Interview with “The Vagina Whisperer” on Pregnancy & Postpartum Health, Advocacy, Being a Mom, and Everything in Between!

pregnant-women-lady-girl-boy-214522

About 2.5 years ago, I had the incredible opportunity to join Herman & Wallace Pelvic Rehabilitation Institute as a Faculty instructor for the Pelvic Health Series. This was an absolute dream come true for me, as I completely love teaching and had always dreamed of teaching continuing education in pelvic health. (Seriously… as a new grad, I remember asking an instructor at a course what advice they had for someday becoming an instructor. Funny story is that I now co-teach with that very instructor!).  Teaching in pelvic health has been such a incredible blessing for me– not only do I get to travel across the country and help other clinicians learn to treat my most favorite population of patients, but I also get the opportunity to co-teach with inspiring and incredible experts in pelvic physical therapy.

This past September, I had the opportunity to teach with Sara Reardon, PT, DPT, WCS, BCB-PMD, who is not only an incredible clinician, but is also hilarious, down-to-earth, and passionate about women’s health. One night at dinner, Sara, Darla Cathcart, and I had a long conversation about pregnancy, childbirth, the postpartum period, and becoming moms. At one point, I think all of us had tears in our eyes, as we shared our own journeys, challenges we/our family/our patients have had, and our hopes for making everything better. After that chat, I just knew I needed to interview Sara here so all of you have the opportunity to learn from her and feel her passion! I hope you enjoy this interview! Please feel free to leave any questions or comments below!

If you would like to see Sara’s work, check her out at www.thevagwhisperer.com. Here, you will find information about seeing Sara in-person, her online therapy options, mentoring options, and her instagram/blog presence!

Happy New Year!

Jessica

If you want to see all of our expert videos in one place, be sure to check out my youtube channel! This video as well as the others can be found here!

 

 

How to Poop

3 years ago, I wrote a post on dyssynergic defecation that over time has become the most viewed post I have ever written. Y’all, people are struggling with pooping. Bowel health is something we all tend to take for granted until it stops working right. So, what is dyssynergia? Basically, dyssynergia refers to a state where your muscles are working against you when you have a bowel movement. Instead of the muscles coordinating well to open and relax to allow the stool to come out, the muscles will contract and fight against the stool coming out. This is a big problem for people struggling with constipation. In fact, this review suggested that around 40% of people with constipation have this problem.

frog-1037252_1920

 

How do you properly poop? 

“Why aren’t we ever taught these things?!” I hear this all the time from patients after we discuss the often basic techniques to improve bowel and bladder health. In reality, these habits should be learned and passed down through families, but the reality, more often than not, is that that majority of people do not learn proper habits until problems start happening. So, let’s get started, and get to healthy pooping.

Step 1: Use Optimal Pooping Posture & Positioning 

Yes, how you sit on the toilet really does matter. The optimal toilet positioning is one that will allow the muscles around the rectum to relax. This helps to open the angle between the rectum and the anus, and will allow stool to pass more easily. Our friends at Squatty Potty have made major $$$ on this concept with their handy stool. They do have some great videos, and this one listed here gives a nice overview on why a squatted position is more optimal for defecation.

Now, as an aside, should everyone sit with their knees elevated that high on the toilet? That’s going to be a big NO. The optimal position for you may not be the optimal position for the person next to you. The key here is that you need to be as comfortable as possible while sitting on your throne. If your hips hurt, or your back feels tight, etc. when you are squatted like this, change the angle until you find the best position for you. 

Step 2: Take Your Time 

We all know those people who grab a book and head to the bathroom, only to be seen 30+ minutes later, right? Well, they actually do have the right thought process. Many people get into a pattern of sitting on the toilet and immediately straining and pushing to empty their bowels. This is not often necessary, and actually overrides the normal processes of your colon and rectum. The best habit is actually to 1) Head to the bathroom as soon as you can when you feel the urge to have a BM and 2) Sit and relax on the toilet, giving your body at least 5 minutes to get things moving on its own. If you do need to push or help the body in the process, move on to the next step.

Step 3: If You Need to Push, Push Properly. 

