Cycling and Pelvic Floor Dysfunction…

Cycling and Pelvic Floor Dysfunction…

Austin is known to be an active city and we are especially known for our cyclists. While cycling is considered a good form of low impact, cardiovascular exercise, few people consider the impact that it may have on pelvic floor pain and sexual function. There are many potential causes of pelvic floor issues with cycling, including trauma from a fall or trauma involving the crossbar. However, the key factors of cycling that may be discussed during physical therapy are the bicycle seat and rider’s position on the bicycle (forward flexed posture).

Cycling can create neurovascular injuries (injuries to the nerves and blood vessels) of the pelvic floor which has been associated with sexual dysfunction. The injury to the nerves and blood vessels has been linked to the repetitive compression that occurs during cycling. Your ischial tuberosities or “sits bones” (the bones you feel when sitting on a hard chair) elevator your body so that if you are in proper posture your pelvic floor does not receive compression in sitting. However, your bicycle seat fits between your sits bones and applies direct pressure to the pelvic floor muscles, including the nerves and blood vessels. It has also been suggested that pedaling the bicycle creates stretch to the pudendal nerve which innervates the pelvic floor muscles.

What can you do to protect your pelvic floor while cycling? Unfortunately, there is not much research on this topic. However, it has been suggested that use of a wider posterior section of the seat to support the ischial tuberosities will help to alleviate pressure on the pelvic floor muscles, nerves, and vasculature. Other recommended saddles include noseless saddles and moon saddles which will give support to the ischial tuberosities. Since these saddles do not have a nose, it will take the pressure off of the pelvic floor muscles, nerves, and vasculature. If you do have a saddle with a nose, consider taking breaks from the forward flexed position to sit upright on your sits bones to relieve pressure. If you are not training competitively for a cycling competition, cross training such as swimming, walking/running, and elliptical training are also recommended to allow for healing time and reduced strain to the pelvis.

Constipation is the Root of All Evils…

Constipation is the Root of All Evils….
Constipation is a big problem. Everyone knows it’s uncomfortable not to be able to poop for a few days, or, in some people, up to a week or more. Some describe constipation as a feeling of being unable to empty their bowels when they try to sit on the toilet, while others think more of hard, painful stools that require straining. But constipation can be a much bigger problem than it seems.
Do you know that the US has a much higher prevalence of constipation than other countries? Let’s start off with the fact that many individuals subscribe to the Standard American Diet (note the acronym …SAD.. because that’s an accurate descriptor). We drink insufficient amounts of water, and eat much less good fiber from whole foods like fruits and vegetables than is recommended, while eating all sorts of nasty-for-us foods. Some constipating favorites include cheese, peanut butter, marshmallows, tapioca (in granola bars, fruit snacks, candies), applesauce, arrowroot (gluten alternative), bananas, low fiber grains like white bread, white pasta, white rice, crackers, tortillas. A second contributing factor is that we’re sitting straight up to try to have a bowel movement, while many other cultures are squatting. The fact is, you can’t poop well sitting straight up. In fact, your body is actually designed to prohibit this from being a possibility. If you have an elevated toilet, it’s going to be even more difficult. Putting your feet up on a stool to get your knees above your hips can help get you closer to a squat position that will be much more effective for passing stool.
Once you’re backed up, your body is unhappy. Having a bunch of hard, clumpy stool sitting in your rectum predisposes you to urinary tract infections, fecal incontinence, and urinary incontinence. If you’re consistently having backups, you’ll tend to strain against your pelvic floor. This can result in pain, hemorrhoids, fissures, and eventually prolapse, from the pressures exerted against your pelvic floor muscles. All of those are issues better avoided than fought against later.
The bottom line (no pun intended) is that constipation’s not only unpleasant, but is oftentimes the first factor in a lineup of unpleasant bowel, bladder, and pelvic floor fallout issues.
What can you do? Eat a good, well rounded diet (remember those 5 recommended fruits and vegetables daily?). Drink at least 50 oz of water, and limit constipating foods. Sit with your feet up on a stool when trying to have a bowel movement. Don’t strain. If constipation is already an issue, see a pelvic floor physical therapist for help and recommendations to get yourself back on track.

