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What to Wear to Pelvic Floor Therapy

Tue, 21 Apr 2026 20:56:19 GMT

Pelvic floor therapy involves both conversation and physical assessment, which makes choosing the right clothing an important part of feeling prepared. Below we explain what typically happens at a first visit and how your outfit can support both comfort and mobility during the evaluation.

It also outlines when undressing may be part of the session, what types of clothing work best, and what to avoid. Pelvic floor therapy is designed to meet you where you are, making preparation simple and patient-centered.

What to Expect at Your First Appointment

To better understand what to wear to pelvic floor therapy, you first have to understand what to expect at your first appointment. During the first appointment, or initial evaluation, we will start by talking about what brings you to pelvic floor physical therapy. Sometimes this may only take the first portion of the evaluation, sometimes it takes the entire first appointment - it is completely up to you.

For some people, they feel it is important to get to the hands-on assessment as soon as possible. For others, they just want to have a provider who finally gives them the time and space to share their lived experience with their symptoms. At Pelvic Pride we prioritize making the evaluation appointment meaningful for you, which means we will ask you what you want to accomplish on day one and tailor our visit to that goal.

Once we get through our conversation about your symptoms, we will move on to the assessment portion of the appointment. We have plenty to look at from head to toe, but in general we can split the objective testing into two categories: a pelvic floor exam and an orthopedic assessment.

During a pelvic floor exam, we can perform an external and internal assessment, with your enthusiastic informed consent. To perform a hands-on or observation-only pelvic floor assessment, we will ask that you undress from the waist down. This allows us access to observe and palpate your pelvic floor soft tissues.

On the other hand, when we perform an orthopedic assessment, you will stay clothed as we perform various tests, measures, and observations of your body head to toe. This may include things like bending forward and backward, jumping, marching in place, muscle strength testing, flexibility testing, and more. If we want to assess posture or muscle activation better we may ask that you move clothing out of the way - i.e. remove your shirt to see shoulder and neck posture, lift your shirt to assess abdominal activation and for diastasis, or lift your shorts/pants to assess leg muscles.

Upon completion of the objective assessment, we will review what we found, its impact on your symptoms, and discuss our plan for care. This may include beginning various treatments on day one, depending on how much time is left in the session.

Best Types of Clothing to Wear

As you can see it is important to wear the right kind of clothing. This may mean wearing a sports bra, a tank top, shorts, or loose fitting clothing you can move in. Leggings are also a good choice as long as they let you move around. Keep in mind that we may need to move them above the knee to take a look at the lower legs. As for footwear, wear shoes that provide you with support and will not easily slide off. If you have a specific sport or activity you are trying to return to, it is important to wear or bring the shoes you plan to wear for that activity with you.

What to Avoid Wearing

Almost as important as knowing what to wear to your appointment is knowing what NOT to wear. When attending your pelvic floor therapy appointment, it is advised that you avoid wearing tight fitting clothing that does not let you move around, jeans, dress clothing, and improper footwear.

If you are required to wear specific shoes for certain activities, like work or dancing, and you are having pelvic floor symptoms while wearing them, definitely bring them to your appointment so your therapist can assess you while you wear them. Otherwise heels would also be on the list of what to avoid.

Do You Need to Undress

As discussed above, undressing is a common part of the pelvic floor assessment. However, we did note that this should come with enthusiastic informed consent. If you do not feel comfortable doing a hands-on pelvic floor assessment and undressing on the first visit it is important to let your therapist know. But, if you feel comfortable to move forward with a pelvic floor assessment and your therapist suggests it, you will need to undress so we can examine the pelvic floor muscles for strength, coordination, and tension/tenderness.

How to Feel Comfortable and Prepared

The best way to feel comfortable and prepared for your evaluation is to do your research. Take a look at the clinic website, review the FAQ page , and read your therapist’s bio if they have one available. Familiarize yourself with the area of the clinic including the parking situation and how to find the entrance to the therapy practice. If you have any questions ahead of time, be sure to give the front desk a call to get them answered. If they are clinical questions, be prepared to bring them with you to the evaluation appointment.

Common Questions About Pelvic Floor Visits

Beyond the above advice, keep in mind that as pelvic floor PTs, we are working with patients’ pelvic floors every single day. This means there is not such thing as TMI or weird questions. Other questions we hear often include:

Do I need to shave?
Nope! Unless you want to. We don’t care either way, and that includes all areas of your body.
What if I am on my period?
Still come in - we are used to periods! But if you have concerns about doing internal pelvic floor work while you are bleeding just let you therapist know and we can focus on other treatments that session.
Can pelvic floor therapy help me?
Yes! We rarely have patients come in who cannot benefit from pelvic floor therapy.

Looking for Pelvic Floor PT in Maryland?

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients struggling with pelvic floor issues so you are in the right place!

We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

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7 Must-Ask Questions When Choosing a Pelvic Floor Therapist

Thu, 09 Apr 2026 23:26:01 GMT

Choosing a pelvic floor therapist requires understanding qualifications, treatment approaches, and what to expect throughout care. This guide outlines seven essential questions to help you make an informed and confident decision.

It emphasizes the importance of whole-body assessment, individualized treatment, and clear communication when starting pelvic floor therapy. Finding the right provider can directly impact your outcomes and overall experience.

Whether you are navigating pain, postpartum recovery, or bladder concerns, pelvic floor therapy can offer targeted, effective support when guided by the right professional.

So you’ve figured out that pelvic floor therapy might be the best place to address your concerns around something like incontinence, pelvic pain, pregnancy/postpartum symptoms, or any other pelvic related concerns. But, how do you find the right fit? What questions should you ask? As pelvic floor providers we know the information you need, so we put together this handy list to help you find the best provider for you! Here are the 7 must-ask questions to ask before selecting your pelvic floor therapist!

1. What are your qualifications and experience in pelvic floor therapy?

Not all physical or occupational therapists specialize in pelvic health, so it is important to find a provider who has advanced training in pelvic floor therapy. Look for providers who have taken advanced coursework from institutions like Herman & Wallace, American Physical Therapy Association, Brooks Institute of Higher Learning, Evidence in Motion, Pelvic Health Solutions, and Pelvic Floor University. If you have a specific condition—for example, pelvic organ prolapse, endometriosis, or postpartum concerns—inquire about their experience in treating it.

Ask this: “What kind of training and experience treating patients with pelvic floor issues does this therapist have?”

2. Do you treat the whole body, not just the pelvic floor?

The pelvic floor doesn’t work in isolation—this is a classic case of “everything is connected”. Our pelvic floor function is very closely connected to your entire system from your jaw to your toes. A whole body approach to treating the pelvic floor will ensure that a provider is not zooming in too deep to only look at the pelvic floor while ignoring the big picture, which is where contributing factors to pelvic floor dysfunction are often found. Therefore, a therapist should assess and treat the entire body to better understand and address the root cause of your symptoms.

Ask this: “Does this therapist assess beyond the pelvic floor, or will the assessment only focus on the pelvic floor?”

3. What conditions do you commonly treat?

Some providers specialize in pregnancy and postpartum care, while others focus on chronic pelvic pain, neurological conditions, bowel and bladder dysfunction, gender-affirming care, and so on. You will also find therapists who are experienced in working with all conditions and genders. If you have specific concerns or diagnoses, don’t be afraid to ask if the provider is familiar and experienced with that condition.

Ask this: “What are the most common conditions this provider treats? Do they have any experience working with patients who have x?”

4. Do you offer internal and external pelvic floor assessments?

The answer to this may vary based on the setting a provider is treating, as well as their experience levels. If you are seeking pelvic floor therapy, it is important to choose a provider that is skilled in both internal and external pelvic floor assessment. A thorough assessment is key to understanding your pelvic floor function. Some therapists only perform external evaluations, as where others are trained in and skilled at performing both external and internal assessments as part of their practice. While a patient’s preference and consent for internal vs. external is always the main driving factor of if and when this exam is performed, it is important to note that a provider who does not offer internal assessment and treatment at all may not be the best provider to find the root cause of a pelvic floor concern.

Ask this: “Is this therapist trained in internal and external assessment? Will an internal assessment be discussed during the initial evaluation?"

5. What treatment techniques do you use?

Pelvic floor therapy involves WAY more than just kegels! In fact, it commonly may not even include kegels at all. A skilled provider uses a combination of hands-on manual therapy, behavioral strategies, neuromuscular re-education, and movement-based treatments. Understanding their approach can help you determine if their treatment style aligns with your needs and preferences. Keep in mind that different treatment approaches may be used to treat the pelvic floor in different ways , i.e. directly treat the pelvic floor and surrounding structures, indirectly treat those structures, or to treat and influence the nervous system.

Ask this: “What kind of treatment techniques does this therapist utilize in their treatment sessions?”

6. What should I expect during my first visit and throughout treatment?

Understanding the treatment process can help you feel more at ease. Ask about the setting itself and the layout of the clinic, structure of the first session, how long treatment typically lasts, and what kind of progress you can expect over time. A good provider will outline a clear plan and set realistic expectations. This may change as you go through the therapy process, but it can help you understand the length of an estimated plan of care.

Ask this: “What can I expect to happen during my first visit? Will there be any treatment during that session or only assessment?”

7. What does payment for services look like at your clinic?

Pelvic floor therapy is an investment in your health , but it’s important to understand the financial aspect for continuity of care and to complete your treatment plan. Some providers accept insurance, while others are out-of-network clinics that are fee-for-service and offer superbills for reimbursement directly to you from your insurance. Reimbursement varies based on your insurance plan.

Reaching out to your insurance provider can help you better understand what this may look like for your plan. If you decide to work with a clinic that is in-network with your insurance plan be sure to ask about additional fees, like if they are associated with a hospital and charge a hospital fee (averaging $200-$350 on top of your copay or co-insurance), if you will have to pay cash for specialty treatments like dry needling, or what happens if your insurance denies coverage for visits that you have already been seen for.

Ask this: “Are you an in-network or out-of-network provider?”

If In-network: “Are you associated with a hospital? If yes, do you charge a hospital fee? Are there extra fees associated with specialty care like dry needling? What do I owe if insurance denies a visit I have already attended?”

If Out-of-network: “What is the cost for care for the evaluation and follow up visits?”

Choosing the right pelvic floor therapist is about more than just convenience—it’s about finding someone who makes you feel comfortable, listens to your concerns, and provides expert care tailored to your needs . By asking these questions, you can ensure you’re making an informed decision and setting yourself up for success on your healing journey. If you have additional questions or want to see if Pelvic Pride is the right fit for you, we would love to hear from you!

Looking for Pelvic Floor PT in Maryland?

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients struggling with pelvic floor issues, including constipation, so you are in the right place!

We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

How Many Sessions for Pelvic Floor Therapy?

Mon, 30 Mar 2026 16:17:56 GMT

Pelvic floor therapy is a personalized treatment approach designed to address bladder, bowel, sexual health, and pelvic pain concerns through targeted muscle and movement work. This blog explains what therapy involves, how it progresses through structured phases, and what patients can realistically expect.

At Pelvic Pride, pelvic floor therapy is guided through four phases that build from assessment to full independence, helping patients restore function and return to meaningful activities. The number of sessions varies based on symptoms, goals, and consistency, but most people can expect a general range of care.

Understanding the process and committing to treatment helps patients get the most out of each session while working toward long-term symptom relief and confidence in their bodies.

If you’re reading this, pelvic floor therapy has already been put on your radar somehow. Maybe your bestie went to pelvic floor therapy postpartum and it helped in her recovery, or maybe your cousin saw a pelvic floor therapist for pelvic pain and suggested it may be helpful for you, too. Or maybe you went down a rabbit hole trying to figure out your own pelvic health symptoms to see if this whole pelvic floor therapy thing may actually have some relevance for you. No matter how you found us - you are in the right place.

