Cancer

There are many different types of cancer whose treatments may impact the ability of the pelvic floor muscles to function properly. These types of cancer include, but are not limited to, uterine, cervical, vulvar, ovarian, prostate, colon, rectal, and anal cancers. Most often, patients will undergo surgery, radiation therapy, chemotherapy, or a combination of these. The impacts from each of these treatments may impact the pelvic floor in different ways.

Surgery can disrupt muscle fibers or the nerves that supply sensation. This may impact a person’s ability to effectively contract the pelvic floor muscles which may contribute to incontinence. Surgery can result in scar tissue formation which may lead to muscle tension, pelvic pain, pain with intercourse, as well as muscle weakness. Alterations in hormones may also take place with removal of reproductive organs which can impact libido and a variety of other processes.

Chemotherapy has a high impact on mucosal membranes which may contribute to sores, decreased lubrication, and overall irritation of the tissues. This process may contribute to pain during intercourse and can potentially increase pelvic floor muscle tension.

If radiation is required, fibrosis of the tissues may occur. Tissue fibrosis is a hardening of the tissues which can impact the ability of the pelvic floor muscles to contract and prevent bowel/bladder leakage and can cause the muscles/tissues to have difficulty stretching which can contribute to pelvic pain, bowel/bladder urgency, and sexual dysfunction.

Although these treatments may contribute to pelvic floor dysfunction, there is good news! Research has shown that pelvic floor physical therapy can decrease the occurrence of pelvic floor dysfunction and improve quality of life in cancer survivors. A pelvic floor physical therapist may work on pelvic floor muscle strengthening to help with incontinence.  Alternatively, they may begin working on scar tissue mobilty and techniques to decrease pelvic floor muscle tension which can help reduce pain and bowel/bladder urgency.

 

Rectal Dilators

Most people associate using a dilator to treat women experiencing pain with vaginal penetration, whether it is pain with intercourse, gynecological exams, and/or use of tampons. While this may be the case, there are so many other uses for a dilator program. To elaborate, a dilator is not only used vaginally and it is not only used for women. Some patients who seek pelvic floor physical therapy have issues with constipation and/or rectal pain. Often times these symptoms are a result of tension in the pelvic floor muscles. The tension is causing difficulty for the muscles to relax and thus difficulty with stool evacuation. The tension in the muscles can also produce spasms and result in rectal pain. Myofascial release and connective tissue manipulation in the external pelvic girdle such as the abdominals and inner thighs can help alleviate these symptoms but internal rectal release of the pelvic floor muscles has an even bigger impact on symptom relief. Often patients ask, “Is there anything else I can do at home aside from stretches to help me manage my symptoms?” If they are open to it and if they have found internal rectal release helpful, they can perform self trigger point release with a rectal dilator at home. A rectal dilator is used for the purposes of stretching the rectal tissue and also assisting with relaxation of the muscles.

A rectal dilator can also be used to help with re-training your muscle coordination.  When the pelvic floor muscles contract, they are holding back urine, stool, and gas. When they relax, they are allowing for the initiation of flow of urine and the passing of gas or stool. If there is an issue with muscle coordination, patients may have difficulty emptying their bladder or bowels. Patients with constipation can practice inserting a rectal dilator and actively practice relaxing their pelvic floor muscles to “pass” the rectal dilator, similar to the passing of stool.

As I mentioned, rectal dilators are not only for women experiencing pain with vaginal penetration. If a person is engaging in anal intercourse and having pain, a rectal dilator can be appropriate for this person to use. The rectal dilator can be used to stretch tight muscles affecting a person’s ability to enjoy intercourse. A person can progress to a dilator size similar to the size of the object that is performing the penetration, whether it is a digit, toy, or phallus. While there are a number of purposes to use a dilator as a supplemental treatment for physical therapy, it is important to ask your medical provider whether it is appropriate to use and to learn proper instructions.

Pudendal Neuralgia

Picture this: you’ve just trekked through the entire mall buying Christmas presents and all you want to do is sit down for a moment to rest and offload all the bags you’ve been carrying. You sit down and start to feel a pain building in the pelvic region and then you’re presented with a significant discomfort that is urging you to stand back up. Some break, right? Experiencing pain when sitting could be a sign of pudendal neuralgia.