Coccydynia …. Coccydynia is defined as

Coccydynia ….
Coccydynia is defined as pain in the coccyx or tailbone. The tailbone is the very end of your spine and has a natural slightly curved shape. This bone is the site of multiple muscle and ligament attachments and serves as a support structure when seated. Because of this function, pain typically occurs with touch to the tailbone, sitting- especially on a hard surface, transitioning from sitting to standing, and during defecation. Common causes include trauma (falls and childbirth), prolonged sitting, degenerative joint disease, or too much/too little joint movement. Pain could also be referred from the lumbar spine, pelvic floor muscles, bony spurs or infections. Usually, pain can be the result of multiple sources, and the skill of a pelvic floor physical therapist can help determine appropriate treatments.
For example, research as shown that stretching of hip muscles, including the piriformis and iliopsoas, has had benefits on decreasing tailbone pain. Furthermore, conjunction of stretches with addressing spinal mobility has shown a decrease in pain and improved sitting tolerance. Additionally, research shows effectiveness of tailbone manipulation and tailbone muscle massage performed rectally. It’s important to note that a single tailbone manipulation or mobilization is not likely to decrease pain immediately. People usually have a false belief that a single movement “back into place” will make the pain go away. This is rarely true. Our muscles and nerves also require time to become less sensitive to whatever changes have occurred since the time of injury or start of pain. It can take weeks or month to have significant pain reduction. In the meantime, it may be helpful to use a donut cushion, take a sitz bath, and apply ice or topical analgesics to help manage pain. If pain continues in severity it may be important to consult your therapist and pain management physician regarding more aggressive treatments such as steroid injections, anesthetic injections or nerve blocks.

Avoiding Aches and Pains in Pregnancy…

Avoiding Aches and Pains in Pregnancy….
Pregnancy is not always the most comfortable of times. A rapidly changing body size and shape and a new cocktail of hormones surging through the bloodstream can result in many shifts- some of those being in bones and joints, resulting in pain and limited function. Bodies are smart and spend 9 months preparing to allow for delivery, so ligaments increase in their ability to stretch, creating laxity and potentially causing too much motion. While every case requires individual evaluation by a physical therapist, here are some basic rules for staying more comfortable and keeping your body safe in pregnancy.

No crossing your legs (or ankles): The more we bend ourselves into pretzel-like shapes, the more opportunity we give our joints to stretch to their maximum and potentially shift out of place. This is common in the Sacroiliac joint and the pubic symphysis. To keep happy pelvic bones, sit on sturdy surfaces with knees in front of hips and feet firmly planted on the ground. While this feels boring, it can prevent many problems and even make currently achey joints feel better.
Sleep supported: Sleep on 1 side with a king sized pillow or pregnancy pillow between knees, extending down to between ankles. Similar to the concepts above in sitting, this will keep knees aligned with hips and prevent twisting of those looser pelvic joints. Mid back soreness? You may also want to hug a pillow in front of your chest to keep from twisting your trunk in the night.
Watch out for workouts: Many moms were runners or participated in high impact workout activities prior to pregnancy. While we absolutely support exercise in the appropriate pregnant population, those bouncing and jarring motions that your body could tolerate prior to pregnancy can now cause serious shifting and damage in the loosened joints of your knees, feet, pelvis, and low back. Talk to a physical therapist about modifying exercise so that you still feel like you’re getting a workout, but you’re not putting yourself at risk for pain and dysfunction.
No sit ups or crunches: Think you can crunch off that baby weight and keep your tummy tight through pregnancy? Wrong. These maneuvers can contribute to a splitting or tearing of the abdominal muscles known as diastasis recti, and can also put lots of pressure on the pelvic floor. There are safe ways to utilize your abdominal muscles and protect your spine, but crunches and sit ups are NOT an option. This goes for postpartum workouts as well. Talk to a physical therapist for more information.

Breath and Pelvic floor….. Why does yo

Breath and Pelvic floor…..
Why does your pelvic floor physical therapist give you deep breathing if you have been breathing just fine, without need for instruction, your whole life? It’s because of the connection between the diaphragm and the pelvic floor. They move together like a piston, IF you are breathing correctly. I imagine the diaphragm being bossy and saying “MOVE get out of the way organs. The lungs need room for oxygen.” The abdominal and pelvic organs, following instructions, move downwards into your pelvic floor, allowing the diaphragm to expand and pull oxygen into the lungs. This downward motion of the pelvic floor means that it is relaxing. This is especially important for people who suffer from pelvic pain or other conditions that are caused by pelvic floor tension. For those of you that say, huh, well this doesn’t apply to me, I don’t have pelvic floor tension, I would say – breathing correctly applies to everyone. For people that have pelvic floor weakness, the upward movement of the diaphragm during exhalation can facilitate a pelvic floor contraction. If you have trouble contracting your pelvic floor, breathing can be a useful tool! Your pelvic floor PT likely has some other ideas for you as well, but a proper breathing pattern is a good start.
Now that we know breathing will affect our pelvic floor the most important thing is to do it correctly. A lot of us breathe in by sucking in our stomachs and lifting our chests, this is called shallow breathing. In order for our diaphragm to be able to descend and pull oxygen into our lungs, our lower abdomen needs to expand and blow up almost like a balloon. Our chests may rise slightly, but more movement should be coming from our abdomen. If you are someone that has pelvic floor tension, it may feel like your abdomen does not expand a great deal at first; this will likely improve the more you practice. You might also say, “I can’t feel that this is doing anything to my pelvic floor!” You may start to feel more movement as you and your therapist work on your pelvic floor tension. Changing your breathing pattern is hard at first and it takes some time to get good at it. Also – let’s be realistic, it’s not as if we won’t get enough oxygen if we breath by raising our chests, but it won’t have the most beneficial impact on your pelvic floor.
Some people like to count the seconds as they inhale and exhale but the important part is that you feel relaxed as you breathe. This means you do not want to breathe too rapidly. You can start with inhaling for 3 seconds and exhaling for 5 seconds; see how that feels. Adjusting the length of time for what is comfortable for your is perfectly fine.
Deep/diaphragmatic breathing is a good tool that you can use to decrease your pelvic floor tension. There are many instances in which deep breathing is a good idea and it can be especially helpful when you’re in pain. Deep breathing stimulates the parasympathetic nervous system, which is the system that is activated when we are in a calm environment. It is likely that if you have been a patient at Sullivan Physical Therapy, someone has talked to you about breathing and how it affects your pelvic floor. If you have questions about deep breathing – how it may affect you, when and how long you should do it, talk to your physical therapist!

