What is Endometriosis?

Endometriosis is unfortunately a common health problem in women, 1 in 10 women are dealing with this diagnosis today. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. Endometriosis happens when this tissue grows outside of your uterus into other areas of your body where it doesn’t belong. It can most often be found in the ovaries, Fallopian tubes, and in the abdominal area surrounding the uterus. The vagina, cervix, vulva, bowel, bladder, or rectum can also be affected.

Symptoms felt with Endometriosis?

There are several types of symptoms that can occur with Endometriosis and women can present differently with what they may feel. Common symptoms reported are pain – severe menstrual cramps that may progressively get worse with age, or chronic pain in lower back and pelvis area. Pain with intercourse (dyspareunia), can be described as deep or superficial pain with penetration. Intestinal pain, and pain with bowel movements or urination or blood in stool or urine are also reported.

In addition, patients often present with bleeding or spotting between menstrual periods. Other common complaints include difficulties with conceiving/infertility, digestive issues – IBS, constipation, bloating, and/or nausea.

Diagnosis of Endometriosis?

There are several ways a physician may diagnosis Endometriosis.

  • Pelvic exam – During a pelvic exam, your doctor will feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are harder to feel.
  • Ultrasound –  to check for ovarian cysts from endometriosis. Both vaginal or abdominal ultrasound can be helpful in diagnosis.
  • MRI – another common imaging test to help assess.
  • Laparoscopy – a surgical procedure doctors can use to look inside your pelvic area to see endometriosis tissue. Surgery is the only way to be sure you have endometriosis.

Treatment of Endometriosis?

Pelvic Floor Physical Therapy specialists can help to manage and decrease symptoms of endometriosis such as painful menstrual cramping, abdominal discomfort, pelvic floor pain, and painful intercourse by treating connective tissue dysfunction, treating myofascial trigger points, visceral mobilization  (helping restore the proper mobility of the internal organs, such as the uterus, bladder, colon and small intestine), correcting postural and movement dysfunction, and providing patients with the information and advice they need to take charge of their bodies.

Integrative medical options such as Acupuncture, Chiropractic, Massage, Nutritional therapy, Yoga, Meditation, etc. can be extremely helpful as part of your rehabilitation plan.

Medicine – Your doctor may prescribe things like hormonal birth control, Intrauterine device (IUD), and pain medication to help reduce pain and bleeding.

Surgery is usually chosen in cases in which other interventions were not successful overall. During the surgical procedure, the surgeon attempts to locate any areas of endometriosis and remove them. After surgery, hormone treatment is often continued. Pelvic Physical therapy is important in the recovery to help improve abdominal mobility and minimize any adhesions from surgery and surgical scars.

If you or anyone you know is struggling with this, please don’t hesitate to contact our office for help.

Helpful references to learn more:

http://endometriosis.org/

www.womenshealth.gov

www.endofound.org

www.acog.org

Pregnancy Pain and Physical Therapy

Pregnancy can be blissful and care free, or some women start to develop musculoskletal problems such as pelvic pain, back pain, hip pain, and bladder pain. Our national organization has links explaining pregnancy related physical therapy, and specifically pelvic pain, check it out: http://www.womenshealthapta.org/patients/

pregnant-belly-2-1431447-639x961Be an advocate for yourself and speak to your health care provider to obtain a prescription for specialty Pelvic PT, with goals to increase your comfort, confidence, safety, and fitness power during the pregnancy and in preparation for baby care. Direct access also allows women to come in independently for musculoskeletal screening, such as diastasis rectus abdominus testing, load transfer and body mechanics, sacro -iliac and pubic symphysis alignment, pain and spasm, and biomechanic analysis. (Also I screen for red flags such as high blood pressure which may sneak up on you). Pelvic muscles and the abdomen and spine can benefit from mini workouts and longer exercise routines as needed. Women who exercise at their own comfort level and capacity have better pregnancy outcomes in general re shorter labors and interventions.Also, binders, belts and belly bands may help and we can offer expert advice and equipment sampling.

Here is a direct quote from a recent systematic review of Physical exercise during pregnancy, Nascimento, S, Surita, F, and Cecatti J, Current Opinion, http://www.co-obgyn.com, Lippincot Williams and Wilkens; “Exercises during pregnancy are associated with higher cardiorespiratory fitness, prevention of urinary incontinence and low back pain, reduced symptoms of depression, gestational weight gain control, and for cases of gestational diabetes, reduced number of women who required insulin.”

