Bladder leakage with exercise is NOT normal.
I had the opportunity to help a patient awhile back. Let’s call her Ashley. When I met Ashley, she told me her story, an all too common tale for many women. Here’s her story…
Ashley is a 31 year old mother of two kiddos under the age of 3. Her youngest was born 6 months prior to the time she came in to see me.
In the past, she exercised a few days per week varying her activity from walks around her neighborhood, to boot camp and strengthening classes at the gym, to the occasional run.
At 6 weeks postpartum, when she was cleared to return to exercise from her OB/GYN, she returned to regular walks pushing a double stroller. Her body felt pretty good overall.
At around 8 weeks postpartum, she returned to the gym for her first boot camp class. She realized quickly how little strength she had in her body, especially her abdomen. What startled her most was that she could not seem to do any jumping exercises without a trickle of urine coming out.
Ashley fully admitted she figured the leakage was a fluke- maybe she hadn’t emptied her bladder fully, or she drank too much water before class… but it wasn’t a fluke.
Ashley explained to me that her urinary leakage continued to happen every time she would jump during boot camp— jump squats, jumping jacks, even with mountain climbers. Then she noticed leaking urine when she would cough or sneeze. Her problem seemed to be getting worse, not better.
She was frustrated.
She couldn’t exercise like she wanted to, nor could she let out a cough or sneeze without fear she would pee herself. She eventually stopped going to boot camp classes and started wearing a pantyliner “just in case.”
Then one day, scrolling through social media, she read a post on how physical therapy could help with bladder issues. She figured it wouldn’t hurt to try. That’s when she called me at 6 months postpartum.
She told me her goal was to be free of leakage again— to not leak urine when she jumped, coughed, or sneezed. She wanted to return to bootcamp classes 2 times per week and potentially run a 5k in the future. She did not want to wear a pad every day. She did not want to feel limited by her bladder problems.
Ashley met with me for weekly appointments to start, then phased down to appointments every few weeks as she saw improvement in her urinary leakage. We worked together on focused strategies and exercises to target her specific problem areas.
By the end of our time together, she wasn’t leaking any longer with a cough or sneeze. Ashley had returned to boot camp classes without fear of bladder problems.
Ashley told me at her final visit, “I am so grateful that I found pelvic physical therapy. No woman should have to live in fear of her bladder. And I’m thankful I no longer have to.”
If you have a story similar to Ashley, we want you to know that you are not alone. 1 in 3 women will experience bladder leakage some time in their lifetime. You DO NOT need to live with it. Pelvic Physical Therapy can help. If you are experiencing bladder leakage with exercise, contact us at 636-225-3649 to set up a free discovery session to see if Pelvic Physical Therapy is right for you.
Sex feels usually feels great, but what if it doesn’t? Painful sex is more common than you think—nearly 3 out of 4 women have pain during intercourse at some time during their lives. For some women, the pain is only a temporary problem; for others, it is a long-term problem. Pain during intercourse is known as Dyspareunia. It can make women avoid, reduce the frequency, or outright stop having sex. Women of all ages can experience dyspareunia.
Have you ever struggled with painful sex? You are not alone. Many women suffer in silence when sex starts to get painful. Others may be brave enough to bring it up with doctors, only to be given unhelpful advice such as “drink some wine,” “just relax,” “you had a baby recently this is normal,” or “just use more lubrication.” Each of these statements are real quotes from patients of ours here at Legacy Physical Therapy. We want to spread the word that there is hope and help!
Earlier this fall owner, Brooke Kalisiak had the pleasure of joining Angela Skurtu M.Ed, LMFT (AASECT) Certified Sex Therapist on her podcast About Sex. During this episode we discussed some of the common causes of painful sex, potential treatment options, and how pelvic physical therapy can help.
To listen to the episode you can go to:
Or you can watch the LiveStream Video below. Brooke Kalisiak brought along her pelvic anatomy model to the taping. Watching the video you will get to have a visual of some of the anatomy she is discussing.
