fbpx

P-A-I-N is a 4 letter word, but so is T-E-A-M

IMG_4839Why a team approach of seeing MD and Physical Therapy under one roof is ideal for treating chronic pain.

If you have chronic pelvic, urologic,  sexual pain/dysfunction and can answer “Yes” to this statement:

“I’ve been to a number of medical practitioners about my pelvic condition and still don’t have a definitive treatment plan”, you’re not alone!

Just like the saying  “No man is an island”, no single practitioner can provide the breadth of treatment to help patients heal from chronic pelvic pain/dysfunction without working together in a TEAM of health care providers.

” Pelvic Help for Pelvic Pain”  is a 2 week intensive, non surgical program in NYC designed and provided by EMH Physical Therapy and Dr. Robert Echenberg MD.

The program is based on a Bio-psycho-social model of care which is evidence-based on neuroscience and pain processing disorders that are triggered by both functional and structural pain generators.

During the 2 weeks, you’ll receive a thorough education about pain and how pain can be retrained, receive a variety of treatments that includes medicines, trigger point injections, manual therapies, biofeedback and instruction in a tailored home exercise/management program.

It makes sense to address pain from all angles at the same time and this team approach with such open communication between MD, PT’s and other disciplines such as acupuncture and talk therapy is unprecedented and unmatched today. If you think you’ve tried everything else, try one more thing because it works!

Patients who attended our 2 week “Pelvic Help for Pelvic Pain”  program report a sense of well being, get pain relief, learn many self help tools and feel empowered that they can continue to heal.

The following is an interview of an international 32 year old female patient with 20 years of pelvic pain who traveled to NYC to attend our program:

Q: What was the best part of the intensive 2 week “Pelvic Help for Pelvic Pain” program?

A: The best part was the global approach to my health condition by MD and DPT. Working together,  which is rare in my country, gave me a broader view of my pain and of my power to overcome it.

The compassionate way Dr. Echenberg and the EMH PTs treated me was very supportive. As chronic pain is very stressful, the caring treatments and the kindness of these health professionals were very important and one of the best parts.

Q: How did you feel at the end of the 2 weeks?

A: I felt very well educated about my pain and about my role in my treatment. I was trained by PT to be able to continue my exercise program in South America and I felt I wasn´t alone with my pain, because they told me that they´ll continue support me even with the distance. The symptoms didn´t disappear, of course, because it´s a chronic pain but I felt better and well prepared to deal with it.

We have openings in our program!

Call (212) 288-2242 to schedule your appointment.

For more information about Dr. Echenberg go to his website, http://www.instituteforwomeninpain.com/For more information about EMH physical therapy, go to their website, http://www.emhphysicaltherapy.com.

Prolapse: My Organs are Dropping- What Now?

Pelvic Organ ProlapseWhat is it?

Pelvic organ prolapse is a common condition that occurs most often in women following childbirth or menopause. The muscles inside the pelvis become weakened and lack the endurance or strength to support the body’s internal organs. This can result in a descent of the bladder, uterus, rectum, or even the vagina itself into the vaginal canal. The degree to which the pelvic structures descend can vary greatly. Some women with pelvic organ prolapse may have no signs at all and be completely unaware of their condition, while other women may have a larger grade of loss of support to their pelvic organs and develop more significant symptoms.

How might you know if you have a prolapse?

Some symptoms of pelvic organ prolapse include:

  • Sensation of a bulge/protrusion- feeling like something is coming out of the vaginal canal
  • Pressure and/or heaviness in the vagina
  • Urinary leakage, frequency, or urgency
  • Weak urinary stream, hesitancy with urination, incomplete bladder emptying
  • Painful sexual intercourse
  • Feeling of incomplete bowel emptying
  • Fecal incontinence or leakage
  • Low backache
  • Vaginal bleeding or discharge

What are the risk factors for pelvic organ prolapse?

While women who have been pregnant or given birth vaginally are the most at risk, especially in cases where the mother has given birth to a large baby or experienced prolonged pushing during labor, there are many other causes of pelvic organ prolapse.  Some are work or lifestyle related, such as heavy and frequent lifting.  Others stem from other medical symptoms such as chronic coughing, chronic constipation and/or straining with bowel movements, connective tissue disorders, prior pelvic surgery, or obesity.  Pelvic organ prolapse may also occur as a result of a genetic predisposition or from increasing age.

How can physical therapy help?