The trouble with musculoskletal pain is, it may limit your ability to participate in activities of daily living as well as fitness programs. Feel free to call for a complimentary question and answer as you may need,

I often provide yoga and pilates exercises adapted for therapeutic purposes, to make programs fun and mind body spirit engaged. All the best to you,

stay fit and functional,

Maureen.mom of 2 girls!

What exactly is the “PELVIC FLOOR”?

This is the same question I had several years back even coming out of my program when first introduced to Pelvic Floor Physical Therapy. Surprisingly enough, most Physical Therapy Programs offer little education on the Pelvic Floor throughout their curriculum. If seeking a specialist in this field they will have (should DEFINITELY have) several years of additional continuing education in this specialty in order to treat your pelvic floor diagnosis/symptoms appropriately.

Unfortunately, the Pelvic Floor is often a forgotten land. Rarely will someone go to the gym to work on their Pelvic Floor, or seek nutritional advice to improve this part of their body. However, if you have a specific “problem” with anything associated with your Pelvic Floor then it is THE MOST IMPORTANT part of your body and you will do ANYTHING to get rid of your symptoms, whatever they might be.

I think it’s important to note that both women and men have a Pelvic Floor, and can have pain/symptoms associated with this area. They are essentially made up of the same structures with differences in external parts. Statistically (according to the Journal of American PT Association – Sept 2012, and what we normally see in our clinic today) the ratio of female to male patients seeking help with Pelvic Floor symptoms is approx. 92% female to 8% male.

Anatomically speaking, your Pelvic Floor, sometimes referred to as the Pelvic Diaphragm, consist of three layers of several very important muscles (seen in images below) attaching to your sacrum and iliac bones (your hip/pelvic bones).

Superficial perineal layer: Bulbocavernosus, Ischiocavernosus, Superficial transverse perineal, external anal sphincter (EAS).

Deep urogenital diaphragm layer: Compressor urethra, Ureterovaginal sphincter, Deep transverse perineal

Pelvic diaphragm: Levator ani: pubococcygeus (pubovaginalis, puborectalis), iliococcygeus, Coccygeus/ischiococcygeus, Piriformis, Obturator internus

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Surprising to see how much is “down there” right? And that isn’t including organs, blood supply, or external genitalia.

The Pelvic Floor has many functions which make all these muscles very important. To name a few it helps supports pelvic floor organs, assists in urinary and fecal continence, aides in birthing children for women, aides in sexual performance, stabilizes connecting joints, and supplies and acts as a venous and lymphatic pump for the pelvis overall.

And this is all assuming everything is working properly of course!

Now that we can identify WHAT and WHERE the Pelvic Floor is, we can discuss some of the MANY diagnosis and symptoms that can occur effecting this area and that can alter, most of the time SEVERELY alter, our lives in many ways.

  • Urinary Incontinence – Involuntary loss of urine
  • Stress urinary Incontinence – Involuntary loss of urine with stress (i.e. cough, laugh, sneezing, exercise)
  • Encopresis – Involuntary loss of stool
  • Pelvic Organ ProlapseCystocele, Rectocele, Enterocele, Uterine Prolapse, Rectal Prolapse.
  • Dyspareunia – Pain with Intercourse
  • Vulvodynia/Vestibulitis – Pain/Inflammation at the Vulva
  • Interstitial Cystitis – pain, pressure, or discomfort associated with the bladder
  • Rectus Diastasis – Separation of Rectus Abdominus resulting in pain or dysfunction
  • Constipation/Irritable bowel Syndrome/Other
  • Endometriosis
  • Pubic Bone Pain/Tail bone pain
  • PGAD – Persistent genital arousal disorder
  • Post Prostatecomy symptoms
  • Penile Pain
  • Other post-partum complications/symptoms
  • General Pelvic instabilities

Of course I could go into specific details about each and every diagnosis listed here (which I plan to do in future blogs, especially if feedback requests for info on a certain topic) yet the important KEY POINT to take from this in general is your Pelvic Floor is NO LONGER a “forgotten land” and many times the answer that’s normal at your age, It’s all in your head, you just need to relax, and/or You just had a baby not too long ago, give yourself more time is NOT the end all. There is help!

I feel like I should say that again, THERE IS HELP! Specialists that CARE and can aide in decreasing any symptoms you may have.

So at this point you might ask…What is the first step?  Who can I talk to?  Who can I contact for more information in my area?

Great question! First speak with your physician about seeing a Pelvic Floor Physical Therapist. If you are in our area please don’t hesitate to contact us for any information needed or to set up an appointment for an evaluation.

There are also thousands of pelvic floor therapist around the world.

Here are a couple websites that can help you find one is your area.

http://www.womenshealthapta.org/pt-locator/

https://pelvicrehab.com/

Please contact FunctionSmart Physical Therapy for any questions you may have!

