Postpartum Exercise- Why You Should Proc

Postpartum Exercise- Why You Should Proceed with Caution

Waiting in line to check out at the grocery store, it’s hard not to catch headlines about a celebrity getting her “pre baby body back” after delivery or someone else “still hanging on to their baby weight.” It seems like there’s a lot of pressure on new moms to get back to grueling exercise as soon as possible. However, as women try to jump right back into the same types of workouts they were performing pre-baby, we see many people really hurting themselves.
The misconception out there is that once you deliver, your body is ready to jump up and get back to all of its normal activities. In actuality, regardless of the method of delivery, even very straightforward childbirth is one of the largest traumas an average body will go through in a lifetime. You would not recommend a person return to Cross fit 2 weeks after a serious car accident- your pelvic tissues need similar healing time periods.
The following wisdom was shared with me by midwives at Austin Area Birthing Center:
Week 1 postpartum: IN the bed. That means laying down. You may get up to go to the bathroom. All baby care can be performed in the bed or at bedside. Others should be responsible for cooking, housework, running after additional children. Do not be entertaining visitors. Sleep as much as your baby will allow and eat nutrient rich foods to replenish your energy stores and healing capabilities.
Week 2 postpartum: ON the bed. You are still mostly sedentary, but can now sit up to interact with baby, nurse, take slightly longer showers, sit in the bath. You are not doing chores or running errands.
Week 3 postpartum: NEAR the bed. Get up and combine some quick ingredients for a snack or walk around the house without lifting anything heavier than baby. Your day is still mostly comprised of rest and baby care, but you are not going grocery shopping and are not going out to exercise.
In the realm of exercise, gentle walking is the best way to start getting back around week 4.
Why so strict? Your uterus needs to be resting to shrink back to its original size and, pending you had a vaginal delivery, your pelvic floor was just stretched to its extreme and needs to slowly return to a functional length. Don’t pay it the respect it deserves? Your organs may start descending downward and result in prolapse, urinary leakage, or bowel dysfunction. Tears will be very painful and have a difficult time healing if tissues are strained. Also, your placenta detached from the uterus and left a salad-plate-sized open wound behind. Bleeding slightly more one day? You opened up your scab by doing too much.
We want you to get back to exercise, but it needs to be done slowly.
Contact a pelvic floor physical therapist for assessment and a rehabilitation plan to allow you to get back to your favorite form of exercise safely. We’d rather see you for 1-2 visits postpartum to make sure you’re safe and have a plan to reach your workout goals than see you down the road when you’ve already done damage.

Multiple Sclerosis (MS) is a disease tha

Multiple Sclerosis (MS) is a disease that affects the central nervous system. When the immune system attacks the myelin, which is the protective coating around the nerves, it results in a process called demyelination. The exact cause is unknown, but is believed to be contributed by a combination of genetics, environmental factors and immune system deficiencies. Common symptoms include fatigue, weakness, blurred or double vision, changes in balance or coordination, pain, and impaired attention or concentration. How does this relate to the pelvis? Unfortunately, with this patient population, up to 80% have bladder dysfunction, more than 40% experience constipation, and 91% of men and 72% of women report sexual dysfunction, according to some studies. Most common bladder dysfunctions include urinary urgency, frequency and incontinence. This happens because the demyelination process affects telling the bladder muscle and pelvic floor muscles what to do. Constipation is a common result not only from changes in nerve function, but also due to a lack of inactivity as weakness and fatigue worsen. Sexual function changes include decrease in sensation, vaginal dryness, erectile dysfunction, and reduced libido.
Research in this patient population is limited, but shows that the best candidates for pelvic floor therapy are those who get treated in the early stages of MS. Pelvic floor physical therapy, with or without the use of biofeedback, has been shown to improve urinary incontinence, nocturia (nighttime voiding), and bladder emptying. Patient education for behavioral modifications including timed voiding, bladder training, and fluid and dietary management assist with improved bladder storage. Conversely, improved bladder emptying can be improved by techniques for triggered reflex voiding, muscle training for both the pelvic floor and abdomen, and positioning. Extensive research has been performed for managing constipation utilizing abdominal massage; this massage helps facilitate fecal matter through the colon. A pelvic floor therapist can provide education on direction, pressure, intensity and frequency of massage routine for optimal results. In regards to sexual function, a skilled physical therapist can assess pelvic floor muscle tone, flexibility and ability to relax for optimum function in both men and women. It may also be important to look positioning, lubricant, mindfulness and fatigability for improved intimacy. With this in mind, please speak up to your provider regarding pelvic health as symptoms may change over time.

