Life After Leaving The Closet

Six months ago I announced that I was ‘coming out of the closet’ regarding my health issue with Pelvic Organ Prolapse. Today I’m back to share how that decision has improved my life.

After dealing with POP symptoms for what seemed like an eternity, I finally decided to seek answers to my questions concerning this health condition. It took a fair amount of courage to face the fact that I needed help. It wasn’t an easy decision by any means because I tried to tell myself it was just part of the aging process and I would just have to ‘deal with it’ the best I could.

I’m here to tell you, that isn’t the case. No woman needs to suffer in silence or hide their health issues in a closet. I totally understand how reluctant some women are to talk about or be treated for this health issue. I grew up in the era when women’s health issues weren’t openly discussed among peers, but were generally relegated to a dark closet. However, times have changed and although some may not know it, there is hope and help for those who suffer with this malady. New treatment options occur on a daily basis that allows women to control, improve and repair this cryptic health condition. It’s time to openly discuss women’s health issues.

Although I tried to keep up with a daily exercise program prior to surgery, it became difficult because of the pressure and pain I was experiencing. Because of this I gained an extra 15 pounds in a very short period of time. It was a very depressing time for me. But, after the brief recovery from surgery in January I was once again able to exercise and follow a simple diet that resulted in my losing 22 pounds by mid-March.

My life today is one-hundred percent better than it was prior to my surgery. I can go for walks, out to dinner, and shopping without having to worry about what might happen.  If you suffer from Pelvic Organ Prolapse I encourage you to not hide in a closet or allow it define how you live your life. Take charge of your health. After all, there is a better life after leaving the closet!

Betty Heath

Did you miss Betty's original article about her surgery? Read it here!


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About The Author:  Betty Heath lives in Colorado with her husband. She is “retired from work, but not from living”, and has a weekly column called “As I See It”, which appears each Sunday in the Longmont Times-Call, owned by the Denver Post. She enjoys writing, cooking, gardening, and quilting. Betty also volunteers in the St. Vrain Valley School District, helping students learn how to write from their heart. For the past six years, she and her husband have volunteered as Santa and Mrs. Claus for the Holiday Festival in the Carbon Valley. You can read more from Betty at her blog, The Rejoicing Soul.

The Mama Body: Physical Therapy During And After Pregnancy

Physical Therapy During And After Pregnancy

A Guest Blog by Lizanne Pastore PT, MA, COMT

Eighty percent of the bodily changes occurring during pregnancy happen in the first trimester!  Isn’t that astounding?  A woman’s body must adjust quickly to a 40% increase in fluid volume, increased heart and respiratory rates and myriad other changes that may affect us in different ways.  The fluid volume increase, for example, can make our connective tissues weaker—our tendons can get a little mushy and our nerves and blood vessels a bit softer.  This extra fluid and tissue weakening makes us more prone to things like leg swelling, varicosities, tendonitis, carpal tunnel syndrome, or sciatica.  

The hormonal changes in pregnancy play a big role in our metabolism, mood, memory and, of course, ligamentous laxity.  Some pregnant women experience instability not only in the pelvis and hips, but also in the joints of the spine, elbows, and wrists.  Our musculoskeletal system is taxed by these changes even before the baby gets very big.  Then, as baby grows, we might begin seeing rectus abdominis separation (“diastasis recti,”) spinal problems from posture and center of gravity changes, even rib dysfunction as the ribs are forced out and up to make room for belly.  Foot pain from falling arches from the sudden weight gain can occur, and on and on. 

In the pelvic girdle, there is a list of other maladies that can be downright scary to a pregnant or postpartum mama.  And most women are not warned about these potential problems.   Pelvic girdle pain manifesting as coccyx, pubic or sacroiliac joint pain; groin or hip pain; pelvic muscle or nerve pain; plus urinary or fecal incontinence or pelvic organ prolapse are some of the more common things occurring during or after pregnancy. 

After birth, as Mom is busy caring for her newborn and any other children at home—schlepping heavy car seats, strollers, laundry baskets, breastfeeding through the day and night, lifting ever-heavier babies into and out of cribs—she wonders why everything hurts, or why she feels a clicking in her pelvic bones when she lifts her leg!  Well, she is busy performing exceedingly challenging tasks with a sub-optimal musculo-skeletal-neural system (not to mention sleep deprivation!) 