A healthy pelvic floor is vital in preventing pelvic organ prolapse, inhibiting further descent of organs that have already begun to fall, decreasing symptoms of pelvic organ prolapse, and as an effective conservative measure to avoid or delay surgery. A study performed by the American College of Obstetricians and Gynecologists in 2007ⁱ found that women with prolapse were found to have defects in the pelvic floor muscles, specifically the levator ani, and were found to produce less power in closing of the vagina with muscular contractions. Pelvic floor physical therapy will directly assess the strength and endurance of pelvic floor and core muscles, look for trigger points within the muscles themselves, help restore shortened muscles of the pelvic floor to their optimal length, and improve awareness of control of pelvic floor muscles with daily activities.

Pelvic floor physical therapy treatment of pelvic organ prolapse includes:

  • strengthening the pelvic floor and core muscles
  • biofeedback to help with improved awareness in using the muscles correctly and effectively
  • education in how to protect from further descent of pelvic organs
  • education in activities to avoid or modify

Women with symptoms of prolapse or who are at risk for pelvic organ prolapse should seek a consultation with a licensed pelvic floor physical therapist to have the best results in long-term pelvic health, function, prevention and management of pelvic organ prolapse.

How Can I Get Started?

Here is one exercise to begin:

Exercise for to help prolapsed organsLie flat on the back with feet propped up and supported on a wall. Place a pillow beneath the pelvis so that the hips are slightly elevated. This will put your pelvic floor in a gravity-reduced position to improve the ease of contractions and encourage an upward movement of the pelvic organs. Next try a pelvic floor contraction by exhaling and drawing the pelvic floor in and upward.  Hold this contraction for 5 seconds and then fully release, allowing the muscles to rest for 5-10 seconds. Repeat 10-20 times.

 

 

 

 

For more information, please go to: http://www.pelvicorganprolapsesupport.org

ⁱDeLancey JOL, Morgan DM, Fenner DE, et al. Comparison of Levator Ani Muscle Defects and Function in Women With and Without Pelvic Organ Prolapse. Obstetrics & Gynecology. 2007; 109: 295-302.

Intimacy Postpartum Doesn’t Have to Hurt

post baby sexIn complete irony the same activity that gave you your little bundle of joy can be painful, daunting, and scary postpartum. I’ve reached the age where the majority of my friends have one or more babies and our group text is rife with complaints about the post baby “bounce back”. If 100% of my girlfriends have complained of pain or aversion to sex post baby I assumed that most women have some concerns about it.

Why Postpartum Pain during Intimacy Occurs

Well, there’s the obvious:  you just pushed a human out of a place that is normally a whole heck of a lot smaller than a baby. If you had a C-section, your doctor had to surgically create an opening to deliver your baby.  If you had an episiotomy or perineal tearing, residual scar tissue can restrict your abdomen and pelvis making intercourse feel painful. In addition, your life just got a whole lot more complicated. You’re now the caretaker for a little miracle and your mind may be on your fragile new baby instead of getting it on with your hubby. Thoughts and distractions can be a powerful libido killer. Lastly, your body is just not the same as it was pre-baby hormone wise. While breastfeeding, your estrogen plummets, and the hormone level in the vagina may be lowered while your whole body focuses on making enough milk for your baby.

post baby massageHow to Overcome Postpartum Pain during Intimacy

  • Firstly, if you had a c-section or episiotomy, self-massage of the vaginal area can be a helpful tool for breaking up scar tissue that may be causing pain. Tips: be gentle with yourself! Don’t rub over the scar but simply hold pressure on the area of discomfort for 5 seconds and then try to move the skin around the incision. Don’t be shy! You can even have your partner gently massage where the perineal or episotomy scar is located if you’re working on an episiotomy scar.
  • Next , when attempting intercourse, use lubrication. Low estrogen levels lead to a lower libido, which means less arousal and less lubrication in the vaginal tissue, and even thinner, more brittle tissue. If you’re into the natural stuff even coconut oil will do. Otherwise try any over the counter kind you like. Your MD may even prescribe a topical cream with some estrogen to help the vaginal tissue bounce back.
  • So you’re lubed up and ready to go…what next? Try different sexual positions, such as being on top of your partner, so you are better to control the depth and speed of penetration. Remember: everyone heals differently. There’s no rush, and you need to communicate with your partner what feels good and what doesn’t.
  • Last tip: don’t forget that you can still get pregnant during postpartum healing.

If you feel like working through the suggestions in this blog on your own is too daunting or you feel like you need professional help, let your MD or physical therapist know. At EMH physical therapy we can help. We specialize in women’s health including any issues that occur post-partum. You deserve to feel like “you” again, so you can be the best mom for that new baby!