Intimacy and Incontinence Incontinence c

Intimacy and Incontinence
Incontinence can impact several aspects of your life: travel, exercise, work, quality of life, and even sexual function. Approximately 1/3 of women with stress urinary incontinence avoid sexual activity because of their fear of incontinence. Let’s talk about some ways to regain confidence in the bedroom:
1.) Seek treatment. This may start with a trip to your PCP, OBGYN, midwife, urologist, or urogynecologist to discuss your incontinence and make sure there are no systemic issues. While at this visit, I recommend asking if pelvic floor physical therapy is appropriate/recommended.
2.) Address your diet. Avoid drinking caffeine or excess fluids prior to intercourse.
3.) Prepare your bedroom. Consider using a mattress cover or laying down towels on the bed to lessen worry about ruining your bedding.
4.) Pay attention to your bladder. Urinate before sexual activity and take a break during sexual activity to use the bathroom if needed. When you do urinate, try double voiding. Double voiding is where you urinate, stand up, sit back down, and try to empty again. Keep your abdomen and pelvis relaxed and sit fully on the toilet for best results.
5.) Try different sexual positions. Sidelying, kneeling, or woman on top may be better positions for your bladder. Your physical therapist can instruct you on different variations of these positions to help minimize pressure on your bladder or straining through your abdomen which can create more leakage.
6.) Avoid excess exercise prior to intercourse. If your muscles are fatigued, it will be harder to control leakage. The best time of day to attempt intercourse is early in the day.
7.) Talk to your partner. You may be surprised at how supportive your partner is and how much more relaxed you feel after. Your partner may be relieved to know that you haven’t been avoiding sexual activity from lack of interest. Open dialogue will also allow the two of you to plan sexual activity and gives you another person to discuss your treatment options with.
Urinary incontinence is difficult to discuss, let alone discussing how it impacts your sexual function. However, your healthcare providers, including your physical therapist, are here to listen and help you with these issues. Please speak up and seek treatment to help you improve your sexual function and quality of life!

Intimacy Post-Prostatectomy… After ski

Intimacy Post-Prostatectomy…

After skin cancer, prostate cancer is the most common cancer among men. Upon receiving a diagnosis several questions may cross your mind. One of the questions that may cross your mind is, “How could prostate cancer impact my sexual function?” Sexual function after prostatectomy is a very important topic as it has been shown to impact self-esteem and quality of life. Almost all men will experience erectile dysfunction after prostatectomy, however approximately 50% will have return of their prior level of erectile function within 1 year of surgery. This statistic varies widely based on the surgeon, surgical technique, and the patient.

There are ways that you can help with recovery of sexual function:
1. Pelvic floor muscle exercises or “kegels” help to strengthen the muscles and provide blood flow to the pelvis that can assist with sexual function. Walking at least 30 minutes per day can also help to stimulate the pelvic floor muscles.
2. Avoid drinking alcohol, smoking cigarettes, and excessive stress.
3. Once you have been cleared by your physician (often 6-12 weeks post-operatively) you can start self-stimulation or use of a vibrator near the head of the penis. This can help with stimulating the nerves and the rebuilding the arousal connection to your brain. This can also be a time to involve your partner, which can help with rebuilding physical and emotional intimacy.
Note: you may not initially be able to achieve an erection or ejaculation, but the goal is to help impact the nervous and vascular systems
4. To help avoid incontinence during sex, men should make sure their bladder is empty before they engage in sexual activity. Some men use a constriction ring to stop incontinence during sex and some wear a condom. In either case, open communication between a man and his partner can help relieve some of the embarrassment and stress associated with incontinence during sex.
5. Talk to your MD about medications and or hormones. If sexual function deficits persist, your MD can also provide you with alternative options such as a penile vacuum pump, injections, or surgical options.

While sexual function is a sensitive topic, remember that your healthcare providers are trained and experienced to assist with these issues. Please do not be afraid to ask questions or voice your concerns!

Holistic Approach to Interstitial Cystit

Holistic Approach to Interstitial Cystitis
Interstital Cystitis can seem like a scary diagnosis at the urology office, especially if you then go home and google it all night. Online blogs, forums, and articles will tell you that you will never be able to eat the things you want to eat, you will be in pain all your life, and it is untreatable. Here’s the scoop. It IS treatable and you can manage the symptoms with the right steps. It will not always be easy and there is a lot of trial and error, however, it is very possible to lead a healthy life with IC given the proper guidance.
Intestitial Cystitis, according to the American Urological Association, is defined as “An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable causes”. Often patients will have symptoms of bladder pain, increased day time and night time urinary frequency, urgency, incomplete emptying, and burning urethral pain. Pelvic floor physical therapy has shown to help release the muscular tension that is likely contributing to symptoms via myofasical release, connective tissue manipulation, education on body mechanics and posture, and providing stretches as a home exercise program. Pelvic floor physical therapists can also educate patients on common bladder irritants. These are common food and drinks that can trigger symptoms of increased urgency, frequency, pain, and leakage. While physical therapists would love to take the credit in helping patients feel 100% better, it is a multidisciplinary approach. We often refer patients to urologists, nutritionists, mental health therapists, and other medical providers to address the patient as a whole person.
Aside from physical therapy, there are other medical interventions patients can research about as other options to address their symptoms. There are oral medications, bladder instillations, hydrodistention, intra-bladder botox, electrical stimulation, nerve blocks, and trigger point injections that can address IC symptoms. Keep in mind, many of these options can have side effects and do not always work for everyone. In fact, some of these interventions can flare symptoms and make patients feel worse. It is always best to consult with your physician on whether any of these options are appropriate for you. There are also complementary treatments such as acupuncture, meditation, and mental therapy that can supplement the stress and pain that is associated with this condition. It is always best to consult with a nutritionist and determine food sensitivities that can trigger IC symptoms. The bottom line is that IC is not a death sentence. There are plenty of options to explore. Discuss with your physician and pelvic floor physical therapists your questions and concerns.

