Let us shed some light on a topic that s

Let us shed some light on a topic that some people may find uncomfortable when first given the opportunity to begin a dilator program. Do not be intimidated. It is not meant to be a sex toy. Beginning a dilator program is one of the most effective tools pelvic floor physical therapist use to address pelvic floor muscle tension. What is a dilator program? The purpose of the dilator program is to stretch pelvic floor muscles that are tight as well as to train an individual to not associate pain with penetration. It can help women tolerate gynecological exams, tampons, and intercourse. Dilators are cylindrical devices that are tapered off at the end. They come in varying sizes, with the smallest size similar to an index finger. A patient typically goes up to the size similar to their partner’s girth. Some pelvic floor physical therapists may advise patients to go up to a dilator slightly bigger than their partner’s girth. Reason being if a woman can tolerate a dilator bigger than her partner’s girth and length, then intercourse should be a piece of cake, especially since she will ideally be aroused and lubricated during intercourse.
There are cases where women tell their physicians that they are experiencing pain with intercourse and unfortunately, sometimes patients are easily dismissed. They are told it is in their head, they just need more lubrication, or go buy a sex toy. Some women purchase a dilator program but are not given proper instructions on how to use it or how to progress. If used improperly, these women will have a negative experience using it and they will think it does not work.
The key to a dilator program is to go slow and at one’s own pace. Again, a dilator program is used to allow one to disassociate pain with penetration. Thus, if a woman goes too aggressively, pushes too hard, and gets frustrated, her body will reject it. Patients are recommended to use their dilators without pushing it beyond mild pain. A dilator is meant to be used daily for about 10-30 minutes. There are 3 components. The first step is to be able to insert the dilator into the vagina until there is about 2 inches of the dilator outside of the body. If only the very tip of the dilator can be inserted without experiencing more than mild pain, then just stop right there. Hang tight and wait for the pain to dissipate or pain to reduce to mild pain. If the full 10 minutes passes and the pain does not reduce, then that is ok. Try again next time. The next component is to be able to rotate the dilator along the sides of the vaginal muscles to stretch tight and sensitive areas that need to be worked out. If a sensitive area is found, apply some gentle pressure until the pain dissipates or if more than 90 seconds have lapsed. Applying pressure for more than 90 seconds should be avoided due to restricting blood flow. Finally, the last step is to be able to move the dilator in and out to simulate the friction involved in intercourse. Once all 3 steps have been completed and the patient feels mild to no pain while using the dilator, she is ready to move up to the next dilator size. The transition to the next dilator size can range from 1 day to several weeks for some individuals. It does not matter how long it takes to progress, as long as it is within the pace of that individual. DON’T be intimidated. DO ask questions.

Deep Breathing and Meditation for Pain M

Deep Breathing and Meditation for Pain Management…
15% of American adults have endured chronic pain at some point in their life. If you or someone you know has experienced any sort of lasting pain, you understand that pain is complex. There are many things that can onset the pain cycle and the factors and degree to which the factors contribute to each pain experience varies between individuals. Even as physical injury is present, our environment, daily stressors, emotions, and biological make-up can change what we feel and how we experience pain. There are two parts to the nervous system, the sympathetic “fight or flight” system, which is activated when the body is on high alert, and the parasympathetic “rest and digest”, which is what we tap into when we are more relaxed.
Using methods such as deep breathing, mindfulness, and meditation, among other modalities, activates the relaxation system and has been shown to relieve pain, depression, anxiety, decrease stress levels, and elicit changes in the brain. One study found 40% of its participants reported a decrease in pain intensity after performing daily meditation over a course of 8 weeks. Many things may come to mind when you think of meditation or mindfulness but it is simply being present, breathing, and noticing what is happening around you.
While the definition is simple, it is certainly something that takes practice and consistency but the benefits are worth it. Here’s some good news, you don’t have to sit for an hour to receive the benefits of meditation. Many people have seen positive benefits with just 10-15 minutes of deep breathing, mindfulness, or meditation per day and will begin noticing the benefits within 2 weeks.
A few ideas to get you started:
1. Sit or lay comfortably and breathe quietly (you may even create a special place just for this)
2. Focus on a word or phrase that is positive and repeat it slowly to yourself
3. Go for a walk and keep your focus on your breathing
4. Sit or lay and just take in the sounds around you
We live in such a busy world and are always thinking 10 steps ahead; don’t forget to take time to breathe. Ask you physical therapist if incorporating deep breathing or any other mindfulness techniques may be beneficial for you.

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!