Category: Southern Pelvic Health

Pain during sex is NOT normal

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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

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

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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 Exercises to Move Better During Pregnancy

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Yesterday afternoon, I met my team of pelvic PTs at at the office for some photo and video time. Our model? Dr. Kellie, who is about to have her last week with us in the clinic before leaving on maternity leave for her second daughter. You see, working at a pelvic PT practice, we have to take advantage of one of our own being pregnant! How could we miss an opportunity to record videos and take pictures to expand our library! 🙂

Movement during pregnancy is incredibly useful. First, it can help with many of the aches and pains that commonly develop. It helps to keep your muscles active, and ultimately, can help prepare you for the process of labor and birth. We wrote a while back on healthy exercise during pregnancy, so start there if you want to know where you should get started for movement.

Today, I wanted to focus on movement to help you feel better. These exercises promote gentle movement around your spine and pelvis and activation of the muscles around your deep core.

Cat-Cow

Goal: Improve mobility around your spine and pelvis. Coordinate movement with breathing.

  1. Inhale slowly, and as you do, gently let your tailbone out, and lift your head

Try not to allow your back to dip super far down but stay within a comfortable range.

2. Exhale and gently tuck your head, lifting your belly up and rounding your spine, allowing your tailbone to tuck.

3. Repeat this flowing gently with your breath as you inhale and exhale

Aim to do this 10-15 times in a row, alternating with the modified child’s pose that is described below.

Modified Child’s Pose

Goal: Lengthen lower back, gluteal muscles, pelvic floor, and inner thighs. Encourages relaxation and opening around the pelvis.

This exercise works really nice to alternate between sets of the Cat-Cow.

  1. First, place pillows in front of you, leaving a gap for your belly. You can use 1-3 pillows, depending on your belly size.
  2. Sit back on your heels, and open your knees to a comfortable width.
  3. Lean over the pillow, allowing your body to relax and reaching your arms forward. Let your head rest to one side or the other.
  4. Relax in this position for 1-2 minutes.

Ball Pelvic Mobility

Goal: Improve the movement around your pelvis and spine

  1. Sit comfortably on an exercise ball with your feet supported on the floor
  2. Inhale, letting your pelvis out, allowing a small arch in your back
  3. Exhale, tucking your pelvis under gently pulling your belly in.
  4. Repeat this to warm-up x 10
  5. Then, add a rotation, inhaling and rotating clockwise with your pelvis until you reach the arched back position. Then exhale, continuing to rotate clockwise until you reach the tucked position.
  6. Repeat this x 5-10 repetitions, then switch to counter-clockwise.

Bird-Dog Progression

Goal: Activate your deep abdominals and pelvic floor muscles paired with your breath.

  1. Begin in a hands and knees position with your spine in a neutral position (not flexed or arched)
  2. Inhale to prepare, exhale and gently engage your pelvic floor muscles while gently drawing in your belly. Aim for a slight contraction (not hard!).
  3. While you do this, extend one arm in front of you.
  4. Exhale, lowering your arm and relaxing your muscles.
  5. Repeat, alternating lifting with your opposite arm. Be sure to keep your spine in a comfortable position while you are doing this exercise. Repeat this movement for 10-15 repetitions.
  6. To progress this exercise, you can also perform with an alternating leg movement, aiming to keep your spine in a neutral position.

Wall Squats

Goal: Coordinate movement with breath, activate pelvic floor with gluteal muscles

  1. Place a ball behind your back and lean against a wall. Keep your feet placed out in front of you, flat on the floor.
  2. Inhale while you bend your knees and lower.
  3. Exhale, engage your pelvic floor muscles slightly, and lift up to standing.
  4. Repeat this exercise for 10-15 repetitions, performing 2-3 sets.

Note: While doing this, keep your feet far enough in front of you that your knees don’t cross your feet.

I hope you’ve enjoyed these exercises! What exercises do you like to do to move well during pregnancy? Any favorites we need to add?

Look for more coming from us on all of this in the future!

5 Common myths about Pelvic Organ Prolapse

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“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

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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

How to build a stellar bowel routine

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Bowel problems are so frustrating. Let’s be real. Constipation remains the #1 GI complaint in the country and impacts millions of people (pun unintended, but I’ll take it!). I love writing about pooping, and we love treating poop problems at Southern Pelvic Health (both virtually & in-person!!). The cool thing about poop, is that often the smallest changes in our habits can make BIG differences. A lot of this is due to the physiology of the digestive tract. Our habits—what we do during the day—can hugely impact this physiology, and that’s what I want to talk with you about today.

How do you maximize the efficiency of your digestive system and build a stellar bowel routine so you can poop better?

