Talking to Your Healthcare Provider abou

Talking to Your Healthcare Provider about Pelvic Floor Issues Part 2…
In the last e-blast I mentioned typical factors that should concern you about your pelvic floor and types of information to facilitate discussion with your healthcare provider. In this article I will talk about who you should see for pelvic floor concerns and what questions to ask them.
If you have never spoken to anyone or have a mixture of symptoms, I recommend seeing your Primary Care Physician first. He or she may be able to help you narrow down the issues and provide you with a referral to the right specialist. Here is an extremely general breakdown of specialists. This is by no means an exhaustive list of the types of issues they treat, just a general guideline for the most common pelvic floor related issues.
1. Gastroenterologists and Colorectal surgeons: consult them if having fecal incontinence, fecal urgency, anal, rectal, or abdominal pain, constipation, or slow motility
2. Urologists: consult them if having bladder pain, urinary urgency, urinary frequency, prostate pain, pain with ejaculation, or urinary incontinence
3. Urogynecologist: consult them if you are experiencing a combination of both urinary and pelvic issues, including prolapse, incontinence, or pelvic pain
4. Pain management specialist: consult them if you are experiencing pain – that seems obvious right? But, make sure to do your research and find a pain management specialist who has experience and interest in treating pelvic pain.
5. Midwives or OBGYNs: consult them if you are experiencing symptoms of pelvic pressure/heaviness, pelvic pain, or incontinence, especially if you are currently pregnant or recently post-partum
6. Pelvic Floor/Men’s and Women’s Health Physical Therapist: Consult if you are experiencing any of the symptoms discussed in Part 1. Keep in mind that depending on which state you live in you may need a referral in order to seek treatment from a PT.
Now that you’ve found who can help you, what should you ask them?
1. How long could it take for my symptoms to resolve?
2. What are my treatment options?
3. Have you treated someone with similar issues as mine? If not, can you recommend a specialist who has or is more familiar with these issues?
4. Are these symptoms likely to recur? Is there anything I can do to prevent recurrence?
5. Could the pelvic floor be related to my symptoms?
6. Am I appropriate for pelvic floor physical therapy?
I hope this information helps you create an open dialogue with your healthcare provider and
wish you the best on your road to recovery!

Talking to Your Healthcare Provider abou

Talking to Your Healthcare Provider about Pelvic Floor Issues Part 1
Less than 50% of women seek care for incontinence issues. This could be for a variety of reasons, but in general most people are unsure of how or who to discuss their pelvic floor concerns with. Unlike back pain, pelvic floor issues are not generally visible or highly discussed among friends, co-workers, or even family members. Despite the difficulty, it is important to speak to your healthcare provider about pelvic floor concerns as this can highly impact both your health and quality of life.
First things first, when should you be concerned about your pelvic floor? This list covers the main concerns; however pelvic floor dysfunction can be associated with other symptoms as well.
1.) Significant and/or persistent change in bowel or bladder function, including constipation, incontinence, urgency, frequency, incomplete emptying, or pain.
2.) Changes in sexual function including changes in arousal, erectile capabilities, ejaculatory/orgasm capabilities, dryness, or pain.
3.) Any numbness, tingling, or pain in the saddle region. Pain at the pelvic floor generally occurs with sitting, but can occur with any activity depending on the cause and source of the pain.
4.) Sensation of fullness, heaviness, or pressure at the perineum.
Your healthcare provider will likely have a series of questions to get more details about your symptoms. The better and more detailed information you can give your provider, the more apt he or she will be able to properly diagnose and treat you. Here are some important details to pay attention to prior to your visit.
1.) When did your symptoms start?
2.) Is there a pattern in your symptoms? (daily, weekly, monthly?)
3.) What activities trigger your symptoms?
4.) Is there any anything you can do to lessen your symptoms?
5.) Have there been any changes in your diet, stress or activity levels?
6.) Have you had any births? How many and were there any complications? (c-section, episiotomy, forceps?)
In part 2 of this topic I will cover who to talk to and what questions you should be asking your provider to make sure you get the best care. For now, start to track (but try not to obsess!) over the above details so you can provide the best information to your healthcare provider!

Swimming and Yeast Infections… Summer

Swimming and Yeast Infections…
Summer is almost here and it is the time of year to get back in the pool! Many of us feel that we are not swimsuit ready based on our winter weight gain. Looking outside of your physique, is your vagina ready for swimming?! Those of you who are already prone to candida or yeast infections may notice an increase in frequency around the time of summer or swimming. What does swimming have to do with yeast infections?