Release Pelvic Pain in 2-3 months with Pelvic Floor Physical Therapy

Many evidence based studies prove that pelvic floor physical therapy is an effective treatment approach for men and women suffering from pelvic pain caused by tight muscles and restricted tissues.  The pelvic floor muscles, namely the levator ani, coccygeus and obturator internus can develop adhesions, tension or trigger points which restrict movement and cause pain.  Trigger points are palpable spasms/knots within muscle tissue and can occur in pelvic floor muscles.  Trigger points can lead to adhesions of fascia/connective tissue of the abdomen, groin, pelvic floor and even restrict the viscera (colon, uterus, bladder, prostate gland) within the pelvic bowl.

The pudendal nerves and its branches, traveling from the sacrum (back of the pelvis) and running all through the pelvic floor region innervates the vaginal/penile and rectal areas. The nerves can become squeezed as it travels through tight muscles and fascia, which then decreases optimum pelvic floor function and increases pain.

The pelvic floor muscles are located INSIDE our bodies, in women the muscles are approximately 1-2 inches up from the vaginal/rectal region and in men, the muscles are approximately 1-2 inches up from the base of the penis/rectal region.

The pelvic floor muscles are key for four functions of the body:

1) lower back/core stabilization; 2)  normal urinary function; 3) good bowel function; 4) satisfying sexual function.

As a core stabilizer, the pelvic floor works with 3 other core muscles, the Transversus Abdominus (deepest stomach muscle), Multifidus- (deep low back extensor muscle), and deep fibers of the Iliopsoas (hip flexor muscle). These 4 muscles work together to keep our core strong, flexible and prevents lower back pain. If one of the 4 core stabilizer muscles becomes weak or injured, then the other 3 muscles have to work harder to compensate. Over time this puts great strain on the whole core, which leads to back pain/stiffness/weakness.

The pelvic floor muscles are directly involved with three bodily functions, urinary, bowel and sexual.

For functional urination, the pelvic floor muscles surround the urethral opening and should relax when you are voiding and maintain closure or tension when you are not voiding.   If the muscles are in spasm, urinary symptoms such as leaking,  or feeling a strong urge to void, or having to go to the bathroom multiple times a day (called urinary frequency) and/or being awoken at night to void more than once (called nocturia), can occur.   Women using public restrooms should not “hover” over the toilet, as this sustained half squat creates tension in the pelvis and does not allow full relaxation of the sphincters around the urethra to allow full urination. Best to use the protective toilet seat covers and sit comfortably.

For normal bowel movements, the pelvic floor muscles should be able to open and widen to allow the full passage of stool. When not having a BM, the pelvic floor maintains tension at the rectal opening to prevent leakage.  If the pelvic floor is weak, leakage can occur.  If the pelvic floor is tight, constipation resulting in sitting too long at the toilet, straining to defecate can occur. Toileting should take no longer than 5 minutes following the urge to void.  Even though you may not feel completely empty, it’s better to stand and leave the bathroom  versus continue to sit and strain. Constant straining can result in hemorrhoids and/or the development of a rectocele, which further impedes good function.

For satisfying sexual function, the toned and flexible pelvic floor allows for more intense orgasms in men and women.  A fully relaxed pelvic floor helps women experience pain free intercourse with their male partners.  Many patients who are experiencing sexual pain may experience difficulty with partner relationships or even avoid them due feeling of shame or inadequacy.

Pelvic pain due to restricted muscles can be released and return to normal function, no matter how long a person has been experiencing symptoms.

Physical therapists trained and mentored in pelvic floor work can:

  • apply targeted manual therapies to rid muscles of trigger points
  • utilize biofeedback therapy to help patients learn how to either downtrain (relax) their pelvic floor or to uptrain (strengthen) the pelvic floor
  • perform visceral mobilization to improve the mobility of organs lying within the pelvic bowl
  • mobilize and teach a patient self-connective tissue (skin rolling) techniques to abolish tight skin and fascia of the inner thighs and abdomen
  • teach patients gentle stretching techniques with foam rollers, tennis balls, knobbles, Theracane,  S –wands and dilators
  • educate in exercises for a strong core
  • teach diaphragmatic breathing and visualization to help lower tension of the pelvis and to increase oxygenation to the body and decreased stress
  • guidance in cardiovascular exercise to pump more oxygen and nutrients to the tissues
  • teach proper bladder and bowel techniques and habits

Most people start to feel better after 2 months of consistent, twice a week therapy which incorporates many of the above techniques. Some reach goals sooner; others may take up to 3 months.  By attending regular pelvic floor physical therapy and performing all the home exercises, faulty pattern are reversed and many people are pain free within 2-3 months.