If you or someone you know is dealing with painful sex, please know, first and foremost that you are not alone, and second that there is help. If you would like to learn more about potential treatment options for painful intercourse, you can reach us at 636-225-3649 to talk with one of our experienced pelvic physical therapists.
Do you need more zzzz’s? Or just better quality sleep??
If you’ve answered yes to the questions above then keep reading! Adequate sleep is essential for good health. Having healthy sleep habits is referred to as good sleep hygiene. If you would like to have better sleep hygiene resulting in improved sleep, then consider following some of these sleep practices below:
- Go to sleep and wake up at the same time every day. Easier said than done, but studies show that consistent sleep and wake times will help to set your natural biological clock.
- Set the environment to promote good sleep. Use your bed for only sleep and sexual activity to help train your body that if you are in bed, you should be sleeping. Keep the temperature of the room comfortable. Avoid eating or working in your bed. Lower the light and noise in the room. Use earplugs or eye masks if necessary to drown out uncontrollable noise or light.
- Avoid using light emitting electronics at least 30 minutes prior to bedtime. The blue light coming from your television, tablet, phone, etc. can disrupt sleep by suppressing melatonin production.
- Exercise earlier in the day. Moderate or vigorous exercise should be done at least 2-3 hours prior to bedtime. Exercise stimulates the body and brain, making it hard to fall asleep. Regular exercise has been shown to improve sleep, so keep moving, just preferably not in the few hours before bedtime.
- Avoid drinking alcohol or smoking 3 to 4 hours before bedtime. Nicotine in cigarettes acts as a stimulant that can make it difficult to fall asleep. Some believe that alcohol will relax the body before bedtime and help with sleep. Actually, it can increase the number of times you wake up during the night and make you wake earlier.
- Create a relaxing bedtime routine for yourself. A relaxing routine may include taking a warm bath, deep breathing, meditating, guided relaxation, doing some light reading, or even a yoga or stretching routine.
- Avoid heavy meals and fluids. Excessively drinking or eating a large meal 2-3 hours before bedtime to allow plenty of time for your body to digest.
- Avoid taking daytime naps. If you have to nap, limit the time you sleep during the day to 30 minutes so you are tired enough in the evening.
- Most everyone has the occasional sleepless night, but if you consistently have problems sleeping after trying to improve your sleep hygiene, it is best to contact your doctor or health professional.
Here’s to you getting more restful sleep. We find that for many people pain issues and/or their bladder may be a disrupting factor during the night. If you find yourself unable to sleep secondary to pain or woken up several times a night because of your bladder then give us a call to find out more about how we may be able to help! 636-225-3649
Wow! We had an amazing response to our last blog post about rehabbing the mummy tummy. If you missed it, please check out our take on the importance of considering many factors when rehabilitating the postpartum core and/or diastasis recti, before reading on.
Diastasis recti is a separation of the abdominal muscles that commonly happens with pregnancy. For some women this separation heals back up without much effort after delivery. However, many women still have a diastasis recti months or years after delivery.
“How do I know if I have a diastasis recti?” This is a question that we get asked all the time. There is a simple test that you can perform yourself to determine if you have a separation of your abdominal muscles? Check out our quick how-to video.
How to Test for a Diastasis Recti?
So, did you perform the test? Do you have a separation of the abdominal muscles? If you had trouble telling if you had a diastasis recti, please contact us at Legacy Physical Therapy for a free discovery session to help you.
Or maybe you performed the test and you realized that you do have a diastasis recti. Now what? There are things that you can do to rehab your core whether you are 6 weeks, 6 months, or 6 years postpartum. Call us to discuss your findings with one of our experienced women’s health physical therapists. We are here to help.
Yesterday my Facebook feed was inundated with multiple shares of this NPR article titled, “Flattening The ‘Mummy Tummy’ With 1 Exercise, 10 Minutes A Day.” After all, with a title like that who wouldn’t want to click on the article and and learn what seems to be such a simple fix for diastasis recti. The trouble is that the “Fix” is never this simple.