Is it ok to sometimes need to push a little to get the poop out? Absolutely! Our bodies are made to be able to do this when needed to assist in getting the stool out. Did you know your GI system actually has several reflexes that aid in pooping? The intrinsic defecation reflex is a reflex that is stimulated when stool enters the rectum. This reflex will trigger the sequence of events that leads to defecation. When this reflex is suppressed (via another reflex, the Recto-anal inhibitory reflex), the colon will be helping you less in getting the stool out. This means that you may need to do a little pushing to assist in the process. So, how do you push?

Proper pushing requires a few things 1) abdominal muscle activation 2) pelvic floor muscle relaxation and 3) breathing. So, if you are holding your breath when you push, that is NOT proper pushing. Before we get started, it can be helpful to test yourself and see what your current habits are. To do this, place your hands on your belly while you sit on the toilet. Perform a fake “push” and see what happens. Did you hold your breath? Did your belly push out into your hands or pull in away from the hands? What did you feel happen at your pelvic floor?

So, now, let’s talk about how to push properly. First, be sure you are in  your optimal toileting position. Now, place your hands on your belly and relax your belly forward. Do you feel how relaxing your abdominal wall allows your pelvic floor muscles to also relax? Interestingly enough, the pelvic floor and the transverse abdominis muscles have a neurological relationship. Thus, for the majority of people, these muscles contract together. So, since the transverse abdominis muscle will pull the belly in (leading to pelvic floor muscle contraction), we want to do the opposite–> keep the belly out. Next, with your “belly big,” take a deep slow breath in. Then, as you blow out, think about blowing into your belly, gently tightening the muscles of your abdomen without allowing the belly to draw in. We call this “belly hard.” Lastly, as you are doing this breathing, think about relaxing, lengthening and opening your pelvic floor as you gently bear down (“pelvic floor drop”). So, in summary, this is what we are aiming for:

  1. Belly Big— relax the belly forward and take a breath in.
  2. Belly Hard— As you exhale, push into the belly, tensing the abdominal muscles, but not shortening them!
  3. Pelvic Floor Drop— while you are exhaling, gently bear down, allowing your pelvic floor to open and relax

(Note- several amazing clinicians have developed these concepts and verbiage that best connects with people. Pauline Chiarelli has a great book called Let’s Get Things Moving: Overcoming Constipation, and she discusses this in detail there. “Belly Big, Belly Hard, Pelvic Floor Drop” is a phrase we teach in our H&W Curriculum, and I believe it is also a phrase used by Dawn Sandalcidi, an excellent pelvic PT and faculty member out in Denver, CO.)

Who knew pooping was so complicated?

Please let me know if you have any questions! If you’re a pelvic PT, I would love to hear from you–especially if you have other strategies you like to use to help people learn how to poop! Let me know in the comments!

~ Jessica

Treatment Highlight: Vaginal Dilators/Trainers for Sexual Pain

 

Last week, one of my favorite things to happen in the clinic happened again. A sweet patient I had been working with over the past few months came in to her session, and as soon as we closed the door, she exclaimed, “We had sex and it didn’t hurt!” As a pelvic PT, there is nothing better than sharing in the joy of the successes of your patients. Treating sexual pain is close to my heart, particularly because this was one of the reasons I became a pelvic PT to begin with. “Treating Sexual Pain” was actually the focus topic for my small group mentoring program this month, so I thought it would be fitting to highlight a common treatment tool/strategy used in pelvic PT to help people experiencing painful penetration.

What are vaginal trainers? 

Ea3noDBY
Used with kind permission from Intimate Rose 

Vaginal trainers are tools used to help to desensitize the muscles and tissues of the canal. They are often helpful when a person is wanting to participate in penetration activities, and is having difficulty doing so due to pain. Vaginismus is a particular diagnosis that refers to painful vaginal penetration due to muscle spasm. Women experiencing vaginimus in particular can be very good candidates for this type of treatment program. That being said, trainers can also be helpful for people with pelvic pain in performing self-manual treatment to the pelvic floor muscles, or for other vulvar pain conditions. Trainers also come in rectal variations, and some patients benefit from these as well depending on their primary complaints and goals.