Your vagina prefers to be acidic (pH of 3.8-4.5) to help with fighting off bacteria and infection. However, your vagina helps to maintain this pH balance with “good bacteria” called lactobacillus. Chlorine is a non-selective chemical found in most pools and will kill both good and bad bacteria creating an imbalance of the pH of your vagina. This same pH imbalance can occur when you take antibiotics.

When lactobacillus is killed off, the pH of the vagina becomes more basic. Yeast or candida thrives in a basic environment. In addition, yeast prefers a humid climate and will proliferate in situations such as wet bathing suits being left on for an extended period of time. Some steps that you can take to help reduce the risk of yeast infections with swimming include:

1.) Do not leave a wet bathing suit on for an extended period of time
2.) Gently dry off the genital region with a towel after being in the pool
3.) Rinse chlorine off genital region after swimming (pouring water from a water bottle while sitting over the toilet can be helpful for this if there is no shower)
4.) Change into cotton underwear quickly after swimming

These similar recommendations can be used if you have any vulvar itching or irritation that may be unrelated to a yeast infection. Chlorine can be irritating to the skin, especially if you have a sensitive vulva. So the above recommendations can also assist with either issue. There is no reason to fully avoid swimming (unless there are other comorbidities and your MD says otherwise), but just be prepared and take good care of your vulva and vagina this summer!

Strong and Mobile Scars It’s pretty like

Strong and Mobile Scars

It’s pretty likely we all have at least one scar; from the time we fell off our bikes in the driveway or a major surgery. They range in size, depth, and methods of healing but they all have one thing in common; when they heal they should be STRONG and the should MOVE.
Intact skin has been laid down in a relatively patterned fashion. It has several functions including keeping us warm, protecting what lies underneath, and helps us feel. When injury comes to the skin, a scar is a natural part of the healing process. The tissue heals back thicker and more fibrous where the wound is located so that it can return to it’s proper function, primarily of protection and give strength.
Depending on the size of the scar it may heal naturally on its own and have no issues being stretched and moved around. Other scars from surgery, c-sections, or larger injuries may be larger and get “stuck” to the tissue around them to try to create better strength. As tissue heals, in order to make it as strong as possible, the fibers laydown in all directions; imagine a meshy spiderweb where there is a lot of overlap. In order for a scar, the larger and deeper ones especially, to be mobile they need some extra help to aid the fibers in lying down in a more regular fashion that is similar to the old tissue. This can be accomplished through scar work or mobilization.
After a certain period of time in the healing process when the wound or incision is completely closed and there is no risk of re-opening this work can be started. It involves rubbing the scar in a lot of directions at different depths of the tissue, picking it up, and wiggling it around. If a scar is not mobile, it can pull on the muscle or other tissues below it and create a variety of symptoms (difficulty with bowel movements, pain, pain with bladder emptying, muscle spasms, limited range of motion, etc). It’s never too late or too early to ask your physical therapist about scar mobilization. If you have recently had surgery, delivered a baby, or have a wound from years ago talk to you pelvic floor therapist and have your scar assessed. We want those scars STRONG and MOBILE too.

Recommendations for Diastasis Rectus Abd

Recommendations for Diastasis Rectus Abdominus

Diastasis Rectus Abdominus (DRA) is a lengthening along the fascia (called the linea alba) between your rectus abdominus muscles or your “six pack muscles.” DRA typically occurs during pregnancy as the abdomen and uterus extend. However, this can also occur with genetics and/or repetitive straining through the abdomen, therefore men can also experience DRA. The goal of physical therapy for DRA is to reduce the width between muscle bellies or to prevent further separation from occurring while improving your abdominal strength and recruitment.
There are several gentle exercises that your physical therapist will instruct you on to work on properly recruiting the rectus abdominus muscles as well as your transverse abdominus muscles. These exercises will then be progressed over time, based on your improvements. Your physical therapist may also recommend use of a DRA splint and/or use of taping techniques to help with manual approximation of the muscles. You will also be given recommendations for your daily activities, such as proper alignment, lifting techniques, and transitions, such as rolling in and out of bed to protect your abdominals.
In addition to exercises to work on, your physical therapist will also guide you on activities to avoid while the tissue is healing and you are building strength. Activities that you may be asked to avoid include: crunches, sit-ups, certain types of swimming strokes, heavy lifting overhead, planks, leg lowering exercises, cobra stretch, and others that may stretch your abdomen or pull on the linea alba fascia. Most of these activities will be temporarily “put on hold,” but a few activities you may be advised to permanently discontinue, such as sit ups and crunches. But don’t fret! You will you be given alternatives to these exercises that are better for your body and your healing DRA. If you haven’t already been assessed for DRA ask your healthcare provider or PT to assess this to see if treatment may be needed!

