Pain during sex is NOT normal

I often get asked why I chose to become a pelvic PT. Many people postulate that I have my own pelvic health challenges (I do…but those came later after 2 c-sections). Others assume I’ve always been super into the pelvis. But neither is really the case. The answer is quite a long one… but, honestly, it all came down to the patients.

Sometimes you have a moment in time that ends up defining the trajectory of your life (if you know, you know). And for me, this moment happen during a rotation in Shreveport, LA, while I was working on my Doctor of Physical Therapy degree through Duke University. I had an amazing clinical instructor (Darla Cathcart, who I now teach with through Herman & Wallace), and we were working with a patient who had been experiencing painful sex for as long as she had ever tried to have sex. I remember her talking with us during her initial evaluation, telling us about the relationships that had ended because of this, and tearfully explaining how she wanted this to not be a factor for her current relationship.

Fast forward, several visits later, she came in for her session, sat down, and started crying. She looked up and said, “I had sex, and it didn’t hurt.” I still get goosebumps as I right this. I got goosebumps in that moment. And, it was then and there that I KNEW that I had to help more people like her. I felt such clarity in my path. And I have never looked back.

Painful sex is extremely common. In fact, some studies show that it impacts around 20% of women. Yes, my friend, that is 1 in 5. However, women aren’t the only ones dealing with pain during or after sex. All people can deal with it– regardless of gender or anatomy. And, it really tends to be one of those things that just isn’t talked about. Nearly every time I post about painful sex on social media, I end up with private messages from people who have been dealing with pain for years, and just thought it was normal. Common does not mean normal. A little louder (for the people in the back):

Just because pain during sex is common, does NOT mean it is normal. Not if you:

  • Have had a baby
  • Have never had sex before
  • Have had sex a lot
  • Have been told you are small
  • Think your partner may be large
  • Have had problems with bladder or other infections
  • Have sensitive skin
  • Anything else

While some of these factors may make someone more likely to have pain during sex (like if you had a baby and had a tear that took a while to heal), this still does not mean that pain is just something you have to deal with. Honestly, there are so many reasons why someone might have pain with sex. It could be related to:

  • Decreased lubrication
  • Hormones
  • Inflammation
  • Neural sensitivity
  • Dermatological conditions
  • Painful scar tissue
  • Orthopedic challenges (especially around the hip or low back)
  • Bowel dysfunction (hello constipation)
  • Conditions like endometriosis/adenomyosis, painful bladder syndrome/IC, or others.
  • Pelvic floor and abdominal muscle challenges

And many, many other things! And so so many different treatments to help! This can include finding the right moisturizers and lubricants for your body, additional medical interventions (medications, hormone creams, and more!) and working with a pelvic health specialist to help you optimize your pelvic floor muscles (through gentle manual therapy techniques, home exercises, lots of education, and a whole lot more!)

If you’ve been dealing with pain during sex, please know that you are not alone.

So so many other people deal with this too. And the great news is that enjoyable sex is possible for you. We can get there. There is treatment available. There are compassionate clinicians who care (if yours didn’t, pllleeeeasssseee go see a new one!). And we can work together to get you feeling better.

I have so much more to say about this!! But for now, I’m going to leave you with a few links for prior blogs with more information!

Vaginal Dilators for Painful Sex

How to Relax Your Pelvic Floor Muscles

Sex After Baby

Are you ready to get started?

We are offering 20% off through September 30th on our 90-min mini classes: Overcoming Painful Sex and Self-Treatment for Pelvic Floor Tension using the code, ENJOY20. These classes are full of awesome information, exercises, and resources for getting started!!

All my best,

Jessica

How to relax your pelvic floor muscles

balance macro ocean pebbles

Whenever I teach coursework to pelvic PTs, a common theme tends to come up. While teaching someone to contract their pelvic floor muscles can be challenging, teaching someone to relax and lengthen? So much harder! And teaching someone to actually bear down (the way you need to move your muscles to have a bowel movement)? Way way harder! So, I wanted to take some time today to talk about how to relax and lengthen your pelvic floor muscles. This is super helpful for anyone experiencing pelvic floor overactivity– which often includes people with pelvic pain conditions, constipation, painful sex, and urinary urgency/frequency. And if you’re a rehab professional, this post will also give you tips to help train your patients to lengthen.

As an aside, if you’re a rehab professional and new to pelvic floor therapy, check out my facebook group, built just for you: Pelvic PT Newbies! This group was born after teaching so many new clinicians who just lack the support they need to grow into the incredible practitioners they can be! So, come join us! And, if you’re a more seasoned clinician who loves supporting newbies, you are welcome as well!

Back to the topic at hand, how do you learn to relax and lengthen your pelvic floor muscles? Let’s get started!

