Healthy Bladder Habits for the Active Woman: Understanding Causes and How to Change

In the spirit of National Bladder Health Awareness Month, we just had to reblog this….it’s just that good!

Postpartum Strong®

Scenario 1

For sale: Skinny jeans. BNWT.

It’s time for a night out. The skinny jeans are calling. The form flattering fabric is just hanging there in the closet, brand new with tags (BNWT). So why is the black leggings and shirtdress of choice the 10th time?! Because the shirtdress-legging outfit covers for laugh, cough, lift and sneeze leakage. It’s also convenient for pads or panty-liners. tight-jeans

The type of bladder leakage described above is stress urinary incontinence (UI). Stress UI is common among women, but that doesn’t mean it should be considered normal.  Coughing, sneezing, laughing and lifting are just a handful of activities that put pressure on your bladder.  If this describes you, research has shown that training the muscles down there can help!  Training your pelvic floor muscles reeducates them to turn on at the right time, and in turn strengthens too. The best pelvic floor muscle training…

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ACOG & IPPS Annual Meetings

The American College of Obstetricians and Gynecologists (ACOG) is the specialty’s premier professional membership organization dedicated to the improvement of women’s health. ACOG boasts more than 58,000 members whose activities include producing practice guidelines and other educational materials as it relates to women’s health.



Cora Huitt, PT, DPT, MACT, BCB-PMD, IF attended ACOG’s 2017 Districts I & IV Annual Meeting in Charlotte, North Carolina. This yearly conference hosts some of the leading experts in women’s health, such as Dr. Thomas Barringer, Dr. Kenneth Weeks and Dr. Denise Elser.  Topics discussed included the multi-faceted approach to women’s healthcare, patient safety, transgender patient care, and innovative Urogynecology. Dr. Huitt has been a long time member of ACOG, and always looks forward to attending their yearly conference and integrating new approaches and information into her practice.

Dr. Cora Huitt (left), reuniting with a former student(right), now colleague physical therapist, at the World Congress on Abdominal and Pelvic Pain hosted by International Pelvic Pain Society


The International Pelvic Pain Society is a group of health professionals committed to an interdisciplinary approach to the treatment of chronic pelvic pain. This forum of professionals serves to share ideas and educate the public on how to better diagnose and manage chronic pelvic pain.

Dr. Huitt also attended the World Congress on Abdominal & Pelvic Pain Conference in Washington, DC. This conference was sponsored by the International Pelvic Pain Society, of which Dr. Huitt is a distinguished member.

This year’s conference featured topics such as, approaches for chronic pelvic pain, male pelvic pain, and pain pathophysiology. These new approaches are especially of interest to Huitt, as a large majority of her patient population presents with various pelvic dysfunctions.


Learn more about Dr. Cora Huitt and the diagnoses she and her team treats by visiting:


Pain Meds or PT?

October is National Physical Therapy Month!

In honor of all that physical therapists do in helping their patients reduce pain, we will be discussing how PT can help you reduce the need for pain medication and improve your individual functional outcome.

Dealing with pain of any kind is hard.

Now, let’s talk about pelvic pain. The exact number of people dealing with chronic pelvic pain is uncertain. This is because the pain can be linked to so many different diagnoses and symptoms, such as dyspareunia, vulvodynia, and endometriosis. For this reason, the pain may be misdiagnosed as a variety of other conditions, making it hard to determine just how many people deal with chronic pelvic pain. (1) One study stated that around 15% of women of the child-bearing age in the USA had pelvic pain that lasted around 6 months.

painful bladder


Pelvic floor physical therapy (PFPT) can be a great first intervention or alternative to medication or surgery for myriad conditions including pelvic pain, incontinence, constipation, pelvic organ prolapse, and/or back pain. PFPT is a specialty practice in which a doctor of physical therapy has additional training to concentrate in abdominal and pelvic conditions.


Certain diagnoses can often have musculoskeletal involvement. For a woman suffering from endometriosis, this will cause severe pelvic pain and she will often have connective tissue restrictions, myofascial pain and muscular restrictions in all of the muscles around the pelvis as a result of that pain. In most cases, if the endometrial tissue is removed via laparoscopy, but the soft tissue restrictions remain, pain will not go away. As highly trained specialists, pelvic floor physical therapists can identify and remove soft tissue restrictions, adhesions between organs, and restore normal mobility of the abdomen and pelvis. That is to say, a multidisciplinary approach to pain tends to be the best to help people achieve optimal recovery.