Visit our website for more information: http://www.functionsmart.com/

 

 

Pediatric Pelvic Floor Therapy

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Potty training for any family is rarely described as an easy process. Yet when the child also struggles with functional constipation (no signs of abnormalities physically, seems to be of functional cause) and/or encopresis (involuntary defecation) it turns into a frustrating process that is difficult to get a handle on. Other factors and diagnosis that can prolong toilet training are Hirschsprung disease, Crohn’s, Imperforate anus, Celiac disease, slow transit systems, developmental delays, sensory processing disorders, Autism spectrum disorders, etc.

Pelvic Floor Therapy using Biofeedback (surface EMG)/Real Time Ultrasound (RTUS), therapeutic exercises, nutrition advice, and life style modifications can help navigate this difficult process and improve symptoms associated with chronic constipation, encopresis, and chronic laxative use.
Several studies have concluded positive outcomes with Pelvic Physical Therapy interventions.

A study completed by Zivkovic et al in 2012 looked at the use of diaphragmatic breathing exercises and retraining of the pelvic floor in children with dysfunctional voiding. They defined dysfunctional voiding as urinary incontinence, straining, weakened stream, feeling the bladder has not emptied, and increased EMG activity during the discharge of urine. Although this study focuses primarily on urinary issues, it also includes constipation in the treatment and outcomes. Forty-three patients between the ages of 5 and 13 with no neurological disorders were included in the study. The subjects underwent standard urotherapy with included education on normal voiding habits, appropriate fluid intake, keeping a voiding chart, and posture while voiding in addition to pelvic floor muscle retraining and diaphragmatic breathing exercises. Results showed 100% of patients were cured of their constipation, 83% were cured of urinary incontinence, and 66% were cured of nocturnal enuresis.

A recent study by Farahmand et al in 2015 researched the effect of pelvic floor muscle exercise for functional constipation in the pediatric population. Stool with holding and delayed colonic transit are most often the causes for children having difficulty with bowel movements. Behavioral modifications combined with laxatives still left 30% of children symptomatic. Forty children between the ages of 4 and 18 performed pelvic floor muscle exercise sessions at home, two times per day for 8 weeks. The children sat for 5 minutes in a semi-sitting (squatting) position while being supervised by parents. The patients increased the exercise duration 5 minutes per week for the first two weeks and stayed the same over the next six weeks. The results showed 90% of patients reported overall improvement of symptoms. Defecation frequency, fecal consistency and decrease in fecal diameter were all found to be significantly improved. The number of patients with stool withholding, fecal impaction, fecal incontinence, and painful defecation decreased as well.

Children and parents gain confidence and knowledge to take control of stooling and urination issues when they have the right information and tools to do so. Overall, it is important to know toileting problems are common in children and Pediatric Pelvic PT can help your family engage in a plan for success.

Call us with any questions and speak with your health care provider if a family member may be in need of this specialty.

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Meditation For Healing

Meditation has many health benefits and can really help you heal from injury, illness or chronic conditions. It doesn’t have to be complicated to get started either. Here is a meditation 101 primer for you, to help you unfreeze, focus, re boot, re-frame and calm your mind.  Use this acronym and the tips below to help start your practice and read on for links to resources.harmony-image

SIMMPLE: this may help you remember elements of a meditation practice: Steps to consider:

Select a place. Sit tall. Sitting tall will help you stay alert. Folded blankets or stacked pillows or a “meditation cushion” can help with support. If you have back pain while sitting, you may lie supine, on your back. If you are lying down, turn your palms up and move your arms out to the side slightly, as in the “corpse pose” at the end of yoga classes, Shavasana. The arm posture will help you to not fall asleep.

Intent: Calming, relaxation, peace, and joy. Interest the mind in calming, relaxation, peace, and joy. Intent: Non -judgmental, beginners mind, noticing thoughts and calmly, gently re-direct to present time. Intent: positive feeling, appreciation.

Mental: scanning, body, skin, pressures supported by the chair and floor, and note sounds, sensations, aromas, mood, moment. Melt away from it all.

Mantra; Your phrase. Choose your mantra for calming your mind, and focus. See the guide at the end of this post.

Pace: your breath, with an easy pulse of airflow in, and a pulse of air flow out. Pure oxygen, Pace 1, 2, and 3 inhale, pace pause, pace 1, 2, 3 exhale, pace pause. Peaceful recharge. Pace the breath as a wheel turns, flowing, circular. Gradually lengthen the inhale, the pause, and the exhale, as you are comfortable.