1. Locate and find your pelvic floor muscles

It’s tough to let go of tension in a part of your body you don’t really know. So, step one is locating these awesome muscles. The pelvic floor muscles are inside your pelvis like a hammock and run from your tailbone to your pubic bone. They support your organs, stabilize your pelvis and spine, control your sphincters, allow for sexual appreciation, and act as a sump pump to pump blood and lymphatic fluid in and out of your pelvis (Yep, those are the 5 S’s we teach at H&W). They are also super important for breathing–coordinating with your respiratory diaphragm, and play a big role in postural stability and movement. So, locate those muscles in your mind, and see what you know. Can you use those muscles and contract as if you were holding back gas or cutting off a urine stream? If you aren’t sure you’re doing it, grab a mirror, and take a look at your perineum. Do you see the anus pull in (like it’s winking) away from you and the perineal body (between the vulva/penis/scrotum and the anus) lift in? Or do you see the anus bulge out? If you have a vulva, you will also see a small amount of lift there and you will see the clitoris do a really tiny little nod of approval (that’s because the pelvic floor muscles superficially attach to the hood over the clitoris). If you have a penis, you’ll see the penis move as you contract.

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Once you connect with your pelvic floor muscles, the opening and lengthening can begin.

2. Pelvic Floor “Drops” with Diaphragmatic Breathing

This is my standby, go-to, exercise for encouraging lengthening and opening of the pelvic floor muscles. To perform this exercise, bring your mind back to your pelvic floor muscles. Then, aim to let go of the muscles and lengthen, as if you are starting a urine stream. Note– this does NOT mean bear down and push out. Urination actually should not require ANY pushing. This is simply opening, letting go, and lengthening. Another tip to help visualize this is to think about a straw in one of your orifices, then imagine that straw is in a cup of water, and you’re trying to gently blow bubbles in the water (believe me, I’m full of weird visual analogies!) After you drop and lengthen your muscles, let’s do slow, diaphragmatic breathing. Breathing well means allowing your chest, ribcage, and belly to expand as you inhale– Yes, this is NOT just belly breathing! Belly breathing really does not harness the diaphragm the same way! So, perform slow breathing inhaling, allowing your ribs to open, chest to lift, belly to expand AND pelvic floor muscles to open, then exhale gently. Repeat this slow breathing for 2-3 breaths. Then, check in with your pelvic floor muscles, drop them again, and repeat! If it is challenging to know if your muscles are opening or not, you can perform a very small (like 10-20%) activation of the pelvic floor muscles before letting them lengthen and open. That being said, if you have significant overactivity, even a small contraction can irritate the muscles– so pay attention to what you feel!

3. The Elevator Let-Go 

This is another visualization that can sometimes help you leg go all of the way of your pelvic floor muscles. To do this, visualize an elevator sitting in your pelvis. This is your main floor, and your building has 10 floors, and a basement. Now, use your muscles to gently lift that elevator to the first floor. Then, drop the elevator to the main floor. Take a deep breath while you visualize the elevator dropping all the way to the basement. Keep the elevator there while you gently take 2-3 breaths. NOTE: This also should not require much effort– we’re aiming to gently relax and lengthen. 

4. Happy Baby Breathing 

This is one of my favorite positions to encourage lengthening of the pelvic floor muscles. For this exercise, you’ll lie on your back and bring your knees up toward your chest, then open your knees and reach through to grab your ankles or your toes (whatever is comfortable and allows you to relax). In this position, take deep long breaths, focusing your breath into your abdomen and pelvis.

Hopefully this helps you get started! Believe me, lengthening the pelvic floor muscles can be challenging, so try not to get too frustrated if you find this difficult at first! If you’re struggling, reach out to a pelvic PT. We’re happy to help you figure this out, and have more tools available if these ones don’t resonate with you!

~ Jessica

Pelvic Floor PT: Soooo IN right now!

I don’t know if you’ve realized it– but the pelvic floor has become crazy popular! This article by The Guardian was published 2 months ago. 3 different patients and a few friends forwarded it to me, as it highlights just how popular pelvic floor rehabilitation has become. And I’m not surprised. When I first started treating pelvic floor disorders, nearly every patient who came in the door had never heard of the pelvic floor, let alone, a physical therapist who treated the pelvic floor. They would look at me with a perplexed and nervous gaze as I would do my best to explain the anatomy and why there really was a GREAT reason that their doctor had recommended them to come see me. This situation repeated itself again, and again, and again.

But now, it’s actually a much more foreign experience. For the most part, my patients have some level of knowledge about the pelvic floor muscles. The internet and social media has allowed people more access to knowledge– including experts who make informative Tik-tok videos, infographics and blog posts 🙂 on their diagnoses and treatment options. This has created more informed consumers who are learning more about their health, care about their wellness, and are seeking to find the best answers for their care.

In fact, it now very rare for for someone to come in and tell me they’ve never heard of pelvic floor rehabilitation. And that is AMAZING my friend.

When I first moved to Atlanta in 2014, I could count the number of pelvic PTs in the area on one hand. Now?? The last time I counted, there were more than 30 of us. I’m sure that number is closer 50 or even more (I know this because nearly every level 1 pelvic floor course I teach has at least a few Atlanta based people in it!!). And while, again, this is amazing– it’s only barely scratching the surface of what is actually needed!