While I appreciate the awareness this article is bringing to the topic of diastasis recti and recovery of the partpartum core, Diastasis recti is far more complex than any one single exercise for one single muscle. Diastasis recti is not just about the abs, but moreover is about full body alignment and optimal intra-abdominal pressure regulation. One of the things that I talk to my patients about all the time is that I can give them the world’s best abdominal exercise program to perform 10-20 minutes a day, but what they are doing the other 23 hours and 40-50 minutes makes a bigger difference to their diastasis recti.
Core muscle function is so much more than static recruitment of a single abdominal muscle. Your transverse abdominal muscles, pelvic floor muscles, diaphragm, and deep back muscles form your deep core canister. They all work together to provide anticipatory stability. So few women realize that their breathing pattern is connected to their abdominal wall performance and their pelvic floor muscle function. My colleague, Julie Wiebe PT has a wonderful video about how all these muscles coordinate together on her webpage. Check it out. If we do not consider breathing pattern when rehabbing a diastasis recti, we are missing a big part of the picture. Chronic drawing in of the abdominal wall is not the answer! If we squeeze in the middle all the time, what are we doing to our pelvic floor down below… setting it up for issues down the road.
The research on diastasis recti is emerging and evolving. There is no way to prevent it during pregnancy by doing an exercise. It is a normal part of many women’s pregnancies. Don’t get me wrong, there are definitely things that you can do before and during your pregnancy to reduce your risk of a large diastasis recti and improve overall core function and support. However there other factors such as one’s genetics, overall tissue laxity, number and proximity in time of pregnancies, and singleton versus multiple pregnancy to name a few.
What’s a Woman to Do?
While this article is good to raise awareness, it barely scratches the surface of what is really needed to address the postpartum core rehabilitation. My best advice is to seek the care of a women’s health physical therapist to do a full assessment of core support system. At Legacy Physical Therapy, we see women all the time who think they are doing the right thing to rehab their core, but find that despite performing the exercises their symptoms are getting worse. If you cannot get to see a women’s health physical therapist, then please do your research when searching for solutions online. Below is a list of some of my favorite go to sites.
- Julie Wiebe PT
- Mutu System
- Brianna Battles – Everyday Battles
- Jessie Mundell
- Healthy Habits Happy Moms
If you think that you are dealing with a diastasis recti or postpartum core weakness, we can help. Give us a call at 636-225-3649 to chat with one of our women’s health physical therapist to see how we can help. If you are not sure if you have a diastasis recti and want to be checked by a professional, call us to set up a free screening appointment. We are happy to help.
In our last blog post we discussed the 10 sign that you may have pelvic floor dysfunction.
If you missed that post, CLICK HERE to read it.
Did you answer YES to any of the 10 signs in our last post? Are you wondering what you can do about it? Read on…
5 things you can do today to help pelvic floor dysfunction
- Learn to kegel. A “kegel” is a contraction or squeezing of the pelvic floor muscles. Try to contract your pelvic floor muscles as if you are trying to stop the flow of urine or hold back gas. If you can feel a squeezing sensation or successfully stop a flow of urine, then you are likely able to kegel. If you cannot kegel or aren’t sure if you are doing a kegel correctly, a pelvic physical therapist can help assess your kegel and then teach you how to properly contract your pelvic floor muscles. It is worth saying that it’s not all about squeezing your pelvic floor muscles or kegeling! The pelvic floor muscles need to be able to relax too.
- Avoid bladder irritants such as caffeine, alcohol, fried foods, citrus fruits and fruit juices, spicy foods, tomatoes and tomato based products, and/or artificial sweeteners. Once you have eliminated the potential irritants for a couple weeks, you can try to add them back in one by one to tease out which substance seems to have the most effect on your symptoms.
- Avoid constipation and straining. Keeping your stools soft through a diet rich in fiber and plenty of fluids (ideally water) will reduce the strain and stress placed on the pelvic floor. Tools such as the “squatty potty” can position you properly to further reduce the strain on the pelvic floor making bowel movements easier. Pelvic physical therapy can also be helpful in teaching you how to properly relax your pelvic floor muscles to reduce constipation or straining with bowel movement.