To understand this, let’s look at the digestive system a little more closely.

When you eat food, digestion begins in the mouth. Chewing helps to break up the food, and your saliva begins to break down the nutrients. Chewing alone is an essential part of digestion. In fact, most of us don’t tend to chew enough. I’ve been there! Years of working as a physical therapist at busy practices, led to a habit of inhaling my food rather than eating slowly and actually enjoying the process. Did you know that in order to adequately digest an almond, you have to chew that almond over 20 times? I learned that a few years ago when I interviewed Jessica Drummond- an incredible clinical nutritionist who also happens to be a pelvic PT. You can see the whole interview here if you’re interested!

Image Blausen_0603_LargeIntestine_Anatomy_-_File_Blausen_0603_LargeIntestine_Anatomy_png_-_Wikimedia_Commons

After we swallow our food, the food travels down the esophagus into the stomach. Here, the stomach churns the food, mixing it with acid and juices and continues the process of digestion. When food enters the stomach, this triggers an important reflex called the gastrocolic reflex, which pushes prior meals and snacks through the rest of the digestive tract. This reflex is SUPER important to know to help stimulate regular movement in the GI system.

The food then exits the stomach and enters the small intestines. Did you know that if you uncoiled your small intestines, they would be 20 feet long? The intestines are where the majority of digestion occurs. Juices from the pancreas and gall bladder are added in here to aid in processing our nutrients. Food moves throughout these coils, then enters into the large intestine via the ileocecal valve.

The large intestine, or colon, is the major water recycling plant in the body. The colon recycles about 70% of the fluid we take in to use throughout the body. It continuously removes fluid from our stool…. So, what do you think happens if you don’t drink enough fluid? Or what do you think happens if your colon moves a little too slowly? Yep, that’s right. You end up with hard and dehydrated stool. When stool enters into the last part of the colon, the rectum, the stretching of the walls of the rectum trigger another reflex. First, an incredible reflex called the “sampling response” takes place. In this reflex, a small amount of contents are allowed to enter the anal canal. Your nerves here sense what is present, and tell your brain if the contents are liquid, gas or solid. (Amazing, right?!) Now, this reflex can sometimes be dysfunctional. So, if you struggle with feeling a strong need to poop, and when you get to the bathroom, it’s only gas? That’s this reflex. OR, if you feel like you have some gas to release, and when you release it, it’s actually a little bit of stool? That’s a sampling problem as well. And guess what—we can actually do things to retrain and improve this reflex.

Image Defecation_reflex

As the stool is filling the rectum, and stretch occurs, the brain will receive the message of what is in the rectum, and gets to decide what to do about it. If there is just gas, you may choose to release it or wait a bit to release it. If it is liquid, your brain knows you better get to the bathroom QUICK! Liquid stool is hard to hold back for too long—the muscles fatigue—THIS is why chronic diarrhea can lead so often to bowel accidents! And if the stool is solid, you can actually defer and postpone the urge, until an appropriate time to go. The challenge there is that postponing frequently can make it so the muscular walls of the colon help you less when it is actually time to go to the bathroom.

When it is an appropriate time to go, you then sit on the toilet, relax your pelvic floor muscles, and this stimulates a defecation reflex which will allow the rectum to empty via the anal canal. Sometimes, we need to generate some pressure to assist this process, and sometimes, the muscular walls of the colon take care of it themselves.

So, let’s get down to it.

How do you use the process of digestion to build your bowel routine?

Step 1: Eat at regular intervals during the day to regularly stimulate your gastrocolic reflex.

Remember, this pushes things through the system, so it needs to happen often. The colon LOVES consistency, and HATES change. So, skipping meals? Eating really large meals sometimes, then nothing the rest of the day? All of this can impact your bowel function.

Step 2: Slow down & chew your meals.

Remember, chewing begins digestion, so, stop what you’re doing and eat mindfully and peacefully. Also, digestion requires a lot of parasympathetic activity—this is your resting & relaxing nervous system—so, slowing down and making time to eat can help stimulate that too.

Step 3: If you need the bowels to move better, eat “bowel stimulating” foods/drinks around the time of day you normally go to the bathroom.

What stimulates the bowels? Warm drinks (especially coffee—because the caffeine is actually an irritant to the GI tract!) are a great place to start. Also, spicy foods can help stimulate the GI system to move.

Step 4: Sit on the toilet around the same time each day, preferably, after a meal.

Remember that gastrocolic reflex? That reflex is helping to move things through the system, so after a meal is a great time to spend a few minutes relaxing on the toilet.

Step 5: Exercise!

Yep, exercise also stimulates the peristalsis of the GI tract! So, aim to get in regular bouts of exercise. And, it doesn’t need to be too extreme? Even going on a 10 minute walk can help get things moving.