Trainers generally come in graded sizes, often ranging from very small (think pinky finger) to large. There are several different companies that make trainers, and I’ll share a few of the different types here:

  • Silicone Dilators/Trainers: These are smooth silicone, and bend and move very easily, so they are what I consider to be top-of-the-line trainers. Soul Source and Intimate Rose are two companies that sell these trainers. Both are great, but I do really like how smooth and soft the intimate rose dilators are. These are a little pricey, so range from $18-50 per trainer $80-200 for a set. (As an aside, Intimate Rose was actually designed by a pelvic PT, Amanda Olson, DPT, PRPC. Amanda has excellent resources on her website, including this great video providing a breathing exercise for pelvic pain)
  • Plastic Dilators/Trainers: These are hard plastic, so they do not move and bend the way silicone trainers do. However, they do tend to be on the cheaper side. Vaginismus.com sells a trainer set including 6 sizes with a handle for about $45. The Berman Vibrating Set includes 4 sizes and often sells on amazon for less than $25. Syracuse Medical also makes a set without handles that is solid plastic, and those trainers are sold individually ($10-20 each) or as a set ($45-80).

How do you decide which to pick?

Well, it depends on a lot of things. Some of my patients prefer to go the cheapest route possible, so for them, it makes sense to get the $25 Berman set off of amazon or the $45 Vaginismus.com set. For others, they really like the softness and bendiness of the silicone sets, so they feel comfortable spending a little more for that type of set. Some sets come with varying sizes, so it is important to pick one that has the sizes you (or your patient) needs to accomplish their treatment goals. Usually, I sit down with my patients, show them a few different sets, then allow them to pick the set they feel the most comfortable with.

Wait…Trainer or Dilator? What’s in a name? 

So, you’ll see these terms used interchangeably quite a bit, but honestly, I think the name really does matter. The term “dilator” never really settled well with me…because…well…dilation is a fairly strong word. Dilation refers to passive opening. I think pupil dilation. I think cervical dilation (although one could argue that is not totally passive!). Honestly, dilation is not what we are aiming for when it comes to the pelvic floor muscles. Trainer on the other hand, is an active term. It requires participation, focus, involvement. It is not a passive process, but rather, is an active journey. And that, my friends, is what utilizing trainers to improve penetration should be.

Getting started with trainers 

A word of advice- please do not try this on your own. I have had so many patients who become discouraged, sore, or get worse from using trainers without the guidance of a pelvic PT. If you are struggling with sexual pain, and you would like to try trainers, please please please make an appointment with a pelvic PT who can evaluate you and guide you in this process.

Once my patients purchase their trainer sets, I have them bring the trainers to the clinic. We then will use them together in the clinic before they begin using them as part of their home program. I have a few rules when it comes to trainers:

  1. We are gently introducing a new stimulus to the vagina; therefore, we do not want to do anything that leads to the body guarding and protecting by pain. So, when people use trainers, all discomfort should be 2/10 or less, and should reduce while we are using the trainer.  (Note: Some very well-intending clinicians will give advice to “insert the largest dilator you can tolerate and leave it there for 10-15 min.” Tolerate is a very strong word, and I find this approach tends to lead to a lot of pain as well as fear and anxiety associated with the treatment.) 
  2. We cap out at 10-15 minutes. I encourage patients to set a timer when they start, and whenever that timer ends, to go ahead and end their session. This keeps the session reasonable in time commitment, and also avoids over-treating the area.
  3. We avoid setting “goals” for the sessions or the week. The goal of using trainers is to gently provide graded exposure to the muscles and the tissues, to allow relaxation and opening without anything being threatening or painful. Our muscles are impacted by many different things, so many patients will find that the size of trainer they use or the level of insertion that happens can vary based on the day, week, etc. So, for this reason, we avoid setting a goal to accomplish, but rather, just aim to spend time focused on breathing, relaxation, opening, and gentle desensitization.

So, how do we use the trainers? 

My approach to using trainers is strongly influenced by my friend and mentor, Darla Cathcart, PT, DPT, WCS, CLT. Darla was my clinical instructor back when I was getting my doctorate 10 years ago, and her approach to using trainers is gentle, progressive, and based in our understandings of muscles and neuroscience. (As an aside, Darla recently started teaching for H&W and I could not be more excited!! We taught our first class together a few months ago, and we will be teaching together again in 2019!! She is the absolute best, and is actually currently doing her PhD research on women with vaginismus. I’ll try to share more as she gives permission to do so in the future!)