It is well documented that both pregnancy and vaginal birth increases a woman’s risk of developing pelvic organ prolapse or becoming incontinent later in life.  And many women think that leaking during or after birth is “normal” because their friends, moms, aunts, and sisters leaked, plus there are 20 different brands of incontinence pads to choose from in the drugstore, so it “must” be normal.   

But this is wrong; leaking and pelvic organ prolapse is common, but not normal or OK.   The same holds true for back or pelvic pain.  Sure pregnancy puts demands on our bodies, but there is no reason to “put up” with pain, leaking, prolapse, numb hands or legs!  There is a health professional who knows all about this—a physical therapist specially trained in women’s health issues and the pelvic floor.  These PT’s are special – they understand the pregnant and postpartum body and are experts in negotiating a path to health and strength for women with special concerns.

After an initial assessment, which often includes a thorough pelvic muscle exam and possibly even a biofeedback analysis, the woman is prescribed a home program.  This program may include a combination of postural or corrective exercises, motor training or strengthening exercises, bladder and bowel re-training, special instruction to change movement strategies to limit stressors on the body, and even self-care techniques for pain or prolapse, such as self massage for constipation, or gentle inversions for prolapse. 

Wouldn’t it be amazing if every pregnant woman and new mama could have a visit with a PT like this?  Guess what – they can!  If you are reading this article and are pregnant talk about this option with your doctor.  And if you have friends, sisters, aunts and co-workers who might be pregnant or new moms, talk to them about it.  Tell them to ask their doctors for a referral to woman’s health physical therapist!  

Need help finding a qualified PT? Visit the NAFC Specialist Locator to find one in your area.

About the author:  A physical therapist for 29 years, Lizanne has specialized in treating women and men with complex pelvic floor and pelvic girdle issues since 2005.  She has worked primarily in San Francisco and the Bay Area, running a successful private practice for the past 18 years. She writes, lectures, and teaches about pelvic health at the professional and community levels and is currently a board member of the NAFC.  

But You Look So Good

A Guest Blog Post from Alice Thomas

In the early days of my MS I regularly heard ‘But, you look so good.’ While I have always been happy to have my good looks admired, rather than feeling like a true compliment, this statement often came across as one of disbelief that there could possibly be anything wrong with me.

I have even been skeptically asked ‘Are they sure you have MS? You don’t look sick.’ To which I am tempted to reply ‘You don’t look ignorant’. Because the question is inherently impudent and compels us to provide proof we actually have a disease. As patients, we don’t want pity but we do wish to be understood and we shouldn’t have to explain. So, what’s the answer?

One of the barriers to negating this confusion is that invisible symptoms can be difficult and even socially unacceptable to talk about. Amongst the many aspects of MS that aren’t obvious to the casual observer, bladder and bowel dysfunction are some of the most distressing. During my own looking so good days, this may have been the most troubling of my symptoms. I didn’t understand it so how could I talk about it and furthermore, why would I want to? It didn’t seem right to answer the old ‘But, you look so good?’ raised eyebrow with the truth that actually I was up all night doing laundry and crying because I’d peed the bed.

Adding to the frustration and confusion that looking good doesn’t necessarily equal feeling good, is that we as patients already question this ourselves and sometimes we are the most unforgiving accusers of all. We too can’t clearly see our own fatigue, nerve pain, numbness, muscle weakness or heat sensitivity. Consequently, we repeatedly set ourselves up for failure by not recognizing or respecting these unseen forces and then feel angry and defeated when we can’t accomplish what we’ve set out to do. We are the unwilling soldiers in our bodies’ civil war and it is a physical battle but also an emotional one. The physical struggle might be about the strength of our legs on any given day but the mental one is often an argument to simply will ourselves to do that which, based on how we look, we think we should be able. What we need to tell ourselves is the same thing we need to hear from others. MS is real. MS is hard.  

The answer to the dreaded ‘looking good’ statement isn’t to defensively list off every manifestation of the nasty disease that exists within us. You don’t owe anyone an explanation of something as intimate as your health. Nor should you have to prove your condition. But the question isn’t going away. Determining what is caring inquiry and what is idle curiosity can inform your response in these interactions. I’ve often found myself uncomfortably blurting out more than I wanted with someone who didn’t really care anyway. Rather than referencing my latest MRI, I’ve learned to point to some resources. Now when someone remarks on my striking countenance I say ‘Thanks, I inherited my mother’s flawless skin. MS is a complicated illness. If you want to know more, may I suggest checking out the MS Society website?’.