What does this actually look like in practice? Here’s a sample routine!

Jane wakes up in the morning and takes the dogs on a short 10 minute walk. She gets home and makes a cup of coffee and her breakfast. She eats breakfast slowly, taking time to chew her food. (Jane also makes sure that she is getting plenty of fiber and whole fruits/veggies in her diet—because this matters too for her stool consistency!). After breakfast, Jane goes and sits on the toilet. She sits in a nice comfortable position, relaxes, breathes, and thinks about her day—spending 5 minutes without trying to force anything to happen. After a few minutes, she starts to feel the need to have a bowel movement. She uses what she learned in the “How to Poop” article, and gently pushes with good mechanics to assist her rectum in emptying her bowels. Jane then goes about her day, eating small amounts every few hours to stimulate her GI system.  

Now, it’s your turn my friend! How is your bowel routine? What can you change to actually use your physiology and poop better?

Want more on pooping? Check out these articles:

How to Poop 

Dyssynergic Defecation or When the Poop Won’t Come Out 

Sex, Drugs…& No Poop? 

Have a great rest of your week!

~ Jessica

 

 

For Pros: Expert Panel Discussion on Virtual Pelvic Health Tomorrow 3/20 at 9PM EST!

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Hello my friends,

Wow- what a few weeks it has been! I don’t know about you, but it has felt completely surreal to me. My practice, Southern Pelvic Health, which has been steadily growing and serving people around Atlanta was suddenly put on hold, and many of my patients shifted to working with me in a virtual setting. Now, I know you may be thinking– how can you help people without actually touching them? I hope to expand on this in some future posts, because, honestly, I believe this is where we are going to be for a while (SO, WASH YOUR HANDS, and SOCIALLY DISTANCE, my friends!). But, this is heavy on the minds of pelvic PTs across the country. Thinking– how can we, as a profession, still help the people who need it? Make a difference in their lives? Help people control their bowels & bladder, have better and pain-free sex, live their lives without pelvic pain?

So, this post is for all of you PTs out there asking yourselves that! Earlier this week, I partnered together with some of the smartest, most innovative PTs I know– who are leaders in our field, and ALREADY practicing pelvic health in a virtual setting– and we are hosting a webinar to teach all of you how to do just that! So, join us tomorrow for this important event:

TAKING PELVIC HEALTH ONLINE!

LIVE Webinar Event: FRIDAY 3/20 AT 9PM EST

Copy of Talking Pelvic Health

We are bringing an expert panel together to discuss how best to screen, examine, and treat patients with pelvic floor diagnoses—without actually being able to touch our patients! These experts have been ALREADY DOING THIS, with success, and we are so pleased to bring this to all of you!

Join me, Jessica Reale, PT, DPT, WCS, as I lead a discussion with Antony Lo of the Physio Detective and the Women’s Health Podcast, Sara Reardon- the Vagina Whisperer, Juan Michelle Martin- founder of the Zero to Telehealth Program, Julie Granger- virtual health and biz coach, and Susie Gronski- author and educator. We will discuss:

âś… How to get your ideal clients to see the value in virtual Pelvic PT care and convert in-person clients to virtual clients

✅ How to evaluate, screen, and provide pelvic health treatments without being able to physically touch or be present with clients.

âś… How to effectively help your virtual clients without manual therapy or internal examinations

âś… How to market your services in a growing and busy online market and build a practice that is sustainable in the long run.

Plus, Antony Lo has graciously allowed all participants to receive a BONUS link to a recorded virtual session of one of his clients with diastasis recti!

JOIN US FRIDAY 3/20 at 9p.m. EST! Registration is $49.

Register today! 

Do you have topics you are hoping we discuss? Please let me know and I’ll be happy to bring them into the conversation?

Stay healthy and stay safe my friends. We are all in this together!

~ Jessica

Virtual Pelvic Floor Physical Therapy

~ jesspreale ~ 2 Comments

We are in an unusual time. Like many of you, I have been reading way too many articles and watched way too many news stories. COVID-19 is sweeping the world, and all of us have this immense responsibility to act, where we are, to do what we can to prevent the spread of this virus. Everyone is impacted, and everyone (hopefully) is trying to make the best decisions for themselves, their families, and society at large.

Healthcare is also seeing a shift—away from in-person care and toward virtual platforms. Right now, this is essential for so many reasons. The interesting thing is that at Southern Pelvic Health, virtual sessions have always been a part of what we do. And now, more than ever, we are working to be sure this service is available for anyone who needs it. Because, the reality is, pelvic floor problems don’t stop during a pandemic. In fact, for many, they can be exacerbated. Social distancing also offers the opportunity to stop and care for yourself, your health (along with your family & the community by flattening that curve!).

