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 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 September 25th 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 Flyer-jpeg

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

 

Do You Speak Pelvic Floor? Guide to Anatomy Part 1: Female Genital Anatomy

woman wearing white high top shoes
Photo by Dương Nhân on Pexels.com

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

Do you speak pelvic floor? I do. There is so much going on in the pelvic floor, that unless you are thinking about it every day, it can be difficult to find the right words to describe exactly what you are feeling where. Today we are going to focus on individuals with female anatomy.

Your Genitals: Your 3 V’s

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When we refer to female reproductive organs many times we say vagina to describe the whole kit and caboodle down there. The truth is the vagina is just part of it. There’s much more going on.

Vagina: The vagina is the passageway from the uterus to the external world. It can expand to accommodate a penis, toy, or allow for the passage of a baby. It can do this shape-shifting because it has folds called rugae, which can stretch out like an accordion to allow the vagina to stretch as needed. Neat, huh? We call the opening the introitus, but we may also interchange it with simply, “vaginal opening”. Either is fine. The introitus can be an area of pain with penetration, so in Pelvic Floorland, we use that term a lot.

Vulva: The vulva is usually what people are referring to when they say vagina. The vulva encompasses all the external genitalia. Including the labia majora and minora (the lips), clitoris, vagina, and urethra.

Vestibule: The vestibule is the area in between the labia minora (small lips) and vagina. This is another special area, that can become painful with certain conditions

Other Vulvar Components

Urethra: This is the exit of the urinary system and is where pee comes out. Between the anus, vagina, and urethra there are three holes “down” there.

 

clitorisClitoris: This part is pretty cool. The clitoris provides sexual sensation. Did you know it averages four inches in length! Externally we can only see a small bit of it. We call that part the glans. Covering the glans, is the clitoral hood, which helps to protect it. Most of the structure of the clitoris is not viewable from the outside. Branching off the glans and traveling underneath the labia are the bulbs of the clitoris and the cura. These elements are erectile and fill with blood during arousal.

Labia Majora: The labia majora are the outer pair of lips when looking at the female vulva. They protect the delicate tissue of the vulva.

Labia Minora: The labia minora are the smaller set of lips and are contained within the labia majora. The labia minora can come in all different shapes and sizes and still be completely normal. Some women have long labia minora which extend past the labia majora, while others may have shorter labia minora which stay tucked within the labia majora. Variation is normal between women.

Having the words to describe where the pain it can be useful to both your pelvic floor physical therapist as well as your doctor. Stay tuned for future additions of “Do you speak pelvic floor?” where we will discuss male genital anatomy as well as the muscles of the pelvic floor itself.

Pelvic floor physical therapists are specialists in this area and have been added in the last decade, to urological and gynecological guidelines as the first line of treatment for various pelvic and sexual pain and weakness disorders.

ACOG Guidelines on Pelvic Pain:

https://www.acog.org/Patients/FAQs/Chronic-Pelvic-Pain?IsMobileSet=false

AUA Guidelines for Pelvic Pain

https://www.auanet.org/guidelines/interstitial-cystitis/bladder-pain-syndrome-(2011-amended-2014)

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)

Ph101 Why is Pooping so Difficult?

toilet 2

Fiona McMahon, DPT

The number of Americans who deal with constipation issues is massive (4 million!)! It seems like every time I mention that I’m a pelvic floor physical therapist, another friend of a friend pulls me aside with bowel movement concerns. Why is it that so many people have issues? And more importantly – what can we do about it? This is the topic of our next Pelvic Health 101 seminar  on  October 11th at 7pm.

Not only will constipation be discussed but other bowel conditions, such as irritable bowel syndrome, fecal incontinence, bloating, and hemorrhoids will be addressed. The lecture will also go in depth on the role of fiber, water intake, toilet posture and pelvic floor muscles in having a successful bowel movement. You will even go home with easy techniques that you can implement immediately to help you get that smooth move! Don’t miss out on this FREE event – it’s a MUST for anyone who struggles on the porcelain throne. Seats are going fast!  Light snacks and refreshments will be served.

Register at pelvichealth101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Check out or upcoming courses!