- Breathe! A few repetitions of deep belly or diaphragmatic breathing throughout the day can help pelvic floor dysfunction. When you breathe diaphragmatically, as you inhale your diaphragm moves down and your belly expands, and as you exhale your belly retracts and your diaphragm goes back up. Deep breathing helps calm the nervous system and reduce urgency and pain symptoms. Not sure how to belly breathe? Pelvic physical therapists can teach you the proper technique.
- If you think you have a pelvic floor dysfunction, the best thing you can do is to have an evaluation done by a trained pelvic floor physical therapist. In your evaluation, you and the pelvic physical therapist will discuss what your symptoms and goals are; the therapist will perform an evaluation to determine the source of your problem; and you will decide together what the best treatment plan for you will be.
It is our mission at Legacy Physical Therapy to help people overcome pelvic floor dysfunction. We would be honored to partner with you in your care. If you are wondering if you are dealing with pelvic floor dysfunction and you would like to talk with one of our talented pelvic physical therapists, you can email or call us at 636-225-3649 to set up a free discovery session.
“Pelvic floor dysfunction, what’s that? I have never heard of pelvic floor dysfunction. Sure I have had a few kids, but I doubt that I have any pelvic issues. Pelvic issues only happen to little old ladies, not me”
Does this sound like what is running through your head right now? You are not alone. Many women suffer from pelvic floor dysfunction, but are unaware that the symptoms they are experiencing are related to their pelvic floor.
Have you ever experienced any of the follow?
- Bladder Leakage– Whether it be a small drop with a sneeze or a complete loss of urine while on the way to the restroom, bladder leakage is NOT NORMAL. However it is common. One in three women will experience bladder leakage in their lifetime.
- Urgency and Frequency– Do you know where all the bathrooms are in town? Do you urinate more than 7 times a day? Do you constantly feel like you need to pee? Are you getting up at night to pee? If you answered YES to any of these then you are probably dealing with urgency, frequency, and pelvic floor dysfunction.
- Fecal Incontinence– This can come in many forms: inability to control gas, staining or smearing on the underwear, fecal urgency, or complete loss of stool.
- Bladder pain or Burning with Urination– Many women think that they are dealing with frequent recurrent UTIs and subject themselves to countless rounds of anti-biotics only to have the symptoms not go away. The missing factor may be pelvic floor dysfunction.
- Constipation and/or Straining to Have Bowel Movement– We are designed to push to have a bowel movement, but not to strain. Our pelvic floor needs to relax appropriately to let the bowel movement pass We should be having regular bowel movements that are the consistency of soft log.
- Pain with Sex, Tampon Use, or Gynecological Examination– These things are not supposed to be painful. Too many women, “grin and bear it” thinking that pain with sex is just part of it. I am here to tell you that it is NOT!
- Vaginal Heaviness, Bulging, or Feeling of Falling Out– These symptoms are common signs of a pelvic organ prolapse, where one or more of the pelvic organs starts to push into the vaginal canal and cause these symptoms. TOO MANY WOMEN are told that these symptoms are normal after having children and they just need to live with it until the symptoms are bothersome enough that surgery is needed. This is NOT THE CASE for many women. By identifying and working to rehabilitate their pelvic floor dysfunction, many women can alleviate these symptoms.
- Low Back Pain, Abdominal Pain, or Pelvic Pain– Many women are surprised to learn that their low back pain may be caused by pelvic floor dysfunction. The pelvic floor is part of our core support system, so if it is not working appropriately then we can get extra stress and strain on our low back, abdominals, or hips.
- Difficulty Starting Urine Stream or a Hesitant Urine Stream– We were not designed to push to pee, but many women feel like they need to push to get the urine to come out.
- Inability to ‘Kegel’– A kegel exercise is the generic name for a pelvic floor muscle contraction. Contracting the pelvic floor prevents urine or feces from escaping. Research has shown that over 40% of women think they are doing a Kegel exercise correctly, but they are not.
