What you should know about Prolapse

Prolapse is a common issue post partum that is not talked about enough. The definition of prolapse is “a protrustion of bladder, uterus and/or rectum into the vaginal wall”. This commonly occurs during pregnancy, labor or with chronic constipation. Common symptoms are a feeling of pressure or falling out in pelvic floor, sexual discomfort and/or incontinence. These symptoms typically get worse in the afternoon or evening time and feel better in the morning.

The first thing you should know about prolpase is that it happens at varying degrees and being aware of your degree of prolapse is /the first step! Yes, prolapse can get so bad that the protrusion into the vaginal wall extends outside of your vaginal opening, BUT just because this isn’t happening to you doesn’t mean you don’t have prolapse. There are things you can do NOW to prevent your prolapse from getting worse and to limit your symptoms.

I frequently have patients coming for incontinence, pain or weakness and during the initial assessment I find they have a prolapse and no one has told them. That’s great they are in my office to learn what to avoid and how to “treat” their prolapse, but what about all the others who aren’t getting to a pelvic PT? They are being told its okay to resume normal activity and even worse RUN, not knowing they could be making their prolapse worse!

Here is what I tell my patients:

-          Your pelvic floor is under the force of gravity when standing and sitting; you need to lie down (even better on an inversion wedge) to give your pelvic floor a break.

•  In the first 3 months post partum I recommend doing this every couple hours or as soon as you feel “pressure” symptoms returning.
•   Remember if you are baby wearing then this will increase the pressure on your pelvic floor which can worsen prolapse; this includes carrying an older sibling too!  So be even more mindful of “pressure” symptoms and lie down when needed. I found this much more difficult after my 2^nd was born because all of my “down time” from the baby I spent with my 2 year old. Bottom line- make sure you are listening to your body and taking care of yourself!
•  Kegels are great for strengthening your pelvic floor and vaginal wall which will give more support to your prolapse. Do 80-100 kegels a day and even better do them lying down or on an inversion wedge.  If you still have prolapse symptoms on a daily basis then do not run or do any impact sports; this will likely worsen your prolapse.  
  
•  Keep focusing on kegels and inversion! If you get to 6 months post partum and are still having symptoms see a specialist to discuss a pessary. A pessary can help your symptoms and allow you to return to exercise such as running.
• Do not strain on the toilet!

           

            Candice Amat, PT, DPT

               candice@duffyandbracken.com

  

Six Reasons to See a Pelvic Floor Physical Therapist Postpartum

Having a baby is a joyful and fulfilling experience but also can take a heavy toll on your body. Growing and carrying a baby for nine months followed by delivery might cause new aches and pains that a Pelvic Floor Physical Therapist can help you address. 

Here are six reasons you may need to see a Pelvic Floor Physical Therapist postpartum

1.      Musculoskeletal pain

-          Growing and carrying a baby for 9 months really can take a toll on our musculoskeletal system. Some common postpartum issues include: tight hip flexors, poorly activating abdominal muscles, low back pain and instability through the pelvis.

2.      Weak Pelvic Floor Muscles (PFM)

-          Pelvic floor weakness can lead to symptoms such as poor or weak orgasm, urine leakage and/or a feeling of “falling out” vaginally.

3.      Prolapse

-          “falling down” or “downward displacement” of the bladder, uterus and/or rectum

-          This can happen in varying degrees and symptoms can include “falling out” feeling vaginally or even vaginal tissue extending externally.

4.      Diastasis Recti

-          The separation of rectus abdominis muscle which can happen during pregnancy.

-          You might notice you have this if you attempt to do a crunch and see a half football shaped bulge vertically on your stomach.

5.      Incontinence

-          Urine leakage, a common compliant post-partum, is another reason to see us!

-          Prolapse, weak PFM and poor neuromuscular control of PFM can all cause this annoying symptom.

6.      Scar sensitivity

-          A sensitive scar can be the cause of painful intercourse, can limit your ability to perform a kegel and/or can cause tension in pelvic floor muscles leaving you with pain.

We, at Duffy &Bracken PT, have the skill set and tools to help you feel like yourself again. We use biofeedback equipment to measure pelvic floor muscle strength, manual skills to treat pain and our skill and experience to teach and encourage you along the way. Let’s not forget what our bodies went through over the last nine months! We need to take care of ourselves and be proactive about our health and wellness; after all we are now responsible for a little one. See you soon!



Candice Amat, PT, DPT

Ladies, Listen Up, Do Your Kegels!

I used to think kegels were for women with 5+ kids.  An up close and personal journey has taught me that, nope, they are for women just like me! I am a physical therapist recently moved from Orlando, FL to New York for my husband’s job transfer, and decided to venture into the “pelvic floor world” of therapy. I am a very active person, I go to the gym 4-5x a week with a variety of cardio and weights, and had an uncomplicated vaginal delivery two years ago.  

 As part of training for my new pelvic floor concentration, I used biofeedback equipment to test my kegel strength and coordination. While I wasn’t expecting high scores, I was shocked to see my poor attempt at a kegel looked more like a muscle twitch on the biofeedback graph.  And to top it off, I used every muscle in my lower body to get a whopping score of 9! Just to give you a frame of reference, that is about 25% of the normal value for women. I have since devoted 20 minutes a day to kegeling and am happy to say my scores are climbing quickly and are now around 25.

