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 

HELP I CAN'T PEE!!!

Here's a testimony from one of our Pelvic Floor patients that was too good to keep to ourselves. 

MY ROAD BACK TO A LIFE

I didn't have a life. That is, not much of one.  Sadly, I'd lost the ability to do many of the things that I enjoyed and that helped make life fun and meaningful. And THAT was because I'd lost the ability to do one of life's most basic tasks...I couldn't pee.

I assume, if you are still reading this, then something similar has happened or is happening, to you.I was in my office when I first realized I couldn't pee. Quite a shock. Quite uncomfortable. Quite a trip to go to the ER and have a catheter installed. That lead to medication to deal with my enlarged prostate that was, apparently, blocking the flow of urine down my urethra. It worked well for many months...until it stopped working well and I was back in the ER. This time my urologist recommended TURP surgery, a laser procedure to reduce the size of the prostate and open things up. Till it could be scheduled I had to wear the catheter. That meant no running, no sports, no working out, difficulty sleeping, occasional discomfort, and walking slowly.

Then I had the surgery and all was well...for about 2 months. And then the same problem returned. My urologist kept saying he didn't understand, the prostate was no longer squeezing on my urethra, it must be that I was doing something wrong, I must be getting too anxious and tightening my sphincter and preventing the urine flow.

So, apparently, it was all my fault for being too anxious. So we tried a few different anti-anxiety medications. I took them and he took the catheter off. And a few days later I couldn't pee and it was back to the ER. After some tests they could find nothing amiss, my urologist recommended redoing the TURP. We did. Nothing got better. By now I was getting recognized on my return visits to the ER.

Life had become nightmarish. I decided to try something different.

I went to another urologist who specialized in difficult cases. He recommended that I learn to self cath when needed. That way I could avoid ER trips and not have to wear a catheter. It was the scariest thing I ever heard of. No way I'd EVER do something like that! But what was the alternative? So I learned it and it was painless and no big deal.

And I told him I wanted to try physical therapy. He agreed and gave me a few names. I called around and that's how I ended up at Duffy and Bracken. Lucky for me!

I began seeing Ann Duffy twice a week. In the evaluation she used a biofeedback mechanism to measure the strength of my Pelvic Floor Muscles. I didn't know I had a Pelvic Floor nor did I know that there were muscles there. Turned out they were extremely weak. She could also measure their ability to relax. Turned out they were not very good at that either. My pelvic floor muscles were under strength and over tense. "You have pelvic floor dysfunction," Ann told me, and traced it back to surgeries I'd had in the area some years ago. She explained that, because the muscles are weak, they had to work extra hard to keep me from being incontinent. As a result they were in a constant state of tension. And that is what lead the muscles to over tighten at the wrong times and prevent me from being able to pee.

We had a theory on what was wrong that went beyond telling me to relax or giving me anti anxiety medications! And that lead to a theory of what would help: Strengthen the pelvic floor muscles and supplement that with relaxation techniques.

So that's what we did. I learned Kegle exercises (though probably not how to spell them correctly) that I did both with Ann and on my own as well as other exercises I could do at home. Using biofeedback we could measure the muscles' strengthening and also see what relaxation techniques worked best for me. We found deep belly breathing did the trick.

Things did not immediately get better. I had to self cath a number of times. Sometimes I felt pretty discouraged and anxious. Ann was encouraging but also action oriented. "What good does getting anxious serve?" she asked once. We got back to the Kegels.

Then things improved significantly! I had a long stretch of feeling fine. When I had a rough few days, Ann quickly figured out the problem...I'd hurt my lower back lifting some boxes I shouldn't have. The muscles there tightened and that caused surrounding muscles to also tighten...including those pelvic floor muscles. So Ann gave me stretches to do and then strengthening exercises for the area. Things have gotten better again.

I think the best thing I can say about my work with Ann at Duffy and Bracken is that it is individually oriented and self empowering. That is, what she did is figure out what was going on with ME and then devise exercises, stretches and relaxation techniques that enable me to vastly improve and, hopefully, remedy the problem. NOT oriented at all (at least in my case) to medications and that is something I think is a very good thing. They almost always have side effects.

Duffy and Bracken is a business and I'm sure Ann is a good business woman. But everyone knows that physical therapy can take a while and that can be expensive and cause people to shy away. But what I found with Ann is that she'll do her best to work with you, to use your insurance, to come up with something fair should the insurance stop helping or be unavailable for whatever reason.

I'm very happy with what I've accomplished with Ann's help. I'm back to my active life. I'm pretty confident that you will improve things, probably greatly, if you work hard and consistently with the folks there.

I'd be happy to talk to you about all this if you think it could be helpful.

Regards, 

Michael Leiman

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