Pudendal neuralgia is also commonly known as the ‘cyclist’s syndrome’, ‘pudendal canal syndrome’, or ‘Alcock’s syndrome.’ Pudendal neuralgia pain is caused by inflammation of the pudendal nerve. This inflammation may have been sparked by cycling, childbirth, surgery, constipation, trauma to the tailbone, or a musculoskeletal issue resulting in muscular imbalance and/or pelvic misalignment.  The pudendal nerve is located in the pelvis and has nerves branching to the genitals, urinary, and rectal regions. In severe cases these branches may be affected, resulting in genital numbness, fecal incontinence, or urinary incontinence. These are difficult topics to discuss and sometimes seeking help is the hardest step to returning to a pain free lifestyle. Physical therapy is an excellent way to start the healing process and we here at Sullivan Physical Therapy will make the recovery as comfortable as possible.

 

Midnight Bathroom Trips

How incredibly bothersome is it to wake up multiple times every night to pee? I don’t know about you, but I thoroughly enjoy my beauty sleep and I don’t want anything to interrupt it. Waking at night can be brought about for a number of reasons: drinking too late in the evening, sleep apnea, weakness and/or tension of the pelvic floor muscles, and the list goes on.

A few simple lifestyle changes can make all the difference in minimizing your urinary output in the night. If you have a tendency to frequent certain beverages you’ll want to make sure that you are ingesting them wisely. It’s best to avoid liquids at least 2 hours before bed, especially alcohol. Avoiding caffeine in the afternoon will also cut back on the frequency of bathroom trips throughout the day and possibly into the night as well.

Sleep apnea can also lead to multiple bathroom trips in the night. Oftentimes the body associates waking up with needing to urinate, like it normally does in the morning, so when you wake up in the middle of the night the body is tricked into thinking it needs to go. Being consistent with the use of your sleep apnea machine is essential.

Lastly, any tension or weakness to the pelvic floor muscles can also contribute to those nighttime trips. If you feel that you are waking an abnormal amount in the night, be sure to speak with your physical therapist to start discovering ways to combat this nightly routine.

 

Incontinence and the Elderly

Did you know that urinary incontinence is associated with increased falls risks, increased rates of hospitalization, and increased rates of institutionalization later in life? Urinary incontinence is preventable and treatable, but if we don’t know how or when to seek care, the effects of quality of life for older adults are massive.

45% of adults experiencing difficulty with bladder control do not seek care for their symptoms because they assume the symptoms are a normal part of aging. Incontinence is common, but it is not normal. Estimates show that 50% of people over 60 years old experience urinary incontinence, that number increasing with age. Furthermore, those estimates rise to 77% of those in nursing facilities. Urinary incontinence is associated with increased anxiety and social isolation, as well as decreased self confidence.  In older adults, specifically, it is also associated with a faster rate of functional decline, increased rate of falls, frailty and depression.

These symptoms negatively impact their ability to stay active and live independently, and it’s a dangerous combination. Hip fractures are a serious outcome of falls for older adults. In those 60 years and older, hip fractures double mortality rates in 12 months, however much like incontinence, falls are preventable.

Discuss your bladder health with your medical doctors. Seek help if you have difficulty controlling your bladder when you cough or sneeze, when you exercise, or if you have a strong, inexplicable urge that makes it difficult to stop the flow of urine. Urinary incontinence is not a normal part of aging, and preventing or treating these symptoms will help you lead a longer, healthier and happier life.

 

Healthy Birth Practices

The Lamaze International has determined six ways to keep a mother’s birth healthy and safe as possible. 1) Let labor begin on its own. There are cases in which labor needs to be induced for the safety of the mother and the baby. However, there are situations where labor is induced for convenience and the risks for induction are not taken under consideration. Risks can include chance of cesarean delivery, more labor pain, and health issues for the baby. Consider choosing a provider who is aware of these risks and does not induce labor unless medically necessary.

Another tip to consider is 2) Walk, move around, and change positions throughout labor. The ability to move and change positions reduces pain and aids in the labor progress. Movement allows contractions to work more efficiently and gravity allows the baby to lower in position. Determine if your birth setting allows safe places for walking.