I should point out that I had absolutely no symptoms of incontinence, and therefore if not a PT would have never sought out pelvic floor therapy. I am very fortunate to have discovered my weakness prior to symptoms, because with my 2^nd pregnancy in progress and such poor pelvic floor strength, I would say incontinence was in my near future! I have since started telling all of my family and friends to do their kegels! And with talking about kegels I have found that a lot of women had the same ideas that I did. “Those are for my grandmother!” “That just comes with pregnancy” “Incontinence runs in my family.” And my favorite one from my mom: “You’re a physical therapist, so why are you teaching people to kegel? And how exactly are you doing this?”

I use my personal story as an example of why women should be proactive about their health. Let’s stop dismissing incontinence as just one of the effects of pregnancy or age, it doesn’t have to be! Your pelvic floor muscles are just like any other muscle; they need attention, time and consistency. And, yes, physical therapists treat pelvic floor muscles just like any other muscle in your body. If you’re a numbers person like me, call our office and schedule an appointment with one of our pelvic floor therapist and get your baseline scores and set goals for yourself. Or just start kegeling! You can start with quick contractions x 20 reps and endurance contractions up to 10sec x 10 reps and repeat this 5-10x a day. You can do it on your commute to work, while you watch TV, shower or at the gym.

 

 

 

 A quick summary:

 What is a Kegel?

·       A contraction of the pelvic floor muscles

 Purpose of the Pelvic Floor

1.    Support- acts as a sling or “hammock” to the bladder, uterus, intestines

2.    Sexual function

 Importance of a strong Pelvic Floor

1.    Supports healthy pregnancy, successful birth and minimizes postpartum complications

2.    Increased sexual pleasure

3.    Minimizing problems with urinary incontinence

4.    Decreasing risk for prolapse

                         

    

Candice Amat, PT, DPT
212-402-5430 

Sex & Your Pelvic Floor!

Did you know that physical therapy can help your sex life??

Duffy & Bracken, PT has a unique specialty called Pelvic Floor Physical Therapy that can benefit both men and women. There are very few physical therapy clinics that specialize in this and Duffy & Bracken was one of the first to do so. Not to mention, we now have 20 years experience in this area. 

Painful sex is NOT normal!! Many people experience ongoing pain during sex, and the longer they let this go on, the more chronic and stubborn it may become. We all know that a woman’s first sexual experience is often painful because the hymen, which is very sensitive may still be intact. Anything from tampons to GYN exams (with a speculum) or physical activity before intercourse may have widened the hymen. However, some women are unable to use tampons or have sex due to extreme sensitivity, pelvic muscle spasm or nerve pain-neuralgia. Fear-avoidance also adds to this problem since fear acts like cement to pain and makes it difficult to overcome. Understandably, everyone is afraid of pain but understanding where the pain is and why it’s there, in addition to learning techniques to decrease it; can slowly stretch the vaginal opening allowing you to have pain free intercourse. This process can be quite quick if you do your homework, and usually resolved in 6 to 12 visits or sometimes even less! Even chronic cases sometimes resolve quickly especially if you work at it with your therapist.  

Pelvic Floor conditions do not only affect women. Men who have pain with ejaculation may have painful or trigger points in their pelvic floor muscle (PFM) that can be treated with retraining and massaging of the muscle. Additionally, getting education that explains 'pain' can aid in reducing the fear and hopelessness that sometimes accompanies pelvic pain.

Pelvic pain and dysfunction may also cause urinary and bowel problems or vice versa since the pelvic floor controls voiding. Poor posture and muscular skeletal problems involving the back, pelvis, sacrum, coccyx (tailbone) and hips, can also be a cause or a result of pelvic dysfunction - or as we like to say the 'culprit or the victim.' 

Likewise, women may experience pelvic pain during or after menopause as we lose estrogen and the pelvic floor muscle thins and atrophies (muscle gets smaller). Men lose testosterone around age 60 and sexual dysfunction may accompany this. Strengthening the pelvic floor muscle can help keep and sustain erection plus improve orgasm for both men and women.

There are many reasons to keep the pelvic floor muscle healthy including: pain free sex, better orgasm, and improved sexual stamina. Not to mention, a healthy pelvic floor also prevents: prolapse (the bladder and cervix can fall out of the vagina), incontinence (leaking of urine or feces), and flatulence (gas). It also improves posture and results in a flatter stomach, as the pelvic floor muscle works together with the transverse abdominis (which holds the belly flat).   

Medical terms used to describe these problems include: pelvic floor dysfunction, dyspareunia, levator ani spasm, vulvodynia, vulvar vestibulitis, vaginismus, and erectile dysfunction. These conditions may accompany: coccydynia, low back, sacroiliac or hip diagnosis, urinary or bowel frequency, constipation or irritable bowel or bladder disorder, interstitial cystitis, and post-partum scars from tearing during childbirth.

Let us help you with these very personal problems today. So get a move on receiving help or recommending anyone you know to a specialized PT. We will make you feel comfortable in more ways than one!

Ann Duffy, M.A., P.T.

Owner & Pelvic Floor Expert