We are all curious from time to time. Let us act out of compassion and before we glibly assess the state of someone else’s health, of which we actually know nothing, pause a moment and instead of saying ‘but, you don’t look sick’ admit that we don’t really know much about the problem and ask how we could find out more.

Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  
Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  

I am not MS, by Alice Thomas

MS is not a suffix at the end of my name. My life with MS, is just my life. 15 years after my diagnosis an MS-free existence is as foreign to me as all night study sessions and the days when my RDA of fruit could be met with grape jello-shots and strawberry pop-tarts. That was another life. One that would hopefully seem strange and remote to me now regardless of my health status. My life with MS is not a separate thing. My life with MS is just my life.

When I was diagnosed I expected everything I knew about myself to change. Suddenly I was a Person With A Disease. I didn’t know what that meant but I was convinced I was about to become someone else. A statistic. A sick person. Irrelevant. Nothing else about me would matter. The first and most important thing people would learn and know about me would be that I had MS. I was terrified of how others would perceive me but more importantly of how my own sense of self might be lost to a new reality. This identity crisis which threatened to convince me I was ‘less than’ for simply having a disease, was as disabling as any physical symptom I’d experienced. 

The early years of my diagnosis brought about massive changes to my life. Optic neuritis meant I was no longer able to drive a car. Weakened legs caused me to change apartments because of stairs and I was forced to leave my job. MS introduced tremendous challenges to my world. But that’s not the whole story. It seems at best cliché and at worst sacrilegious to admit but there have been some positives. Eventually I took the crisis as an opportunity to re-assess what is important to me. It helped me clarify my priorities. I do what I love.

Over time I have adapted to my changing physical body and circumstance and surprisingly I haven’t stopped being me. I didn’t become ‘less than’. In fact in some ways it could be argued I became more me. The things that are fundamentally Alice cannot be altered by a disease. I am incontrovertibly a story-teller, a traveler and a lover of life. A singer, a volunteer, an art loving, wine drinking, dog mum. I am empathetic, enthusiastic, creative and kind. I am curious about the world. I am an advocate and an ambassador. I am a foodie, a fun time, a baker and a homemaker. An optimistic, advisor, a student and a teacher. My life as an artist, a wife, daughter, sister, aunt, friend, these are the things that define me. I am not my job, my car or some stupid apartment. MS is not the most important thing about me, nor is it the most interesting. I am not MS. 

Peace didn’t arrive overnight. Every loss has been mourned. I must consider X, Y and Z each day and while it’s true most may not, they have their own alphabet soups to contend with, full of realities and problems completely foreign to me. As novelist Tom Holt says, “Human beings can get used to virtually anything, given enough time and no choice in the matter whatsoever.” We can adapt. The degree to which we are able to reconcile and coexist with calamity is the degree to which we are able to find our peace.

Grieve the changes. Adjust expectations. Live your life. 

Life with MS is complicated. We argue a lot. But it’s my life and I’m grateful for it.

Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  
Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  

Incorporating pelvic floor exercises into your general workout routine - 3 best moves to add now.

3 Pelvic Floor Exercises to add To your workout routine now.

A guest blog written by Michelle Herbst, PT

Pelvic Floor Exercises, or Kegels, is the contraction of the muscles between the pubic bone and tailbone. When a pelvic floor exercise is performed, the person should feel a gentle tightening and lifting sensation in the lower abdomen and perineum. The pelvic floor muscle contraction is complete when the muscles relax and let go of the contraction.

Please keep in mind these tips when performing a pelvic floor exercise to protect yourself from undue harm. One, you must be able to maintain your breath and therefore be able to inhale and exhale while performing a Kegel and avoid breath holding or bearing down. Two, your muscular effort should be around 75 to 80 percent. If you are exerting 100 percent effort, you are likely using the pelvic floor muscles and many other muscle groups as well.

There are many variations and progressions of a Kegel exercise.

Here are 3 ways to incorporate pelvic floor exercises into your daily routines.