The reality is that pelvic floor problems are super common, and people dealing with pelvic floor problems are often struggling to find care! Look at some of these numbers:

Chronic pelvic pain effects at least 5-23% of women and 2-16% of men

Approximately 36% of female athletes leak urine

33% of individuals postpartum experience bladder leakage

Approximately 22% of older men experience bladder leakage

35% of people postpartum experience pain during sex

Vaginismus (painful vaginal insertion due to muscle spasm) occurs in 5-17%

20% of people experience constipation

Approximately 10% of people experience fecal incontinence

So… while we are serving so so many more people than we used to, we are just scratching the surface! If you are new to this blog, and want to read a little bit more to start learning about the pelvic floor, check out some of these posts:

Meet the Obturator Internus

FAQ: Isn’t Everyone’s Pelvic Floor A Little Bit Tender?

Head, Shoulders, Knees…And Pelvic Floor?

Yes, Men Can Have Pelvic Pain Too.

Also, if this is resonating with you, and you’re feeling like you may need some help, reach out and let us know!! You don’t need to be one of those statistics– you can get relief, you can feel better! And if you’re not ready to see someone in person, check out some of our mini-courses online on pelvic floor topics!

Expert Interview with Dr. Yeni Abraham on Pelvic PT to Optimize Fertility

This past year, I was so fortunate to meet Dr. Yeni Abraham, an amazing pelvic health physical therapist and educator. Dr. Yeni is incredibly knowledgeable and owns a private practice, Triggered PT, in Arlington, TX. A few months ago, I saw Yeni post about traveling to pursue a specific training utilizing manual therapy to optimize fertility health, and I knew, I just had to talk with her!

I’ve been working with people struggling with conception for many years. I initially started helping this population around 10 years ago when I lived in Greenville, SC. I had connected with a few fertility specialists in the area, and they started referring patients to me who were trying to conceive, but had struggles related to pelvic pain and pain with sex. It was incredibly rewarding to work with these people, helping them feel better and have pain-free sex. And, that follow-up e-mail of, “Guess what? I’m PREGNANT!” was literally the absolute best!! So, I’ve known for a while that there is power in touch, helping a person connect with and optimize their bodies. And, through witnessing many of my friends, patients, and colleagues struggle with fertility challenges, I’ve learned that fertility challenges are complicated, multifactorial, and often require a team-based approach.

So, enter Dr. Yeni. This amazing, passionate person, who truly cares so much about helping people! Her journey toward helping this population was inspiring, and I’m amazed at what can be done to make a difference for people. I hope you’ll enjoy listening to her interview as much as I loved recording it!! Please know that Yeni sees patients in her office in Arlington, TX, and some patients additionally travel to see her. So, contact her if you want to learn more!! Thanks again Yeni!! <3

5 Common myths about Pelvic Organ Prolapse

“I was just showering and reached down and suddenly noticed a bulge”

“I had no idea something was wrong until my doctor examined me and told me I have a stage 2 cystocele”

“I started feeling heaviness in my pelvis, then was wiping after I went to the bathroom, and noticed something was there!”

Pelvic organ prolapse impacts a lot of people. Some studies show that between 50-89% of people experience prolapse after vaginal birth (if they’re examined and someone is looking for it!), however, people can experience prolapse when they have never been through pregnancy or childbirth. Prolapse is one of the “scary diagnoses” as I tend to call them– not because I think it’s actually scary– I don’t– but because there is so much AWFUL information about prolapse out there. And when people suddenly learn about this, they dive deep into a rabbit hole of research, and often end up scared about what the future holds for them. BUT– I’m here today to tell you that: 1) Prolapse is actually very common and 2) there is so much you can do to help this problem!

To digress slightly– Working with people dealing with prolapse is a passion of mine, and I’m super excited to be teaching a LIVE class on managing pelvic organ prolapse with my friends and colleagues, Sara Reardon & Sarah Duvall. It’s going to be happening this Sunday at 4pm EST, and registration is limited! I hope you’ll join us for this awesome class! (Note: If you’re reading this after the event, and missed it– no worries! The recording will be available– just click the link above!)

What is Pelvic Organ Prolapse?

Before we jump into the myths surrounding prolapse, let’s talk about what it actually is. Pelvic organ prolapse refers to a loss of support around the bladder, uterus or rectum, and this causes descent one or more of these organs into the walls of the vagina. The organs themselves are supported by fascia, ligaments, connective tissues and… you guessed it! Muscles! So, how can loss of support occurs? Well, it could be due to straining of these tissues like would happen during pregnancy and childbirth, particularly if people have injuries during birth like stretch injuries to the nerves of the pelvis, tears in the connective tissue and fascia, or tears in the pelvic floor muscles themselves. This can also be due to chronic straining of the tissues that might occur with age, chronic lifting (with poor mechanics) or chronic coughing problems. Other factors like hormones, body size and joint hypermobility can also be involved.

