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

  

Protecting your package

Testicular Pain in Men after exercise

There is no denying the numerous benefits that exercise has to offer. It helps to increase your energy level, improve muscle strength and helps to maintain a healthy weight just to name a few. For some men a high impact or high intensity workout is your way of reaping those benefits. But as a physical therapist who specializes in Pelvic Floor dysfunctions, I remind my patients to protect your package.

What do I mean by that? Some of these high intensity or high impact exercises can lead to testicular and groin pain in men. It can be accompanied with symptoms of increased urinary urgency, frequency, difficulty to initiate urination, painful intercourse and constipation. Plus there can also be some abdominal pain or discomfort.

Although, it is important to rule out more serious causes like a hernia, testicular torsion, epididymis etc. often times the injury is from a musculoskeletal cause such as abductor muscle sprain, strain, pelvic floor muscle injury or spasm which can be aggravated by heavy exercise. There can also be altered body mechanics or posture which can put your muscles in compromising positions which make you prone to injury.

So What Do You?

• Visit your doctor to rule out serious pathology
• If there is a sprain, strain or pelvic floor spasm, visit a physical therapy clinic with a pelvic floor PT. 
• Wear cotton breathable supporting underwear to reduce irritation from sweat and help minimize excessive movement 

Here are some stretches that might help you if tight abductors or your pelvic floor is the cause:

Butterfly Stretch

Happy Baby

Frog Stretch

Piriformis Stretch 

What we do at Duffy and Bracken 

• We are a team of sports, orthopedics and pelvic floor physical therapists who follow a team approach to use our skills to your benefit
• Our Pelvic Floor physical therapists work with you for pelvic pain and urinary/constipation symptoms
• You are assessed for proper mechanics and posture using wearable sensor technology called dorsaVi
• We help to improve your movement patterns to eliminate the cause of pain and/or injury

Bhavti Soni, PT
Pelvic Floor Therapist
bhavti@duffyandbracken.com

Top 7 Reasons EVERY Woman Should See A Pelvic Floor Physical Therapist After Having A Baby

This likely doesn't come as a surprise to you, but when it comes to women's health, the US is pretty far behind the eight ball. While we do have extensive measures in place to help ensure a safe gestational period and delivery, our healthcare system does very little in the way of caring for women following childbirth. In fact, our society has virtually taken the opposite stance, writing off those post-partum pathologies as normal, or part of the territory, thereby convincing women that they don't actually need to seek medical guidance. This couldn't be further from the truth. 

Childbirth is an extremely traumatic event for a woman's body. During a vaginal delivery, the muscles of the pelvic floor are significantly stretched and can tear. Cesarean deliveries decrease tearing at the pelvic floor, however the muscles of the abdomen do not fare as well as they are cut and stretched to allow the baby to be retrieved. Let's also not forget the 40 weeks during which the pelvic floor muscles need to support the weight of that growing baby. 

Enter pelvic floor physical therapists. As explained on my website, TheMovementMaestro.com, a trained pelvic floor therapist is able to evaluate your pelvic floor via an internal and external exam and assess muscle function directly. Additionally, pelvic floor physical therapists understand the relationship between the pelvic floor and the rest of the body, therefore making them well-suited to identify how dysfunction at a different part of the body could cause pelvic floor dysfunction and vice-versa. 

More specifically regarding the aftermath of childbirth, pelvic floor physical therapists, unlike the doctors delivering your baby, are concerned with YOUR functionality, YOUR ability to return to all the tasks required of you on a daily basis, and getting you back to doing all the things that YOU enjoy doing. If I haven’t convinced you yet, here are 7 reasons why EVERY woman should meet with a pelvic floor physical therapist, even if it’s only once, after having a baby.

 1. You and your baby shouldn’t be in diapers at the same time.

Although urinary incontinence is common both during and following pregnancy, it is NOT normal. Most women will either be informed by a health care provider that incontinence will go away on its own and to not worry about it, or they will be welcomed into the sisterhood of mothers by a female relative or friend with the sage advice that incontinence is part of having a baby and to just accept it. The only truth regarding these statements is that every time one of these phrases is uttered, a kitten dies. Incontinence indicates pelvic floor dysfunction. While it may resolve over time without formal intervention, the pelvic floor generally remains weak and is working on reserve capacity. To that end, it's not uncommon to see this incontinence returning down the road or following subsequent deliveries. Additionally, urinary incontinence isn’t the only type of incontinence caused by a dysfunctional pelvic floor. Two words for you, ladies: fecal incontinence. Pelvic floor physical therapists treat both urinary and fecal incontinence, often achieving full resolution of symptoms. Save the Huggies for your kid and get in to see a pelvic floor PT.

 2. Sex isn’t supposed to hurt.

Tearing is a very real part of childbirth, with the aftermath being scarring and tightening of tissues of the pelvic floor. Additionally, hormonal changes can lead to vaginal dryness. A pelvic floor physical therapist can work with you to decrease scar tissues, loosen tight muscles, and give you helpful hints on how to get your groove back. 

 3. Your organs should remain on the inside of your body.

The trauma and weakening of tissues that is associated with carrying and delivering a baby can cause what is known as pelvic organ prolapse. In layman's terms, this is when your insides end up on the outside. A falling or sliding out of place of the vagina, uterus, urethra, or rectum can occur, and can vary in severity from slight descent where the organ remains inside the body, to full prolapse where your organs are resting on the treatment table. Google it. It's real. Pelvic floor therapists can not only identify and assess a prolapse (many women don't even know they have the early stages of this), but they can provide exercises to prevent or improve this condition. Hint: there's more to it than just kegels. 