Body Mechanics with Baby …… As a new

Body Mechanics with Baby ……
As a new mom with an extremely fussy baby, I know that we will do ANYTHING to calm our sweet babies. Even as a physical therapist, I have found myself compromising my back, neck, and shoulders. So what can we do to have happy babies and happy mommas? Here are some of my tips from both clinical expertise and personal experience:
1.) Whether you are bottle feeding or breastfeeding, use a positioning pillow. I personally like the brest friend, but there are lots of great options including the pillows on your bed!
2.) Expanding on Tip 1: if you are breastfeeding, always bring your baby to the breast, not the breast to the baby. This is difficult, especially in the middle of the night, so have your pillows next to the bed and ready to go! Personally, I had my husband change the baby while I took 2 minutes to set up the pillows – your body will thank you and it allows your partner to help!
3.) Start gentle exercise early if you are cleared by your healthcare provider. I asked my MD on post-partum day 2 if I could start pelvic floor and abdominal contractions. She looked at me like I was crazy (clearly she had forgotten what I do for a living). I promised her that I would only do exercises in bed, through a pain-free range, and without weights. She eventually agreed, but reminded me that if uterine bleeding increased and was filling more than 1 large pad per hour that it was too much exercise.Your PT can help you identify which exercises are safe to do and when to start.
4.) Use post-partum support and/or a baby carrier. I tried a few different products including the bellefit and the belly bandit. I like the concept of the bellefit because it has a strap that comes between your legs and could potentially support the pelvic floor. However, the recommended size for me felt like it was squeezing my organs out. So, I switched to the belly bandit which allowed for more flexibility in the size and position. Honestly, the belly bandit is very similar to a back brace, so I do caution overuse of this and recommend actively contracting your abdominals while wearing it to avoid creating muscle atrophy. If you are not using a baby carrier, the post-partum support is nice to protect your muscles while you are performing standing and walking tasks (like singing Ohio State marching band songs while parading your baby around the living room in hopes she will fall asleep!). If your baby will tolerate a baby carrier, this is also really helpful for body mechanics, skin to skin time, and being hands free!
These are just a few of my tips to get you started. For more information or help with other activities, talk to your PT and they will help you modify your activity!

Anjeculation Men who have recently under


Men who have recently undergone a prostatectomy may experience dry ejaculation or anejaculation. Anejaculation is the absence of seminal fluid release during ejaculation despite stimulation to the penis. For those with recent prostatectomy this is typically associated with surgery, however, men with an intact prostate can also experience this symptom. The common causes of anejaculation include: surgical procedures, neurological issues, psychological inhibition, low testosterone, blocked seminal vesicles, or uncontrolled disease such as diabetes. Anejaculation should not be confused with retrograde ejaculation which is a condition where the seminal fluid enters the bladder instead of being excreted out of the urethra. Retrograde ejaculation is tested for via urinalysis immediately following orgasm.
Anejaculation is often categorized as either orgasmic or anorgasmic. Those with orgasmic anejaculation are able to achieve an orgasm, but do not have any fluid released. This condition is commonly related to a blocked seminal vesicle or nerve damage. Those with anorgasmic anejaculation cannot achieve an orgasm nor have release of seminal fluid. Anorgasmic anejaculation may be related to lower testosterone levels or psychotrophic medications. Anorgasmic ejaculation may also be associated with psychological inhibition or someone who requires a high level of stimulation that cannot be achieved with standard sexual activities. If anejaculation appears to occur only in specific situations this may be related to psychological inhibition and sex therapy has been recommended as a form of treatment for this.
While the primary concern of anjeculation is infertility, it may also be a sign of more serious conditions. If you currently have diabetes or have noticed additional neurological signs it is important to have this assessed by your healthcare provider. Also, since anejaculation can also be related to medications, you may also want to discuss this with your healthcare provider if you have noticed a recent onset of this issue associated with a recent medication change