Back to trainers, I encourage people to start with the smallest trainer (or for some, I may recommend a different size based on what I noticed with the exam). First, I encourage creating a comfortable environment to use the trainers– this means calm lighting, comfortable space, pillows to support legs and torso so that muscles can relax, and sometimes even a nice candle or soft music. We begin with placing the smallest dilator at the opening of the vagina, then slowly insert until the person feels discomfort (2-3/10) or guarding. When this happens, we stop moving, and they take slow long breaths focusing on relaxing and opening the pelvic floor muscles. They can then gently (like with 25% force) contract and relax the pelvic floor muscles, aiming to completely let go and rest the muscles. If the tenderness/guarding they felt resolves, they continue to slowly insert the trainer and repeat this process until the trainer is completely inserted. If at any point the discomfort does not reduce, we then will back the trainer out a little bit and rest/breathe there for a minute, then try again. If it still does not reduce, then the body is giving a cue that it is ready to take a break from trainers, and we go ahead and stop the session.

Once the trainer is completely inserted, we add movement. This can include turning the trainer side-to-side, or pressing it right, left or down. We avoid turning or pressing the dilator toward the pubic bone as the bladder and urethra live there, and they don’t generally like being mashed on. We can also move the trainer slowly in and out, stopping again during this process if anything is uncomfortable and repeating the steps above.

One that size trainer is completely comfortable, we move on to the next size and repeat the process. This continues until the 10-15 minute session ends, and then wherever we are, we stop for the day. We can add modifications in to trainer sessions, and this will depend on the particular patient. Sometimes this includes partner involvement with trainers or it can include visualizations or imagery to aid in the process.

With this slow, graded, and gentle approach, I find that most patients can do very well and this can be an excellent treatment to help them achieve their goals! I hope this was helpful in better understanding an approach to this treatment! If you are a patient and think you may benefit from using this approach, I would strongly recommend discussing this with your physician and seeking out a pelvic PT to help you guide the process!

If you are a pelvic PT, feel free to share any additional tips or recommendations you have for trainers in the comments below!

Have a happy Thanksgiving!

~Jessica

Your Pelvic Floor as a Threat-o-meter

This past weekend, I was fortunate to work with an incredible group of practitioners at a Level 1 Pelvic Floor Course in my home city of Atlanta. I always leave these weekends renewed, excited, and yes, somewhat exhausted ;-). Not only do I get to teach with some pretty incredible colleagues (in this case, Sara Reardon– the VAGINA WHISPERER!!, and Darla Cathcart–who literally is the reason why I practice pelvic health!), but I also get the opportunity to see the transformation of clinicians who start the weekend a little nervous about the possibility of seeing a vulva, and end the weekend confident and empowered to start helping people who are experiencing pelvic floor problems. (Ok, some may not be 100% confident–but definitely on the road to confidence! ;-))

image1 (2)
Sara, Darla and I after our first day of teaching. This was before we were rained on and had to run to our hotel!

One of my favorite research studies of all time (yes, I am that nerdy) is always shared at this course with participants. This study by van der Velde and Everaerd examined the response of the pelvic floor muscles to perceived threat, comparing women who have vaginismus (painful vaginal penetration) compared to women who don’t.

Throughout my clinical career, the concept of stress and threat worsening pelvic floor problems has been a consistent thread. I frequently hear:

“My job has been so incredibly stressful this week. I am in so much pain today.” 

“Everything started this past year…during that time, my parents had been very sick and it was a very emotionally and sometimes physical stressful time for me” 

“I’ve been having a severe flare-up of my pain. Do you think the stress that I’ve been dealing with in going through a divorce/break-up/job change/move/new baby/new house/etc. etc. etc. could be related to this?” 

