Parkinson’s disease (PD) affects a specific area of the brain that is responsible for movement. The disease causes nerve cells in this area to break down, decreasing the amount of dopamine in the brain. Dopamine is a chemical messenger that plays a role in various behavioral and physical functions including motivation, sleep, mood and movement. As PD progresses, there is less and less dopamine to go around, which can lead to symptoms like  tremors, slowed movement, and rigid muscles. Furthermore PD is often accompanied by additional symptoms including bladder problems, constipation, sexual dysfunction and pain. This article will focus on the influence of constipation throughout the disease process.

Before being diagnosed, early screening for PD looks for changes to the autonomic system. The autonomic system is responsible for involuntary bodily functions such as regulating your heart, temperature, breath, and intestines. Three of the most common early autonomic changes include constipation, changes to sense of smell (known as olfactory dysfunction)and changes in sleep behavior. Between 70-80% of people diagnosed with PD will experience some type of autonomic change. Constipation is the most common change, with research showing that for men with less than 1 bowel movement (BM) per day, there is up to a 4.1 fold risk of developing PD when compared to men with greater than 2 BM/day. By no means does constipation definitely result in a diagnosis of Parkinson’s disease, but knowing this data allows clinicians and patients alike to better understand and manage bowel habits. Upon diagnosis, constipation continues to be a concern, especially since most medications to treat PD have constipation listed as a side effect. Additionally, changes like reduced physical activity, altered hunger signaling, loss of taste or smell, and slowed gastric emptying time can increase the risk of constipation.

Pelvic floor rehabilitation can be an excellent choice for conservative management in bowel habits and routine. Research suggests improvements in bowel emptying with changes to fiber intake, fluid consumption, abdominal massage, stretching and pelvic floor strengthening. Getting started can seem overwhelming, but appropriate instruction and expectations can be learned during visits with your pelvic floor provider.


Toe Yoga

There are many styles of yoga out there, but ever heard of Toe Yoga? Our feet are so important for our posture, balance, and how we take in information from our surroundings. They also play a vital role in our gait and how we transmit forces from the ground up through our legs when we walk, run or climb stairs.  In today’s society, we rarely go barefoot. That means that our feet don’t get as much information as they once did, and wearing shoes all the time can alter our toe alignment, potentially leading to painful bunions or stiff joints.

Stiff joints overtime can lead to further compensations in our posture, affecting our knees, hips, pelvis and even our spine. This can lead to inflammation and potentially chronic inflammatory or overuse injuries, making it painful to move or do the things we love.

Toe Yoga is simply an exercise or activity that can help keep your joints flexible and strong. It might be challenging at first, but you might be surprised how quickly your toes can wake up and ideally move better! Here’s a quick activity you can try at home to test how well your toes are actually moving!

-Sit in a chair with your feet firmly planted on the ground (no shoes!)

-Slowly lift ONLY your big toe off the ground, while keeping all other toes on the floor. Try to keep the toes that are on the ground as relaxed as possible.

-Lower the big toes, and lift the 4 other toes off the ground, making sure the big toes stay in contact with the ground.

-See if you can alternate back and forth between these.

-Too easy? Try lifting each toe one at a time like a wave, and then slowly lower back the other way.

Give us your feedback! Do you find this challenging? Too easy? Or just right?

Tinkle Troubles

Have you ever coughed or sneezed and experienced a dribble of urinary leakage or have you taken a swing of the golf club and felt a release of the bladder? Urinary incontinence is a common phenomenon among men and women and the likelihood of urinary leakage continues to increase with age. There are many circumstances that result in leakage and none of them are to be considered normal. Knowing how and when to seek help is key to starting the road to recovery. And yes, urinary leakage can be treated and cured!

Fifty percent of all individuals over fifty years old experience some form of urinary incontinence, chances are fairly high that you know someone with leakage or you are that someone. Having urinary leakage impacts the quality of life many ways. It can contribute to anxiety, social isolation, and overall depression. From a safety standpoint, people with urinary leakage will also have an increased risk for falls due to trying to rush to the bathroom to prevent further leakage.

