1 in 7 Women Suffer From This…

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May is Pelvic Pain Awareness Month.
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As pelvic floor physical therapists, a large percentage of patients who come to see us, are experiencing pelvic pain.
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CPP can be caused by many things such as #vulvodynia#vaginismus#endometriosis, musculoskeletal problems, chronic pelvic inflammatory disease, scar tissue post-surgery, irritable bowel syndrome (#IBS), painful bladder syndrome (interstitial cystitis)
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DID YOU KNOW:
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1 in 7 women between the ages of 18 and 50 suffer from chronic pelvic pain. The lifetime incidence of CPP is as high as 33%. 😧
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Pelvic floor physical therapy can help to relieve and even eliminate the pain caused by chronic pelvic pain.👍 https://goo.gl/HTJ2Zp

“Accidents” Do Happen

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Bladder leakage is a physical condition that affects an estimated 14 million Americans every day. 💧
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It happens to both men and women of any age, and is a result of a variety of physical conditions.
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Struggling with urinary incontinence can leave you feeling embarrassed and alone.
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Your body seems to be no longer in control. You cannot depend on it functioning in the way it once did; you cannot depend on it functioning in the way it should. But for some, talking about your symptoms with others just seems to personal, even with a health care provider.
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However, there is no need to feel this way. There is help out there, and you are not alone! With treatment, you can get your urges back under your control. 👩‍⚕️
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“Accidents” do happen, but that does not mean they need to be a part of your everyday life. 🧘

BIG NEWS: FDA Halts All Sales of Vaginal Mesh Products

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BIG NEWS: FDA Halts All Sales of Vaginal Mesh Products (Source: https://www.fda.gov)
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If you are dealing with incontinence or pelvic organ prolapse, clinical evidence has shown that pelvic floor physical therapy can help!
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One of the contributing factors for urinary incontinence and prolapse is a weakening of the pelvic floor.
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Pelvic floor physical therapists use a variety of methods to help you correct pelvic floor dysfunction. Utilizing specialized exercises and modalities can strengthen and increase coordination of the pelvic floor muscles.
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Bladder retraining assists by helping you regain regular urinary cycles.
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If you are dealing with complications as a result of vaginal mesh surgery (such as pain, scar tissue and painful intercourse), pelvic floor physical therapists can help with that too!
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If you have any questions about pelvic floor physical therapy and how it may help you, send us a message!

This Assessment Should be a Part of Every Woman’s Post-Birth Plan

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…even though a woman may look “back to normal” on the outside, very often the pelvic floor & abdominal muscles are still weak from pregnancy & birth.🤰
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Many women will experience nagging issues like peeing when exercising, painful intercourse, pelvic pain and discomfort and weak abdominal muscles.🧘
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These issues do not just go away on their own and can often become much more serious if not addressed earlier.😱
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This is why post-birth rehabilitation of the pelvic floor, back, and abdominal muscles, coupled with proper breathing, is so important!👍🏿
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Getting a musculoskeletal assessment should be a part of every woman’s post-birth plan!

Avoid Pain and Improve Function

During pregnancy, a woman will likely experience a changing center of gravity, hormonal increases, postural dysfunction, stress and additional weight gain. The body must adapt to the uterus growing 1,000 times l

50-70% of those who are pregnant experience back pain and other complaints.

Often, muscle strength and flexibility are not optimal for the childbearing year.

It is important to be fit to prepare for these changes to avoid pain and improve function.

Women’s health physical therapists have specialized training in changes occurring during a woman’s life including pre-pregnancy, pregnancy and postpartum periods.

Valsalva and the Vaginal Vacuum

Terminology and Technique for Pelvic Floor Rehabilitation

The time has arrived to correctly describe and effectively use the Valsalva maneuver–and the all-important Vaginal Vacuum that can accompany the maneuver–in pelvic floor rehabilitation. How one performs the Valsalva breath holding technique is an important consideration in pelvic floor health and rehabilitation. The Valsalva maneuver was introduced as a medical procedure in 1704 by an Italian physician to expel pus from the middle ear. Over the years, the Valsalva maneuver has been used in medicine for everything from changing cardiac rhythms to testing for disc herniation.