Honestly, I could go on and on with continued statements like this. Stress is a complicated topic, and there are many factors involved that can contribute to an alteration or increase in symptoms when a person is in a persistent stressful situation. So, back to my favorite study. In this study, the researchers had the participants watch four different film excerpts that were considered to be: neutral, threatening, sexually threatening or erotic. They then recorded the response of the pelvic floor muscles using EMG. The results of this study were fascinating. They found that with both the threatening stimulus(which happened to be an excerpt from the movie Jaws) and the sexually threatening stimulus (which was an excerpt from a TV movie called Without her Consent–which frankly, sounds awful to me!) the pelvic floor muscles demonstrated increased muscle activity. And this was true in both the groups of women who had vaginismus and the groups of women who did not. (side note: they also saw that the upper traps had this same activation pattern! Makes sense, right?)

Fascinating right? So, what does this mean? I always tell patients that the pelvic floor can be like a threat-o-meter. When a person is experiencing a threat–this can be a physical or emotional threat– the pelvic floor will respond. You can imagine then what happens when that stressful situation or threat stays around for a long period of time! This knowledge alone can sometimes be so empowering for people in better understanding why their bodies might be responding the way that they are.

So what can we do about it?

If you are dealing with pelvic floor muscle overactivity problems or pain, and you find yourself in a stressful or threatening period of time in life, try these ideas:

  • Be mindful of what is happening in your body: I encourage people to do regular “check-ins” or body scans throughout the day to feel how their pelvic floor muscles and other muscles might be activating. If you feel any muscles gripping, try to see if you can consciously soften and let go of tension you might feel. After doing this, try to take a slow long breath in and out thinking of letting tension release.
  • Remember that self-care is actually self-less: Taking care of our own needs allows us to better care for the needs of those around us. Remember the last time you flew in a plane– secure your own oxygen mask before helping those around you! Self-care can mean making time in your day for regular exercise, taking steps to ensure you get the right nutrition you need to feel healthy, taking a break for yourself when you need it, being conscious about following the recommendations given to you by your pelvic PT 😉 or spending time doing a guided meditation or relaxation exercise. 
  • Drop it like it’s hot: Your pelvic floor, that is. Several times throughout the day, consciously think about letting your pelvic floor drop and lengthen. If you have a hard time feeling what your muscles are doing, you can try performing a small (think 10-25%) activation first and then think about letting go of any muscle activity.
  • Don’t be an island: Know that there are so many resources to help you if you need them! Working with a skilled psychologist or counselor can be incredibly beneficial to many people! And, if your pelvic floor is giving you some problems, always remember that you can go see a pelvic PT– yes, even if you had worked with one in the past! We are always here to help you get through life’s hurdles! Sometimes people end up needing little “refresher courses” along the way to help when the body needs it.

So, what are your favorite ways to manage stress? Fellow PTs- how do you help patients handle flare-ups that happen when life starts to get stressful?

I love to hear from you, and meet you! Always feel free to reach out to me here! If you would like to take a course with me, check out the schedule listed on my For Professionals page! I hope to meet you in person soon!

image2
Meet your newest pelvic health professionals from PF1 Atlanta 2018!

 

 

Are you a physical therapist interested in small group mentoring? Help me out by taking a short survey!

It’s almost here! I have been working on developing a small group mentoring program over the past few months, and it is almost ready to be rolled out!

As an instructor for Herman & Wallace Pelvic Rehabilitation Institute, I have been fortunate to work with hundreds of excellent clinicians who are at various stages of their journeys into the exciting world of pelvic health. While some clinicians enter into the field with a vast network of seasoned pelvic floor experts to support them, others have the additional challenge of being an “island”–basically, being the sole practitioner in their practice, city, and for some, within a 100+ mi radius.

My goal with small group mentoring is to be a facilitator for those journeying into this incredible specialty–to help not only with building the skill, knowledge and clinical reasoning necessary to create outstanding clinicians, but also to help connect clinicians together so no one has to go at it alone.

If this resonates with you, and you’re interested in learning with me, I would love to hear from you! I created this survey to better assess the needs of those interested in small group mentoring. Please take a few minutes to complete this survey, and look out for future announcements when the program is ready for rolling out!