What does prolapse feel like?

Maybe you’ve been diagnosed with prolapse, maybe you just think this is a problem you have, or maybe you know that you have this problem. Regardless, let’s chat about what prolapse can feel like. These are some of the things people who have prolapse can feel:

  • A bulge coming out of the vagina
  • Pressure in the pelvis or perineum
  • Lower back ache
  • Difficulty emptying the bladder
  • Difficulty emptying the bowels
  • Heaviness or a dragging feeling in the pelvis

Symptoms are often better first thing in the morning, then worsen as the day goes on (thanks so much gravity!). Symptoms vary person to person based on where they have prolapse and the severity of their prolapse.

So, now that we know what it is and what it can feel like, let’s jump into prolapse myths.

Common Myths Surrounding Pelvic Organ Prolapse

Myth #1: “You’ll likely need surgery at some point.”

I hear this one all the time. A well-intending physician tells their patient that they have prolapse, then follows it with, “we can fix that whenever you’re done having children” or something along those lines. While some people do end up needing surgery– particularly with more severe prolapse or if their prolapse is significantly impacting their function, many people are able to manage well conservatively with specific exercises or pessaries.

Myth #2: Prolapse is probably the cause of your pelvic pain, pain during sex, or genital pain.

So, you’ll see that I listed low back pain in the symptoms, but I didn’t list other types of pelvic pain. While I get that prolapse can look like it would be painful, it typically is not a painful condition. It’s an annoying condition, and can lead to behaviors that may cause pain (like constantly trying to grip your pelvic floor muscles to prevent things from falling down!). Prolapse can cause a back ache that worsens as the day goes on, and this is due to the ligaments around the organs stretching as the descent occurs. Additionally, the pressure/bulge can be uncomfortable, and people may feel like something is being pushed on during sex. That being said, we very often find that people have prolapse and something else going on when they are dealing with significant pain.

Myth #3: Because prolapse is structural, physical therapists likely won’t be able to help.

So first, support of the organs requires coordination of forces– ligaments and fascia are involved for sure, but muscles are also involved. All that aside, prolapse is a problem related to pressure management– so it matters what is happening at the pelvis, but also, what is happening outside of the pelvis that is impacting the pressure system.

Pressures within the intrathoracic and intraabdominal cavities can impact what is happening in the pelvis. Several muscles are involved in this pressure system, including the glottal folds at the top, the intercostal muscles, the respiratory diaphragm, the transverse abdominis muscle, the multifidus, and the pelvic floor muscles. These muscles work together in a coordinated way to help manage pressure and spread the load (so it is not funneled down to the pelvic floor).

Physical therapists help people with pelvic organ prolapse by helping them manage their pressure system as optimally as they can. This means looking at posture, spinal mobility, movement patterns, hip function, breathing habits, and so much more! It also means optimizing the function of the pelvic floor muscles. With this approach, we see good improvements. A Cochrane review of 13 studies in 2016 found that most people saw good improvements in their prolapse symptoms and their severity of prolapse on exam. A multicenter trial published in 2014 found that individualized pelvic floor training led to good improvement in symptoms and severity of prolapse.

Myth #4: Pessaries are for “old people”

Not true. Pessaries are amazing medical devices that help to support the walls of the vagina and can be very useful for reducing symptoms of prolapse. There are lots of different types of pessaries, and generally, people who wear them really find them to be helpful! In fact, this study found that 96% of the people who were appropriately fit with a pessary were satisfied and thought it helped with the severity of their symptoms.

Myth #5: If you have prolapse, you should never do certain exercises and movements so your problem doesn’t get worse.

I’ve said this before, and I’ll say it again– there are no bad exercises– BUT there may be times when certain exercises may not be optimal for you. Ultimately, the best thing to do is to work with a professional who can watch you move, watch you exercise, and see how you modulate pressure during these movements. Then, they will be able to make recommendations specifically for you– help you modify where you need to modify, observe your form during movement, and then strategize with you to make a plan to get back to whatever movements you would like to get back to!

If you’re experiencing prolapse, or you think this might be you– there is hope available! I’m very excited to be working with Sara Reardon and our special guest, Sarah Duvall to jump further into this topic in our upcoming class this Sunday 10/25 at 4pmEST on Managing Pelvic Organ Prolapse. Come join us LIVE and get all of your questions answered! If you can’t make the live, no worries!! A recording will be available.

What prolapse questions do you have? Let me know in the comments!

~ Jessica

Meet the Obturator Internus

You all know by now that I’m fairly nerdy. I love reading research articles, trying to understand complex topics, and everything about learning. Honestly, I think that is why I love pelvic health so much! The pelvis is so complicated! There’s so much to know, and the more I learn, the more I truly realize how much more there is to know! As an anatomy nerd, you know I have favorite muscles. I’ve written about the respiratory diaphragm, who is one of my most favorites, but I haven’t spent much time introducing you to my other love~ the obturator internus!