“I had a c-section, so my pelvic floor is totally fine.”

“I had a c-section, so my pelvic floor is totally fine.” Probably not.
Patients who have undergone vaginal delivery and are working with me to eliminate postpartum symptoms such as urinary leakage, pain with intercourse at the site of tearing, or prolapse will sometimes say “I wish I would have just had a c-section , then I wouldn’t have all of these problems.” Well…yes and no. They may not have presented in exactly the same way, but I think, when it comes to coping with symptoms postpartum, the grass is always assumed greener on the other-method-of-delivery side.
For individuals who have undergone a c-section, sometimes I feel that postpartum recovery education is even less available (if that could be possible). There are many symptoms that we see in these moms that are very treatable, even years down the road but everyone seems to think that because they had a surgical procedure, they just have to deal with the aftermath. False.
Symptoms commonly reported:
1) Problem: The scar itself may be painful and restricted or is unsightly
Fix : we can perform scar massage to decrease restrictions and alleviate pain, while desensitizing the skin, sometimes even (as a bonus) getting clothing to fit better and get rid of that shelf-like appearance over the scar.
2) Problem: The individual feels like they have no abdominal strength, or they have back pain

Insight/Fix: Again, we’ll work through scar tissue while teaching the patient to properly activate abdominal musculature in the proper manner . Once abdominals can work as they were prior to surgery, those muscles can support the spine, thereby resulting in decreased back pain with activities and safe return to exercise.

3) Problem: Bladder frequency and urgency, leakage
Insight/Fix: This one is actually often overlooked as having anything to do with caesarean history. Very frequently, we find significant scar tissue deep to the visible scar. What you can see is really just the tip of the iceberg. Those deep aspects can become wrapped around the area of the bladder, limiting the bladder’s ability to fill well and causing bladder spasms. This can make it feel like you have to pee all the time or actually contribute to bladder leakage when it feels like you have to pee. Manual work to the scar and bladder can often make a huge impact in these symptoms.

4) Problem: Painful intercourse
Insight/Fix: if the uterus or deep aspect of vaginal canal are also restricted or have scar tissue wrapped around them, the scar can actually be a large contributing factor to painful intercourse.
A mix of internal and external manual therapy can alleviate this pain.

Take home points: A caesarean is not a routine procedure. It involves lots of disruption of the musculature and tissue throughout the area and forms significant scarring that can cause numerous abdominal and pelvic symptoms. See a pelvic floor physical therapist to assess your scar and find out what can be done to help you heal fully.


The “Evil Triplets” of Chronic Pelvic Pain

The “Evil Triplets” of chronic pelvic pain include endometriosis, interstitial cystitis/painful bladder syndrome, and pudendal/levator neuralgia which are called triplets because they frequently can occur together.
Endometriosis is a condition where the endometrial lining of the uterus grows outside the uterus. This abnormal tissue growth occurs most commonly in the tissue lining the pelvis. This condition can cause chronic pelvic pain, dyspareunia, scar tissue formation, and fertility issues.
Interstitial cystitis/painful bladder syndrome is often characterized by pelvic pain, pain with intercourse, urinary frequency, and urinary urgency that is not associated with an active infection.
Pudendal/levator neuralgia is frequently associated with tenderness and pain to tissues about the pudendal nerve, changes to tissue texture, decreased tissue blood supply, and muscle weakness and atrophy.
What can be done about the “Evil Triplets?” Physical therapy treatment of pelvic pain frequently includes an assessment of a variety of structures including the spine, pelvis, abdomen, and lower extremities. Alignment, range of motion, muscle strength, muscle extensibility, and connective tissue mobility is frequently assessed. Physical therapy treatment may include manual treatment such as trigger point release, neuromuscular re-education, relaxation techniques, therapeutic exercise, and physical therapy modalities. Patient care for this population frequently involves a cross-disciplinary approach.