Dr. Casey Smith with patient in room 1

PFPTs usually work very closely with surgeons and urogynecologists to help patients achieve optimal recovery. Surgery will often correct an anatomical problem, but it is important to have improved muscular control and function to help a person attain optimal outcomes after surgery. Research has shown that physical therapy prior to and after surgery improves patient outcomes as well as reduces the need for future surgery.

vag dilators

Constipation is a good example of a common condition that most people treat with medication, however, pelvic floor muscle tightness can be a cause or effect of chronic constipation and can be addressed with pelvic floor physical therapy. We use a variety of interventions to retrain individuals to improve their digestion and evacuation more naturally. The same muscles can also influence your urinary control and sexual function. PFPTs work with your doctor to optimize your recovery to balance medication, behavioral training, nutrition, and pelvic floor retraining



(1) Mathias, S. D., Kuppermann, M., Liberman, R. F., Lipschutz, R. C., & Steege, J. F. (1996). Chronic pelvic pain: Prevalence, health-related quality of life, and economic correlates. Obstetrics & Gynecology, 87,321–327.


National Women’s Health & Fitness Day



National Women’s Health & Fitness Day is observed on the last Wednesday in September. It is the nation’s largest annual health promotion event for women of all ages.


This holiday was started in 2002 by the Health Information Resource Center. You can visit their website here.


Find a park with this helpful search tool from NPR!

Get a group of girls together and go for a run, walk or a fitness class at your local gym!

Get a musculoskeletal assessment! This type of assessment is done by a women’s health specialty PT. They will diagnose and help prevent issues like incontinence, prolapse and low back pain that may require surgery down the road!

Find a big grassy area …. Autumn is the perfect time for a picnic and brisk walk!

Make fun food art!

food art

food art 3


Post a picture of you and your little one exercising together with the tag #postpartumstrong on your social media!

yoga with baby4

Share your inspirational photos of health and fitness and use #WomensHealthFitnessDay and #PostpartumStrong



What is Your Post-Birth Plan?

Many of you saw the article that NPR published some weeks ago (see screen shot below) and were quite shocked by what you read.


Here’s a bit from that article:

“Nearly half of the nurses who responded to the survey were unaware that maternal mortality has risen in the U.S. in recent years, and 19 percent thought maternal deaths had actually declined. “If [nurses] aren’t aware that there’s been a rise in maternal mortality, then it makes it less urgent to explain to women what the warning signs are,” says study co-author Debra Bingham, who heads the Institute for Perinatal Quality Improvement and teaches at the University of Maryland School of Nursing.

Only 12 percent of the respondents knew that the majority of maternal deaths occur in the days and weeks after delivery. Only 24 percent correctly identified heart-related problems as the leading cause of maternal death in the U.S.”

If you missed this article, please take a few minutes to read it here . . . 

Moms are urged to create a birth plan, but what about their post-birth plan?
For example . . .
As an additional response to this article, we wanted to get the perspective of an experienced birth worker who spends quite a lot of one-on-one time with new moms, Sarah Newton – a doula in Richmond, Virginia.

We are in a society that places a lot of attention on baby once baby has arrived. And we think that everything is under control and great because a new mom has her baby. The truth is that mommas are lost in the shuffle. Babies need to be cared for, but if you have a new momma who is well cared for, fed, supported, and educated on what they need to look for and be aware of….I promise you, that baby is taken care of as well, and will lack for nothing. The longer I am a doula the more I see the importance of it.

There are so many important benefits in helping educate and prepare new couples for birth, as well as with hands-on support during labor and delivery. There is a HUGE benefit to postpartum support as well. I have supported 92 families over the last 6 years now, and in that time I have observed a large lack of support after delivery for new moms – or any moms for that matter. They leave the hospital with a pat on the back, as if to say…you can handle it all.

Now, perhaps that is true. Perhaps these moms are extraordinary and they can handle it all. But that is not often the case. They shouldn’t have to be expected to carry the intense emotional load of how to be a mother along with healing a newly postpartum body AND having a tiny new baby to nurture, feed, and care for. Sleep deprivation and the knowledge needed to take care of a tiny new baby at home is, at the very least, overwhelming…so giving new moms easy-to-follow instructions is important.

Specific training on this for nurses is a great idea, alongside a reminder that even though this is a hard topic to discuss with their patients, it’s still extremely important if they truly want those families to have the “happily ever after” they imagine. Educated women are better able to handle things after going home because they were given good information before arriving there.