Pelvic Health 101 Fall 2017

 

May is Pelvic Pain Awareness Month

Mayis PelvicPainAwarenessmonth

Fiona McMahon PT, DPT

May is Pelvic Pain Awareness Month: #PelvicPainAware. This is a big deal to us at Beyond Basics Physical Therapy, where we see it as our mission to spread awareness of pelvic pain and dysfunction to clinicians and patients alike. This month is spearheaded by the International Pelvic Pain Society (IPPS), of which, the founder of Beyond Basics, Amy Stein is the president. Amy took time to sit down with me to describe all of the fantastic things that are planned for this month so I can share them with you.

Before we get started, I want to share a little about IPPS, the organizer of Pelvic Pain Awareness Month. IPPS was founded in 1996. It is a society of healthcare clinicians who treat abdomino-pelvic pain conditions in men, women, and children. Their mission is twofold: “To educate healthcare professionals how to diagnose and manage chronic pelvic pain, thereby changing the lives of patients worldwide.” and “To bring hope to men and women who suffer from chronic pelvic pain by significantly raising public awareness and impacting individual lives.” Pelvic Pain Awareness month, is our opportunity to spread awareness among professionals and public alike in hopes of improving outcomes and demystifying pelvic pain.

Now let’s get started with Amy’s interview!

Fiona: Why did IPPS feel the need to start a pelvic pain awareness month?

  • Amy: I felt like it was needed. As president of IPPS, I wanted to make some changes to awareness, and I felt this was a great opportunity to get the word out and stop patients from having to suffer in silence. I wanted it to be abdomino-pelvic pain awareness month, but the phrase was too long.

 

Fiona: What activities does IPPS have planned this month to spread awareness of pelvic pain?

  • Amy: We created a pelvic pain awareness page on facebook and continue to tweet about it @intpelvicpain. We are also doing a blog talk radio interview with Lorimer Moseley, PhD, PT from Adelaide, Australia, on blogtalk radio/pelvic messenger on Thursday, May 18th at 7.30pm EST. Lorimer Moseley has written 270 articles and 6 books on pain. If you want to interview someone who is experienced in the study of pain and the brain, he is a good person to be interviewing. May 17th in New York City, we are doing a local fundraising/ networking event in the Green Room on 23rd street from 6:30-8:30pm to create more awareness locally. On may 25th, 9pm EST, 6pm PST we are doing a twitter journal club. An article on sexual health in women affected by cancer  will be featured, as well as one on vulvodynia, and prostatitis . [Click here to access the articles we will be discussing!] Each year we plan to add on more events for May is #PelvicPainAware both locally and internationally. 

 

 

Fiona: Why is it so important to build awareness of abdomino-pelvic pain conditions? What was the big driver for IPPS in doing this work?

  • Amy: Bringing awareness of abdomino-pelvic pain conditions is one of the main missions for IPPS, as well as Beyond Basics Physical Therapy and I believe it is a mission of many of other clinics, hospitals, etc, that treat pelvic pain. Again, it is such a common experience of many, many patients who visit us, to have gone to various well-known institutions throughout the country for pelvic pain, to be told it is all in there head and that they just need mental health therapy or a glass of wine. This infuriates me STILL (20 years later!), as well as the patients. Often times it will take just one session with an experienced pelvic health physical therapist or healthcare provider to have hope again. Many of our patients have been to 5 up to 10 physicians/healthcare providers and ended up being misdiagnosed, undiagnosed, or told to go home and relax; or even worse, have more sex or switch partners. Yes, pain is processed in your brain, but there is a physical component with most of these patients.

Fiona: Where would you suggest someone who is starting their journey? What resources would you recommend?

  • Amy: I would suggest to look at International Pelvic Pain Society, International Cystitis Association, IC-network, Endometriosis Association, National Vulvodynia Association, American Physical Therapy Association (APTA) or Herman and Wallace “ Find a provider”, for you to find physical therapists and physicians. Even taking that a step further, when you find a provider, do some research: ask how often your provider sees pelvic pain patients,, how long have they been treating in this area, because that can make a difference. If you go to someone who is not as experienced or is not trained, you might hit a roadblock or plateau in your progress.
  •  I would caution against looking up too much on patient-centered forums; however, here are a lot of great blogs out there that can help give you helpful information. There are some great books out there, like Heal Pelvic Pain, and Pelvic Pain Explained, Sex without Pain, and Pelvic Pain Management.  For providers, I want to add that IPPS is hosting the World Congress on Pelvic and Abdominal Pain in Washington D.C. at the Renaissance Hotel in October 11-15th. We have Lorimer Moseley and Paul Hodges flying in from Australia. They both have done extensive research in pain. This year we are doing 9 clusters on different topics with poster and abstract presentations, as well as a post conference on The Pain Revolution, with Paul Hodges, PhD and Lorimer Moseley, PhD, PT

Fiona: If you had to distill your message for May is Pelvic Pain Awareness month, what would you like the public, people with and without pelvic pain to get from this month?