Let: Let go of your thoughts, your busy rabbit brain, let your mind wander and come back, let your thoughts be without judgment. Leave the concerns of the past, leave concerns of the future, and let yourself be. Let go of the need to move or “do” let go, to be present. Let all be. Continue the mantra, and the breath cycling, flowing.

Enjoy: positive feelings, a positive thought, enjoy gratitude. Enjoy a sense of gratitude for the positive things in your life. Enjoy being, and your mantra, and your breath. Enlist all thoughts of gratitude and appreciation.

The practice of meditation can allow you to slow down and focus on moments during the day, with appreciation. This is when meditation overflows to mindfulness. Mindfulness entails a slowing down sense,  appreciation and being in the moment throughout the day,

The mantra:  A great text is Strength in the Storm, by Easwaren, founder of the Blue Mountain Center of Meditation in Berkeley Ca. Easwaren provides examples of how individuals of various faiths can use a mantra specific to their faith for meditation. He advises half an hour in the morning, and evening if possible for meditation and spiritual reading. Even 5 minutes AM/PM can be a good start. You may use his guide for selecting a mantra or simply make one of your own that’s meaningful to you.

There are many free online-guided meditations that can be useful to guide your practice. Here are some links:

Meditation guides

About Meditation: This is a nice site with free offerings of guided 10 -minute sessions, great for mini breaks, and more extensive options for those who want to study as a free course.

UCSD Mindfulness UCSD hosts mindfulness based stress reduction training classes, and they offer free online guides, such as a body scan, and loving-kindness. Choose a voice you like, and start with a short one to develop the ability to “be” vs. “do”.

Meditation music

Last FM, Free music downloads

Ipnos Apps:  Relax Melodies, apps available for i-phone and Android. I use the combo ocean wave sound, and flute, during yoga, and some meditation session.

Medical effects and benefits of meditation are abundant and there have been many articles in medical literature to describe them. Here are just a few of the benefits: Improved status of those with PTSD, reduced worry and reactivity, improved sleep, improved cortisol levels, reduced signs of cellular-DNA aging with longer telomeres,reduced BP, weight loss, and other benefits as noted in these links:

Health benefits of meditation from ADHD and anxiety to cancer and menopause

Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres.

Meditation benefits for Youth

Meditation is becoming more of a mainstream practice for all of its benefits and ease of performance with simple training. Enjoy creating your own practice, and reap all the benefits that come with regular time for re framing and re booting your body and mind.

About the author:   Maureen is a Board Certified Women’s Health Specialist, Credentialed Clinical Instructor, and Professional Yoga Therapist utilizing Medical Therapeutic Yoga. She is an advocate for resiliency training in human performance, and she utilizes principles of meditation/relaxation and yoga postures as part of her Physical Therapy intervention. You may schedule with her at Function Smart to create your own unique mind -body program for wellness.

Pelvic Pain and Nutrition

Pelvic Pain and the Gut; Nutrition Facts!

Maureen and Natalie have 2 conferences they attended recently and we are excited to help you on your healing journey with science:

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There is an explosion of information regarding the “Gut”,and clinicians are helping their clients TURN OFF PAIN by adjusting their nutritional intake. Notice I did not say “DIET: which is restriction based. New approaches guide individuals to gradually add more positive elements to their nutrition profile, and gradually release habits that are pro inflammatory. There are common threads in Pelvic Rehab and as I observe MD, ND, DO, and NP, PT, D.C. and RD directed, “PELVIC HEALTHY” NUTRITION approaches, I see my clients transform. Sleep improves, bowel and bladder function improves, and pelvic pain often reduces or may be eliminated in some cases. It all comes down to science and optimal nutrients that are easily digested, absorbed and assimilated, and excreted. Our PELVIC ORGANS include the bowel, bladder, uterus, and ovaries, and or in males, the prostate and testes. It turns out the best nutrition will help us build and maintain a barrier and insulation of each organ system vs Leaky Gut, or Leaky Vagina or Leaky Bladder. A fun weird fact: The “Vagina Diet” is coming out in 2018 dealing with these issues, from an integrative OBGYN.The synergistic effect of a nutrition –based approach for Pelvic Pain can have a profound, life changing influence on other health factors as well, such as optimizing weight, blood sugar regulation, improved – tissue pliability and appearance, and resistance to illness. But it can take some detective work, and a food/beverage/symptom diary can be illuminating. Reactions can take a few days to occur after ingestion. You are unique and so are your sensitivities and food pleasures that that can help you heal.