If you answered YES to any of the above then you may have pelvic floor dysfunction. The National Institutes of Health found that pelvic floor disorders affect 10% of women ages 20-39; 27% of women ages 40-59, 37% of women ages 60-79 and nearly 50% of women over 80.
If you have experienced any of the 10 signs listed above you are a perfect candidate to explore the possibility of your pelvic floor being the cause or a contributing factor.
Remember there are treatment options for you! Don’t suffer and compromise your quality of life when the treatment is so easy! If you believe you or someone you know may be dealing with
pelvic floor dysfunction, call our office at 636-225-3649 and
we will help you determine your best treatment options.
If you are like us here at Legacy Physical Therapy, this warmer weather is inspiring you to get outside and get more active! We thought what better way to get active than to do it together!! Starting MONDAY MAY 5th join us for MONDAY WORKOUTS in MAY!! That’s right, instead of picking up the margarita for Cinco de Mayo come break a sweat at Legacy Physical Therapy instead. Every Monday in May (except Monday May 26th for Memorial Day) you can come train with the physical therapists at Legacy from 6:15-7:15pm.
WHAT: Workouts will vary but will involve a mix of cardiovascular and strength training. Workouts will happen rain or shine, but weather permitting we will go outside. Feel free to bring a yoga mat and your own set of small hand weights if you have them, but not necessary. All fitness levels are welcome as workouts can be tailored to the individual.
WHEN: Monday May 5th, May 12, May 19th & Tuesday May 27 (Because of Memorial Day) from 6:15-7:15pm
WHERE: Legacy Physical Therapy 2961 Dougherty Ferry Road Suite 105 63122
COST: Space is limited to 10 participants each class. To reserve a space, call us at 636-225-3649 and ask to sign up for any of the dates above. Classes are $8/person/class if you call ahead to reserve a spot. Classes are $10/person/class if you walk in without reserving a spot ahead of time (We cannot guarantee a spot). Whether you reserve a spot ahead of time or not payment is due at the time of class, CASH or CHECK only.
If this is well received we may continue the workouts throughout the summer! Please call 636-225-3649 with questions or to reserve your spot!
February was National Heart Awareness Month, so we wanted to take a moment and discuss the difference in heart attack symptoms between men and women.
MEN AND WOMEN ARE DIFFERENT!
Shocking…. I know. Heart attacks and heart disease are just another way that men and women differ. Although, both genders are susceptible to heart disease and heart attacks, a woman presents differently during a heart attack than a man does. Unfortunately, for us women, it is less clear that what is actually a serious concern is not “just nothing” like heartburn, the flu, or anxiety.
In fact, HEART DISEASE is the number ONE killer of women in America. So how do we know if we are having a heart attack?
- Uncomfortable pressure, squeezing, fullness or pain in the center of your chest
- Pain in one or both arms, back, neck, jaw, or stomach (MORE DIFFUSE THAN THE CLASSIC SIGNS OF LEFT ARM PAIN IN MEN)
- Shortness of breath (aka dyspnea)
- Cold sweats, nausea, lightheadedness, dizziness
- Extreme fatigue
ANY of these signs may indicate heart attack, therefore, if present, call 911 immediately.
Women are MORE LIKELY to present with atypical symptoms of heart attacks than men, however, chest pain is still a pretty good indicator to go to the nearest ER.
HOW can we prevent heart disease and heart attacks?
- Get Active! If you already have cardiac disease, or any other co-morbidity, your physical therapist is the best person to determine an exercise program for you!
- Eat Better! Diets lower in fat and bad cholesterol are proven to lower the risk of heart disease.
- Lose weight
- Stop smoking: this is the number one risk factor for heart disease and can cut your risk of coronary heart disease in half if you QUIT!
- Manage your blood pressure: High Blood pressures may be a sign of a more serious problem, and if managed effectively, can prevent your risk of more serious issues
So, to recap, as women we have a lot of heart! We consistently put our families and loved ones first in our lives, often brushing our own needs off. It’s especially important for us to take care of health, however, so that we can live long enough and well enough to continue to make the most of time with our families!