  • Amy: I would like them to know there are resources and providers out there for abdomino-pelvic pain conditions. But remember to do your homework when deciding who and what is best for you. For providers, there are great resources too, including the International Pelvic Pain Society to help better your practice.

We also want everyone to know we are having a give away in honor of Pelvic Pain Awareness Month! Learn more info below!

For Everyone!

IPPS Facebook Page

Twitter: @IntPelvicPain #pelvicpainaware

IPPS

Blog Talk Radio/Pelvic Messenger

 

For Patients!

International Pelvic Pain Society: Find a provider

National Vulvodynia Association: Health Care Provider List

APTA Find a clinician

Herman and Wallace Find a Clinician

 

Give Away Information

Giveaway open internationally ). Must provide a mailing address within 48 hours of notification of winning, otherwise another winner will be selected at random. Click here for full details,
We have several generous donors lined up for the hour and will be randomly giving away the following items during the event:
1 Copy of Amy Stein’s Book “Heal Pelvic Pain” & DVD Healing Pelvic and Abdominal Pain”  (follow @beyondbasicspt @HealPelvicPain2)  (Open to International)
1 Copy of Heather Jeffcoat’s book “Sex Without Pain: A Self Treatment Guid to the Sex Life You Deserve” (follow @SexWithoutPain @TheLadyPartsPT) (Open to International)
1 Copy of Stephanie Prendergast and Elizabeth Rummer’s book “Pelvic Pain Explained”   (follow @PelvicPainExp @PelvicHealth) (Open to International)
1 Gift Card to Soul Source Dilators (link to soulsource.com)  (follow @SoulSourceTD) (Open to US only)
2 EndoFemm heating/cooling pads by Pelvic Pain Solutions (Open to US only)
2 CAPPS Travel Cushions by Pelvic Pain Solutions by Pelvic Pain Solutions  (follow @EndoFEMM) (Open to US only)
2 Multi-Comfort Therapy Pads by Pelvic Pain Solutions (Open to US only)
Official Rules: This giveaway is open to US only (except where specifically indicated as international above). The following guidelines must be followed to be eligible: Use the #PelvicPainAware hashtag during the twitter party from 6PM PST to 7PM PST to be entered into the random drawing. Must follow @IntPelvicPain @TheLadyPartsPT so we may contact you after the event regarding your winnings. Winners will have 48 hours from the time of notification to provide us with their eligible mailing address, or else a new winner will be randomly selected.
 
Twitter Party/Journal Club Disclaimer: Tweets during the 1 hour event are not to be taken as medical advice. We recommend following up with your team of providers to gain your most optimal care.

 

Ph101 Why is pooping so difficult?

toiletFiona McMahon, DPT

The number of Americans who deal with constipation issues is massive (4 million!)! It seems like every time I mention that I’m a pelvic floor physical therapist, another friend of a friend pulls me aside with bowel movement concerns. Why is it that so many people have issues? And more importantly – what can we do about it? This is the topic of our next Pelvic Health 101 seminar  on  March 30th at 7pm. 

Not only will constipation be discussed but other bowel conditions, such as irritable bowel syndrome, fecal incontinence, bloating and hemorrhoids will be addressed. The lecture will also go in depth on the role of fiber, water intake, toilet posture and pelvic floor muscles in having a successful bowel movement. You will even go home with easy techniques that you can implement immediately to help you get that smooth move! Don’t miss out on this FREE event – it’s a MUST for anyone who struggles on the porcelain throne. Seats are going fast!  Light snacks and refreshments will be served.

Register at pelvichealth-101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Check out or upcoming courses!

pelvic-health-101-spring-2017