Recognize:Power packed nutrition for health:

  1. Cooked vegetables
  2. “Good fats” Omega 3 as found in Salmon, Sardines, and more
  3. Berries and cherries
  4. Lean protein
  5. Nuts and seeds
  6. Yogurt ,* or other source of probiotics

Reduce/trial, and if reactive: gradually eliminate

  1. Refined carbs: they spike sugar and increase inflammation
  2. Gluten, Dairy, Soy: most common food allergens
  3. Alcohol: limit to a few oz., but not daily
  4. Processed meats
  5. Fried foods
  6. Cold beverages such as iced smoothies, milk shakes, icy raw veggies drinks

Also hormone influences can be associated with pelvic pain so if there is a concern check your labs with your health care provider. Studies are demonstrating that a combination of medication and probiotics helps reduce recurrent bacterial vaginosis. In those with Interstitial Cystitis/Painful Bladder Syndrome, attendees of the San Diego Support group have had some success following NIH guidelines :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153925/

https://www.ichelp.org/

https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrom

And last but not least, the GUT BIOME is being identified as a perpetrator in chronic health conditions including pain and anxiety. Here is a link from a local Dietician Donna Wolf who halted her fibromyalgia with nutrition and self care:

http://healthydirectionsforyou.com/leaky-gut-what-it-is-why-its-significant/

Consider what new items to add for health and what you may need to taper or even eliminate. Consult Your Pelvic PT specialist for more information, such as the myofasical basis of pelvic pain, as well. Power On!

Enjoy this THANKSGIVING MONTH and sample a new healthy treat, let us know. This is from S.F. based Seed and Salt:

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Mind Body Skills: The Pelvic Floor

rock stack beach image Your pelvic health, is it “balanced”?

I am speaking this week at the Academy of integrative Health and Medicine AIHM17# , on The Secret World of Pelvic Physical Therapy. Some “secrets” I will divulge include:

1.Kegel Power (Pelvic Muscle Strength) does not always =bladder control, or continence.

2.A “Short Pelvic Floor” is a common condition, and it is too tight to function well! It may be associated with pelvic pain, bladder leakage or pain, constipation or bowel leaks,  pelvic pain with rest and play activities, and/or sexual problems.

3. Sexual  function may be improved with pelvic physical therapy!

4. Mind-Body Skills such as Medical Therapeutic Yoga, Meditation and Mindfulness Training can help improve quality of life, reduce pain, and provide a drug free “re-set”, all helping your Pelvic Floor with improved function. Respiratory exercises and daily health care routines established in therapy can enhance your well being.

Many people are shy about pelvic problems, and so are many medical professionals, so if you have a pelvic health concern, talk with your health care provider regarding conservative care with Physical Therapy.

Meditation, mindfulness training requires “practice”, I suggest my clients start with a comfortable position for 10 min per day, 3 x a week. Results are “dose related”.

https://health.ucsd.edu/specialties/mindfulness/programs/mbsr/Page

Pelvic PT for men and women; details:

http://www.womenshealthapta.org/patients/

 

 

 

What is Pelvic Physical Therapy?

What is pelvic physical therapy?

Pelvic physical therapy is a specialization within physical therapy that addresses musculoskeletal dysfunction of the muscles of the pelvic floor as well as the muscles stabilizing the hips and core. Dysfunction in these muscles can lead to urinary or fecal incontinence, constipation, pelvic pain (including pain with sexual activity), difficulty reaching orgasm and even erectile dysfunction.

Who can benefit from pelvic physical therapy?

Men, women and children can all benefit from pelvic physical therapy. Some common diagnoses include:

  • Children with constipation, bed wetting, soiling of urine/feces during the day.
  • Women with pelvic pain, urinary incontinence, prolapse and post-partum.
  • Men with pelvic pain (including testicular and penile pain), erectile dysfunction, and urinary incontinence post-prostatectomy.

Who can practice as a pelvic physical therapist?

A physical therapist who completes post-graduate advanced education on the evaluation and treatment of pelvic floor dysfunction. These physical therapists often have additional post-graduate education on other systems including orthopedic, gastrointestinal, pediatric, reproduction/sexual health and are experts in treating musculoskeletal conditions of the pelvis.

A New Resource for Pelvic Floor Physical Therapy

This site is currently being constructed to serve as a resource for physicians, therapists and patients seeking more information about treatment options for a variety of pelvic floor dysfunctions.  The site will be managed by San Diego Pelvic Floor specialist Renee Cinco, PT of FunctionSmart Physical Therapy.  We will feature articles from experts both local and national to provide an online resource for men and women seeking options for care.  Many men and women suffer in silence with symptoms of incontinence, pelvic pain, painful intercourse, chronic constipation and much more.  We feel it’s time to break the silence.  Thank you for visiting.