Having supportive company is important in the labor process. 3) Bring a loved one, friend, or doula for continuous support. Research has shown doulas (professional labor support companions) decreases need for an epidural, increases chances for a vaginal birth, and improves the experience for the woman and her partner.

As mentioned, 4) Avoid medical interventions that are not medically necessary. These interventions can include giving fluid through an IV, epidurals, continuous electronic fetal monitoring, speeding up labor with pitocin, breaking the bag of water, and episiotomy.  Find a provider that is able to justify which procedures have benefits that outweighs the risks.

There are many positions that a woman can deliver birth that does not necessarily have to be on their back. 5) Avoid giving birth on your back, and follow your body’s urges to push. Positions such as standing, kneeling, squatting, or lying on the side in the second stage of labor allows gravity to assist in the baby’s descent and gives the pelvic bones more movement. Your body is sending you urges to push.  Go with these urges rather than being told when to push. Do not hold your breath. Become comfortable with different positions and practice before labor. A provider may not give you the option to do any position aside from lying on your back. If that is the case, ask to put rolls of towels underneath your sit bones to elevate the pelvis. This will allow your sacrum and tailbone the space it needs to tilt to make room for the baby to descend.

Finally, 6) Keep your baby with you- It’s best for you, your baby, and breastfeeding. Skin contact allows the baby to breath easier, regulate temperature, and learn how to nurse. Babies who spend the night at the nursery cry more and have more difficulty with breastfeeding.

These are all suggestions for a healthy, safe birth. However, medical problems do arise that may warrant intervention and make these suggestions difficult to adhere to. Talk to your physician about a birthing plan and ask questions.

 

The Six Lamaze Healthy Birth Practices. Happy Birth Way | Tampa Bay birth classes in Pinellas, Hillsborough, Pasco and Manatee Counties. http://happybirthway.com/the-six-lamaze-healthy-birth-practices/. Published 2009. Accessed November 2, 2017.

 

Grounding

We all experience stress at some point in our lives.  Stress is necessary in order to survive, and how our caveman predecessors fed themselves and stayed alive from the animal chasing them that was trying to do the same. Excessive stress, however, can lead to changes in our behavior, emotional and physical well being that may not benefit us for survival. In fact, it may make our day to day lives more challenging to endure by producing fear, anxiety, memory problems, difficulty concentrating, difficulty sleeping, health issues, and even pain.

Recognizing stress or factors that may cause stress can be the first step in reducing it. Some people have a difficult time identifying things in their lives that may be causing the stress, but feel out of sorts, not themselves or simply uncentered.

Grounding can be a simple and effective way to help in reducing stress and feeling more centered.  Being grounded can mean a few different things, but most commonly can mean either feeling centered or fully present in your body, or physically feeling connected to the earth.  Ever wonder why it feels so good to walk barefoot on the beach or feel grass between your toes? In our culture it is rare that we ever have a direct connection with the earth, without the soles of our shoes or a concrete sidewalk acting as a barrier between us and the earth.

The earth has a subtle natural electric charge to it, kind of like a giant battery. Our body produces free radicals that carry a charge to them, which over time can lead to chronic inflammation or contribute to other chronic conditions. With the earth having an unlimited supply of free electrons, research suggests physically being grounded can enable these free electrons to spread over and into the body, where they can have antioxidant effects.

Grounding research has shown improvements in decreasing levels of inflammation and pain, improving sleep quality, and reducing stress levels. It has also been shown to improve circulation, which can allow increased oxygen and nutrients to flow to tissues and even improve the speed of wound healing. Grounding also has shown to improve emotional health by reducing irritability, anxiety, tension or stress.

Beach vacations are not the only way you can achieve a more grounded state. The simplest way to ground is to walk or stand barefoot in the grass, sand, or dirt in your backyard. Researchers recommend a minimum of 30 minutes of direct contact per day, if possible, in order to have significant health benefits. There are also products available such as mats, sheets or patches that function by tapping into the grounding wire out of a standard outlet. These resources can provide the benefit of grounding, even for those that spend most of their day behind a desk or don’t have the opportunity to step outside.

Next time you find yourself enjoying the outdoors, kick your shoes off and get some grounding in. It may do more for your physical and emotional health than you realize!