Having a postpartum doula or an in-home nurse visit new moms shortly after arriving home could really help these statistics as well, because they can ensure they are getting all the help they need. While they are not trained to make a medical diagnosis, postpartum doulas can certainly identify symptoms of postpartum depression or hear when a mom says she’s experiencing XYZ symptoms in her body, and encourage her to contact her care provider or 911.


Sara NewtonSarah Newton is a doula, serving Richmond VA, Chesterfield, Petersburg, Hopewell, Colonial Heights and the surrounding areas.
With years of doula experience, she is ready to support you through your birth journey. She is passionate about guiding women and their families through pregnancy, childbirth, and the post-partum while attending all types of births as a doula! Her goal is to educate, encourage, and support women during this incredible journey to motherhood… Whether it be the first or fifth time…medicated or natural birth….cesarean birth or vaginal birth…whether it is a home birth, hospital, or birth center. Each mother deserves to be unconditionallysupported emotionally, mentally, and physically.
Visit Sarah’s website to learn more about how a doula can support you through your journey of motherhood,


Have something more to add to this response on the NPR article? Let us know your thoughts in the comments section, or write to us at:



When Sex Doesn’t Feel Good . . .

Ladies, let’s talk more about painful intercourse. This topic can tend to be brushed aside and many women may feel too ashamed to bring it up to their doctor or other health professionals. This particular type of pain can cause self esteem and relationship issues. As a continuation to our previous blog post, let’s explore another term used to describe painful intercourse – Vaginismus.

What is Vaginismus?


A vaginal tightening causing discomfort, burning, pain, penetration problems or complete inability to have intercourse. 

The woman does not directly control or “will” the tightness to occur; the tightness is actually caused by involuntary contractions of the pelvic floor muscles surrounding the vagina.  She may not even have an awareness that the muscle response is causing the tightness or penetration problems.

Primary Vaginismus occurs when first trying to insert a tampon or attempting to intercourse.  For some women, Vaginismus occurs after experiencing yeast, urinary tract infection or when having sexually transmitted disease.


Talking to Your Doctor

Introduce the problem: “I have been having problems with pain during sex and hope you will be able to help me.”

Provide a description of the pain (be specific):

  • It happens when…”My partner tries to penetrate me” or “once they are inside and start to move, I feel burning and I tighten up”, etc.
  • The pain is located …”at the entrance of my vagina. My vagina is like a wall; nothing can get in.” or “after something is inside I feel burning just inside my entrance”, etc.
  • The pain lasts…”as long as I keep trying”. Especially mention any past problems: Have you previously had any sexually transmitted diseases, yeast infections, bladder problems or any pelvic pain outside of penetration?


Mention any past sexual abuse.

Traumatic events, past emotional and sexual abuse as well as witnessing violence or abuse may all be contributing factors. Though they may seem unrelated and go unmentioned, these events and feelings are important to mention to your doctor and/or therapist.

Dr. Katherine Bettin specializes in sexual and relationship issues for individuals and couples of all sexual orientations and lifestyles. Her conversation-based therapy has helped countless clients achieve lasting happiness in their personal lives. Dr. Betting is one of the only AASECT-certified sex therapists in Richmond, Virginia.

State what you think the problem is.

“I think it may be Vaginismus. My symptoms are similar to those outlined in an article/brochure I read.  However, I have read there are other things that can cause pain during intercourse and would like to have them ruled out.”

How can physical therapy help with treatment?

  • Progressive desensitization exercises
  • Exercises to control and relax the pelvic floor  muscles around the vagina
  • Soft tissue mobilization with dilators
  • Modalities to increase circulation in muscles
  • Pain elimination techniques

Exercises can be done at home and when practiced regularly results occur over a period of weeks to months 


Vaginismus is considered the most successfully treatable female sexual disorder.  Many studies have shown treatment success rates approaching nearly 100%



Let’s Talk About Painful Intercourse (aka Dyspareunia)

Painful intercourse can be difficult to talk about. If you’re experiencing painful  intercourse, you may wonder if the pain is all in your head or the result of something you’re  doing wrong in bed. After all, sex is supposed to be pleasurable, right?

The truth is that sex isn’t pleasurable or pain-free for all women all the time. In fact, many women experience painful intercourse at some point in their lives, due to muscle tension, dryness, and fragile connective tissue.


Dyspareunia is persistent or recurrent genital pain that occurs just before, during or after intercourse and that causes you personal distress.

Painful intercourse is worth talking about; physical therapy can help you get this very special and important part of your life back.