Exercise One: Kegel Progression

The pelvic floor muscles are made of two muscle fiber types – fast and slow. Therefore, Kegels can be progressed by varying the hold time and intensity of the muscle contraction. One of my favorite progressions is simply lengthening the hold time followed by a few quick pelvic floor contractions. For example, a Kegel can be held for 5 seconds followed by 5 quick contractions. This Kegel Combo can be done in any position – seated, standing or lying down. It can be done to the beat of music while seated at a stop light or at the end of a cardio or lifting session when you are your mat working the abdominal exercises.

Exercise Two: Kegel with Breath Work

Yoga is the all the rage and you my find your zen when performing a Kegal with breath work. While your yoga instructor is cueing you in inhale and exhale think about what your pelvic floor. Typically, during focused breathing such as in a Yoga Class, there is always slight tension on the pelvic floor. However, you further engage the pelvic floor muscles when you forcibly exhale. During this type of exhalation, the pelvic floor muscles tighten further along with our deep abdominal muscles to push the air up and out of our lungs. Try it. It may transform your yoga practice.

Exercise Three: Kegel with Plank

Plank. It is a much loved and hated exercise. It is a great way to fully engage our core. And, to reap the benefits of the plank - you must focus on the pelvic floor. If your wrists and feet can tolerate a full plank – go for it! If you need to modify, do a half-plank on your knees. Or, try a wall plank by standing with your feet an arms-length away from the wall and placing your hands on the wall.

Here are a few head to toe cues to get you planking.

When in plank, the hands are stacked under the elbows and shoulders. The chin is slightly tucked lengthening the back of the neck. Your shoulder blades are pulled down and back towards the spine. The chest opens and the pelvis is slightly lifted. Your legs are hip width apart. In full plank, your ankles are 90 degrees as you weight bear through the toes. Now, draw your focus to your pelvic floor muscles.  When you tighten the Kegel muscles, you may feel like your tailbone lift up and in. Hold your plank and breathe. Smile too – you just may enjoy how strong you feel.

 
Michelle Herbst, PT

Michelle Herbst, PT

 

Why Didn't Anyone Tell Me About Pelvic Organ Prolapse?

A Guest Blog By Sally Connor

I am a 38-year old woman, and I am angry. Angry that my body has changed so much since I’ve had children, angry that I developed a prolapsed bladder after the birth of my first son, angry that I can no longer run the way I used to without making several trips to the bathroom, or worse, wetting myself. I am angry with my doctors for not telling me that this may be a side effect of pregnancy and that there were steps I could have taken to prevent it. I’m angry with other women for not telling me that it has happened to them. I am angry for my sheer ignorance of the situation until it happened to me. But more than anything, I am angry that no one knows any of this because in our society, it feels too embarrassing to really talk about.

When we are young, we don’t think about these things. Before I had children, I don’t think that I ever even gave the pelvic floor much thought. Quite frankly, I didn’t even know what it was.  Here is what I didn’t know:  That the pelvic floor muscles act as a basket, supporting your bladder, uterus, and rectum. It is also connected to and supported by your deepest core muscles – your transverse abdominus (below the ‘six pack’ abs) and your multifidus (the tiny muscles that support the spine), and is affected by almost every movement you make.  The pelvic floor, what I now refer to as the epicenter of my body, is called upon every time you sit, stand, squat, walk, and even breathe. 

So I ask, why is it that we don’t hear more about this vital web of muscles? Why are we kept in the dark until it is too late? Because, really, much of this can usually be prevented. The pelvic floor, just like any other muscle in the body, can be strengthened and trained. With regular exercise, the pelvic floor and the supporting muscles around it can provide a strong foundation for continence for your entire life. But, like any other muscle, if it is already in a weakened state, and then becomes traumatized by something like childbirth, well, the damage is done. 

That is the case with prolapse. You can try to repair it, and may see marked improvement through physical therapy, or even surgery, but once the damage is done, it is done. 

It doesn’t mean that there is no hope though. I know this. I have seen great improvement in my symptoms and am grateful to have had access to a very skilled physical therapist who was able to show me how to strengthen things up ‘down there’. But, I still do experience some symptoms and I can’t help wonder if things would be the same had I been more aware of this muscle and what I should have been doing to keep it strong prior to and during pregnancy. 