One of our top frequently asked questions at Pelvic Pride is ‘how long is this going to take?’ and truthfully, we get it. You’re trying to spin all the plates of your daily life demands, and adding in other appointments on top of that can feel like a lot. Keep reading and we will clarify what you can expect in your pelvic floor therapy treatment plan.

What Pelvic Floor Therapy Treats

Let’s start from the beginning. At pelvic floor therapy, a specialized pelvic floor therapist will work with you to treat the muscles of the pelvic floor which support the bladder, bowel and reproductive organs. We’ll also treat surrounding muscle groups like the diaphragm, abdominals, hips, back, and even down into the legs and feet. Anything pertaining to pee, poop, sex, pelvic pain, prenatal or postpartum care, perimenopause and menopause , is in our wheelhouse!

How Pelvic Floor Therapy Works

Pelvic floor therapy starts long before you step foot inside of the clinic. Prior to coming in for your first visit, it is important that you pick a clinic that is going to be a good fit for you. To learn more check out our blog post “How To Find A Pelvic Floor Specialist Near Me” which covers the steps to vet a pelvic therapy clinic and find one near you.

But to really understand how pelvic floor therapy works I think it is best to understand the phases of treatment. At Pelvic Pride we work through four phases starting with figuring out what is going on and ending with your independence with movement and symptom resolution or management.

Phase 1: Figure It Out

In the first phase we start with the evaluation. This is where we will talk in depth about your health history and symptom presentation. From there we will perform hands-on and observation assessments of anything from your pelvic floor to how you transfer load in your legs and feet, to how you breath, and more. We want to make sure we spend plenty of time understanding your lived experience with your symptoms so the assessment process typically takes a few visits to gather all the data we need. Don’t worry though, we are providing treatment each session even on Day 1 to help you on the path to symptom reduction or resolution. We typically see patients weekly in this phase.

Phase 2: Facilitate the Change

Here we will increase our implementation of treatment. This can look like changes in posture and movement, hands-on manual therapy techniques both directly and indirectly to the pelvic floor and all surrounding muscles and structures, habit retraining, breathing mechanics, re-educating the brain and body connection, and mobility and stability exercises progressions. This list is not all inclusive and we tailor each treatment session to your needs that day while working towards your ultimate goal. We typically see patients weekly in this phase.

This transition is where the magic really starts to happen. Oftentimes we find patients feel “good enough” right at the transition from Phase 2 to Phase 3. And that is where things can go haywire. When you feel “good enough” your tissues (muscles, ligaments, tendons, nerves) may not be ready to support you as you continue to increase your load. Meaning, you may have felt pretty good during that 5K but your ultimate goal is to run the Baltimore Marathon in October and your tissues don’t necessarily have the resilience yet to tolerate that increase in demand.

Phase 3: Add Back In

At this point we are starting to add back in the movements, exercises, or demands that you have been avoiding due to your symptoms. It is vital that we test the system while keeping skillful eyes on your tissues to ensure success and not regression of symptoms. Here we will address any symptoms that may pop back in, adjust your home program as needed, and work towards independence. We typically see patients every other weekly in this phase.

Phase 4: On Your Own

Once we have tested the system, added back in all the activities and movements that you are used to doing, it is time to see if you have the skill set to keep your symptoms at bay. Flare ups of your symptoms may occasionally occur, but our goal is that you have the tools to manage without needing weekly care. At this point we are checking in way less frequently but are only a phone call away if you need some more guided support.

Factors That Affect Treatment Duration

Just a few of the factors going into this planning can be frequency of scheduling, individual needs and preferences, symptom severity, and more.

Severity of symptoms: are your symptoms very intense and debilitating, or are they more like a mild bother that intermittently reminds you of their presence? Often, increased severity of symptoms may point to someone benefitting from more therapy sessions. We find patients who are in an acute flare up benefit from seeing their therapist twice a week for 1-2 weeks to help get the symptoms down before returning to weekly visits.
Persistence of symptoms: have you been living with pelvic pain, bowel, or bladder issues for years on end, or are your symptoms new within the very recent past? If symptoms are longer-standing, they may require a bit more time to quiet down and establish healthier pelvic health habits moving forward. Unfortunately we cannot help undo 20 years of pain in 5 visits. But it also won’t take another 20 years to address either!
Your individual goals: are you coming to pelvic floor therapy to restore your baseline level of activity, or are you preparing for a major event like running a marathon or childbirth? We are huge fans of individualized treatment planning here - everyone’s goals are unique and will come with their own treatment plan which will dictate how many visits are needed.
Consistency with home exercise participation: are you able to carve out some time in between sessions to keep up with your home exercise program or other ‘homework,’ or is your plate simply too full to squeeze in anything else between sessions? (We know life can get in the way sometimes!) The more consistent someone is able to be with carrying over their exercises in between sessions, the more steady progress we tend to see. If you don’t have the bandwidth to do things at home, no worries, just keep in mind we will be doing a lot in our time together so we may need more sessions to reach your goals.

With all of that said….everyone’s treatment plan is going to look different based on their symptoms, health history, goals, and availability of time and energy to tend to their goals and therapy program.

Signs You May Need More Sessions

While you are working through pelvic floor therapy, it is important to monitor for these sights that you may need more session:

Your symptoms are improving but not fully resolved (see that magical transition from Phase 2 to Phase 3 above!)
Your symptoms come back when you stop your pelvic therapy exercises or self-treatment techniques
You are unsure if you are doing your exercises correctly
Your goals aren’t met yet. We want to ensure we are reaching your ultimate goal so as long as we are making progress forward, you may need a few more sessions to reach the finish line.
Life or body changes pop up. Maybe you became pregnant, have delivered, received a new diagnosis, or some other big change that signifies continued treatment is needed.

What Happens During Each Visit

At the start of each session, you and your therapist will touch base on how you’re feeling that day, any changes or new developments since the previous session, and get clear on any specific priorities you may have for that day’s session.

From there, treatment will be tailored to the information shared at the beginning of the visit while working towards your therapy goals. Within the session we may review and/or build on your home exercises and self-treatment tool kit as well as continue our skilled hands-on care including manual therapy to the external muscles and/or internal pelvic floor muscles.

At the end of the session we will review what we found, the progress made, the plan for the next session and what you should focus on until we meet again.

So, How Many Visits Will I Need

The short answer for how many sessions you really need : drumroll, please…..it depends! I know that’s about as clear as mud, but the plan of care length truly varies case by case for a variety of reasons I’ll get into shortly. Overall, though, you could typically expect to come for pelvic floor therapy for anywhere from 10-12 sessions on average .

While we’re big fans of the four phases here at Pelvic Pride, you may be thinking ‘that kind of sounds like a lot ...any chance I can make this move a little faster?’

How to Maximize Your Progress

We hear you. So, how do you get the most out of your pelvic floor therapy sessions?

Attend your sessions consistently. Carving out the time to come in at the agreed upon frequency and prioritizing your pelvic health is the most efficient means to see real progress!
Follow your home exercise plan between sessions - putting in the time now will lead to more measurable results as you go.
Communicate openly and honestly with your therapist. We can be the most effective when we have all the information we need, and we’re here to hear it all!

When You Can Expect Results

Some clients start to see initial progress as soon as the first 1-2 sessions. They may start to feel less muscle tension while performing their home exercises, or they may notice a little less urgency to empty the bladder or less discomfort with inserting menstrual products, for example.

We often start to see the bigger signs of progress or functional improvement after a few sessions when we get to phase 2 - when we’ve laid the groundwork and established consistency in managing your symptoms. The real magic happens when we reach the stage of adding back in previously challenging activities while keeping your symptoms at bay! Everyone will experience results differently, and when the results arrive? They’re worth it.

TL, DR:

The amount of sessions someone may need for pelvic floor therapy is variable and individualized - however, 6-12 visits can serve as a rough estimate.
A variety of factors determine how many sessions you’d benefit from, including severity and persistence of symptoms, your individual goals, and home exercise participation.
At Pelvic Pride we use a phased model to structure our treatment plans - you can get the most out of each session if you’re consistent, do your therapy ‘homework,’ and communicate openly with your provider.

Looking for Pelvic Floor PT in Maryland?

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients struggling with pelvic floor issues, including constipation, so you are in the right place!

We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Can Pelvic Floor Exercises Help Constipation?

Wed, 11 Mar 2026 16:11:02 GMT

Constipation can be influenced by how well the pelvic floor muscles coordinate relaxation and support during bowel movements. When these muscles remain too tense, emptying the bowels can become difficult, uncomfortable, or incomplete.

Healthy bowel function relies on a balance between pelvic floor relaxation, breathing, hydration, fiber intake, and daily movement. Small adjustments in posture, breathing patterns, and targeted exercises can help the body release stool more comfortably.

When symptoms persist despite lifestyle changes, pelvic floor pt can help identify coordination issues and guide individualized strategies that improve bowel function and reduce strain.

While many topics related to pelvic health have been discussed more openly in recent years (we love to see it!), one topic that can still feel a bit ‘TMI’ to bring out into the open are bowel routines - namely, constipation.

Before we dive into the question of the day: can pelvic floor exercises help with constipation? We have a bit of clarifying to do first:

Constipation is not just being unable to empty your bowels (i.e., you’re only constipated until you’ve emptied - not so). Let’s see if these examples ring any bells for you:

having to strain or ‘push’ while you’re trying to empty your bowels
going to the bathroom frequently because you’re only emptying the bowels a little bit at a time and never feeling truly emptied
having pain or discomfort with bowel movements.

If any of these sound familiar to you, read on - you’re in the right place!

So…what is the role of the pelvic floor in bowel movements?

Like any other muscle in our body - the pelvic floor can contract and it can relax. In regards to bowel movements, the role of the pelvic floor is to contract to prevent stool leakage while we’re going about our daily routines, exercising, etc. And then the inverse, the relax and let us empty our bowels when we need to. If the pelvic floor muscles are unable to contract when needed or relax when we are ready then we may end up with stool leakage or constipation. Many of the patients we see at Pelvic Pride struggle with the inability to relax their pelvic floor which can result in constipation.

Since we are complex beings, constipation is not only driven by the pelvic floor. Movement, water intake and fiber intake are also huge contributors to our ability to go. However, you can be a total rockstar in the fiber and hydration department, but if your pelvic floor is too tense or can’t coordinate relaxation effectively when you’re on the toilet - you’re going to continue to experience discomfort.

Sign the Pelvic Floor is Not Relaxing Properly

So how do you know if your pelvic floor is not fully relaxing? In addition to signs such as incomplete bowel emptying or having to strain when you’re trying to have a bowel movement, other signs that your pelvic floor may have difficulty relaxing can include (but are not limited to) feeling like stool is ‘stuck’ in your rectum, taking a long time trying to empty the bowels in the bathroom, or continuing to struggle with constipation despite adjusting your water and fiber intake levels. Additionally, tailbone pain, hip and glute pain, low back pain, and/or pelvic discomfort with insertion activities such as using menstrual products or with pelvic exams can be signs that your pelvic floor may be having difficulty coordinating effective relaxation.

Pelvic Floor Exercises for Better Bowel Coordination

So, what should we actually be doing to help our pelvic floor muscles relax when we’re trying to go? Can exercises even help that? The short answer: Absolutely!

As I mentioned earlier, the coordination between strength and relaxation of the pelvic floor muscles is key when it comes to maintaining healthy bowel habits. To see where pelvic floor exercises fit in, let’s first break down the mechanics of toileting.

First you need to be able to sit down on the toilet with your feet flat on the floor, or a step stool. Next you need to be able to sit up tall (although some patients find it easier to go if they lean forward slightly), let go of your pelvic floor muscles, and breathe out (or blow as you go). So what exercises help with this?