All the best,

Jessica

CLICK HERE TO ACCESS THE SURVEY ON SMALL GROUP MENTORING 

Treatment Highlight: Internal Pelvic Floor Manual Therapy

Over the past week, and really the past year, the cases of sexual abuse and assault perpetrated by Larry Nassar, a medical doctor with MSU and USA gymnastics, have rocked the nation. The horrific abuse he inflicted on well over 150 young women, under the guise of “appropriate medical intervention” is deplorable, and I know many of us were glad to see him held accountable for his actions with both the verdict and sentencing last week.

In the pelvic PT world, this hit very close to home, and made all of us completely infuriated. For this person to take a completely valid, evidence-based and extremely beneficial treatment technique, and contort it into being an avenue for abuse was unfathomable to those of us who have dedicated our careers to helping men and women with pelvic floor problems. Several colleagues have spoken out about this. Particularly, Lori Mize, the incoming Vice President of the Section on Women’s Health, wrote an excellent post for the Huffington Post, that I would strongly encourage you to read.

Over the next year, I want to highlight a variety of treatment techniques used in pelvic floor physical therapy to help you better understand treatment options, and hopefully alleviate some fear that some of you may have about “the unknown.” In light of these current events, I thought it would be meaningful to start by discussing internal manual therapy techniques for the pelvic floor muscles.

What is it?

Internal manual therapy techniques are a treatment used for someone who has overactive, tender and/or shortened pelvic floor muscles. Before we get started, if you want to better understand the anatomy of the pelvic floor, check out this post by my friend and colleague Tracy Sher. Tender or overactive pelvic floor muscles can occur when someone is experiencing problems like pelvic pain, painful sexual intercourse, tailbone pain, as well as urinary or bowel dysfunction.

These techniques are performed either vaginally or rectally by a skilled medical practitioner who has undergone advanced training to learn to evaluate and treat the pelvic floor muscles. They are only performed once the patient has been thoroughly educated about the treatment techniques and consents to participating in the treatment.

What does treatment involve?

The goal of internal manual therapy is to improve the relaxation, lengthening and tenderness of the pelvic floor muscles. Generally, the patient is first positioned comfortably in either hooklying (on their back with knees bent, sometimes resting on a pillow– yep, no stirrups needed!), sidelying or sometimes on their stomach, depending on what position is preferable to the patient and allows the therapist access to the tissues being treated. The therapist then places one gloved finger within the vaginal or rectal canal and gently presses on the muscles of the pelvic floor to identify (with constant feedback from the patient) where the muscles are tender or uncomfortable. Manual therapy techniques then can be performed to help improve the tenderness of these muscles and promote relaxation and lengthening. These techniques can include:

  • Holding gentle pressure while the patient focused on relaxing and breathing
  • Holding gentle pressure while the patient performs a contact/relax of the muscles or a pelvic floor bulge.
  • Holding gentle pressure while simultaneously pressing with the opposite hand on a point around the pelvis to produce slack in the muscle (a modified strain counter strain technique.
  • Sweeping stretches over the muscle belly

Different therapists have different approaches, but they all are done in complete collaboration and communication with the patient and are modified based on the patient’s comfort and response to the treatment. Personally, I tend to prefer more gentle approaches while also focusing globally on improving awareness and calming the nervous system. This is not a “no pain no gain” situation– in fact, most often we see the best results when we are able to keep pain at a very minimal level.

What type of training should the therapist have?

It is very important that the person performing this treatment has had specialized training in this technique. At minimum, they should have attended an initial continuing education course that teaches a beginner level evaluation and treatment of the pelvic floor, generally weekend course including at least 24 hrs of instruction. Many training programs now include a 3 or 4 course series, and I strongly encourage clinicians to complete the coursework to learn how to comprehensively care for their patients. At Herman and Wallace Pelvic Rehabilitation Institute, the organization I am a faculty member of, we have a 4-course series which includes a level 1, 2A, 2B and Capstone. The Section on Women’s Health has a 3- course series and there are now several other companies offering varying training programs. Of course, I’m biased as a faculty member of H&W and if you’re reading this and work in healthcare in pelvic rehab, you should definitely come to one of my courses!

Who does this treatment help?

As I mentioned above, manual therapy to the pelvic floor is helpful when a person has overactive, tender and/or shortened pelvic floor muscles that are contributing to the problem they are experiencing. This can occur when a person has pain in and around the pelvis or if the person is experiencing urinary, bowel or sexual dysfunction.