With over 25 million Americans experiencing incontinence, I am baffled that the issue is not publically talked about more often. It is estimated that about 40% of women will experience prolapse at some point in their life. When will we decide that these conditions deserve attention? Talking about them would encourage more people to get help, and, maybe even more importantly, take steps to prevent it. 

Instead, the silence only encourages the shame, embarrassment, and isolation that many people with incontinence experience.  It does nothing to help those who are experiencing the issue to know there are ways to treat it.  Nor does it educate those who have not experienced it to know that this is something that should be considered. Until we can all be more open and recognize that this is a problem worth talking about (shouting about!), we will be a society that continues to allow it’s people to ‘quietly manage their symptoms’ instead of really preventing or treating them. 

So please, speak up about your incontinence, your prolapse, or any other pelvic floor issue you may have. While it may be common, it’s not normal, and is nothing that anyone should have to suffer with in silence.

About the author:  Sally Connor is a mother, wife, entrepreneur, and homemaker who suffered a prolapse after giving birth to her son. She has refused to let this symptom rule her life and strives to increase awareness of pelvic floor issues and what women can do about them by simply talking more about the issue.  She hopes that one day pelvic floor issues and incontinence will be a less taboo subject.

Why You Shouldn't Just Live With OAB

Overactive Bladder Should Not Be Left Untreated

Overactive Bladder Should Not Be Left Untreated

A Guest Post By Steven G. Gregg, Ph.D., Executive Director, NAFC

Overactive bladder affects millions of American women and impacts their daily lives in many ways.  Some women experience mild symptoms – running to the bathroom a few times per day – without much more impact to their lives than that.  Others are on the other end of the spectrum – unable to make it to the restroom in time, dealing with constant leaks, and always living in fear of having an accident.  And while the medical community has made major strides in treatments available for OAB, many women continue to suffer in silence. 

NAFC recently conducted a survey of women dealing with OAB to see how many of them actually reach out to their doctor about their symptoms, how many receive treatment, and how many actively treat their condition.  And while some of the results were expected, many of the answers surprised us. 

When we asked patients why they had not talked to their doctor about their condition, embarrassment topped the list.  This is not so shocking, given the nature of OAB.  However what really gave us pause is that of those who have never been diagnosed, 54% of women and 71% of men say they actually have had a discussion with their doctor.

These findings reveal that for different reasons, many are still not receiving treatment for OAB, a largely treatable condition.  While there are definitely those who are simply too embarrassed to talk to someone about their condition (I’ll get to that in a minute) many people are in fact reaching out to their doctors for help and, for some reason, they are not getting it.  Perhaps they are being prescribed a treatment that doesn’t work for them or has too many side effects.  Perhaps their doctor has brushed off their concerns without elevating them to a specialist, like a urologist, who may be able to provide a more customized treatment.  Or maybe the patients downplayed their symptoms due to their own embarrassment.  Whatever the case may be, it is startling that such a large percentage of people continue to suffer even after requesting help. 

My advice to you would be this:  don’t settle! Continue to talk to your doctor (or another doctor, if yours won’t listen) and demand a treatment plan.  Educate yourself on your condition and the options available to you (NAFC is a great resource for this!). There are so many treatment options – medication, physical therapy, botox, interstim, ptsn, surgery, etc.  Learn all you can about these so that you are aware of what is available and know what you are willing to try.   Be your own advocate and continue to push the medical professionals in your life to help put you on a path toward treatment.

Now, for those of you who are still too embarrassed to talk to your doctor at all, let’s talk about this.  Yes, OAB can be an embarrassing condition.  Yes, it can be hard to bring this subject up to your doctor.  And yes, based on our findings, your doctor may even imply that OAB is nothing to worry about. 

But, let me tell you – OAB is not a part of getting older.  It’s not normal.  It can, and should be treated. 

So it’s time, once and for all, to brush off your embarrassment, arm yourself with information about treatment options, and march into your doctor’s office to talk about this condition and demand treatment for it.  If your case is severe (and really, even if it’s not), you may ask for a referral to see a urologist to ensure you are seeing someone who is specialized in treating OAB.  And if you need help finding a specialist, use the NAFC locator tool to find one in your area.

What’s the main takeaway here?  If you struggle with symptoms of OAB, it’s time to get treatment.  OAB is something that no one has to live with and with so many treatment options available there is no reason that anyone should.  Take matters into your own hands, be brave, speak up, and demand treatment.  If you don’t do it for yourself, no one else will.