Karla Wente, PT, DPT, CLT
Legacy Physical Therapy
Women’s Health Clinical Resident
BONE HEALTH FOR ALL AGES:
Why does bone health matter?
Healthy bones can help you stay strong and active throughout your life. If good bone health is achieved during childhood and maintained, it can help to avoid bone loss and fracture later in life. For bones to be healthy, it is important to maintain physical activity with a healthy, balanced diet full of calcium, vitamin D, and other supplements as needed.
So what is a physical therapist’s role in bone health?
Physical Therapists are experts in the movement system. They can help patients achieve peak mobility and strength, all while keeping your individualized care in mind. The advanced knowledge of PTs is especially important for patients who already have compromised bone health or risk for fracture like: osteoporosis, female athlete triad, fad dieters, obesity, post-menopause age, long-term steroid therapy, cigarette smoking, high alcohol intake. This is not a complete list! Based on information HERE: Fracture Risk Factors!
What is osteoporosis and what does it have to do with physical therapy?
Osteoporosis is a common bone disease that affects both men and women (mostly women), usually as they age. It is associated with low bone mass and increased fragility of bones, making them more susceptible to breakage. This is typically diagnosed by a physician with a bone mineral density scan, taking into account blood levels of vitamin D, calcium, and history of prior fracture. For more information about osteoporosis in general look at: National Osteoporosis Foundation!
Physical therapists are the ideal providers to create an exercise program for those individuals who have osteoporosis, osteopenia (low bone density, but not quite osteoporosis), or those who have risk factors for fracture or falling. PTs are trained, as part of their 3 year doctoral program, to understand postural alignment, movement, gait analysis, balance, and the importance of weight bearing exercise to increase bone density and prevent injury.
So what are weight-bearing exercises and how can I do them?
First off, noone who is at risk for falls, fracture, or who has a known medical condition should start an exercise program without the consultation of a physical therapist or physician first!
Second, weight-bearing exercise includes anything the stresses the bones through their long axis. This includes:
- Walking (best results for strengthening the femoral neck, thereby decreasing risk for hip fracture)
- Yoga (Controversial: may provide whole body weight-bearing, however, can increase risk of lumbar bending which can increase compression fractures; Additionally, fall risk should be assessed before performing higher level balance exercises.) Read more here: Yoga, vertebral fractures, etc.
- Dancing (Those dancing with the stars celebrities are protecting their bone density!)
- Tai Chi (TONS of benefits, see effects on bone density HERE)
So, isn’t this just for “older” people?
NO! Starting healthy habits sooner ensures more compliance later. It is much more difficult to start an exercise program after diseases or injuries have already occurred, so better sooner than later! Additionally, your peak bone mass is about 18 in women and 20 in men…. so START NOW!
For fun activities for your loved ones who are younger check out: Best Bones FOREVER!
What does posture have to do with it?
Obviously, as a physical therapist, I am biased about good posture. However, I know how hard it is to make this a habit. The reason it is so important is that proper posture can prevent injury, pain, falls, and FRACTURE. This is critical for those high risk people! Here are some tips:
- Remember the plumb line: Keep ears in line with shoulders in line with hips in line with ankles. See PLUMB LINE!
- Use pillows when sitting or lying to support yourself in a good position.
- Bend your knees and keep your back relatively straight while you lift things. Always keep loads close to your body.
- Maintain regular fitness as staying active can prevent injuries.
Remember: By 2020, over 50% of Americans are expected to have osteoporosis. Let’s try to keep that number lower and reduce fracture risk in the future!
If you feel you are at risk or you already have osteoporosis, call us today at Legacy Physical Therapy to set up an appointment to see how physical therapy can help. 636-225-3649
Karla Wente, PT, DPT, CLT
Legacy Physical Therapy
Clinical Resident in Women’s Health Physical Therapy at Washington University in St. Louis