Monthly Archives: April 2015

Do men have pelvic floors too? The truth about 10 common pelvic myths

Earlier this week, I asked the Twitter and Facebook PT world a simple question:

What are the common misconceptions you hear about the body?

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My initial goal was a fun blog post on common misconceptions about anatomy, etc…but I was not prepared for the huge response I received—over 40 responses with SO many different things that people often misunderstand! Some pelvic, some general—and it made me realize there is SO much bad information out there!! So, what once was one post will become two. Today, we’ll hit on 10 common myths related to the pelvis (you knew I’d start there!). Then stay tuned for a future post hitting other misconceptions related to…well… the rest of the body, fitness, wellness, pain etc.  So, here we go:

1. Men don’t have pelvic floor muscles: They do, I promise. And guess what? The anatomy is not quite as different as you would think! The same muscles that contribute to urinary, bowel and sexual function as well as lumbopelvic stability in women do that in men too. Pelvic PTs treat men with incontinence, pelvic pain, constipation, painful sexual intercourse and much more.

 2. Vaginas need a lot of work to keep clean. No, they don’t. The Vulva (vagina really just refers to the canal itself) is actually self-cleaning. It does not need to be scrubbed with soap. You can totally just shower and run water over it, and it will be just fine. In fact, scrubbing the vulva can irritate it and even kill the good bacteria that prevent infections! I could say so much more, but you really should just read this article on Pelvic Guru by Sara Sauder, PT and this one by Dr. Jen Gunter.

 3. Abdominal pain is always caused by organ problems. Not necessarily. Now, don’t get me wrong, abdominal pain can definitely happen with ovarian cysts, appendicitis, constipation, and much more—but abdominal pain can also happen when the organ is not to blame. This is so common in men and women with chronic pelvic pain. These people often will have very sensitive nervous systems, tender muscles around the pelvis and in the pelvic floor, as well as even neural irritation (lots of nerves run through the abdominal wall!). So, if the organ has been ruled out as a source of pain and the pain persists- it may be worth considering something different.

4. Not having enough sex OR having too much sex OR masturbating too frequently causes pelvic pain. I cannot tell you how many times I have had a patient timidly ask me if there sexual habits or frequency are to blame for their pain. No. Just no. You should be able to have sex as little or as frequently as you want without any problems or pain. Now, being forced to have sex—that may cause a strong protective response of the pelvic floor muscles. But, consensual sexual activity is normal and should be enjoyed by all without worrying about pain. And if you are having pain? Don’t ignore it– go talk with your physician or physical therapist!

 5. Tight pelvic floor muscles are healthy pelvic floor muscles. Guess what? Tight ≠ strong. Flexible ≠ weak. Strong ≠ Well-timed. Functional pelvic floor muscles are non-tender, flexible muscles that are able to activate when they should activate (well-timed). We want the pelvic floor to stretch to allow you to poop and have sex, and we want the muscle to activate at the right time with enough strength to help you not leak urine when you cough.

6. If the doctor says “all looks good” 6 weeks after having a baby, it means your body is completely back to normal. Newsflash here, you’re body isn’t really going to go back to being exactly what it was like before the baby. It’s not meant to, and that is ok! It can still be an awesome, strong and well-functioning body– but you do need to take care of it. Remember that urinary or bowel leakage, constipation, persistent low back/pelvic pain, vulvar pain, and pain with sexual activity are NOT normal. If “all looks good” at 6 weeks, but you are having these problems, find a skilled pelvic PT near you to get evaluated and get some help! And even if you are not having these issues—your body has been through a lot! Take time and care in slowly getting your body back into good movements. Also, check out this article by Ann Wendel, PT on 5 myths surrounding the pelvic floor after pregnancy.

 7. If a woman had a c-section, her pelvic floor was not impacted, and she doesn’t need to think about it. Guess what the biggest risk factor for urinary incontinence is? PREGNANCY. Although mode of delivery is important, simply being pregnant and carrying a baby puts significant pressure on the pelvic floor. Both vaginal deliveries and c-sections impact the body—remember, a c-section cuts through the abdominal wall! Remember that team of muscles that work together for lumbopelvic stability? The abdominal wall is a KEY member. Regardless of your mode of delivery, seeing a skilled physical therapist after having a baby is crucial to help your musculoskeletal system function optimally, manage unwanted pain or leakage, and get back to the fitness activities you enjoy. And guess what? It’s standard care for all ladies postpartum in many countries around the world.

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8. Urinary incontinence is always due to a weak pelvic floor muscle group. I wrote a whole blog on this one, so I recommend you read it here. The short answer is, No. No problem is due to solely one muscle. Our body is a system, and we have to always treat it like that.

 9. Hips and sacrums dislocate regularly in some people. This is such a common one too—I’ll have patients come in and say, “My hip keeps ‘going out’ and I have to do this <does weird hip movement> to put it back in.” OR “My SI joint keeps ‘popping out of place.’” Let’s all be honest about this- dislocations of joints do happen, but it tends to be pretty painful, likely traumatic, and if your hip dislocates, you bet you are going to the ER. That “pop” you hear? It’s likely just a joint cavitation- basically a decrease in pressure causes dissolved gasses in the joint fluid to be released into the joint. Same thing happens when you pop your knuckles. If it happens frequently and is associated with pain, talk with a physical therapist.