About Steve Gregg, PhD  

Steve Gregg is the Executive Director of the National Association for Continence. He has a PhD in exercise biochemistry from the University of California at Berkeley, and has spent his career in product marketing at agencies such as Ogilvy & Mather, Ammirati Puris Lintas, and most recently, at AbelsonTaylor, among the nation's leading medical marketing and advertising firms.  While at AbelsonTaylor, Steve played a key role in the company's direct-to-physician sleep aide category as well as their direct-to-consumer women's vein health and child nutrition efforts. Steve is also a world-class athlete, having medaled in nearly every major world swimming event, including the Olympic Games in 1976. 

"What I appreciate most about my role at the NAFC is that I have the opportunity to combine my executive leadership background with my passion for healthcare promotion - especially patient advocacy," Steve says. "It's a great challenge to increase awareness and understanding of continence issues, and we have the opportunity to make strides that can improve the lives for literally millions of friends and family members. I don't think I've ever had a more important mission in my entire career."

Preparing Your Pelvic Floor For Pregnancy And Beyond

Preparing Your Pelvic Floor For Pregnancy

Preparing Your Pelvic Floor For Pregnancy

A guest blog written by Michelle Herbst, PT

Congratulations! As you prepare for your baby there is a lot to think about. Doctor’s appointments. Baby showers. Child care. Nervous talks with the Dad-to-be. And, don’t forget - YOU. When you start sharing your news - everyone will give you advice. Some stories will be embellished for the good and others will be overstated for how difficult their pregnancy was. But, keep in mind - this is your experience.

Realistic Expectations:

Some Moms-to-be have problems with leakage. Others do not. A positive pregnancy test does not mean you will develop incontinence or a prolapse - which is a descent of the pelvic organs into the vaginal canal. But, normal changes during pregnancy and the process of labor and delivery can set up the conditions for incontinence and prolapse to occur.  

So, here is my advice as a Mom and a physical therapist for preparing your mind and body for your big day.

Kegel:

You will read about these. Your OB Nurse will ask, ‘Are you doing Kegels?’ But, why are Kegels so important during pregnancy?

Performing Kegels during pregnancy can help you prevent or manage bouts of leakage, and will also help you tune in and tone the muscles that will help push and slide your baby out of the birth canal. Here are a more few reasons why Kegels are so important:

-        To establish a mind-body connection of how the kegel muscles feel when activated.

-        To help create stability of spine and pelvis as your baby grows.

-        To prepare for the arrival of your baby and protection of your pelvic organs during delivery.

Labor can be quick or long. Labor can be easy or difficult. You do not get to choose. But, with preparation of your mind and muscles, along with the skills of your birthing team, the end result will be you holding your precious new baby.

Thoughts on Kegels during Pregnancy:

Think of the pelvic floor as a muscular sling that is tethered between your pelvic bone and tailbone. During pregnancy and labor the pelvic floor muscles lengthen but also need to be able push. The goal of performing Kegels during pregnancy is to improve the strength and function of the pelvic floor as well as encourage lengthening of the pelvic floor muscles.

When performing a Kegel it will feel like a gentle tightening and lifting up and in of the muscles between the pubic bone and tail bone. You may also feel a slight tightening between the belly button and pubic bone. That is your abdominals helping out too. That is OK. Now, hold the Kegel as you inhale and exhale. Relax, and let your pelvic floor muscles return to a normal resting tone or sensation.

The Kegel is a cyclic contraction. It is a shortening of the muscle fibers followed by a relaxation and lengthening of the muscles. If you contract the pelvic floor, and follow that with another pelvic floor contraction without focusing on letting the muscles relax and lengthen, you are training the pelvic floor to become shortened strong muscles not the lengthened strong muscles needed to help push and slide your baby out.

Squat:

Yes – squat. Deep squatting is a normal position to void and give birth. Performing a deep squat as an exercise will help you prepare for the positioning and muscle work needed during delivery.  Deep squatting will open your hips, aide in lengthening the pelvic floor and strengthen your glutes. 

How do I do this?