Squats - or any other mobility exercise to ensure your hips and knees have the range needed to sit down on the toilet and place your feet flat
Abdominal exercises - strength in our core in essential to being able to sit on the toilet in an upright position while we go
Pelvic floor lengthening - think the exact opposite of a kegel. We don’t want to squeeze the pelvic floor, we want it to let go and relax. Some of our go-to’s include child’s pose, happy baby, or deep squat.
Breathing exercises - you will often hear us tell patients in the clinic ‘blow as you go’ as a mechanism to help manage the pressure in the belly and provide a blood pressure safe way to give the bowels and the pelvic floor a little more support
Abdominal massage - ILU massage is one of our favorite exercises at Pelvic Pride to help get the gut motility going (motility - contraction of the muscles in the digestive tract)

Now I know what you may be thinking: isn’t only one of those a pelvic floor exercise? Actually, they are all pelvic floor exercises with different goals around supporting the pelvic floor. Exercises don’t all need to engage the muscles you are working and don’t need the goal to be strength. Many exercises are utilized to work on coordination, working together in a system, and even lengthening the muscles involved.

When Kegels May Make Constipation Worse

Maybe you tried kegels because it was the first pelvic floor exercise you heard of. It’s highly likely that it hasn’t helped make your bowel movements better, in fact it probably has made your constipation worse. This is because when you kegel you are telling the pelvic floor to contract or tighten up - the opposite of what we need. When the external anal sphincter (muscle around the butt hole) is tight it is not relaxing to let poop out - it is holding it in, or at the very least making it painful to come out.

If your pelvic floor is already a bit too tense at rest, focusing on strengthening is only going to increase that tension rather than facilitating the gentle coordination between activated and relaxed that we need in order to empty when it’s time.

Other Strategies that Support Easier Bowel Movements

In addition to the gentle exercises mentioned earlier, there are plenty of other strategies to support healthier bowel emptying including:

Create a consistent bowel routine (i.e. having a warm beverage around the same time each morning and planning to visit the bathroom around approximately the same time each day)
Ensure you are eating a variety of soluble and insoluble fibers. And don’t be afraid to supplement by adding something like psyllium husk into your smoothie, yogurt, oatmeal, or coffee in the morning.
Stay hydrated! The body will literally steal the water from your poop if you are not hydrated enough - so the more well hydrated you are, the easier it is to go.
Try adding calm, deep breathing into your bathroom time to allow intra-abdominal pressure help you out
Adjust your posture on the toilet! Ever seen a Squatty Potty or a small stool in someone’s bathroom? Elevating your knees above the level of your hips while sitting on the toilet automatically helps to lengthen the pelvic floor muscles that wrap behind the rectum making it easier to poop

When to See a Pelvic PT

Now, while these exercises and tools can be a very helpful starting point, everyone’s body has its own unique needs. If you have tried the massage, and water, and fiber, and movement, and all the things but are still struggling with constipation then it is time to make an appointment with an in-person pelvic floor pt. Not only will we perform a thorough assessment through a whole-body lens, but we will also be able to give you highly individualized feedback pertaining to your body’s unique needs to develop a plan that will best fit your personal goals - without any guesswork required from you.

Looking for Pelvic Floor PT in Maryland?

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients struggling with pelvic floor issues, including constipation, so you are in the right place!

We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

What is Pessary Fitting?

Mon, 09 Mar 2026 16:07:42 GMT

Pelvic organ prolapse occurs when the bladder, uterus, rectum, or vaginal vault shifts downward due to weakened pelvic floor support structures. This can create symptoms such as heaviness, pressure, bulging, urinary leakage, or difficulty emptying the bladder or bowels.

A pessary is a removable silicone device placed in the vagina to support pelvic organs and reduce your symptoms. It can provide immediate relief and help people return to daily activity and exercise with greater comfort.

Pessary use often works best alongside pelvic health pt that focuses on pelvic floor muscle coordination, strength, posture, and abdominal pressure management. Our pessary fitting service helps determine the right shape and size so the device supports both symptom relief and long term rehabilitation.

Pelvic health therapy plays a crucial role in supporting individuals experiencing a variety of pelvic health conditions, through a variety of treatment methods including pessary fitting. This is utilized with our patients who are experiencing pelvic organ prolapse (or POP). POP occurs when the pelvic organs (bladder, uterus, rectum, or vaginal vault if the uterus is removed) shift in a downward or outward direction leading to protrusion into the vaginal canal.

Prolapse typically occurs due to weakening of the connective tissues and ligament structures supporting the vaginal wall as well as the musculature of the pelvic floor. This can lead to symptoms of vaginal or pelvic heaviness, bulging, pressure, and discomfort that may worsen with activities 'on your feet' - think picking up your little one throughout the day or trying to go for a run.

POP can also be associated with other symptoms such as low back pain, pain with sex, and difficulty fully emptying your bladder or bowels. Further, weakening of the connective tissues supporting the urethra can lead to stress-based urinary leakage with activities like coughing, sneezing, or exercising. If you're interested in learning more about the ins and outs of what POP is and why it may happen, check out our blog post here!

In addition to the variety of treatment methods we incorporate at pelvic health therapy to support your symptoms (*think pelvic floor and kinetic chain strengthening, posture mindfulness, breath and pressure mechanics with daily activity), there is another tool we can offer to assist with your symptoms...a pessary! What is a pessary? Let's dive deeper.

What is a pessary and how could it help me?

A pessary is a small, removable silicone device inserted into the vagina to provide support for the pelvic organs. Pessaries come in a variety of shapes and sizes to create a custom fit for each individual and works in conjunction with a comprehensive pelvic health therapy plan of care to improve your outcomes.

Common ways a pessary may help

Symptom relief - A pessary can provide immediate relief for POP symptoms by supporting the tissues and lifting the bladder, uterus, or rectum to relieve symptoms of heaviness or bulging, and may help improve bowel or bladder emptying as the organs are in a more optimal resting position. A pessary can also help create a 'backstop' at the urethra to assist with urinary leakage. This relief may help with return to daily activity and exercise which may have felt symptom-limited prior to a pessary.
Adding to pelvic floor rehabilitation - Pelvic health therapy commonly aims to improve the coordination, mobility, and strength of the pelvic floor muscles. A pessary can help lift the intravaginal tissues 'up' and reduce the load on the pelvic floor muscles and surrounding ligamentous tissues. This may improve the supportive ability of your pelvic floor muscles during daily activity and exercise.
Helping to support movement patterns and lifestyle changes - Pelvic health therapy should include a holistic approach, including assessment of the kinetic chain, lifestyle management, and how looking at the 'big picture' is impactful for supporting POP and stress leakage symptoms. This may include addressing posture and ergonomics during daily activities such as lifting and squatting, breath mechanics for improved pressure management, and full-body strengthening. A pessary can act as a supportive tool during these adjustments, allowing you to transition to these habits with more confidence.
Conservative care - Individuals may be deciding whether surgery for POP or stress-based leakage is the best fit for them; in the meantime, a pessary may offer a conservative management option for symptom relief and may be a great fit in lieu of surgery

Curious about a pessary fitting? Here's what's helpful to know:

There are multiple styles and sizes - at Pelvic Pride, we offer cube & ring pessaries
Pessaries are not a 'one size fits all'.
It may take a few attempts to find the right size of pessary during a fitting appointment.
Pessaries should be fit by a pessary-fitting-specialized healthcare provider like pelvic floor pt
Wearing a pessary will require a few visits to make necessary adjustments and yearly follow up to monitor continued proper fit
Success with a pessary can be supported with a pelvic floor therapy plan of care to address all components of prolapse symptoms, including pelvic floor muscle tension or weakness, lumbar spine & hip strength training, posture support, and pressure management

What to expect at a pessary fitting at Pelvic Pride

During your fitting, our pessary-fitting pelvic floor pt will complete an evaluation to learn about your current symptoms and concerns, review your medical history, and discuss your goals

for pessary use. During the appointment, you can expect:

An external and internal pelvic floor muscle evaluation to assess the current status of your pelvic floor tissues including vulvar-vaginal tissue health, degree and type of prolapse, as well as muscle coordination and strength
Fitting trials with the recommended pessary shape and size to find the best fit and comfort for you (this can include incorporating specific movements such as squatting, walking, and jumping)
Review of pessary care, wear schedule, removal technique, and follow-up care recommendations

A pessary may benefit many during their pelvic health journey, offering relief from symptoms of POP and stress-based leakage when combined with a pelvic health therapy plan of care to help optimize your return to and comfort with daily activity and exercise. If you're experiencing vaginal pressure or heaviness, urinary leakage, difficulty emptying bowel/bladder, or any other symptoms of prolapse, we recommend speaking with a pelvic health therapist to determine if a pessary may be a helpful fit for you!

Looking for pelvic floor pt who fits pessaries in Maryland?

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients struggling with pelvic floor issues, so you are in the right place! Dr. Marlena is our resident pessary expert and is happy to help fit you for a pessary for symptom reduction and progress towards your goals.

We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD (Pessary fittings currently offered in Federal Hill only). Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

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Can’t I Just Do Pelvic Therapy at Home with One of Those Devices?!

Mon, 15 Dec 2025 17:23:09 GMT

The In’s & Outs on Home Devices for Pelvic Health

Pelvic floor exercise devices have been around for quite a while now - but if you’ve been watching the pelvic health space for a minute, you’ve probably noticed they’re getting a bit more attention recently. Many home devices are even becoming affiliated with insurance companies - I personally have received ample mailers from my insurance company, enticing me to sign up for the pelvic floor training device they’ve brought into their plan.

If your plan covers one, a device is shipped to you which typically connects to an app that monitors your activity and gives you feedback on your usage (‘biofeedback’ is the buzzword you may have heard before). Some companies even offer virtual consultation with a pelvic floor specialist for additional guidance on using the device and tailoring your exercise plan.

The devices are often pretty cute, too - a fun on-trend color and gently curved shape that looks visually appealing.This sounds great, right? While we love that pelvic health needs are becoming more openly discussed and devices such as these are becoming more accessible to the masses, there’s a pretty big catch here:

Not everyone should learn how to kegel, or strengthen, their pelvic floor as these devices aim to do.

Somehow, a misconception has developed over the years that if you’re having a wide variety of pelvic health symptoms ranging from urinary leakage postpartum to pain with tampon insertion to tailbone pain with prolonged sitting, pelvic floor strengthening must be the answer for you. Sometimes strengthening the muscles of the pelvic floor can be part of the solution, but very often we need to train these muscles to relax first. It seems to be a well-kept secret that symptoms such as leakage and pain can often be caused primarily by having too much tension in the pelvic floor rather than weakness.

Pelvic floor strengthening has its value, to be sure: it’s often included in later phases of treatment. Once we have addressed pelvic floor muscle tension and the factors that contribute to it, many people then benefit from moving into a strengthening phase to ensure the pelvic floor can meet the demands of your everyday activities (think maintaining continence, healthy bowel & bladder habits, inserting menstrual products without pain or participating in intimacy comfortably).

If you skip over the phase where muscle tension is addressed and jump right to strengthening, however, you’ll be likely to remain frustrated by persistent and potentially uncomfortable symptoms.

Let’s dig a bit more into how these home devices actually work: once you’ve connected the device to an app on your phone, you can insert the device vaginally with your preferred lubrication. The app will then provide various prompts to contract and relax your pelvic floor around the device, which is measuring your muscle activity and sending that data back to the app, which tells you how you’re doing in the various exercises (aka, the biofeedback I mentioned earlier).

If your pelvic floor muscles aren’t particularly tense and only need some targeted strengthening, this may be beneficial for you. However , if you do have muscle tension in the pelvic floor, inserting the device may be uncomfortable as well as attempting to contract or squeeze around the device once it’s inserted.

Additionally, multiple sources who have tried these devices have reported back that the cues given from the device about their activity weren’t particularly accurate. One of the therapists on our team decided to give it a whirl, in the name of science of course! As a trained clinician she was very aware of when she was squeezing her pelvic floor vs. relaxing her pelvic floor. Unfortunately, the device was confused. It would congratulate her on a good relaxation while she squeezed and vice versa. This is one of our main concerns when it comes to home devices without the guidance of a skilled provider - how do you know if you are doing it correctly?