Valsalva vs. Strain Maneuvers and the Pelvic Floor (PF)

First, we need to define Valsalva versus Strain from a pelvic health and rehabilitation perspective. Clarifying these definitions is a beginning, improving the understanding of the effect of managing Intra-Abdominal Pressure (IAP) in pelvic floor dysfunction (PFD).

The Valsalva maneuver is a moderately forceful attempted exhalation against a closed airway. The 2017 International Urogynecologic and Continence Societies (IUGA/ICS) joint Terminology Report for the conservative and non-pharmacological management of female pelvic floor dysfunction defines the Valsalva maneuver as “the action of attempting to exhale with the nostrils and mouth, or glottis closed. Valsalva is usually performed with digital closure of the nose, as when trying to equalize pressure in an airplane.” Properly used, the term “Valsalva maneuver” does not address the pelvic floor.

In contrast to the Valsalva maneuver, the strain maneuver is a forceful bearing down which can cause excessive perineal descent. We use a strain maneuver to test for pelvic organ prolapse, but it is otherwise discouraged in most of our patients with prolapse or incontinence. Straining/bearing down as defined in the above IUGA/ICS terminology report “may have a similar meaning to Valsalva; however, in practice, straining/bearing down may be interpreted as meaning pushing downward and trying to relax the pelvic floor, as when defecating.” A strain maneuver therefore does address the pelvic floor.

In reality, the Valsalva maneuver does affect the pelvic floor. During the Valsalva maneuver the pelvic floor elevates. I term this elevation the Vaginal Vacuum. For more information on pelvic floor elevation during the Valsalva maneuver, see Talasz et al., 2012 which states that “the Valsalva maneuver reflects an expiratory pattern with diaphragm and pelvic floor elevation, whereas during straining the pelvic floor descends.” Also see Baessler et al., 2017, who demonstrated that Valsalva maneuver is associated with better bladder neck support and a stiffer pelvic floor.

Vaginal Vacuum Technique (VVT)

I consider using the Vaginal Vacuum breath holding technique when the primary presenting pelvic floor muscle diagnosis (Spitznagle et al., 2017) includes a force production deficit with or without movement pattern coordination or IAP impairments. In my practice, patients with some pelvic floor muscle awareness and without pelvic floor muscle overactivity respond the best to the VVT.

Most pelvic rehabilitation practitioners are familiar with coaching a pre-contraction of the pelvic floor (termed the “Knack”) prior to a symptom-provoking cough. The Vaginal Vacuum Technique is designed to be a symptom reduction breathing technique.  It is a short duration Valsalva breath hold used with a symptom-provoking activity like a lift or a push. The VVT can be accompanied by pelvic floor activation either reflexively or with coaching pelvic floor cues.

To identify if the patient has a reflexive Vaginal Vacuum effect, instruct the patient in a brief, sub-maximal breath hold on exhalation to be directed upward against a closed throat and mouth, (clearing your ears on the airplane– Valsalva maneuver) and observe for the response of stiffening or lifting of the pelvic floor.

Non-responders may need coaching. I suggest adding a contraction cue for the pelvic floor or providing more training in the coordination of this technique. Patients with significant PFD may need to use both the Knack and the VVT to manage IAP. For some, this Valsalva breathing technique may never produce an elevation of the pelvic floor.

Management of IAP with the Vaginal Vacuum Technique

Management of IAP is an important treatment consideration in patients with PFD.  Breath holding, often unavoidable when pushing or lifting heavy loads, can be performed with different pelvic floor responses.  The Valsalva maneuver can be of value in pelvic floor rehabilitation. Terminology is important, and I encourage you to reverse the trend of using Valsalva as a term to describe a straining/bearing down maneuver in clinical practice. I also encourage you to perform terminology fact checks: look closely at research publications for their specific descriptions of the Valsalva maneuver.