Meet the Obturator Internus

The Obturator Internus (Or OI, as they are known by friends) is a muscle that lives inside your pelvis in the obturator foramen and attaches to the hip via the greater trochanter. You can see it here:

The OI has several major functions for the body. First, it is a deep hip external rotator, and has shown to be active during the movements of hip extension, external rotation and abduction. In fact, this research showed that it was the first muscle to turn on in these motions (which I theorize could be part of it’s connection to the pelvic floor muscles and the anticipatory role the pelvic floor has in movement, pressure management and postural stability). My theory on this makes sense when we look at some of the research on the involvement of the OI in hip stability. This excellent article identifies the obturator internus & externus, quadratus femoris, and gemelli as important synergistic muscles that work together to modulate the position of the femoral head in the acetabulum during movement. This is particularly cool because in many ways, this function is very similar to the pelvic floor muscles! The authors suggest a dynamic stabilizing role for these muscles, making subtle alterations in force to control the femoral head position.

This study also recognizes the stabilizing role the OI can play, particularly when it works as a team with the other deep hip rotators. The authors here highlight that the obturator internus, obturator externus, superior & inferior gemelli (who I affectionately call the gemelli brothers) are essentially fused. And this fusion, actually leads to a decent cross-sectional area and ability for force generation. The orientation of the fibers adds further credence to the view that these muscles are crucial to hip stability.

The OI shares fascial connections and attachments with the pelvic floor muscles, which makes it an even more unique muscle. The iliococcygeus attaches to the arcus tendoneus linea alba, a fascial line that is also an attachment of the obturator internus. Additionally, the pubococcygeus and OI are fascially connected around the pubic bone, and the fascia around the bladder and urethra also is connected to the OI. What does this mean? It means that the OI can be impacted by what happens at the pelvic floor and can impact what happens at the pelvic floor. And research tends to show this. This study showed that the vast majority of people with pelvic girdle pain have obturator internus tenderness. This study found that most people with chronic pelvic pain have obturator internus tenderness with palpation. And here’s another study that found that 45% of people with pelvic pain had tenderness at the obturator internus. Another study found that in people with lumbopelvic pain, experiencing urinary urgency, and central sensitization made them 2x more likely to have concurrent pelvic floor and OI involvement.

Finding the Obturator Internus

One of the cool things about the OI is that it is a muscle that can be palpated both internally via the vagina or rectum, and also externally. The OI is palpated internally with an examining finger angling out toward the hip. You can see the palpation here on my lovely pelvic model.

My finger here is inserted, curving toward the left to access the OI

The OI can also be palpated by examining medial to the ischial tuberosity, then angling in toward the obturator foramen. You can see where palpation would be happening here.

Treating the Obturator Internus

If you think your Obturator Internus is involved in the pain or pelvic floor problems you’re experiencing, the first step is to have it examined. Your PT can palpate these muscles as described above. The muscles should be soft and move well, so they should not be sensitive or painful to touch. If they are, they could potentially be involved in the pelvic problems you are experiencing.

From a treatment standpoint, we can address the OI by first improving the mobility via gentle manual therapy, and then improving the overall hip stability (retraining the anticipatory function through the relationship between the pelvic floor & OI). It usually isn’t the “sole” problem happening. But including it within your treatment can be key to helping you get better!

Cheers!

Jessica

Do you leak when you run? Try this!

I love running. To be honest, I’ve been out of a good running routine since Mary was born. She’s one now. I would like to change that. I’m scheduled (yes, my husband and I literally have to schedule everything with our crazy work weeks!) for a run this week and I’m thrilled.

As a pelvic physical therapist, my goal is always to help my support my patients in whatever exercise or fitness routine they enjoy. Sometimes, pelvic floor problems get in the way. I can’t tell you how many times I’ve heard things like: “I used to run all the time, but ever since I had a baby, I just can’t” or “I tried just wearing a pad while I was running, but I can’t get over the feeling that I’m making everything worse” or “I can run if I go first thing in the morning, empty my bladder before I leave, and then stop at the park on the way to go again.” Bladder leakage during running is ANNOYING. It can be so impacting to people, and for many, it can lead them to stop a movement or activity they enjoy, for the long-term.

5 years ago (has it really been that long!?!) I wrote on the topic, “Is running bad for the pelvic floor?” after receiving that question several times. Spoiler alert: There are times when it may be appropriate for someone to stop running for a period of time to retrain their body and regain their pressure modulating system optimization– however, running can be an excellent way for someone to exercise and move! There are no “Bad” exercises, just bodies that sometimes aren’t quite ready for them.

So, if you’re struggling with leaking every time you hit the pavement, what can you do?

running-573762_1920

Let’s consider what happens during running, from a pelvic floor standpoint. Several studies in the past few years have demonstrated that the pelvic floor muscles are active during running. This study from 2017 used EMG electrodes at the pelvic floor muscles, and found that there was increased activation of the pelvic floor prior to heel strike and reflexive activation after heel strike during running. This is in line with what we know about the pelvic floor muscles. They play a crucial role in anticipating movement, preactivating, then have modulating force during movement based on the task at hand. And, this is protective. We would want the muscles to have varying levels of activation so that we can support ourselves during movement, support around the urethra, not leak.