One of our patient’s who attempted to use a home device before coming in for a session at Pelvic Pride mentioned that between the device feeling uncomfortable to insert given her pelvic floor tension combined with cues that didn’t totally ‘click’ with her and continued reminders from the app to carve out time for using the device, she just ended up feeling defeated and frustrated - though she recognized that it might be a useful supplement to her treatment plan down the road.

So, what’s the best course of action given all of this?

When in doubt, make an appointment with an in-person pelvic floor therapist. Not only will they perform a thorough assessment through a whole-body lens, but they’ll be able to give you highly individualized feedback pertaining to your body’s unique needs to develop a plan that will best fit your personal goals. No guesswork for you, no wondering if your bluetooth connection is working properly, no wondering if your body is the problem if the device doesn’t help - just specialized support and care from a highly trained therapist.

Looking for pelvic floor therapy in Maryland?

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients struggling with pelvic floor issues, so you are in the right place!

We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

TL;DR:

Pelvic floor home devices, or biofeedback devices, may be helpful for some individuals - but there’s no way of knowing if you’re one of them unless you’ve been seen by an in-person pelvic floor therapist.
These devices may be difficult to use or even lead to worsening symptoms if your pelvic floor holds a bit too much tension.
We at Pelvic Pride are here to work with you and develop an individualized plan to support your body’s unique needs!

Should I See a Pelvic Floor Therapist During Pregnancy?

Mon, 08 Sep 2025 19:36:06 GMT

So you are pregnant and wondering: “Should I see a pelvic floor therapist during pregnancy?” The answer: YES!

That’s it. Blog post done. Go schedule now!

Okay but seriously we will talk more about it, however, the short answer truly is yes!

Tldr;

Coming to see a pelvic floor therapist is important so you have:

Rapport with a provider and a place you trust to return to after delivery
A better understanding of the pelvic floor and its role in delivery
The knowledge and skills to prevent stalls as you move through the delivery process
A provider to help you navigate any aches or pains that arise

In the rehabilitation medicine world we think of treatment in two camps: proactive & reactive. With proactive care, patients are seen prior to any symptoms or issues popping up, as where reactive care is in response to the onset of pain or other pelvic floor issues.

Regardless of whether you are coming for proactive or reactive care, establishing care with a provider before you deliver is the most ideal!

In my almost 13 years of treating, I have noticed a trend of patients who come in after delivery and state either A) they wish they knew more about pelvic therapy before delivering or B) they wish I knew what their pelvic floor felt like before they delivered to know if the issues they are having were there before or came from delivery.

With my patients who did see us before they delivered, they tell us that coming back after delivery is like coming back to tell a friend all about how things went.

While we are working towards the best possible outcomes, we are the provider to hold space as you share the tough parts of the delivery process. Pelvic floor therapy is already such a vulnerable time, it is helpful to have good rapport with your therapist when sharing about your delivery journey.

Having to meet someone for the very first time during your postpartum phase can feel like a lot - mentally, emotionally, and physically. (And if you are reading this and didn’t find pelvic floor therapy until after delivery that is OKAY! We will still make space and work to ensure you feel as safe and supported as possible to share as we build rapport with you!)

So what do we work on during pregnancy? Let’s break this into proactive and reactive care since we already laid that foundation.

Proactive Care

When patients come to Pelvic Pride without any pain or symptoms, we will use our evaluation time to establish their baseline. This means a full medical history, review of current movement routine and delivery goals, as well as a hands-on assessment to look at pelvic floor muscles for tension, tenderness, weakness, or difficulty coordinating. We also check for signs of prolapse, look at breathing mechanics, and test your range of motion, strength, and flexibility of your abdominals, low back, hips, lower extremities.

Treatment will include addressing any significant findings and working through our intentionally designed push prep to ensure you are ready for each phase of labor and delivery. We make sure to cover perineal massage, how to breathe, and how to push - regardless of if you are having an unmedicated or medicated birth. We will review movement techniques to prevent delivery stalls and discuss the recovery expectations for delivery after c-section so you are well prepared.

Reactive Care

It is not uncommon for pregnant patients to experience pubic symphysis pain, sacroiliac (SI) joint pain, pelvic floor pain, pressure, or heaviness, and low back pain.

With reactive care we will assess and address any aches or pains you are experiencing while providing you the treatment and skills to manage your symptoms. We will also discuss the use of supportive devices like an SIJ belt or belly band, how taping can help with diastasis recti, and the importance of managing intra-abdominal pressure if you are experiencing pelvic floor heaviness or pressure.

Each treatment will be aimed at helping you become as pain/symptom-free as possible and maintain the movement level you would like to have throughout pregnancy. We will also work through everything laid out in the proactive section above but through the lens of understanding the challenges you have had during pregnancy so far.

In both proactive and reactive care, we will make sure you have a thorough understanding of the pelvic floor’s role during pregnancy and delivery. This helps to dispel the myth that you don’t need pelvic floor therapy if you deliver via cesarean or if you aren’t having any pain or leakage.

In the end, our goal at Pelvic Pride is to make sure you feel seen, heard, and empowered & leave our clinic with the tools you need to rock your delivery! We will be here to help you out on the other side!

Looking for treatment for pregnancy in Maryland?

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with pregnant patients whether you are dealing with pelvic floor issues or just want to come in and establish your baseline, so you are in the right place!

We are conveniently located in the Federal Hill & Roland Park neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

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Will a Wet Bathing Suit Cause a UTI or Yeast Infection?

Sat, 28 Jun 2025 00:32:22 GMT

Summer is fully upon us and you may find yourself spending your days lounging by the pool or spending a week at the beach. Either way, you will likely end up sitting in a wet bathing suit at some point.

And a few days later you may find yourself with a urinary tract infection (UTI) or a yeast infection - the real question is do you realize that one may have led to the other?

So time to unpack the question of if a wet bathing suit can truly cause a UTI or yeast infection.

Let’s start with UTIs:

While there is no direct connection between being in a wet bathing suit and having a UTI, you do run an increased risk due to the moist environment of your bathing suit causing the spread of bacteria. But since your wet bathing suit sits so close to your urethra, the likelihood is not 0%.

You also have increased risk of contracting a urinary tract infection in situations like swimming pools or hot tubs that may not be properly cleaned and can harbor bacteria.

And how about yeast infections?

As for yeast infections, YES you are absolutely increasing your risk of contracting a yeast infection if you sit in your wet bathing suit for a prolonged period of time. The warm moisture of a wet bathing suit will create the perfect storm to set off a yeast infection by disrupting the vaginal pH.

Luckily there are things you can do to help prevent UTIs and yeast infections this summer - and all year round!

Drink plenty of water to help keep the bladder and urethra flushed out to minimize risk of bacteria causing a UTI. You know your are well hydrated when your urine is light yellow to clear.
Change out of your wet bathing suit as soon as possible.
Be sure to fully dry your vulva when changing out of your bathing suit.
Opt for loose, breathable clothing and natural fibers like cotton for under and outerwear
After having sex, be sure to pee. Once you are done peeing, make sure you wipe front to back to decrease the spread of bacteria.
Avoid scented soaps and lotions for the vulva and vagina - ALWAYS!

As a reminder, many people contract what they think is a UTI and it is in fact not a UTI, but is pelvic floor dysfunction as t ightness in the pelvic floor muscles will mimic the signs of a UTI like:

Pain or burning with peeing
An increased frequency of needing to pee
An increased urgency to pee
Going pee more often, including at night

If you have ever felt like you have a UTI but tested negative, it is time to see a pelvic floor specialist! We are the experts here to help you figure out if your symptoms are coming from a tight pelvic floor, rather than an infection.

Looking for treatment for pelvic floor dysfunction in Maryland?

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients suffering with all kinds of pelvic floor conditions, so you are in the right place!

We are conveniently located in the Federal Hill & Roland Park neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

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Is Pelvic Floor Therapy at Home Effective & Can AI Replace In-person Pelvic Health?

Fri, 23 May 2025 16:25:29 GMT

Recently a local provider slid into my DM’s to chat about a letter she received from her insurance boasting “no-cost digital pelvic PT” and her response is exactly the same as mine: WTF?

I’m sure we’ve all seen some form of this by now either on social media or directly from our insurance providers. Especially since one of the largest insurance companies is sending emails out to all of their customers to introduce them to this ‘service’ which includes working with a pelvic health specialist and an intravaginal device to monitor pelvic floor contractions and relaxation.

So is it worth it? Does this truly replace in-person pelvic floor therapy? Let’s break it down!

First we have to address if the device actually works and how. The intravaginal device they send out is a form of biofeedback that will monitor for pelvic floor squeezes and relaxations. So if you truly only have an issue with weakness this MAY be helpful.

But let’s be honest, in the 12 years I have been a pelvic floor therapist and doctor of physical therapy, most of the patients I and my colleagues have seen are not dealing with a simple issue.

Most patients aren’t properly diagnosed or referred to pelvic floor therapy until six years after symptoms start. On top of that, many patients wait months to years to get help and sometimes go through a few therapists before they find the right fit! This means they likely have picked up a few more contributing factors to their symptoms beyond weak muscles.

So for those with a more complex diagnosis or layers of tissue issues that need to be addressed, sticking a device internally and following along as it cues you to squeeze and release will not fix the issue. We actually end up seeing symptoms get worse and if the patient is not already experiencing pain, this may kick start it!

Knowing that the device is just intended to make you squeeze and release, let’s cover what this device does NOT do.

It does not monitor for compensation of accessory muscle s (aka cheating with your abdominals, adductors, or glutes).
It does not assess your breathing and pressure management within the core canister.
It does not differentiate between engagement of the front pelvic floor muscles (responsible for urinary leakage) and the back pelvic floor muscles (responsible for fecal leakage).
It does not help pelvic floor tightness , in fact it will make it worse!

So does the device work? Kind of, maybe, for a small subset of patients?

How about the care from the provider via telehealth or over an app?

While working with a pelvic health specialist will be beneficial there are limitations to doing pelvic floor therapy exclusively online. During an in-person session your therapist will be able to perform a comprehensive assessment which may include a hands-on pelvic floor exam.

At this time, we are feeling for muscle tightness and guarding, compensations from surrounding musculature, and picking up on the nuance of your movements with functional activity . We are also checking in on muscle strength and coordination which includes muscles far beyond the pelvic floor.

To do this we perform an exam called a manual muscle test where we provide graded resistance from our own hands against a muscle to test how strong it is. We then grade it on a scale of 0-5 and this helps guide our exercise prescription. During this testing we are able to pick up on common compensation patterns and areas of weakness that may be contributing to your symptoms which we are able to address and correct for.

This is important because the pelvic floor works in a system with the rest of the body including the hips, the feet, the diaphragm, and even the jaw. When we prescribe exercises for pelvic patients we are not just doing kegels, we are treating the whole system . This requires a comprehensive exam that goes far beyond the data collected from an intravaginal device .

Within this exam, we are also monitoring for both verbal and non-verbal feedback about what is happening in your body. Oftentimes there are small signs like a twitch in a muscle or a slight weight shift during an exercise which clue us into the true source of your symptoms. But we are also vigilant throughout our appointments to pick up on cues that the patient may be nervous to do a pelvic exam, or showing signs of an upregulated nervous system which is common with patients experiencing chronic symptoms or with a trauma history.

The other obvious big limitation here is that the device is only for those with a vagina - and those who can tolerate inserting something into their vagina. Patients with pelvic pain cannot necessarily do this! This method of providing online or AI-based treatment excludes millions of patients who suffer with pelvic floor dysfunction every day, namely those with a penis. Since this device is not designed to be inserted rectally, men, penis-owners, and those with vulvas who cannot tolerate vaginal penetration are not able to benefit from this treatment. But they can benefit from seeing a pelvic floor therapist in-person!

