All posts by ntfunctionsmart

About ntfunctionsmart

Natalie Thompson is a Physical Therapist Assistant who has experience in all areas of PT yet has a specific passion for Women’s Health, Pelvic floor Dysfunction, and Pediatrics.  After graduating from Loma Linda University, CA Natalie chose to further her education in the specialty of Pelvic Floor Physical Therapy by completing several years of continuing education courses. Natalie strives to treat every patient as a whole, and feels this is critical in the rehabilitation process.  Growing up Natalie was a competitive gymnast which sparked her interest in PT from a young age. In her free time she enjoys spending time with her family, friends, and has a passion in all things involving fitness and nutrition.

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:

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


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.

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

Visit our website for more information:



Pediatric Pelvic Floor Therapy


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.