10. Sucking in the stomach constantly creates a strong “core” and a flat abdomen. You know what creates a flat abdomen? Eating healthy and exercising regularly. Contracting any muscle constantly is not functional, nor does it really do what we want it to do. Sucking in the stomach actually tends to make it more difficult for your diaphragm to move well when you breathe and also can cause the pelvic floor muscles to over contract and become tender/uncomfortable. It can also inhibit movement, and we know moving well with variety is SO key to a happy body. So, relax your stomach and allow yourself to breathe (remember how important that diaphragm is!)

I hope you gained a little insight with this list—it was fun to write! This is by no means an exhaustive list (over 40 responses, remember?), and I’d love to keep the conversation going! Special thanks to my world-wide pelvic health team! It’s so fun collaborating with such a great group!

Have you heard anything else about the body that does not seem to be right? Ask here and we’ll do our best to answer! Physical therapists out there—what are your other favorite myths to de-bunk? Let’s all work to spread accurate knowledge—knowledge really is power! Have a great Wednesday!

~ Jessica

Sex, drugs, and… no poop?

Really, I could have left off the “sex” at the beginning of the title… it would be more appropriate to the topic by saying “no sex” for reasons you will see…but I just couldn’t. The title was too great. So, there you go.

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So, leaving out the “sex”- what do drugs and “no poop” have in common? Actually, a lot. Constipation is a common side effect or adverse reaction to many medications. I see this all the time when working with men and women for pelvic floor problems, as well as common orthopedic complaints. The problem is, many people do not really know how to handle it since stopping the medication would lose the benefits of the medication. Constipation is really the worst– pooping is one of those things many of us take for granted, but I’ll tell you, when things aren’t running smoothly, it truly impacts a persons quality of life. (see what I did there?) So, first, let’s go through what medications are known to have constipation as an adverse reaction/side effect:

  • Anticholinergics: These medications block the action of acetocholine in the brain, which basically decreases the involuntary movements of muscles. As a pelvic health PT, I generally see my patients with overactive bladder problems and urge related incontinence using these medications (detrol, ditropan, vesicare, oxybutnin, toviaz) as these medications can decrease the contractions of the bladder muscle. There are lots of other reasons a person may use other kinds of anticholinergics, and this website gives a good summary with a list of medications included in the group.
  • Opioids: Many people are familiar with these medications and know them as the strong pain medications (morphine, codiene, oxycodone). These medications block receptors in the brain, but also have strong constipating effects in many people.
  • Benzodiazepine derivatives: These medications impact the nervous system, and are commonly taken by people with anxiety/panic disorders and for sedative purposes. Some of the more common ones are xanax, valium, and ativan.
  • Antidepressants: These medications are of course taken for improving depression, but also can be used to help with chronic pain or certain pain disorders (like vulvodynia or fibromyalgia) due to the mechanisms of these medicines. Common antidepressants include cymbalta, amitryptiline (elavil), wellbutrin and effexor.
  • Propionic Acid derivatives (NSAIDS): Yep, this fancy name includes the common OTC medications ibuprofen and naproxen, as well as several other medications. Tricky thing here is that another more common adverse reaction of these medications is diarrhea– we see this type of thing happen all the time– so know that the GI system can be affected, one way or another. Constipation as a side effect happens more commonly in older adults.
  • Other: This is by no means an exhaustive list-– if you think your medication may be causing you some unwanted side effects, research the medication on a website like drugs.com. This website also has an interaction checker, which is SO important.

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So, what can you do if a medication is contributing to constipation? 

1. Talk to your prescribing physician: No, stopping the medication is not always the answer! If you just started the medicine and are noticing a change in your bowel function, I recommend talking with your prescribing physician to discuss the symptoms you are having and discuss alternatives medication options. I often will have patients who will stop a medicine if they notice side effects without allowing their provider the opportunity to help them! Remember, there are often several medications which can provide a similar benefit! You may not react as strongly to one vs. another.

2. Develop stellar bowel habits: We’ve talked about this in the past, and it’s always important, but I would argue it’s even more important when you have something working against you.

  • Eat a healthy diet with plenty of fiber-filled fruits and vegetables
  • Aim to get some level of physical activity each day– even a short walk around the neighborhood can help so much with bowel regularity!
  • Drink plenty of fluids, mostly water!
  • Keep consistent! Eat meals/snacks regularly and at similar times every day to help stimulate the normal colon reflexes.
  • Use optimal positioning on the toilet (squatting!) and make sure to relax, breathe, and spend a few minutes allowing your bowels the opportunity to empty.
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Image from my good friends at http://www.squattypotty.com–check them out!

3. Consider a little short-term help if you need it!  I’ll be honest– I don’t love long-term laxative use. My preference is always to try to help the body in a more natural way if possible. That being said, there are times when a short-term helper can be so important! I always recommend that my family members (names shall remain anonymous) use miralax (an over-the-counter osmotic laxative) during recovery from surgeries to help combat the side-effects of pain medications. A fellow pelvic PT used a laxative for a short period of time while she was pregnant because she had a difficult time getting the constipation under control. This can sometimes be super helpful! I always recommend talking with your physician and getting a good recommendation for something to try to help if it is needed.