As our world continues towards more integration of AI into our everyday lives, this is a major area where human connection will always reign supreme over technology. This would be like trying to deliver your baby with your providers over Zoom. Sound crazy? Exactly! You would rather have the provider right there to support you and provide the skilled hands-on care they are the medical experts at providing. Pelvic floor therapy is the same - a skillset that deserves to be in-person and hands-on as much as possible to ensure top level care.

While the convenience factor is very enticing and the thought of a quick fix with some kegels while a device tells you what to do seems low stakes, the outcomes are not what you are hoping for. When your body has a history of pain, tension, guarding, trauma, weakness, or anything else contributing to dysfunction, a quick fix is not a lasting solution!

Looking for in-person treatment for pelvic floor therapy in Maryland?

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients suffering with all kinds of pelvic floor conditions, so you are in the right place!

We are conveniently located in the Federal Hill & Roland Park neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

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Healing After C-section

Sat, 19 Apr 2025 13:26:56 GMT

Okay so you read the books, took the classes, and followed the Instagrammers to get ready for labor and delivery.

But did any of them talk about healing after c-section?

If you are lucky, the answer is yes! But for the majority of pregnant folx, the classes and books they read are all about what happens with a vaginal delivery. And this makes sense, as almost 70% of births each year occur via vaginal delivery. But that leaves 30% of those who delivered a baby without somewhere to turn.

Welcome to our take on healing after c-section.

First things first, c-sections are a major surgery! Your delivery surgeon had to pass through seven - yes, SEVEN - layers of tissue to deliver your little one into the world! Let’s pause a moment and just appreciate each layer of your body that is healing from this:

Skin
Subcutaneous tissue (aka the adipose/fat layer under the skin)
Fascia
Muscle (luckily these are just parted and not cut into on the regular anymore)
Peritoneum (the tissue inside of the abdominal cavity)
Uterus
Amniotic sac

And because this is a major abdominal surgery, your body (not just the incision site) deserves rest, support, and proper care. That proper care includes seeing the experts in rehabilitation (aka pelvic floor therapists!) to help you navigate the healing process for your abdominals as well as your pelvic floor and the rest of your body!

I mean think about it - during pregnancy the abdominal muscles & fascia are stretched and the connective tissues are stressed to support the baby growing in the womb.

Add on top of that the scar tissue that is now affecting the abdominal fascia, the bladder, and even the bowels. Without proper mobilization and attention, this scar tissue can continue to impact how we move our body and how our bowel & bladder functions for years to come.

Finally, we cannot forget the pelvic floor! This is an often overlooked component, however these muscles have been firing daily for nine months supporting an ever increasing load. You may be thinking, “but wait, isn’t pelvic floor therapy just for vaginal deliveries?” Not at all!

During pregnancy, as your baby grows, your pelvic floor is constantly adapting to the changes in posture, stability, and strength. Common postural changes may include excessive anterior pelvic tilt (hips forward, butt out) and lumbar curve (an increase in your low back arch), and reduced thoracic (mid to upper back) and ribcage mobility (hello difficulty with breathing!).

Changes like these impact core pressure management, which will impact how the core and pelvic floor reacts to increases or changes in pressure - which can commonly present as urinary leakage during activity or a cough/laugh/sneeze, but this is just one scenario.

Even if you never pushed or attempted a vaginal delivery, this is still 9 months of intense work and constant recalibration. Traditional healthcare is mainly concerned with the quality of healing of your scar at your 6 week check-up, however, as you can see, recovery and healing go beyond skin-deep. So if you aren’t already seeing a pelvic floor therapist ( You should be! ), then after you see the OB and get the ‘all clear’ give us a call to get started on your full body recovery!

When Can You Start Therapy?

As early as you’d like! Some patients see us as early as 2 weeks post-delivery. Afterall, you were just sent home with a brand new baby that you are expected to care for, along with caring for yourself. So while most people think six weeks is the magic number, you could still use some support and guidance with things like getting on/off a chair, in/out of bed, picking up and carrying little one, navigating urination and bowel movements after abdominal surgery, and any other tasks you life demands from you, earlier than six weeks.

However, once we reach the coveted six-week mark we are now able to begin mobilizing your c-section scar - if you are up for it! At this point your body is through the majority of the skin healing, your collagen fibers are laid down, and they are ready for some remodeling. I know this sounds silly but it’s true! Our role here is to help make sure you can bend and reach and twist and lift without pain or pulling in your c-section scar.

Are you further along than six weeks post-delivery? Don’t worry! There is no such thing as “too late” when it comes to your healing. Even if you are months - or years - out from your c-section, it is never too late to start! Everyone’s journey is different and no matter if your goal is to hold your little one without pain or to train to run a marathon, we are here to support you and your progress.

Why Would I Need Pelvic Therapy?

Unfortunately, we have been convinced that several postpartum symptoms are just a “normal” part of life, but they’re actually signs your body could use support. Some of these symptoms include:

Pelvic heaviness or pressure (including feeling like something is “falling out”)
Urinary leakage or strong urgency
Core weakness or the persistent “mom pooch”
Diastasis recti, or separation of the abdominals
Scar sensitivity, tightness, or numbness
Low back or hip pain
Pelvic pain
Pain with movement
Pain with intimacy
Constipation or hemorrhoids
Fearfulness around return to exercise or movement

What Happens in a Pelvic Floor Session?

While each session is individualized based on patient concerns, for a postpartum assessment you can typically expect:

Emotional support and space to share your story
Assessment of posture, breathing, and core function
Assessment of the pelvic floor (internal and external options available)
Gentle work on scar tissue and surrounding muscles
Strategies for safe movement, lifting, and daily life
Progressive strength-building and coordination

We will work together one on one in a private treatment room to provide you the safety and comfort to discuss any concerns you may have.

How You Can Support Healing at Home

Your recovery starts with simple, intentional steps:

Rest early, and skip the pressure to “bounce back”
Practice diaphragmatic breathing to engage your core, focusing on full 360 degree expansion of the ribcage
Take gentle walks when you feel ready (and be sure to listen to your body when it says you’ve gone far enough)
Stay hydrated and well-nourished, adjusting intake if you are breast/chestfeeding
Once cleared, try gentle massage over your scar to restore mobility (we review this with you in pelvic floor therapy!)
Avoid straining when using the bathroom (bring on those breathing techniques and pooping postures!)

An important thing to remember is that r ecovery is a journey and not a race. A s difficult as it can be, comparing yourself to others can be more emotionally draining than helpful. Your timeline is your own, but know that you do not need to live with symptoms or pain. It is okay if you don't know where to start- that is quite literally our job to help provide that type of guidance.

If you're healing after a c-section and want expert, compassionate, and inclusive support, reach out to learn more about how our team of occupational and physical therapists can help you get started!

Where to find treatment for pelvic floor therapy in Maryland

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with patients in their postpartum state with all kinds of pelvic floor conditions, so you are in the right place!

We are conveniently located in the Federal Hill & Roland Park neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

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Okay, But Like Really, How Awkward is Pelvic Floor Therapy?

Wed, 09 Apr 2025 12:31:37 GMT

Listen, I have treated patients for pelvic floor concerns for over 11 years now so I have seen and heard A LOT!

With that said I am going to unpack the most common concerns we hear from patients about starting pelvic floor therapy & why they think it may be awkward.

To start, I get it! You have to undress, lay on a treatment table, on a sheet (hopefully not one made of paper), covered with a gown (again, fingers crossed it isn’t paper), and then let someone look at and poke around at your genitals…. And how isn’t this awkward?!

I mean when you put it like that, yeah it does sound awkward. But your pelvic floor therapist has been there, done that. When we are learning to be a pelvic floor therapist we go to a course, listen to a ton of lecture material to understand the in’s and out’s of pelvic floor therapy. Then we partner up with strangers, make quick introductions, and half of the class undresses while the other half makes an educated guess as to how we assess the pelvic floor (we do this on each other so you don’t have to be our guinea pigs).

So yeah, we have experienced the whole letting-a-stranger-assess-our-pelvic-floor-shortly-after-meeting-them thing. We do this so we can truly understand how our patients may be feeling that first day and so we can do everything in our power to make it less awkward.

And, okay so we aren’t just poking around, I swear we have a lot of training to do this . We want to be here! We think the pelvic floor, and all the mysteries it holds, are so fascinating. So what is there to be concerned about?

Being naked?

We have seen more vulvas, vaginas, penises, testicles, butts, and boobs than we can count. This is a normal part of what we do and it is important that we are able to see the areas involved in your symptoms. But don’t worry, we still respect your modesty and will keep as much covered as we possibly can to help put your mind at ease.

Shaving?

Why? Do you want to shave? Then shave! Do you hate shaving? I get it! We have seen all levels of pubic hair so nothing surprises us. And we have no expectations as to what your vulva or penis or testicles or anus should look like. They all look different and yet they all look the same.

Sometimes the labia minor is longer than the labia majora, sometimes the labia majora houses everything underneath it. Sometimes the penis has a foreskin and sometimes it doesn’t. Sometimes the anus has a hemorrhoid and sometimes it does not. No matter what, you are normal! Oh and that pertains to your legs too - we don’t care if you shave your legs or not.

Smells?

Bodies smell - it is part of being human. When skin touches and bodies sweat they have smells - not necessarily bad smells, just smells. We are used to that. Trust me, once you’ve treated a teenager’s feet after they have been in the same shoes all day at school and sports practice and then come to PT and do those exercises before you do the manual therapy part of the job, no other smells bother you anymore. #iykyk

Blood?

Periods happen. We don’t mind a little blood (or a lot of blood) when we are doing internal work. But we get it, you may not feel the same way. We don’t have to do internal work if you don’t want to during your period (or really any time if you aren’t feeling up to it). There are always plenty of other things we can work on.

Pee or poop?

This one isn’t super common but even so, we are wearing gloves and have these special pads we lay down just in case things happen. And yes, sometimes we can feel stool in your rectum when we do internal work. If we are lucky, you will go home after we have treated your pelvic floor and have a great bowel movement! We hear this a lot after we do ILU massage too.

But, what if I fart?

So you fart! You won’t be the first, or the last. It happens - not often - but it happens. And we just keep on going as if nothing happened. Or we acknowledge it and laugh together and keep on treating. Again, bodies are bodies, and part of that includes farting.

TMI?

There truly is no such thing as ‘too much information’ in pelvic floor therapy. We need to hear all about your poop - color, consistency, frequency, positioning, etc; your pee - color, frequency, amount; pain with intimacy - where, when, what position; etc. We want to hear it all because it helps us to understand what you have been dealing with. These details tell us more than you can imagine.

Negative feelings?

Sometimes pelvic floor therapy brings up old memories or unwanted feelings - unfortunately this is part of the process. We are trained to be ready for this and help you navigate through it. We also work with amazing mental health providers if you need a recommendation to help you unpack the feelings and memories that may come up.

Vanity?

Are you worried that your concerns about your vagina looking different after your delivery will sound vain? Maybe how your c-section scar makes your stomach look now? Or should you get circumcised now, after all these years? Or that you are considering a tummy tuck or mommy makeover to help with your postpartum body?

You are ABSOLUTELY not alone. We hear this all the time and they are valid concerns. While your medical providers will tell you things look fine or your partner(s) will tell you things are great - you are still allowed to feel all of the feels.

We will help you navigate each one from the pelvic floor expert lens, share how and what we can do to help your pelvic floor and abdominal tissues function and look the way you want. But we will also be honest about the limitations of pelvic floor therapy and when your goals are outside of our scope of practice.

Trust me, deciding on surgeries such as getting that mommy makeover is not the easy way out! It is major surgery and your body will need help from the experts to recover and regain strength and mobility - so we are here to catch you on the back end.

All that to say, if you are feeling nervous about coming to pelvic floor therapy that is totally normal! We will do everything we can to make it as comfortable as possible. We explain each step of the process, why we want to perform a certain assessment, and what it will tell us about your symptoms so you can make the most informed decision. We also do this so we can help make it as un-awkward as we possibly can.