We are producing more and more research about these techniques every day, but here are a few snippets:

  • In this study, 50% of the men treated to address chronic scrotal pain saw a significant reduction in their pain.
  • In this study, 93 people were treated with pelvic floor techniques to address coccyx pain (as well as pain after coccyx removal). Overall, they saw an average of 71% improvement.
  • This study compared comprehensive pelvic PT to cognitive behavioral therapy for women with provoked Vestibulodynia. They found that 80% of the women in the PT group had significant improvements compared to 70% in the CBT group.
  • This study evaluated the effects of pelvic floor physical therapy techniques on pain reduction in men who had chronic pelvic pain. Treatment included internal and external techniques and over 70% experienced moderate or robust improvements.
  • This study found that 62% of women experiencing urinary frequency, urgency and/or bladder pain who were treated with physical therapy interventions, including internal manual therapy techniques, reported feeling “much better” or “very much better” following the interventions.

I hope this was helpful and removed some of the fear from this technique! If you think this treatment may be a helpful one for you, talk with your health care provider! As always, I love to answer any questions you may have!

~Jessica

Prioritizing Self-Care

So, as you may have realized, I periodically write about topics that hit close to home. This was especially true while I was pregnant and trying to live the advice that I often give to patients (Teaser: Do as I say, not as I do.). As a mom to a now 1-year-old, the topic of self-care has been on my mind quite a bit recently. I remember when my daughter was 6 months old, going to the dentist. As I tried to come up with a reason why they hadn’t seen me in almost a year, the best I could do was to honestly say, “Really, I haven’t done much of anything to take care of myself since my daughter was born.” And guess what? It was totally true. I was having a hard time getting back to exercise. I wasn’t sleeping all that well (I mean, who sleeps well with a new baby? If it’s you, don’t tell me.) And, I had skipped many of the typical self-care things that I normally enjoy doing regularly.

My experience unfortunately is not that unique to many new moms (and old moms, and lots of other people too!). In discussing this with my friends and patients, I often find that people live very busy lives and struggle with prioritizing themselves amidst an often hectic schedule. By the time we wake up, make lunches, get everyone out the door, work a busy job, cook dinner, tidy up the house, prepare for the next day, etc… there really doesn’t seem to be time left. The idea of adding in an hour for exercise, meal-prepping or seeing a doctor/dentist/physical therapist can feel impossible.

But, the truth comes down to two key points:

  1. We have time when we make time. 
  2. When we care for ourselves, we actually care better for others. 

Did you know that stress can worsen chronic pain? And that stress is connected to all sorts of illnesses (like heart disease, among others?) Did you know that exercise has all sorts of amazing benefits? (see the awesome whiteboard video below)

In short, when we care for ourselves through exercise, quiet time/meditation, quality time with friends/family, or necessary medical/dental/physical therapy visits, we actually equip our bodies with the tools we need to better handle the stress that comes our way and ultimately, to better care for the important people in our lives.

So, how do you make time for self-care? 

  • Set a realistic expectation: If you do not currently exercise at all, don’t start with a goal of exercising every day. You will probably fail. Instead, make a goal at exercising 2-3 times in the week. If you know that your mornings are completely hectic and busy, that may not be your best time for quiet time/meditation. Instead, perhaps in the evenings as you are wrapping up your day may be a better time.
  • Be specific on your when, what and how:  When I was in PT school, we learned that goals should be objective, measurable and achievable.  This not only sets our patients up for success, but lets us evaluate if our intervention is working. So, if your goal is to exercise, try being specific on your when, why and how. For example, I could aim to run 30 minutes on Tuesday and Thursday evenings after work.  The more specific and scheduled, the more likely you will be to achieve success.
  • Get help when you need it: If it is challenging to hold yourself accountable, talk to a friend or a partner to get some help. Verbally expressing your goals and detailed plan to another person can often help provide the necessary support and accountability for success. If you know you need more tangible help to be successful, make sure to ask for it. This may mean something like planning ahead with your partner to manage childcare responsibilities or it could mean finding a friend who will actually go and exercise with you.

What other strategies do you have for self-care? How have you been successful in the past?

As always, I would love to hear from you!

~Jessica