Thankfully, there are exercises that can be done to help combat urinary leakage- kegels! Unfortunately, it’s difficult to know if you are performing the kegels correctly since it is not a muscle that can be seen. Pelvic floor physical therapists are available to help teach proper kegel techniques and give exercise prescriptions for different types of exercises that can strengthen muscles and decrease incontinence. At Sullivan Physical Therapy this is our specialty. For more information, visit or email


The Prostate

Over 30 million men suffer from prostate conditions that impact their daily life and function. Each year, over 230,000 men will be diagnosed with prostate cancer, which is why early screening and detection are so important! The prostate is a walnut sized organ found in men between the bladder and penis that produces fluid that protects sperm when ejaculation occurs. The urethra runs right through it, which is important to take notice of. If the prostate becomes enlarged (BPH), it can start to grow compressing the urethra and making urinary function a little more difficult. Think of the urethra like a garden hose, and if you kink the hose or start to squeeze it, less liquid is going to be able to escape. BPH is more likely in men ages 50 and older, causing increased urinary frequency, urgency and needing to get up at night to empty.

Prostatitis, or inflammation of the prostate, can be a driver for pelvic pain and chronic infections in some men. Prostatitis can be broken down into 4 major categories: chronic prostatitis/ chronic pelvic pain syndrome, chronic bacterial prostatitis, acute bacterial prostatitis, and asymptomatic inflammatory prostatitis. Pelvic floor muscle tension can be a cause of nonbacterial prostatitis, causing muscle or nerve irritation and symptoms common to that of a UTI, yet negative cultures when tested.  

Prostate cancer is another diagnosis involving the prostate, and can also impact the pelvic floor. Prostate cancer is the second most common cancer among men, yet doesn’t seem to get that much attention. Digital rectal exams can detect size changes to the prostate, as well as PSA levels with blood work. Early detection is key, so make sure to ask your doctor when you should start screening, keeping in mind any family history, your ethnic background, and diet and smoking history. For those who undergo prostate removal, urinary leakage and erectile dysfunction are common side effects following surgery. Many factors are at play, but typically men can see an improvement in urinary leakage with consistent pelvic floor strengthening within 3-6 months after surgery.

Sexual Orientation, Gender Identity and Lifestyle

Sexual orientation and gender identity are frequently misunderstood, and simultaneously more and less complicated than they seem. Matthew Daude Laurents, a philosopher, educator and clinician, came to speak with us in May regarding this very topic. He relayed a quote by Brendan Jordan: “Sexuality is who you go to bed with; gender identity is who you go to bed as.”


Sex, sexual orientation and gender identity are often bundled together, although they are distinctly different. When a baby is born, they are assigned a sex, typically defined by their secondary sexual characteristics. As this baby becomes a child, an adolescent, and an adult, this assigned sex may or may not align with what they feel about themselves or their bodies. Gender is a more complicated construct, taking into consideration not one’s secondary sexual characteristics, but rather how they feel about who they are, and how they choose to express themselves to the outside world. While sex is what a person is assigned a birth and is most commonly broken down into male and female, gender identity can be more fluid.


If one’s sex assigned at birth aligns with how they feel, they are considered cisgender.  If someone feels that their assigned sex is different than how they identify, how they feel, this is called transgender. There are also a number of additional terms that people feel suit them better, such as genderfluid, or gender queer, while others prefer not to be labeled altogether.


Sexual orientation, on the contrary, is not about who you are. Sexual orientation is who you like, who you are attracted to. We are familiar with heterosexuality and homosexuality, but similar to gender identity, sexual orientation is more fluid than these two boxes. Asexuality, for instance, fits into neither of these boxes. Those who identify as asexual, or “ace” for short, may find others physically attractive, but they do not feel sexual attraction. Bisexuality is another orientation that does not fit in to these boxes as well, allowing for a more diverse orientation, with the definition varying from person to person.


People like to fit each other into boxes, and boxes provide a useful framework to understand the world, but not to understand all individuals. At Sullivan Physical Therapy, we treat those of all orientations, identities and lifestyles. We strive to continue learning and adapting to best serve all of our patients, regardless of who you are, who you like, and what you like.