I hope this is helpful! In conclusion, I just want to reiterate– communication is always SO important between the patient and ALL health care providers. If you are having undesirable side effects from a medicine, call your physician! Talk to your pharmacist! And develop amazing, awesome, and smooth bowel habits :).

Happy Wednesday!

~ Jessica

TBT: 4 Children’s Books to Improve Your Child’s Bathroom Health

I know it’s been a while since I had a good throw-back for you of an old post— this one was written just last fall about books I love for the kiddos I treat! If you are new to the blog, you may now know that along with treating adults, I also treat children with bowel and bladder problems in physical therapy. I had a great meeting yesterday with a local pediatrician. Along with talking about treating children for constipation, bed-wetting (enuresis) and other bladder problems, we also talked about children’s books! I promised I’d share some of my favorites with him, so thought you might as well benefit too! Hope you enjoy! 

First, let me say that I LOVE children’s books. I love the photos, the stories, the fantasy–I have many wonderful memories of my mother and father reading classics like Goodnight, moon!, The Rainbow Fish,and  Alexander and the Terrible, Horrible, No Good, Very Bad Day. Maybe that’s why I loved seeing all of the children’s books specifically written to help kids with bathroom health. Regardless, here we go– 4 books to improve your child’s bathroom habits (in absolutely no particular order).

1.) Everyone Poops by Taro Gomi

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What child doesn’t love a book with the word “poop” in the title? Everyone Poops is perfect for the child who is embarrassed of having to have a bowel movement. Although embarrassment may not seem like a big deal initially, it is important to recognize that for some children, embarrassment could be the start of a pretty big problem. Often children who are embarrassed to have a bowel movement will develop chronic holding patterns which can create painful hard stool, bowel leakage, and difficulty having bowel movements. I love Everyone Poops because it’s funny, fun, and normalizes having a bowel movement to take away the fear. Plus, it only costs $4.99 on Amazon.com–who can say no to that?

2. Look Inside: Your Body (Usborne Look Inside)

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Ok, I will be honest with you– this may have recently become my most favorite children’s book ever! How could it not be? It literally has over 100 flaps to open inside! When this arrived to my clinic I forced my poor student to listen to all of the fun little facts under each flap in this book. It is filled to the brim with excellent information on the body and even has a beautiful 2-page spread on the digestive system. Plus, it’s interactive–your child can lift a flap and see how the bicep muscle works…lift another flap and see how our ears hear!  My only beef is that they really did not include much information on Urinary function…but other than that, it is amazing! It may have just become my book I give all of my pregnant friends for their new kiddos. Amazon.com $10.48 and worth every penny!

3. It Hurts When I Poop: a Story for Children Who Are Scared to Use the Potty, by Howard J. Bennett

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Back to the poop– Constipation is the worst! And fear related to using the bathroom can be equally as bad as embarrassment in creating holding patterns and constipation in children. This book was written by a physician who provides a relatable story for children fearful of using the bathroom. The story follows a young boy Ryan as he goes to see a doctor to help with his constipation. Dr. Bennett also does a great job at providing great recommendations for kids and parents to help improve bowel function! I especially love his page on “foods that make poop hard” and “foods that make poop soft.” This book is an absolute must for children dealing with constipation. The reviews on Amazon.com really say it all, and this book only costs $8.96.

4. Sammy the Elephant and Mr. Camel: a Story to Help Children Overcome Bedwetting, by Joyce Mills and Richard Crowley

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How could you not love the sweet story of an elephant who struggles with carrying water, is mentored by a camel, and goes on to save the town by putting out a fire? This wonderful story not only provides a powerful image for children having difficulty with enuresis (bedwetting), but it also is great for improving self-esteem in children and decreasing feelings of guilt or low self-worth. This book also includes information in the back for helping parents take the next steps to improve a child’s bladder function. An excellent read for kids and parents alike! And only $8.96 on Amazon.com!

I hope you will consider picking up some books if your child is having bowel or bladder problems! Do you have any other great books for this? Let us know in the comments!

Have a great Thursday!

~ Jessica

Listen to Jessica’s podcast on Pelvic PT & Join us at our open house this SATURDAY 4/11!

Several weeks ago, I was honored to be interviewed with Ivy Radio on pelvic floor physical therapy! We had a few phone issues, but overall it went very well!

In the podcast, we discuss:

  • What the pelvic floor is
  • How problems happen with the pelvic floor
  • Common diagnoses treated in Pelvic PT
  • What you should expect in examination and treatment
  • Barriers involved in men and women seeking help
  • How to find a Pelvic PT

I hope you enjoy the podcast!! Don’t be too hard on me… We had some phone issues in the middle that made me fumble a bit!

Also- I would like to formally invite all of you to our official open house this Saturday April 11th, 11am-2pm!! I would love to meet anyone local and show you our beautiful facility!! Hope to see you there!