So, what is virtual pelvic floor physical therapy and what can it do for you?

The initial visit starts the same as an in-person session. We spend time discussing what is bothering you, in likely more detail than you thought we’d be discussing. We talk about your history, what happened when all of this started, what changed along the way, what is happening now. We discuss any pain or orthopedic problems you are having, your bladder health, bowel movements and sexual function. And most importantly, we discuss your goals—what you want to achieve how you hope to feel.

Next, we provide an exam. Now, here’s the difference in the virtual session. The components of the exam during which your PT would palpate your muscles or feel you move—we can’t do that. So, the exam takes on a different flare. We still watch you move from head to toe to identify how your body is working for or against itself. We may ask you to do different self-tests, feel different areas and see if you have soreness/sensitivity. We will give you additional information to see if you can activate certain muscles. And, from here, we can actually glean quite a bit of information. You see, the pelvic floor does not work in isolation. So, watching a person move alone can give us so much information about your function. I’ve written about this before, and here are a few that address this:

Head, Shoulders, Knees and Pelvic Floor!

6 Reasons Why the Diaphragm May Be the Coolest Muscle in the Body

Pelvic Floor Problems in the Adult Athlete

Next, just like in-person sessions, we start you on a plan to address the problem areas we have identified. This likely includes specific exercises for you to get started on, and some educational pieces to start improving your habits. We will also make a plan for the future—which could include virtual sessions only, recommendations for in-person consultations, or perhaps a hybrid! At our practice, we already have much of our content and exercises in a digital format. Any exercises we recommend will be given to you via video instruction in your patient portal. Behavioral education and other pieces like that will be provided for you both in our virtual session, but also via handouts e-mailed to you after.

Already an established patient?

This is even better. We have already done a comprehensive exam (or perhaps, another PT has already done this exam!), so we will have a complete picture of your situation.  We will be able to discuss your progress, modify and progress your exercises, continue providing specific education, and help you continue to move forward to improve your function.

Live out of state?

This one is a little tricky. Technically, we are not able to see patients for physical therapy services if they do not live in Georgia. BUT, that does not mean we are not able to help you. We regularly offer virtual consultations and coaching services for people all around the country. This has been an amazing service to provide to play a critical role in helping to guide people to the services they need to get better. Our virtual consultations offer a similar format as our initial telehealth sessions. The difference here is that we would not be able to examine you and progress you in a program. We can offer some general guidance based on your symptoms, and very importantly, we can help you connect with more local practitioners to be on your healing team. We do the legwork for you—we find you resources, skilled practitioners (yes, we help you decide who your best options are!), and coach you along the way.

Are you ready to take the virtual leap? E-mail us today to arrange your first session at Jessica@southernpelvichealth.com!  

Stay healthy my friends! And please, wash your hands!

~Jessica

Podcast Interview: Real Talk with the Pelvic Docs

~ jesspreale ~ 2 Comments

Happy Monday Everyone!

I am 2 weeks in to my new practice, and absolutely loving it! I was fortunate this past week to be a guest on the podcast series, Real Talk with the Pelvic Docs. Jenny LaCross has been a friend for a few years (we connected when she was in her residency program), and she’s doing amazing things for the pelvic health community! It was such a pleasure to talk with her about my experiences with pregnancy, childbirth and my own postpartum recovery. You’ll also hear more about my journey to private practice and my hopes and dreams for the future! I hope you enjoy this podcast as much as I enjoyed recording it!

Episode_6__Labor__Delivery__and_New_Beginnings-_Interview_with_Dr__Jessica_Reale_by_Real_Talk_with_the_Pelvic_Docs_•_A_podcast_on_Anchor

Click here to listen to my guest interview on Real Talk with the Pelvic Docs!

We’re live and going social!

~ jesspreale

Hi everyone! I’ve been staying up till midnight nearly every night, and no, it’s not because of my baby (she’s an amazing sleeper!). It’s because TODAY is move-in day at Southern Pelvic Health! My garage is packed with furniture, and I can’t wait to get this space ready!

Along with that, I am finally ready to launch my website!! Check out www.southernpelvichealth.com and see what you think!

We are also getting social!! I love blogging here, and I’m excited to bring smaller bits of content, tips, and pelvic floor love to the social media scene! Check out our Instagram and follow @southernpelvichealth! You can also find us on Facebook!

We will begin seeing patients on Monday September 30! If you’d like to set up an appointment, you can register as a new patient online!

Can’t wait to get started! Thank you for the outpouring of love and support as I’m starting this journey!

❤️ Jessica