So if you think you need the help of a pelvic floor therapist give us a call!

Where to find treatment for pelvic floor therapy in Maryland

At Pelvic Pride Physical Therapy & Wellness, we are THE clinical experts at working with all kinds of pelvic floor conditions, so you are in the right place!

We are conveniently located in the Federal Hill & Roland Park neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Why Does Tummy Time Matter? 5 Big Benefits of Tummy Time

Thu, 20 Feb 2025 01:34:57 GMT

5 BIG Benefits of Tummy Time

I am sure you have heard everyone tell you that you should be putting your baby in tummy time, but why does it really matter? That’s a great question and we are here to answer it for you!

Tummy time, especially within the first few months of life, is critical to help infants build strength, joint stability, coordination, and motor skills. It helps them learn not only about their body and where it is in space, but also about this big, new world they are living in.

Why Tummy Time REALLY Matters:

Strengthens muscles - Tummy time helps babies develop neck, shoulder, and core strength needed for milestones such as sitting, rolling, crawling, and meeting general milestones on time.
Prevents flattening of the skull (or plagiocephaly) - You may have heard about this in some of our other blog posts , but tummy time reduces prolonged pressure on the skull. When too much time is spent with pressure on one spot, especially when a baby prefers to look to one side more than the other, they may have flattening of the skull in that spot.
Enhanced fine motor and gross motor skills - Tummy time encourages turning the head and reaching the arms toward stimuli while the muscles are actively working and bearing weight, unlike when the baby is on their back. Engagement in tummy time is also directly correlated with self-care and academic skill in later childhood such as manipulating fasteners, handwriting, utensil use, and many more activities that begin with shoulder stability and weight-bearing through the upper arms when in tummy-time.
Visual development - Tummy time helps babies develop spatial awareness and depth perception as they learn about where their body is in space (proprioception) through weight bearing and moving while on their stomachs.
Sensory development - Tummy time provides a great opportunity for babies to explore textures, look toward sounds and engaging sights, strengthen their vestibular system with movement to help them roll over between 4-6 months, as well as improve their tactile sense and body awareness (proprioception).

Maybe you’ve tried tummy time and your baby simply HATES it or cannot tolerate more than about 30 seconds at a time? Maybe your baby loves tummy time but you always end up with stiffness or muscle tension? This is not uncommon and we are here to help!

Pelvic Pride is hosting monthly Baby Wellness classes consisting of small-groups split between 0-6 months (Tummy Time) and 5+ months (Movers & Crawlers) for individualized and milestone-specific tips and tricks for both you and your little one to thrive. The focus will be on both infant development and parent body mechanics to reduce the strain of floortime and improve happiness and joyful engagement for everyone! Learn more about our classes here.

Classes will include:

Personalized strategies for increased engagement
Adjustments for comfort - If your baby resists tummy time, we can help identify underlying issues that may be present, such as muscle tightness or a side-preference.
Guidance for parents/caretakers
Early detection of developmental delays - While tummy time struggles don’t always indicate a problem, collaboration with an OT or PT can help reduce risk of delays down the road.

Where to find treatment for infant development in Maryland

At Pelvic Pride Physical Therapy & Wellness, Dani is THE clinical expert at working with infants on development & motor milestones, as well as working with parents with pelvic floor concerns, so you are in the right place!

We are conveniently located in the Federal Hill neighborhood (& coming to Roland Park in March 2025) in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 66: The B’well Mindset: An Interview with Jake Jackson-Wolf

Wed, 19 Feb 2025 13:24:20 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 66 I had a lovely chat with Jake Jackson-Wolf of B’Well Counseling Services to talk all about how he got started with B’Well and how it has grown into the incredible therapy clinic it is today.

Jake & I immediately hit it off when we first met in Fall 2024. What started as a lunch meeting turned into a four hour conversation and an incredible new connection between our practices. During that discussion over business models and treatment approaches I realized that Jake (& Katie) have carefully curated an amazing team of practitioners that have a wide range of specialities making it tough not to find someone who is a great fit for your needs.

Hopefully with this podcast episode you will get a glimpse into what I saw and hear the passion with which Jake drives his team and provides a safe space for all of B’Well’s clients. Since recording this podcast episode I have had the opportunity to connect with more of B’Well’s providers and they are all just as awesome to meet.

Head over to B’Well Counseling Services to check out their line up of providers, read through the bios, and when you’ve found the provider (or two) who feel like the best fit be sure to send them a message to discuss starting your care!

Also be sure to check out What’s a Dad to Do? a therapy group for fathers! They meet virtually on Mondays from 4-5pm.

You can also find B’Well Counseling Services…

on Instagram
In person at 400 West Pennsylvania Ave, Towson, MD 21204
Or give them a call: 443-718-0496

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 65: When to See a Pelvic Therapist During Pregnancy: Part 2

Wed, 12 Feb 2025 14:57:06 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 65 I continued our two part series on when & why you should see a pelvic floor therapist during your pregnancy - this time for reactive care.

When a patient comes into pelvic floor therapy reactively (i.e. as a result of pain or symptoms) we have plenty of things to assess & treat to keep them as comfortable and mobile as possible during pregnancy.

Common symptoms or areas we treat during pregnancy:

Pubic symphysis pain and sacroiliac (SI) joint pain
Pelvic floor tightness and pain
Pelvic floor weakness including heaviness sensations and urinary leakage due to stress or urge
Low back, hips, abdominal weakness
Breathing
Upper back discomfort from changes at the chest during pregnancy
Any other issues head to toe that may pop up

If you didn’t get to pelvic therapy before delivery and are just now finding us, don’t worry! You are still welcome here!! If you have not delivered yet or aren’t even to the phase of trying to conceive but these methods intrigue you, give us a call!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 64: When to See a Pelvic Therapist During Pregnancy: Part 1

Tue, 04 Feb 2025 15:12:47 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 64 I review when & why you should see a pelvic floor therapist during your pregnancy for proactive care. Stay tuned for Part 2 where we review how pelvic floor therapy can help with reactive care.

When a patient comes into pelvic floor therapy proactively (i.e. without any symptoms) we have plenty of things to assess & teach to set them up for success.

The current state of the pelvic floor - Is it tight? Weak? Coordinated? Does it need some help?
Navigating continued exercise and movement throughout pregnancy and how to modify when things become too difficult or aren’t feeling as easy as baby grows.
Labor & delivery prep for helping to prevent stalls and know ways to move during delivery with or without medication.
Perineal massage to help reduce tearing during pregnancy.
The knowledge of what was going on in the body before delivery as compared to after delivery to minimize the common question we hear of “was it like this before my delivery?”
And a feeling of coming back home to share your birth story in a familiar and welcoming space.

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 63: Should I Still Come to Pelvic Therapy if I Did Not Do My Exercises?

Tue, 28 Jan 2025 13:11:38 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 63 I get honest about how “compliant” I have been in my own PT as well as why you should still go to your appointment even if you haven’t done your exercises!

It is not uncommon for us to hear a patient wants to cancel their appointment because they haven’t done their exercises. But this is exactly why you SHOULD come in! There are a few reasons we often hear as to why patients don’t do their exercises:

They didn’t have the right equipment
They didn’t have enough bandwidth
They didn’t understand the WHY

In that next appointment it is our job as therapists to either make sure you get the right equipment or we adapt the exercises to the equipment you have; streamline the exercises to meet you where you are and fit within your current available bandwidth; and explain the ‘why’ so that you understand how important the exercises are and how they will help your symptom resolution.

But this takes honesty from you! You need to be real with your therapist about why you haven’t done your exercises so we can help figure out a solution that fits your needs.

So next time you try to use the excuse “once X is over things will slow down” remember you are living a meme, be honest with yourself (and your provider), and let’s figure out a routine that works for you!!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 62: 10 Things to STOP Doing This Year for a Happier Pelvic Floor

Mon, 13 Jan 2025 20:34:37 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 62 I counted down the top 10 things you should STOP doing for a happier pelvic floor and finished it up with the #1 thing you SHOULD be doing for your pelvic floor this year.

The 10 Things to STOP Doing:

Hovering
Going ‘Just in Case’
Waiting to Pee
Using Vaginal Washes
Blindly Doing Kegels (or any other pelvic exercise)
Avoiding Drinking Water
Thinking Constipation Doesn’t Impact the Pelvic Floor
Trying to Grin & Bear It During Intimacy
Gripping Your Abs & Glutes
Holding your stress in your pelvic floor

And the #1 Thing You SHOULD Be Doing for Your Pelvic Floor:

Seeing a pelvic floor therapist!

Not sure where to find one? Check our blog post: How To Find A “Pelvic Floor Specialist Near Me”

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

The Best Stretches for Torticollis

Mon, 13 Jan 2025 15:53:57 GMT

A Guide to Gentle Stretching and Positioning

for Babies with Torticollis

Have you noticed that your baby tends to prefer looking to one side or feeding on one side and may get fussy when you try to switch. So you turn to Google and look up what causes this and find out it may be torticollis.

This leads you to wonder what the best stretches for torticollis may be. And, once you read enough about torticollis you start to wonder if you have it yourself after all the time looking at your sweet new baby. Lucky for you we have outlined the best stretches for your little one’s torticollis.

First, in case you landed here instead of other places on the internet and are wondering what torticollis is, we have you covered!

Torticollis is a condition where a baby's neck muscles tighten causing babies to tilt their heads to one side while their chin points in the opposite direction. This muscle imbalance usually limits the baby’s ability to turn their head fully. This lack of mobility can have short term and long term implications, making early identification and intervention crucial for proper development.

A comprehensive treatment plan is key to addressing torticollis. Not only can it help improve a baby’s neck mobility and positioning, but it can also support timely achievement of developmental milestones. Additionally, parents learn essential techniques to care for their child and promote proper muscle function.

The primary focus of treatment revolves around being purposeful with play and positioning. Depending on your baby’s age, much of this can be done through gentle stretching exercises —specifically side bending and rotation movements—along with positioning techniques to encourage improved neck movement. Below is an overview of effective stretches and positioning strategies that parents can easily incorporate into their daily routines for purposeful play and positioning.

Clarification for right vs. left sided exercises:

Left Torticollis: muscles on the left side of the neck are tighter, resulting in a head tilt to the left and a tendency or preference to look to the right, especially in a resting position.
Right Torticollis: muscles on the right side of the neck are tighter, resulting in a head tilt to the right and a tendency or preference to look to the left, especially in a resting position.

Stretching: Neck Rotation 

Stretching: Side Bending

Positioning Techniques

Proper positioning can be very helpful for stretching and strengthening the muscles on the affected side of the neck. These strategies are easy to integrate into daily care routines.

Floor Time: Side-Lying Position

Position: Lay your baby on their side on the floor.

For Left Torticollis : Place the baby on their right side to naturally stretch the left neck muscles.

For Right Torticollis : Position the baby on their left side to allow gravity to help stretch the right side of the neck.

Additional Tips for Torticollis

Position your baby across your shoulder or in baby carriers so they face their non-preferred side
During feedings, position them to encourage turning their head to the non-preferred side.
In the crib, arrange activities or visual stimuli on the non-preferred side to promote head turning in that direction.
Use stimulating toys and position yourself on the non-preferred side to encourage neck rotation in that direction, and make that side as exciting as possible.

When to Seek Professional Support

Is your baby showing signs of torticollis despite trying stretching, floor time, and positioning?

Don’t hesitate to reach out - it might be time to consult a physical or occupational therapist. These professionals can guide you through more advanced techniques and provide tailored support to help your baby overcome torticollis. Additionally, the hips and pelvis are often involved in torticollis, and engaging in neck-focused exercises and positioning will not directly correct the imbalances if lower body muscle involvement is present.