What happens then when someone is leaking with running? We of course, want to say that this reflexive thing is not happening. This review did show some alterations in the way that those who leak contract vs. those who do not leak. However, this study found that the reflexive action was the same in those who leaked and those who didn’t. This one also found that patterns of engagement were the same. So, it is likely that there are sometimes differences, but sometimes not. And this seems in line with what we know about leaking. Leaking during running is a pressure system problem. So, to help it improve, we have to address the whole system– which includes the pelvic floor muscles, but not only the pelvic floor muscles. It makes sense that sometimes the issue is stemming from these muscles not activating at the right time, with the right force–but sometimes, the pressure problem is from something else.

How can we address the pressure modulation system?

First, we need to evaluate the system to see how the structures are functioning, and this includes looking at you– the full person– to see how you control pressure through your pelvis. So, we need to look at how you move from head to toe, then evaluate your running mechanics, then look more closely at your breathing pattern, your abdominal wall, and your pelvic floor muscles. Once we do this, we often have a clear idea of what is happening and can make a strategy to get this better.

So, my big Tip #1– Go see a pelvic floor PT–but make sure it’s someone who is trained at looking at the whole person and can really evaluate you well.

If you’re nervous about doing this, I feel you. It can be hard to talk to someone about very private things. And I totally understand that the idea of having an internal examination can be a barrier for some people. BUT, know that those of us living in the pelvic floor world talk about this stuff ALL THE TIME. You won’t surprise us. Seriously, we hear this stuff all day. And, if you don’t think you’re ready for an internal exam, that’s cool. Honestly, we don’t mind. There is SO much that can be done to help the pelvic floor and bladder leaks that can be done without an internal exam! If you want to learn more, give us a call. One of our doctors of physical therapy will be happy to do a virtual consult with you and get you started!

Ok, off my soap box… What else can you do to impact the pressure modulation system and decrease leakage?

Tip #2: Breathe!

This seems so simple. I know, you’re thinking, “Of course I’m breathing!” But, are you? Or are you going through a series of breath holds? Next time you run, pay attention, and keep your breath flowing in and out as you run. The diaphragm is the major pressure regulator of the body. So, we need to keep your breath moving so pressure is spread out!

Tip #3: Let your ribcage move!

Many people tend to run with stiffness, locking down their ribcage. This can funnel pressure downward toward the pelvic floor muscles leading to increased load, and potential leaking. Instead, relax your ribcage, let your arms swing and allow your trunk to rotate. This will actually turn on more of the muscles around your core improving the synergistic activation of your pressure modulating system.

Tip #4: Lean into the hills! 

When going up or down hills, it is easy to lean back to try to control the movement. This can alter the position of your ribcage over your pelvis which will impact your pressure control. Instead of doing this, lean into the hill as if you have a strong wind blowing against you (I love this visual I got from my friend & colleague, Julie Wiebe!). When going downhill, lean into the downhill and let yourself pick up a little speed instead of leaning back to slow down. Relax into the hill. Many of my patients find that doing this actually reduces the pressure they feel and can decrease leakage.

Tip #5: Get a running evaluation!

Running form matters, it really does! So, go see someone and have them take a look at your running form to offer you guidance on how you can optimize it! Be sure you’re using the best type of shoes for your foot as well! This can make a big difference! Awesome running stores in your area should be able to help you with this!

I hope this is helpful! What questions do you have about running and the pelvic floor? Ask away! We are here to help!

Have a great week!

~ Jessica

 

Daily Movement Sequence for Pelvic Pain

Happy baby pose with knees up and open, supporting legs with hands

May is Pelvic Pain Awareness Month, so I thought it was only fitting to write something about pelvic pain before the month is over. Pelvic pain impacts so many people, in fact, the International Pelvic Pain Society estimates that over 25 million women suffer from chronic pelvic pain. While the number is generally lower in men, some studies estimate that around 1 in 10 men experience chronic pelvic pain (often termed chronic prostatitis).

Next week, my clinic is officially re-opening our doors for in-person sessions, after operating completely virtually for the past 2.5 months! During this time, I tried to stay as connected to our patients as I could, and sent out a newsletter each week full of pelvic health tidbits. One of the new things I created was a daily movement sequence for pelvic pain, and I wanted to share it with all of you here!