Slowly work into a squat. You may want to or need to keep your squat shallow by holding onto the back of a sturdy chair or counter top as you start bending at your hips and knees. Keep your gaze forward. Work on keeping your knees behind your toes or stacked above your ankle. Think about keeping your shins perpendicular to the floor. If you are able to get into a deep squat, you may want to place your hands at your chest and gently push your elbows to the inside of your knees.

How long and how many?

This will depend on you. You may want to focus on working into and holding the deep squat. Once you have achieved a deep squat you can work on relaxing into this position. Or, you may want to perform slow repetitions of a shallow squat to standing position and put your emphasis on tightening the glutes when returning to standing.

There really isn’t a right or wrong way – just your way and your focus or intent of the exercise. Pay attention to how you feel and listen to your body.

Your Story:

There will be aspects of your pregnancy and the arrival of your baby that you will not be able to control. But, remember, this is your story. You can prepare your mind and body to set up the best possible set of circumstances to deliver a healthy YOU to motherhood. 

 
 

How Physical Therapy Can Help Your Fitness Plan

Physical Therapy And Fitness: How They Work Together

A guest blog post from Michelle Herbst

Fitness is defined as the condition of being physically fit. There are many parameters to assess one’s fitness level.

Patients often focus on how fast, how far and how long an activity can be completed,  while physical therapists (PTs) focus on the mechanics of a body’s ability.

Because physical therapists are intimately aware of musculoskeletal anatomy and comprehend how the individual joints, muscles and nerves work together synergistically, physical therapy compliments general fitness by designing an individual home care and exercise plan allowing you to go faster, farther and longer.

Because PT’s tend to think beyond the fitness concerns of a patient, many questions are asked about the onset of the injury or current limitation a patient is experiencing. All of these questions help PT’s get to the root of the information that help them formulate an individualized plan.

Some questions patients often here are: How did the injury happen? When and where?  What did you do after the injury? Have you seen your primary care provider? Are you on any medication to treat the injury? How is this effecting your daily activities?

When a particular task, such as walking, has been negatively impacted by injury or illness the physical therapist may measure how fast, how far and how long the patient can complete the activity before symptoms worsen or force the patient to stop.  The information gathered is used to develop an individual treatment plan.

At the end of the day, a PT’s job is to get the patient’s body mechanically fit to complete fitness activities and excel at regular, day-to-day movements that are necessary for an active life.

About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.
About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

Questions to ask your PT at your first appointment

Have you finally made that appointment with a PT to discuss incontinence issues? Kudos to you for seeking out physical therapy for your incontinence problems. As you prepare for your first visit questions may be circling through your mind. That is OK and is normal. Do not feel imitated by asking your physical therapist questions. 

Physical therapists love patients who are engaged and choose to participate in their treatment plan. A fully engaged patient will have better compliance resulting in an improved overall outcome. The end result may be a happier and healthier YOU!  

Carefully chosen questions will allow you to get to know your physical therapist and why they treat patients with your condition. No question truly is a bad question. So, let’s fire away. Below are some questions that should be on your list for your first appointment.

How long have you been practicing physical therapy?

Go ahead and ask - this question will provide a brief history of your therapist.  In order for your physical therapist to have obtained the skills necessary to properly evaluate and treat incontinence she will have been out of physical therapy school for a few years.  

What additional training have you received to evaluate and treat my condition?

It is ok to ask this question – this is your health and you want to be seen by a qualified provider.  Here is the reason why. The skill set necessary to treat incontinence is an advanced skill set that isn’t developed in physical therapy school. Your physical therapist will have taken at least one advanced course past physical therapy school in order to properly evaluate and treat pelvic floor conditions.

How long have you been seeing patients with my problem?

Asking this questions will establish your therapist’s experience with your condition.  Please do not be put off if you are one of her first patients.  Often times, when a therapist is ‘new’ to a condition – that patient is her primary focus and challenge.

What can I do outside of my physical therapy appointments to help in my treatment?

Ka-ching! Great question to ask.  Physical therapists love patients that want to work hard.  Your therapist will LOVE providing you practical and progressive home program to complement your clinic treatments.

Do you have or know of any resources that help me understand my condition?

Again, a great question. The therapist will likely have printed materials to give you but will also have recommendations for valid and reliable online resources.