Torticollis can be frustrating for parents and babies alike, but with early intervention and purposeful play, most cases of torticollis resolve rather quickly. Reach out to our front desk if you are interested in an evaluation to further guide and support your family.

Where to find treatment for torticollis in Maryland

At Pelvic Pride Physical Therapy & Wellness, our occupational therapist, Dani, is the expert at treating little ones with torticollis, so you are in the right place!

Next on Your Reading List

10 Things You Should Stop Doing This Year For A Happier Pelvic Floor (& The #1 Thing You SHOULD Be Doing for Your Pelvic Floor!)

Fri, 03 Jan 2025 14:36:27 GMT

I mean honestly who does not like a list? And this one is going to tell you things to STOP doing to have a happier pelvic floor - what could be better?!

Pelvic health has become all the rage lately thanks to social media so sometimes it is hard to figure out what to believe. Trust me, we hear all sorts of interesting suggestions on Google from patients trying to help themselves.

Lucky for you, this list is evidence-based and coming to you directly from a Doctor of Physical Therapy (not that this is medical advice, always consult with your own medical team for specific questions).

1. Hovering

Recently I was in a pilates class and the instructor cued us to squat like we are hovering in a porta potty. And you know what? Everyone knew exactly what she was referring to! But it isn’t just porta potties that we squat over. This happens frequently over standard toilets as well - but why?

I get it, you don’t want to sit on someone else’s pee - eww . But the solution for that is simple: wipe it off. Or if you have enough time, build yourself a little nest out of toilet paper (or use one of those toilet covers that most bathrooms tend to be out of).

The issue with hovering is that your pelvic floor muscles are not able to fully relax making it hard to go to the bathroom. It is also worth noting that hovering over a toilet is very different from squatting like people in other countries do when using the facilities. Getting into that deep of a squat is actually a great position for pelvic floor relaxation.

So ditch the squat, take a few seconds to wipe off the seat or build a TP nest and sit down so your pelvic floor can relax.

2. ‘Just In Case’ Voiding

We hear this ALL THE TIME! Patients frequently report they go to the bathroom ‘just in case’ when they are out in public, going for a roadtrip, or before they leave home for any type of activity. The ‘just in case’ comes from a fear of finding a bathroom when you need it the most.

The issue here is that you are not necessarily allowing your bladder to fill all the way up. This will start to train your bladder and your brain that the volume of pee needed to send the ‘time to go’ signal is reduced. In turn you may find yourself going to the bathroom even more often which puts you into a cycle of frequent urination.

If you aren’t sure how often you should be going to the bathroom check out our blog post How Much Should I Be Peeing? Spoiler alert: It won’t tell you to go before you leave the house, when you are switching from Target to the grocery store, or right before a road trip - ‘just in case.’

Aim for going every 2-4 hours and if you aren’t able to wait that long then it is definitely time to get some pelvic floor help!

3. Waiting to Pee

I’m looking at all of my nurses, teachers, and parents right now (among other professions). See last sentence above (“aim for going every 2-4 hours”) which does not mean go once all day long or wait until the end of your shift to find the bathroom. You need to prioritize yourself by going to the bathroom once every 2-4 hours!

Waiting to go places unnecessary stress on your pelvic floor and impacts the sensitivity of your bladder muscle to signal the brain that it is time to pee. Prolonged waiting can negatively impact the bladder and the pelvic floor which may lead to urinary retention or leakage due to a lack of signal to go - we don’t want that!

If you wait too long due to factors that feel outside of your control, then you may also be guilty of avoiding water - see #6 for more!

4. Using Vaginal Washes

Say it with me: The vagina is self-cleaning!

You do not need to buy any fancy soaps or cleansers promising to make you smell like a bouquet of roses or a summer meadow. Truly you don’t need anything more than water!

Now for the external vulva tissue you can certainly use a very mild, unscented soap to clean outside, but nothing should be placed inside of the vagina. Using soaps with scents, polishing beads, or lotions will throw off the pH in your vagina and can lead to issues like yeast infection or BV. Why risk it?

(For my post-op vaginoplasty girlies, chat with your surgeon about the best douching routine to keep your vaginal tissue happy and healthy!)

The truth in the matter is, bodies have scents and smells. Vulva and vaginas are not supposed to smell like flowers. And if you start to notice a scent or smell that seems off, that is your body’s way of saying ‘Hey something is not right down here and you should get it checked out!’

5. Blindly Doing Kegels (or any other pelvic exercise)

We all have that ‘friend’ from highschool who drops into our DMs to tell you about this amazing product they’d love you to test out for them! Well as a pelvic floor therapist we get the friends and family sliding into our DMs to ask if they should be doing kegels because they saw some influencer talking about it on social media.

Or even better, they saw someone testing out a pelvic floor product, shorts, or chair and wonder if that will help them too.

So will these things help you? The answer is: it depends!

Do you have a tight pelvic floor? A weak pelvic floor? Do you have any pelvic floor symptoms that you are worried about? How are your breathing mechanics? Can you even coordinate a pelvic floor contraction without cheating with your core and glutes?

If you cannot answer these questions then no, you should not be doing kegels , using a pelvic floor insertable/shorts/chair promising you a strong pelvic floor and less leakage.

It is vital that you have your pelvic floor assessed by a pelvic floor expert (read: physical therapist or occupational therapist with extensive training in external and internal pelvic floor assessment).

6. Avoid Drinking Water

Okay so you feel like you need to pee all the time or you leak some amount of urine with a couch, laugh, sneeze, jump, or big need to pee. The solution is clearly to drink less water so you have less urgency/leakage, right? WRONG!

By decreasing the amount of water you ingest, the contents in your bladder are more concentrated.

Picture this: You fill a clear glass up with 80% coffee and 20% water - can you imagine the color of the contents in the cup? Now imagine you reversed that and filled it with 20% coffee and 80% water - it should be much lighter brown now, right?

Think of the coffee as your concentrated urine which is more irritating to the bladder lining. When you dilute it with water, the irritation on the bladder lining is decreased.

So while in theory it makes sense that drinking less means you need to pee less or have less to leak, the reality is that your bladder is just more irritated and you will still have urgency. And if your pelvic floor is not firing appropriately during activities of increased stress like coughing, sneezing, laughing, or jumping, then you will still leak the concentrated urine you do have in your bladder.

7. Thinking Constipation Doesn’t Impact the Pelvic Floor

Many of our patients come in with pelvic floor concerns and after a few questions find out that while they did not check off ‘Constipation’ on their intake forms and report the consistency of their stool is ‘normal’, they do in fact have signs of constipation.

The normal frequency of bowel movements is anywhere from three times per day to every three days. But even for our patients that go daily (and multiple times per day) they still may lean towards the constipated side.

We don’t just look for hard, dry, difficult to pass stools as an indication of constipation. We also ask things like “Do you feel fully empty after having a bowel movement?” which we get a surprisingly high number of yeses to.

The issue with ignoring your constipation is that the bowel has a major impact on the bladder and can be a sign of pelvic floor dysfunction. When the rectum has stool just sitting in it waiting to get out, it puts pressure on the vaginal walls and bladder which can lead to the feeling of pelvic heaviness/fullness or urinary urgency.

The reason the stool may be difficult to pass could be related to tension in the levator ani muscle group or the external anal sphincter (all pelvic floor muscles). These are things that should be assessed by a pelvic floor therapist to help manage your constipation for a happier pelvic floor.

8. Trying to Grin & Bear It During Intimacy

If we had a nickel for every time a patient was told to “just drink alcohol” before navigating intimacy, well we would have A LOT of nickels! So often our patients try to grin and bear it when experiencing pain during intimacy, with pelvic exams, or inserting a tampon. Drinking alcohol or just living with the pain is not an option & it should not be taken seriously if advised by a medical professional, or anyone really!

Trying to push through the pain will just create a negative feedback loop where you anticipate pain and then feel pain. At some point you start to wonder who is the chicken and who is the egg - the pain or the anticipation.

In every instance it is best to get to the root cause of the pain which is likely coming from tension in the pelvic floor and definitely warrants further assessment.

9. Gripping Your Abs & Glutes

Much like people watching in a mall or airport, pelvic therapists can spot an ab or glute gripper in every crowd. Developing these habits comes from a few places - some sport or activity that cued a lot of core engagement, someone in your life hyperfocused on appearance cuing you to hold it in, or standing in what we affectionately call the baseball coach stance where the hips jut forward and the glutes are tucked under. There are certainly more reasons beyond this but you get the point.

Sometimes we don’t even know we are gripping our abdominals or gluteus muscles until someone points it out or we develop discomfort in these muscles due to their state of always being ‘on.’ The issue with being an ab or glute gripper is that the tension in these muscles will negatively affect the pelvic floor through either tension or poor coordination.

We need the abdominals and gluteus muscles relaxed and ready to fire when we need them, not always in a state of engagement. So the next time you notice that your abs or glutes are firing while you are just standing there try to do a body scan:

Take a deep breath in. As you exhale unclench your jaw, drop your shoulders, let your belly soften, let go of your glutes and drop your pelvic floor.

10. Holding your stress in your pelvic floor

Finally, and maybe the hardest but most important one: stop holding stress in your pelvic floor!

Okay so this truly is tough and it will take a team approach to figure out if you are holding your stress in your pelvic floor (hello pelvic therapy) and why you are holding your stress there (and welcome to the party mental health therapy).

While many people hold their stress in their neck and shoulders, I’d say probably an equal amount hold their stress in their pelvic floor. Why?

There are so many reasons we can speculate on but the top reasons we see in the clinic are that the pelvic floor is so close to our core and these muscles both protect your most delicate organs but also engage to bring us into fetal position which feels the most safe or that there is some type of trauma or past experience that impacts the pelvic floor and draws our subconscious attention to this area with the desire to guard.

But what can be done about this? The answer brings us the the #1 thing you SHOULD be doing for your pelvic floor.

#1 Thing You Should Be Doing for Your Pelvic Floor: Seeing a Pelvic Floor Therapist

We see a dentist for our oral health, a gynecologist for our reproductive health, primary care provider to manage our full body health, a mental health therapist for our brain chemistry health, so why not see a provider for our pelvic floor health?

Afterall, these muscles are the ones responsible for preventing urinary and fecal leakage, urgency, hesitancy, or retention. When they are in good working order (and absent of any underlying conditions that result in chronic pain/dysfunction like Endometriosis, PCOS, EDS, etc) you don’t experience pelvic pain and can have enjoyable intimacy in whatever way that looks for you.

So whether you have a current issue you need support with or you just want to be seen for proactive or wellness care, find a great pelvic floor therapist near you and get started! Not sure where to find one or if they are a good fit? Check our blog post: How To Find A “Pelvic Floor Specialist Near Me”

Where to find treatment for pelvic floor issues in Maryland

At Pelvic Pride Physical Therapy & Wellness, our pelvic floor therapists are the experts at treating all patient so you are in the right place!

Next on Your Reading List

Episode 61: Pelvic Pride's 2024 Wrap Up

Tue, 31 Dec 2024 18:14:25 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 61 I wrapped up 2024 by reviewing some numbers for Pelvic Pride this year, announced our Word of the Year, and discussed our exciting news for 2025!

Pelvic Pride’s 2024 in numbers:

229 new patients evaluated in 2024
334 individual patients seen over the year
Over 1700 patient visits
13 community events attended or hosted

Our 2025 Word of the Year is:

MOMENTUM

BIG announcement (formerly known as announcement #2 which became the only announcement #iykyk)

We are opening a second location in Roland Park at The Quad at Cross Keys - set to open March 2025

Thank you to all of the listeners who have stuck around this year. Cheers to 2025!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 60: Caring for Others Beyond the Patient/Therapist Model: An Interview with Emily Souder

Tue, 24 Dec 2024 10:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 60, I sat down with Emily Souder, a writer, licensed clinical social worker, and an awesome human! Emily and I first connected over a desire to chat about how we help people and I quickly knew I needed to invite her on the podcast to share more about her work.