Finally, try the VVT during your initial patient assessments and use it as an additional self-care behavioral strategy to manage IAP.  Clinically, many patients have reported improved quality of life–an ability to lift or push with fewer symptoms. I hope your patients do too.”

To learn more about advanced pelvic floor examination and the importance of managing IAP visit my  professional continuing education teaching  page.

 


 

Want to learn more about pelvic floor dysfunction and pelvic organ prolapse while earning PT CEU’s? Register for our upcoming course!

A Boost Camp Seminar to Advance Your Clinical Practice Skills Pelvic Organ Prolapse (POP) Exam and Rx (5)

 


 

Kathe-WallaceAbout Kathe Wallace

Kathe Wallace has practiced physical therapy since 1976, focusing on pelvic floor rehabilitation since 1988. As a nationally recognized leader in the pelvic floor specialty of physical therapy, she evaluates and treats many types of conditions referred to her by medical specialists in orthopedics, physical medicine and rehabilitation, urology, gynecology, gastroenterology and colorectal surgery. Full Bio.. →

Every”body” is Unique!

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Healing and re-training your muscles can be a slow process. 🐌

Every”body” responds differently to therapy and treatments. Our therapists take into consideration your particular goals and how your body is responding to exercises, manual therapies and modalities.

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Pain and musculoskeletal dysfunctions often contain many layers and may require a multi disciplinary approach. We assess you as an individual, not just your diagnosis or symptoms. For example, if you come in with back pain . . . we will not only assess your lumbar musculoskeletal function, but also other coordinating muscle groups, such as your pelvic floor muscles and deep trunk muscles.

 

How long will I have to come to therapy?

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Some patients require just a couple of visits while others require much more. Generally, twice a week for four to six weeks is the time it takes for muscles to gain strength, endurance and coordination. The time needed for therapy will also depend on the complexity of your issue, how your body responds and if you are doing your homework (home exercise program).

Trust the process and be patient with your body!

Postpartum Strong® Workshop!

 

Are you pregnant, postpartum or planning to have kids? 👶🏼🧒🏾👶🏿👶🏻
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Don’t miss out on our first Postpartum Strong® workshop of 2019!
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Our workshops are a great way to get connected with other moms, learn about your amazing body and have an engaging Q & A time! (All those things you wanted to know about bladder leakage, uncomfortable sex, weak abs, back pain, etc!)
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In this workshop you’ll:
🤰🏻🤱🏽 Learn about common concerns & issues faced by women during pregnancy and postpartum.
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💪🏾 Learn how you can regain strength & reduce pain!
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🧘‍♀️ Walkaway with expert tips + exercises!
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✅ Receive a belly, posture & body mechanics check ($45 value)
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Kids are welcome!
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Easy parking!
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Tickets available via Eventbrite 

January is Cervical Health Month

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As you may have figured out . . . we are pretty passionate about the pelvic floor. Yes, January is Cervical Health Awareness Month, but how does it relate to the pelvic floor?
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We know that any condition that causes pain in the pelvic organs (bladder, urethra, uterus, cervix, vagina, rectum) can cause pelvic floor dysfunction, and tense/painful muscles.
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As pelvic floor physical therapists, we are strong advocates for knowledge! The more we know about our own bodies, the better able we are to identify when something is not quite right. 🌸
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Some procedures such as hysterectomy and radiation, can lead to symptoms including pelvic pain, loss of bladder control, overactive bladder, constipation, fecal incontinence, painful intercourse, lymphedema and others. Scar tissue from surgery and tissue changes from radiation affect the ability of the pelvic floor to function normally, and can also lead to chronic pelvic pain. These symptoms can have a huge impact on patient’s quality of life and participation in daily activities.
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Pelvic floor physical therapists are specially trained to work with you and assist you in decreasing and even eliminating these symptoms!