About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.
About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

It's All About The Base: Learning How To Work Out Your Pelvic Floor

It's All About The Base

We all have health goals. They are often about being more health conscious and physically active.  I’ve heard varying goals from “I want to lose 15 pounds” to “I want to be able to run my first marathon,” but rarely do I hear “I want a stronger pelvic floor” or “I want to be able to jump or exercise without leaking urine every time.” In fact, most people don’t even know about these muscles and how essential a strong pelvic floor is for everyday function.  

The pelvic floor is an amazing set of muscles that span inside your pelvis, from your pubic bones to your tailbone, that act as the base of your core.  They work to control your bladder and bowel and maintain continence, allow for pain-free and enjoyable intercourse, hold up the pelvic organs and help stabilize the pelvic girdle and spine…that’s a lot of responsibility for muscles that are often neglected in the daily workout plan.

As a pelvic floor specialist, I am often asked “How do I work out my pelvic floor?”  The fact is, most people don’t know how to turn on their muscles the RIGHT way.  They are often trying so hard to squeeze as tight as possible that they are engaging everything but their pelvic floor! They will hold their breath, clench their butt, squeeze their inner thighs, tighten up their abdominals and totally miss the boat. 

A pelvic floor contraction, or Kegel, is a very subtle feeling.  It includes a compression and lifting of the muscles deep inside the pelvis, like you are trying to suck a marble up with your vagina or lift your testicles in fear of walking into ice cold water!  Too frank? Well then imagine that you are stopping the flow of urine, which is actually a good test to see if you are engaging the RIGHT muscles.  You can always tighten your pelvic floor mid-stream and see if you can stop, or at least slow down the flow, but this should just be a test, and never a means to actually exercise these muscles.

Although the pelvic floor is the star of this article, you have to also understand that these muscles don’t work in isolation.  Remember that the pelvic floor is the BASE of the core, but also works with other muscles as an integrated system.  The major supporter of the pelvic floor is the diaphragm, which is the dome-shaped muscle at the bottom of the rib cage that is essential for breathing. 

When you take a deep breath in through your nose, your rib cage expands and the diaphragm moves downwards, changing the pressure system in your abdomen so your pelvic floor muscles RELAX.  As you exhale through your mouth, the diaphragm moves upwards, and again, the intra-abdominal pressure is changed, and the pelvic floor returns to its resting position.  Wow! Who knew that just practicing breathing could also be working the pelvic floor!

If you want to get fancy, you can coordinate the two muscle groups together:  

Start lying on your back with your knees bent.  Place each hand on the side of your rib cage. Inhale deeply through your nose, imagining your rib cage is expanding in all directions into your hands, and keep your pelvic floor relaxed.  As you exhale through your mouth, let your rib cage return to resting position and gently tighten your pelvic floor muscles and hold for up to five seconds, then release.  Repeat this sequence for a good 5-10 minutes each day…it’s more about the quality of the breathing and pelvic floor contractions, not just the quantity.  (If you are a numbers kind of person, then try to shoot for 30-50 contractions a day.)

It is essential that you allow for the relaxing aspect of this exercise.  Like any other muscle in the body, we need to make sure the pelvic floor is able to go through its entire range of motion, which means it should be able to tighten, and then release or relax, so it can be able to contract again.  Remember that these muscles are working 100% of the time, and in order to maintain a strong pelvic floor, you need to let these muscles RELAX in between each contraction

 As you feel more comfortable with this exercise, try it sitting or standing, so you can start working out your pelvic floor throughout the day. The beauty of exercising your base is that no one even knows you are doing it!  You can be standing in line at the grocery store or sitting in your car, waiting for the light to turn green, and BAM!  You are working your base out!  Even better, think about integrating your pelvic floor and diaphragm into your gym routine, especially lifting weights or doing other core work.

I dare you to start thinking about exercising all aspects of your core, especially your pelvic floor.  Remember, it’s all about the base!

Victoria Yeisley, DPT, has been specializing in pelvic floor physical therapy since 2008.  She completed her Doctor of Physical Therapy at Boston University and currently works with Northwestern Medical Group in Chicago, IL, where she is integrated as a part of the OB-GYN team.  Victoria’s passion lies in empowering her patients to not only be educated about their pelvic floor, but to gain control over their symptoms.  She feels extremely lucky to be able to practice her passion every day and hopes to be able to continue to promote pelvic floor muscle awareness for all!