Pregnancy and Sleep For those of who you

Pregnancy and Sleep

For those of who you are currently pregnant you may start to notice more difficulty sleeping during the second and third trimester. The lack of sleep may be related to intense, vivid dreams, but for most women it is the discomfort associated with a growing baby and changing body. Depending on which trimester you are in you may be limited in sleep positions.

The American Congress of Obstetricians and Gynecologists (ACOG) recommend that you avoid lying on your back after the first trimester for longer than 3 minutes at a time because of blood flow. You have a large vessel in your abdominal cavity, called your inferior vena cava, which provides blood flow to your body and baby via the uterine arteries. When you lay on your back the weight of the baby compresses this blood supply and decreases the amount of blood provided to you and your baby. Generally speaking, if you accidentally roll onto your back in the middle of the night your body will become aware of any blood flow deficits and you will roll to your side. However, when you are awake or exercising you should avoid prolonged time on your back, especially if you start to feel symptoms of nausea, swelling, dizziness, or light headedness.

While pregnant sidelying is the recommended position for sleep, primarily on your left side, to help with the promotion of blood flow to your uterus and body. Side sleeping can be challenging and uncomfortable, especially as ligaments become more lax. With ligamentous laxity, there is more separation around the sacroiliac joint which makes hips feel and appear wider for preparation of childbirth. The other aspect of discomfort is the growing abdomen which will also put strain on ligaments around the uterus and sacrum. The best recommendation is to find a supportive body pillow or pregnancy pillow (such as the snoogle). When the pillow is positioned properly, your knees should be approximately hips width apart and your abdomen supported. Though the added pillows may feel cumbersome, you will be happy to have the added support even if it means repositioning when you roll side to side. If you are still having difficulty with sleeping or positioning, speak to your physical therapist who can assist you with these issues. Enjoy your sleep now, Mamas-to-be!

Pregnancy and Sleep by Caitlin McCurdy-R

Pregnancy and Sleep by Caitlin McCurdy-Robinson, PT, DPT

For those of who you are currently pregnant you may start to notice more difficulty sleeping during the second and third trimester. The lack of sleep may be related to intense, vivid dreams, but for most women it is the discomfort associated with a growing baby and changing body. Depending on which trimester you are in you may be limited in sleep positions.

The American Congress of Obstetricians and Gynecologists (ACOG) recommend that you avoid lying on your back after the first trimester for longer than 3 minutes at a time because of blood flow. You have a large vessel in your abdominal cavity, called your inferior vena cava, which provides blood flow to your body and baby via the uterine arteries. When you lay on your back the weight of the baby compresses this blood supply and decreases the amount of blood provided to you and your baby. Generally speaking, if you accidentally roll onto your back in the middle of the night your body will become aware of any blood flow deficits and you will roll to your side. However, when you are awake or exercising you should avoid prolonged time on your back, especially if you start to feel symptoms of nausea, swelling, dizziness, or light headedness.

While pregnant sidelying is the recommended position for sleep, primarily on your left side, to help with the promotion of blood flow to your uterus and body. Side sleeping can be challenging and uncomfortable, especially as ligaments become more lax. With ligamentous laxity, there is more separation around the sacroiliac joint which makes hips feel and appear wider for preparation of childbirth. The other aspect of discomfort is the growing abdomen which will also put strain on ligaments around the uterus and sacrum. The best recommendation is to find a supportive body pillow or pregnancy pillow (such as the snoogle). When the pillow is positioned properly, your knees should be approximately hips width apart and your abdomen supported. Though the added pillows may feel cumbersome, you will be happy to have the added support even if it means repositioning when you roll side to side. If you are still having difficulty with sleeping or positioning, speak to your physical therapist who can assist you with these issues. Enjoy your sleep now, Mamas-to-be!