Getting Started

Before we get started, you should know a few things about pelvic pain. First, each person with pelvic pain is a unique entity. So, while this sequence can feel lovely for many people with pelvic pain, some may not be quite ready for it. For others, they may find that doing it actually increases their pain (clearly, not our goal). For rehabilitation for a person with pelvic pain, it is very important that exercises, movements and activities are done at a threshold that does not increase or aggravate pain or discomfort. This is, as we have spoken about very often, because we want to create positive movement neurotags for the brain. Basically, we don’t want your brain to think that movement is bad or dangerous (because as we all know, it should not be bad or dangerous!). If we do movements that increase our discomfort and make us feel worse, the brain can build a connection between moving that way and bad/pain feelings. Instead, we like to move at a threshold where the body does not guard or protect by pain. So, why am I telling you this? Because, if you start doing these movements and your symptoms worsen, or it doesn’t feel therapeutic to you, you need to stop doing it and see a pelvic floor therapist who can evaluate you comprehensively and help you develop a specific movement plan that IS therapeutic to YOU.  And lastly, remember that anything on this blog is not in any way a replacement of in-person care. You need to consult with your interdisciplinary team (your physician, PT, etc!) to determine the best approach for your health! (And if you’re not sure, schedule a virtual consult with a member of my team to help figure out where to go next!)

Daily Movement Sequence for Pelvic Pain

So, let’s break down this sequence.

Diaphragmatic Breathing

Diaphragmatic breathing with hands placed at ribcage If I could give any person with pelvic floor problems a single exercise to do, it would be this. The breath is SO powerful, and sync’d with the pelvic floor. For diaphragmatic breathing, you want your breath to move into your belly, expand your ribcage in all directions, then lift your chest. A misconception of diaphragmatic breathing is that the chest should not move at all, and this is FALSE. The chest should lift–but–so should the ribcage and the abdomen. You can do this in sitting or lying down. As you inhale, aim to lengthen and relax your pelvic floor muscles, then exhale, allowing your muscles to return to baseline. Start your sequence with 2-5 minutes of this breathing. (and toss in some focused relaxation of each part of your body while you’re doing it!)

Happy Baby or “the Frog”

Happy baby pose with knees up and open, supporting legs with handsThis one is a key movement for anyone with pelvic pain! To perform this, lie on your back and bring your knees up to your chest. Reach your arms through your legs to grab your lower shins, support your legs using your arms, and allow your knees to drop open. You can alternatively hold your legs at your thighs, depending on your comfort and your hip mobility. From here, aim to let go of muscle tension. Then, take slow breaths, directing your breath to lengthen and open your pelvic floor muscles. This is a great position for relaxation and lengthening of the pelvic floor!

Segmental Bridge

Bridge- knees bent, feet flat on the floorThis is a nice movement to warm up your spine and practice using small amounts of tension to perform a graded movement (you know I love my slow movements!) For this exercise, you will lie on your back with your knees bent. Then inhale in to prepare, exhale and slowly begin to roll up off the mat, lifting your tailbone, then sacrum, then low back, then mid back, then shoulder area. At the end of your exhale, slowly inhale, reversing the movement. You can repeat this 5-15 times, and do 1-3 sets. (Vary this based on what feels healthy and helpful to you!). Sometimes people get back pain when they do this (usually their back muscles are trying to do the job of the glutes). So, if this happens, try to bring your feet closer to your buttocks, and press through your feet while you are lifting. If it still happens, stop the exercise, and talk to your physical therapist.

Reach and Roll

reach and roll- lying on side- description belowI love this exercise for improving mobility of the upper back (thoracic spine). For this exercise, lie on your side with your knees and hips bent to 90 degrees, arms stacked in front of you at shoulder level. Inhale, reaching your top arm forward, exhale, and slowly roll your hand across your chest, opening to the opposite side. Keep your hips stacked so you don’t rotate through your low back. Pause here and inhale in, letting your ribcage expand, then exhale letting the hand glide across your chest to meet the opposite hand again. Repeat this movement 5-10 times on each side (You can do a few sets if you would like!)

Cat-Cow

cat-cow exercise in hands/knees positionSo, this is another one of my top exercises. I love the cat-cow as it promotes segmental mobility of the lumbar and thoracic spine into flexion and extension. It is another great movement to encourage minimal tension, and coordination of breath, so it’s a big favorite for people with pelvic pain.  To do this, get into a quadruped position (hands and knees, with hands aligned under shoulder and knees aligned under hips) Inhale, allowing your tailbone to come up and your back to dip down, head looking up. Exhale, dropping your head down, rolling your back up and tucking your tailbone. Perform this movements slowly, using small amounts of tension. Repeat this 10-15 times, 2 sets. You can alternate each set with child’s pose, listed below.

Child’s Pose (Wide-Kneed)

Child's pose with knees in wide position, reaching arms forwardChild’s pose is a beautiful exercise that also encourages opening and lengthening of the pelvic floor muscles. It is nicely performed between sets of Cat-Cow. I like to modify this slightly by bringing the knees into a wide position to further encourage relaxation of the pelvic floor muscles. To perform this, begin in the quadruped (hands/knees) position as above. Open the knees into a wider position, keeping your feet together. Drop your pelvis back toward your feet, reaching your arms forward and relaxing down toward the mat. You can use a pillow (or 2 pillows!) to support your trunk and decrease how deep your child’s pose goes. Hold this position (and make sure you are totally comfortable!) for 60-90 seconds, breathing in long, slow breaths, encouraging lengthening and opening of your pelvic floor. Repeat this 2 times, preferably, interspersed with the Cat-Cow exercise.

