to determine if your child’s BM’s are normal. Types one and 2 indicated constipation. Bowel incontinence is also an indicator of constipation in children. In fact, 90% of children with constipation experience fecal soiling. Kiddos with large fecal masses felt in the rectum by a doctor or through the abdomen, those with history of painful bowel movements, and those who produce large toilet clogging poops are exhibiting symptoms of constipation. Children with constipation may also exhibit retentive posture in an effort to prevent painful bowel movements. They may go up on their toes, squeeze their butt cheeks and thighs together, cry, and rock back and forth. Retentive postures can trick parents into thinking their child is trying to defecate when in fact they are working hard to keep everything inside. If you see any of these symptoms in a child under 4 years lasting for a month, and over 2 months in kids over 4, you are dealing with constipation

Constipation can be divided into two different types, functional and constipation due to an organic or pathological cause. Around 95% of constipation in both adults and children is considered functional. Functional constipation can occur for a variety of different reasons in children. One of the most common reasons is that children can get in the habit of delaying or trying to prevent defecation. Children are often just as busy as the rest of us. They may simply be too busy in the morning to have a full bowel movement. Once they arrive at school, they are faced with bathrooms that have doors that may or may not lock, or they may have to contend with intimidating multi-stalled public toilets. Either way both are not conducive to pooping. After school is usually filled with activities and a mad dash to do homework. You can see that it may be very difficult to schedule in a good time to use the toilet. Kids also delay going to the bathroom because it hurts or may be uncomfortable to go. The more they delay their bowel movements, the more uncomfortable it can be to go. Thus creating a negative feedback loop that just feeds back on itself and worsens the constipation symptoms.

Weeks of delay whether it be secondary to pain, scheduling, or plain old distraction, can cause a big build up of poo in the very end of the digestive system, the rectum.  The accumulated fecal matter may be backed up through the  entire length of the colon. This big build up of feces in the rectum causes it to  stretch out.  A stretched out rectum is not good at holding feces in, or sensing that it is time to go to the bathroom, making the problem even worse. Furthermore, soft poo will easily slide by the hard fecal blockage and create smears or “skidmarks” in the underwear, or even more severe incontinence mistakenly labeled diarrhea. Chronic fecal impaction, and fecal withholding can alter how the muscles that control continence work (the pelvic floor), which may further worsen this constipation syndrome. Skidmarks, constipation and fecal incontinence are not anyone’s fault, especially the child’s, but it is a problem that can be solved.

So what to do about all of this? Is it too late if your child has been constipated for a long time? Tackling poo problems in kids is daunting for both parents/guardians alike. The first step is educating yourself, your doctor, and your child. My motto for the kiddos that I treat is, “Accidents are not your fault, but it is your problem to solve.” Letting children know what is happening in their body can help them further internalize this message and become more invested in the process to remedy their symptoms.

Next you have to tackle the poo situation inside of your child’s tummy, This is where a two pronged approach is key. Both physical therapy and your doctor will get you on the right track. Your doctor will screen your child for that 5% of constipation cases that are caused by organic causes like Hirshprung’s disease, thyroid issues, and notably cow’s milk allergies and gluten intolerance/ celiac disease. It is important to be screened for these allergies and food intolerance as they represent a large portion of organic constipation cases. Once organic causes are ruled out, your doctor will start medication to help clean out the bowels. Miralax (Polyethylene glycol), is a mainstay of pediatric constipation treatment and is generally best tolerated. Miralax may be first given in large amounts to clean out the bowel, and then followed with smaller maintenance and then slowly tapered off as the rectum reduces from it’s stretched out size. It is important to remember that when starting miralax, especially at “clean out”, doses will likely increase episodes of incontinence at first, so prepare both yourself and your child. Make sure to consult your doctor before attempting any sort of clean out on your own.

Next up is physical therapy. Our main goal is to keep poo moving and avoid buildups so your child’s body can heal. We will teach you ways to massage the colon through the belly to keep poo exiting and to reduce back ups and the need for laxatives. We also work to teach your child to sit on the toilet in a way that will help the poo as easily and painlessly as possible. More often than not, kiddos with constipation have pretty weak cores that make defecating difficult. As pediatric physical therapists, I humbly assert that we are the masters at dreaming up fun ways to gain a little core strength in session and at home to help make bathroom trips easier.

What Beyond Basics does that is truly unique from non pelvic floor physical therapists, is we train the muscles of the pelvic floor (the muscles that control both the the anal and urethral opening to better open and close). Kiddos with chronic constipation tend to have pelvic floors that are tight and uncoordinated. Paradoxical contraction occurs when a child tries to open their anal canal, and they truly believe they are doing so, however they are I n fact clamping it shut. We can treat this problem at Beyond Basics.

If your child would benefit from physical therapy, or an evaluation, to make pooping a bit easier, give us a call. Stay tuned for our next blog, where we will go over some practical at home tips for improving both you and your child’s pooping situation!

 

Sources

Afzal N, Tighe M, Thomson M. Constipation in Children. Ital J Pediatr. 2011; 37

 

Poddar U. Approach to constipation in children. Indian Pediatri. 2016;53(4) 319-27

 

 

PH101 Potty Issues with Kiddos

PottyFiona McMahon PT, DPT

Did you know kids can suffer from pelvic floor dysfunction too? Pelvic floor dysfunction in children can result in pain, bladder holding or constipation, embarrassing soiling accidents, frequent nighttime accidents, as well as trouble going potty. For most kids, there is an underlying physical component that needs to be addressed by an expert pediatric pelvic floor physical therapist.

It is very upsetting for a parent, guardian or caregiver to see a child suffer with pain or embarrassment, but there is so much that can be done to help out children with these issues. We use positive charts to develop short term and achievable goals to reinforce  behaviors and steps towards healthy toileting. Simple techniques like using the improving toilet posture, practicing deep breathing with bubbles, using a timer to assist in times voiding, educating the parent/guardian/caregiver on the colon massage, developing a core stability and stretching program, and more can go a long way towards improving bowel and bladder symptoms.

If your child is suffering from urinary or fecal accidents, bed wetting, skidmarks, or painful defecation, join me on May 11th, at 7pm , to discuss pelvic floor dysfunction in children, common conditions affecting pottying, and practical tips you can use to make potty time easier.

This is our last Pelvic Health 101 class of the spring series. We want to thank for an awesome season! Keep your eyes on the blog for the Fall’s PH101 classes!

RSVP: pelvichealth-101.eventbrite.com