 4. Your belly button should be the only "hole" in your belly. 

As the abdominal muscles stretch during pregnancy, a split can develop at the central connective tissue of your six-pack. This connective tissue is known as the linea alba, and when it separates, it is referred to as a diastasis (di-as-ta-ses) recti.  I'm not sure that I need to go into detail as to why having a hole in the middle of your abs is bad, but let's start the list with back pain, core weakness, and breathing dysfunction to name a few. Like incontinence, diastasis recti a very common occurrence, however, it's advisable that you meet with a pelvic floor therapist so s/he can asses the size of it  (in finger-widths) and recommend not only exercises to help it close, but movements and activities to avoid so as to prevent it from getting any bigger. 

 5. Walking and exercising shouldn’t make you feel like your pelvis is going to break into a million pieces.

Many women experience pelvic and low back pain during pregnancy secondary to hormone-related changes that cause laxity in the pelvic ring. Most women think that this pain will automatically go away once that 8lb baby is no longer inside of them. Fast forward a few months and these same women want to kill their partners for helping them get pregnant once they realize that childbirth does not magically rid them of all of their hip/pelvis/low back pain. Pelvic floor physical therapists can help...a lot. Soft tissue techniques, exercises, movement modifications, the list goes on and on. PTs can help with the pain and get you back to being you. 

 6. C-sections are no joke.

Far too often I hear women say they want to schedule a c-section and avoid the aftermath of a vaginally delivery. Clearly these women have never spoken to anyone who has actually had a C-section. The trauma experienced by the abdominals during a C-section is significant, and often renders a woman unable to do much of anything for a few weeks. Imagine having your abs and uterus cut open, your insides sifted through like a game of hide and seek, a 7lb baby pulled out through a 4-inch incision, and then everything sewed up. I really can’t imagine doing much more than blinking my eyes after something like that, nevermind coughing, sneezing, pooping, or taking care of a human life. Pelvic floor physical therapists help women deal with what comes after the c-section, from regaining abdominal strength to preventing back pain and scar adhesions in the future.

 7. Kegels don’t work if you do them wrong. 

I have plenty of moms coming into my office telling me how their incontinence never went away even though they tried doing kegels a couple of times. Here’s the deal: 1) If you’re not performing a kegel correctly, utilizing all the layers of the pelvic floor (wait… there’s more than one layer? More on this in upcoming posts), and getting a full 360 degree contraction, you’re squeezing in vain. 2) The pelvic floor works in conjunction with the rest of your ‘core’, and requires not only the participation of the rest of those muscles for proper functioning, but correct pelvic alignment. Long story short, there’s more to it than just kegels. Let a pelvic floor physical therapist assess your ability to perform a kegel and then instruct you on functional exercises to help facilitate normal pelvic floor function.

I realize that once you have a baby you have very little time to take care of you. That is even MORE of a reason to get in and see a pelvic floor PT. A therapist can and will work with you to educate you on things to avoid and empower you with the knowledge of how to TREAT YOURSELF. Additionally, most therapists are super understanding and are more than willing to having you bring in your baby with you if childcare is an issue. Pain, dysfunction, and wetting your pants does NOT have to be your reality following child birth. Pelvic floor physical therapists are here to help. To locate a pelvic floor physical therapist in your area click here.

C. Shante Cofield, PT, DPT, OCS, CSCS 

Shante@duffyandbracken.com

P3 Pregnancy Program: Don't Become A Statistic!

P3 is a program I developed after my first pregnancy to help women achieve their full potential as moms to be and new moms!

Let's back track a few years, after I gave up my stint with the sports world where I spend almost a decade of my career......and settled into my current Downtown NYC clinic!

Every day we saw women for pregnancy related headaches, shoulder, back and knee pain and then two years later I found myself pregnant...... and I decided "NOT ME", I'm not becoming a statistic.

So the P3 pregnancy program was born four months after the birth of my first child and of course I repeated the program again when I had my second.  

So come along with me on this journey through my blog where I will share tips, secrets, and honest truths plus teach you how to have the best pregnancy journey ever!  

Stay tuned and check out an overview of the program below.

Renuka Pinto, MPT, PGDR, CSCS, CES

The P3 Method: Plan, Prepare, Prevent

The P3 Method is tailored to your particular needs and is even covered by some health insurance plans. The class is held by appointment only, and can be scheduled at your convenience.

Your custom program may include the following:

MANUAL THERAPY

One-on-one, hands-on approach to address musculoskeletal changes

PELVIC MUSCLE RE-EDUCATION

A technique that uses computerized equipment to measure baseline pelvic floor strength at onset of pregnancy and then re-train pelvic floor post delivery

PELVIC FLOOR EDUCATION

Kegel and breathing techniques to facilitate integrity of pelvic floor

POSTURAL RE-EDUCATION AND MOVEMENT TECHNIQUE

A visual and proprioceptive feedback is utilized to adapt to bodily changes

 

STRENGTH BUILDING

GRAVITY small-group personal training is a non-impact tool to help build muscle strength and cardio efficiency

CUSTOM SHOPPING

Individualized education on baby products in relation to your body type and muscle strength (e.g. sling versus carrier)

BABY TRAINING

Specific stretches and strengthening exercises to prevent post-delivery musculoskeletal breakdown when caring for your newborn

GETTING YOUR BODY BACK

Post-delivery exercise program to get back to your pre-pregnancy weight

Q&A

Tips on how, what, when, and where while pregnant, immediately postpartum, and post-labor

© Total Gym

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