What is Dyspareunia?

Dyspareunia is pain before, during, or after intercourse.  It may affect 20-50% of women, although this number is likely smaller than the actual number as many women are hesitant to seek medical treatment.

One common cause:

  • Musculoskeletal dysfunction of the pelvic floor: over-activity of muscles of the pelvic floor including the levator ani.
  • Overactivity of the levator ani muscles is a condition in which these muscles do not relax completely or contract when they should relax.
  • Overactive, nonrelaxing muscles are painful to touch, and the pain itself may cause spasms of the levator ani muscles, preventing intercourse entirely.


In other words, it’s like a “charlie horse” in the muscles surrounding your vagina.

How can physical therapy help with Dyspareunia?

  • The goal of physical therapist intervention for   dyspareunia is to reduce vaginal pain by:
  • reducing over-activity of the pelvic floor muscles
  • improving your ability to control these muscles
  • increasing the ability of the vaginal tissue to tolerate a stretch.


Treatments include:

  • manual therapy
  • neuromuscular re-education
  • exercise
  • soft tissue mobilization
  • vaginal dilators.


vag dilators.PNG


Guess what your “private parts” are made of?

Muscles, tendons, ligaments, and bones.  So when a specially trained women’s health physical therapist performs an examination and initiates treatment, she is treating a dysfunction of muscles, tendons, ligaments, and bones.

superficial and deep pelvic floor muscles


What can you expect from your first visit with a pelvic floor physical therapist ?

  • A private, professional, comfortable space.
  • Courteous, professional staff who understand women’s health issues.
  • Women’s health trained licensed physical therapists.
  • A private room.
  • An initial conversation with your therapist where you will have a chance to describe everything you are going through and ask any questions you may have.
  • A physical examination which will first be explained in detail and over which you will have complete control.
  • The latest equipment and products.






“Ouch…My Tailbone Hurts!”

“I’ve heard the term…but what is Coccydynia?”

Plain ‘n simple….it is pain in the region of the coccyx (tailbone). This can happen for a variety of reasons, and is often a cause of post-delivery pelvic pain.

What does the coccyx do and where is it located?

  • The coccyx serves as an attachment site for tendons, ligaments, and muscles.
  • It also functions as an insertion point of some of the muscles of the pelvic floor.
  • The coccyx also functions to support and stabilize a person while he or she is in a sitting position.

coccyx“So, . . . what exactly causes Coccydynia?”

  • Chronic poor posture
  • Sports Injuries
  • Childbirth
  • Obesity
  • Joint disorders
  • Fall or motor vehicle accident with foot on break
  • Lifting injury
  • Repetitive Strain such as cycling, rowing, etc.
  • Constipation
  • Diseases of pelvic organs
  • Sexual Abuse
  • Muscle Imbalance
  • SI Joint Dysfunction
  • Hormonal Changes
  • Scared Adhesions
  • Tumors / Bone Spurs
  • Sciatica
  • Fear, Anxiety, Stress



  • Pain when sitting
  • Deep ache, cramping, or generalized pelvic pain
  • Constipation or incomplete emptying
  • Pain upon transfers from sit to stand
  • Sexual dysfunction
  • Referred pain in SI joints, buttock, groin, hips, lower extremities, perineum, feet
  • Dyspareunia
  • Headaches due to neural/dural tenion
  • Low back pain, Sciatica
  • Pain with coughing




“How can pelvic floor pt help me?”


  • Soft tissue palpation of pelvic joint alignment to identify pain sources and trigger points.
  • Pelvic Floor Muscle Exam
  • Manual Muscle Test (MMT)
  • Posture Exam
  • Mobility Testing
  • Musculoskeletal Screening Exam
  • Soft Tissue Massage
  • Patient Education


  • Electrical Stimulation
  • Muscle stretching
  • Joint mobilization
  • Body mechanics for daily tasks
  • Spinal stabilization exercises
  • Orthotic-sacroiliac joint belt
  • Correct posture
  • Modalities to reduce inflammation
  • Seat Cushions


If Coccydynia sounds like something you are dealing with, give our offices a call to set up an initial evaluation with one of our therapists! 804-282-3500

As an athlete, girls have been told it’s ok if they leak. Is this true?

As an athlete, girls have been told it’s ok if they leak. Is this true?

Performing impact sports such as running or gymnastics can fatigue the pelvic floor muscles that hold the pelvis together and support the pelvic organs. Pelvic floor muscles must be strengthened and work together with the abdominals and deep back muscles.