And there you have it. My daily sequence for people with pelvic pain to get some movement in!

There are so many other great exercises for people with pelvic pain! Do you have any favorites I didn’t include in this sequence? Any movement challenges you want help solving? Let me know!

~ Jessica

 

 

Mother’s Day Specials!! My gift to YOU!

Good morning friends,

With Mother’s Day around the corner, we’ve been wanting to give back and help out the mothers in our community (around the country…around the world!) who are struggling in this interesting new normal. Figuring out managing caring for children, homeschooling, work/family obligations, all while trying to keep their families safe, sane, engaged. Let’s be honest, being a mom is the hardest, but most rewarding job ever!

To celebrate our mamas everywhere, we have a few discounted specials to roll out to you!

50% off first Virtual Pelvic Floor Consultation

Mother's Day Sale-2

First, we are offering 50% off a virtual pelvic health consultation  with one of our incredible pelvic floor specialists. Honestly, we’ve never discounted our services before, but I just felt like this was the right thing to do. So, for $97 you (or the mama you gift this to!) can receive a 55-minute virtual consultation. If you live in Georgia, this will be a pelvic floor physical therapy evaluation. If you don’t, our license won’t let us provide you with physical therapy, but we can still offer you a virtual coaching consultation.  So, if you’re struggling with any pelvic health problem– constipation? pain with sex? bladder leaks?– or if you need help recovering after children, getting back to exercise, or preventing problems in the future– this deal is perfect for you! Don’t miss out on this opportunity!!

20% Off Online Classes

Copy of Copy of Copy of Copy of Copy of Copy of Copy of Black Friday (1)

Along with this, we are offering 20% off our on-demand classes via the Southern Pelvic Health x The Vagina Whisperer partnership! Each of these classes is 90-minutes and covers SO much information, with great bonuses included! Classes are normally $39 each, so this is a nice discount to get some solid information!! (Gift idea: Consider a birth package for that pregnant mama in your life! Combine our birth prep class with a posptartum recovery class so that new mom has all she needs to rock her birth and after!) Be sure to use promo code MOM20 at checkout! 

These specials are only available through Monday May 11, so don’t delay!

Happy Mother’s Day!

~Jessica

Virtual Care & Pelvic Yoga at Home

If you would have told me two weeks ago that I would have closed the doors to my clinic, Southern Pelvic Health, a week later, and shifted my practice to a virtual one, I would not have believed you. Maybe I was naive (yes, I probably was), but this change came quick to me. It almost happened overnight. And, here we are. I am moving into my second week of working with my patients online. While for many, that seems incredibly scary, I actually think that shifting to an online platform for a while is going to do a lot of good.

Last week, I worked with a few other colleagues to host a webinar on bringing pelvic health online– basically, how do pelvic floor PTs treat most effectively without actually touching their patients? It was a quick production–one built out of necessity–and it sold out in 24 hours because rehab professionals everywhere are trying to figure out how we can still be there for our patients and help them get better during this time. (For my colleagues out there, if you missed it, it’s still available as an on-demand purchase!) I brought together 5 experts from various corners of the country and the world, and we spoke for nearly 2 hours about how we assess the pelvic floor, evaluate patients, and actually help patients get better in a virtual setting. It was full of creative ideas, and also challenged some of the current practice patterns. As you know, I work hard to always question my own practice–learn more–do better– and I’m excited to see what this next period of time does for me as I learn to better and more effectively treat my patients, to be creative with self-care treatments and home strategies, and to use movement to help patients move when my hands are unable to. I will share what I learn with you here, of course.

Pelvic PTs are not the only professionals taking their skills online! Last week, my daughter and I joined a “Frozen Sing-A-long” through a local princess parties company. I have been thrilled to see some incredible resources for people with pelvic floor dysfunction hop online, and I am excited to share some of those with you today!

So, what can you join virtually this week? 

Yoga for Pelvic Health

My dear friend and colleague, Patty Schmidt with PLS Yoga, is incredible and specializes in therapeutic yoga for pelvic floor dysfunction. She is bringing several awesome classes online! AND, they are cheap– $15 per class (which honestly, is a HUGE value for the expertise she brings!) So, I do hope you’ll join in:

Patty also is teaching private sessions virtually at $30 for a 30-minute session. This is a steal, believe me!

I also need to share with you all of the FREE yoga resources through another friend and colleague, Shelly Prosko. Shelly has this incredible library of Yoga options for pelvic health, all available right here.

I hope you are able to partake of these awesome resources. Remember, we are in this together my friends! I’ll leave you with a quote from a much-loved movie in my house, Frozen II, “When one can see no future, all one can do is the next right thing.” Let’s all try to do the next right thing amidst this craziness!

Much love,

Jessica

PS- If you are struggling with pelvic floor problems at home, we’d love to help!! Schedule a virtual session or a complimentary phone consultation with us at SPH!