Can holding your breath contribute to leaking?

Yes. Increasing intra-abdominal pressure will compress the bladder.

Image result for valsalva hold crossfit

Why do women leak more frequently than men?

Women have much shorter urethra than men. The urethra must be compressed quickly (like kinking a garden hose) to close off the tube so urine is not leaked.

How long should pelvic exercises be practiced? 

Pelvic floor exercises are most effective when done for three months. Exercises should be continued throughout life as activities of daily living are performed.

Why does bladder leakage need to be treated?

Female incontinence is embarrassing and can cause emotional distress, which can result in decreased physical activity and social function. The cost of pads is expensive. Women can develop irritation in the region and urinary tract infections.

Image result for sad lady


Is it correct to think that first step to reducing leaking is to cut back on liquids?

No. Decreasing liquids is not a good idea because women can become dehydrated, with an increase in uric acid which can contribute to infection.

Is a side effect of having a baby incontinence? 

Possibly. Pelvic floor muscles are often strained during pregnancy and vaginal birth. Decreased estrogen levels can also reduce the connective tissue thickness reducing the compressive forces on the urethra and the lift of the bladder.

Image result for mom exercising with baby

What types of exercise do pelvic floor physical therapists do?

Exercises include:

  • Training the transverse abdominals, training deep back extensors beside the spine, and pelvic floor muscle to work together when performing daily life tasks
  • Coordinated breathing
  • Bladder retraining to expand the bladder’s capacity to hold urine
  • Urge suppression to reduce leaks. Depending on the individualized exercise program tailored for each woman, the sessions are typically 8 visits of 45 minutes over a 6-8 week period
  • Timed voids, which is slowly increasing time intervals between going to the bathroom

What other treatments are available?

  • Electrical stimulation (often covered by insurance)
  • Surgical procedures
  • Medication (even though the medication action can be helpful, sometimes side effects like dry mouth can be bothersome)

Why do women feel a strong urge to urinate or even leak when she sees a toilet, or walks into the door of her home?

A person can develop a conditioned response associating the toilet with the need to urinate.


Why Didn’t I Know That 1 In 4 Women Leak?

We asked women to send us their most frequently asked questions about bladder issues and leakage . . . so by popular demand, here they are!

The answers here are brief. For a more in-depth look at these issues, use our search tool to find specific blog posts on topics such as, “frequent urination”, “stress incontinence”, “pelvic floor”, etc. 


What is bladder leakage?

Bladder leakage (urinary incontinence) is the involuntary leakage of urine. This may happen when running, jumping, coughing, laughing or may have without any apparent reason.

When do women leak? 

Women most commonly leak during and after pregnancy, menopause, post radiation for breast or uterine cancer, when performing athletics and during intercourse. Some other medical conditions like painful bladder syndrome, neurological conditions such as multiple sclerosis and vulvodynia, can also cause incontinence.

Are there different types of incontinence?


  • stress incontinence – leakage while laughing, coughing, sneezing and jumping
  • urge incontinence – strong desire to urinate when bladder is empty and increased frequency but small volume
  • mixed incontinence – combination of urge and stress incontinence

Image result for mixed stress urge incontinence

What causes bladder leakage?

Loss of bladder control or poor strength, endurance and coordination of pelvic floor muscles. Pelvic floor muscles contract to support and lift the bladder in good position and close the urethra.

Isn’t leaking a normal part of aging?

40 million women between the ages of 18-45 live with incontinence. Urinary leaking should be treated as soon as it begins. Leaking is common but not normal.

However, women over 80 years old suffer due to aging muscles, decreased estrogen and slowed nerve transmission.

How can a woman tell if she is doing her pelvic floor exercises correctly?

Education about anatomy/physiology and specialized equipment, like ultrasonography, a squeeze pressure gauge or an Educator can display correct muscle contraction. Exercises done correctly contribute to 70% improvement in symptoms of stress incontinence. Improvement has been seen across all age groups with a supervised exercise program by specialized physical therapists or continence nurses, versus leaflets or unsupervised exercise.

Image result for pelvic floor exercises

Do I have to put up with incontinence?

No. Whether you are a teen or a mature woman, specific muscle training from a specially trained women’s health physical therapist can be most effective. The Agency on Healthcare Research and Quality endorses such behavioral therapy.


Hope this Q&A was a helpful and informative read! We will have a continuation of this series of frequently asked questions in a follow up post next week!

Do you have a burning question that you don’t see answered here? Send it to