While Emily is in a phase of life where she is not taking on new clients, she is still an incredible resource and currently has three books available to help you in various parts of your life journey. In this episode we unpack each book, how it came to be and who the ideal reader is. We also touched on Emily’s work with meditation that she offers on Insight Timer - if you are listening when this episode drops definitely go check out her Cozy Up Meditation which is perfect for this winter season.

Check out Emily’s website or follow her on Instagram
Buy here books wherever books are sold! If you shop small, just ask your local bookseller to get Emily’s books in for you.
Birth Story Brave, Reimagined: An Updated Guide for Reflecting on Your Childbirth Experience
Birth Story Held for Loss: A Guide for Reflecting on Your Fertility Experience, Miscarriage, Abortion, TFMR, Stillbirth, and Infant Loss
Sparks: Inspiration for Extinguishing the Power of Fear and Igniting Amusement, Knowing, and Trust
Go listen to Emily’s meditations on Insight Timer
Check out RTZ Hope here

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 59: 2024 Recap

Tue, 17 Dec 2024 13:54:42 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 59, I did a quick review of the numbers for Pints & Pelvic Floors for 2024. It has been a busy end of the year with a lot of moving parts and changes coming up. We are super excited for the new year and cannot wait to tell you ALL about it!

Pints & Pelvic Floors 2024: Recap

P&PF grew 112% this year!

Our Top Cities:

Baltimore, MD
Washington, DC
Chicago, IL
Los Angeles, CA
Hermosa Beach, CA

We were listened to in 11 counties! Our Top 5:

United States
Ireland
United Kingdom
Canada
Spain

Our Top 5 Episodes in 2024:

Some other fun numbers:

We hit 1.49k downloads this year!
We released 36 new episodes totaling 1.09k minutes of my voice (and others!)

If you have ideas for topics you’d love to hear about please reach out to me via email or DM me on IG!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 58: Pelvic 2024 - Day 1 Review

Tue, 26 Nov 2024 15:48:46 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 58, I reviewed Day 1 of the PelviCon speakers. It was hard to avoid all of the nerdy pelvic therapy things but I tried to keep it as relevant to patients as possible and include the big takeaways & clinical pearls from each person. The speakers are always amazing and bring their own flair and this year did not disappoint!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 57: Inclusive and Empowering Sex Therapy: An Interview with Noelle Benach

183:788774807 (Joy Noble) — Mon, 18 Nov 2024 23:31:38 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 57, I sat down to chat all about the importance of truly inclusive care in the world of sex therapy with Noelle Benach.

Noelle and I bonded over our mutual desire to provide a safe space for our clients and ensure that we are confident when referring patients out. We both understand that we put our reputation on the line when recommending other providers and I instantly knew Noelle was going to be one of my go-to Sex Therapists in Baltimore! Noelle brings a refreshing approach to her work with clients, especially in regards to body positivity, LGBTQIA+ inclusivity, and ethical non-monogamy. I hope you enjoy our conversation, trust me if we had the time we could have kept chatting for hours! Be sure to find Noelle at the following places:

Follow Noelle on Instagram or Facebook to see her impressive use of reels to educate the masses
Check out Noelle's website to see her service offerings which include sex therapy for individuals and couples

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Do Men Have a Pelvic Floor?

Thu, 07 Nov 2024 14:00:00 GMT

Ah, the question we get asked every single week: Do men have a pelvic floor?

Typically this is coming from a new patient who is asking for their partner, a curiosity after learning about all that the pelvic floor does for individuals with a vagina, or because they see the penis pelvic model in the clinic and decide to ask.

Regardless of why they are asking, the answer is: YES, men (or those born with a penis) do have a pelvic floor!

If you think about the five functions of the pelvic floor it makes sense! The pelvic floor is key for:

So as long as men (or any person AMAB) are doing these activities, their pelvic floor will be important!

Shortly after that question, we get asked: What do you see guys for?

Honestly, the answer is pretty similar to the things we see women for - urinary or bowel issues including leakage, frequency/urgency, difficulty going (including constipation), pelvic pain, and issues navigating intimacy. Let’s dig deeper.

Urinary & Bowel Issues

Any person with a pelvic floor (aka everyone!) can have issues with muscle tightness, weakness, or discoordination. As a result, they may experience issues holding things in (leakage), letting things out (retention), or lacking the right communication between the bladder and brain which can lead to voiding frequency or strong urges due to the feeling of never fully emptying.

Recently we worked with a patient who reported going 40 times per day due to the feeling of needing to go as well as not fully emptying each time he is in the bathroom. That urge continued to build without relief which results in this patient feeling uncomfortable, landing him back in the bathroom every 20 minutes or so trying to get relief.

This same urgency, frequency, and leakage can be true for the bowels; however another common bowel symptom we treat is constipation. While constipation may have a multitude of factors, in pelvic floor therapy we focus on dietary fiber (how much soluble and insoluble fiber are they consuming daily/weekly), muscle tightness and/or coordination for getting stool out.

Pelvic Pain

Pelvic pain is oftentimes the catalyst that will bring men in for treatment. Well that and issues around intimacy, but more on that later.

Men commonly experience pain in their pelvic floors in a few locations:

The groin line
The perineal body
The testicles
The penis (more in the tip than the shaft, but both occur!)
The anus/rectum

This can occur for many reasons, but the most prevalent are muscle tension due to holding stress in our pelvic floor muscles or compression to the pelvic floor muscles and nerves during seated activities like riding a bike. With nerve compression, patients will likely describe burning, numbness, tingling, and/or shooting pain. The pain could be local to one spot or may refer to other areas of the body. We see this frequently with pudendal nerve involvement which sends pain into the penis, perineal body, or anus.

During our evaluation we will get to the bottom of these symptoms as we pinpoint where the pelvic pain is coming from. This will help guide our treatment to ensure you experience relief of your pelvic pain

Intimacy

Issues related to intimacy is another common catalyst to get patients in the door. Whether the issues are related to premature ejaculation, pain with erections/ejaculation, or difficulty with erections/ejaculation, male patients are looking for answers ASAP!

While we approach pain with erections and ejaculation much like the rest of our exploration into what is causing other pelvic pain, when it comes to premature ejaculation, difficulty achieving or maintaining erection, and arriving at orgasm/ejaculation we are looking more into muscle coordination, pelvic floor communication with the brain, and any other sinister pathology that could be occurring.

In this instance, we are going to work closely with your medical team to rule out bigger issues such as cardiovascular issues, hormone imbalances, and pelvic cancers. Once those are cleared and/or treated, we will place our focus on addressing any pelvic floor tension, educating on anatomy and function as it relates to the pelvic floor muscles and vascular systems, and providing you with techniques to employ at home to help support our work in the clinic.

Prostate Issues

Another area we work with male patients in pelvic floor therapy is before and after prostate surgery. It has been reported that individuals may experience urinary leakage, erectile dysfunction, and Irritable Bowel Syndrome after undergoing a prostatectomy.

In a prehab setting we will work to ensure the pelvic floor muscles are engaging appropriately to minimize or prevent urinary leakage and bowel leakage related to IBS symptoms and address any underlying pelvic floor tension ahead of surgery. After surgery we will turn our focus to pelvic floor strengthening for continued support of the bladder and bowels, discuss new methods for voiding, as needed, and monitor for healing, swelling, and pelvic floor muscle guarding as a result of pain.

Pelvic Floor Treatment for Men

In pelvic floor therapy we will assess for weakness, tightness, and coordination as well as review proper bowel and bladder habits to ensure all systems are working as they should. We will incorporate manual therapy techniques as needed to help with tight pelvic floor muscles and instruct patients in a home exercise program to help support the work we do in the clinic.

But is it awkward?!

We hope not!

But we understand that walking into a new space to sit down and discuss very personal issues can be tough. We work hard to make Pelvic Pride as welcoming and safe as possible for all patients. We recognize that this question may be coming from past experiences of going to PT for an injury, working out in a gym full of people, and talking very loudly and openly about your symptoms.

Pelvic floor therapy is different! You will work one-on-one with your pelvic floor therapist in the comfort of our private treatment rooms. All manual therapy, patient education, and exercises will be performed in that room so you don’t feel exposed out in a gym surrounded by people.

So what are you waiting for? If you are experiencing any of the issues we discussed above or have some other pain or problem that you don’t feel like you are getting great answers for, give us a call!

Where to find treatment for male pelvic floor issues in Maryland

At Pelvic Pride Physical Therapy & Wellness, our pelvic floor therapists are the experts at treating all patients, including men, so you are in the right place!

We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 56: Pelvic Floor Tools: Deciding Between Dilators or Pelvic Wands

Tue, 05 Nov 2024 14:25:47 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 56 I break down the difference between pelvic floor dilators versus wands, how to use them and which one is best for your pelvic floor symptoms.

In this episode we will cover:

Vaginal/genital dilators, rectal dilators, and pelvic floor wands
The difference in length, width, materials and overall shape
How to pick the right lubricant to use with your pelvic floor tool
Which tool is best for your symptoms

We are also affiliates* to some of the pelvic floor tools out there:

Intimate Rose Wands & Dilators - Use JOY1 for $5 OFF
Soul Source - Use 53225 for 5% OFF

*All income from affiliate sales are donated

If you are local to the DMV area check us out!

If you are not nearby, look at this list of our colleagues around the country!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Why Does Prolapse Happen?

Thu, 24 Oct 2024 13:00:00 GMT

If you have ever heard the word prolapse or have been diagnosed with a prolapse you are probably asking yourself: Why does prolapse happen?

Let's set the scene.

You are on the toilet, go to wipe and notice a new and weird feeling when you wipe. You grab a mirror Okay let’s be real, you likely grab your phone camera, and you see something that looks like it is falling out of your vagina. Yikes!

Or maybe you go for a long hike and about half way through you start to notice something rubbing against your underwear and think ‘ What in the world is that?!’

In these scenarios it sounds like you may be experiencing a prolapse. The good news is that

You are not alone.
There is help for prolapse!

Now you may be asking 'what exactly is prolapse?'

Pelvic organ prolapse (POP) is a condition in which the pelvic organs shift in a downward or outward direction leading to a protrusion into the vaginal canal. This is likely due to weakening of the connective tissues and musculature in the pelvic floor area that are there to support these pelvic organs. It’s estimated that around 1 in 3 women will experience some form of pelvic organ prolapse in their lifetime.

To get a better understanding of prolapse, it is important to understand the anatomy involved in a prolapse which can help us better understand why prolapse happens.

Pelvic organ prolapse may involve the:

bladder (cystocele)
rectum (rectocele)
uterus (uterine prolapse)
intestines (enterocele)
vaginal vault (seen when the bladder & rectum prolapse after removal of the uterus)
anus (anal prolapse - not pictured)

Now that we have a better understanding of what structures may be involved in prolapse, we can dive into our primary question of ‘Why does prolapse happen?’

While it is commonly believed that prolapse is only an issue for pregnant folx, this is not true. Anyone can experience prolapse, even those who have never been pregnant or experienced childbirth. The most common causes of POP include:

Genetics - Those with a family history of prolapse do have an increased likelihood of developing POP.
Hormonal Shifts - changes in our bodies hormones during perimenopause and menopause result in decreased estrogen levels. Estrogen is a key hormone in vaginal tissue health, so as your estrogen level drops and the vaginal tissues weaken, prolapse becomes more likely.
Chronic Cough - Due to the relationship of the diaphragm, the pelvic floor, and the pelvic organs, chronic cough can place increased, repetitive pressure on the pelvic floor. Over time, a chronic cough in conditions like COPD or emphysema can lead to POP.
High Impact or Heavy Lifting Activities - With high impact or heavy lifting exercises, it is common for individuals to struggle with managing their intra-abdominal pressure. By straining to lift heavy, or failing to breathe properly as we exercise, we set ourselves up for a higher risk of prolapse.
Pelvic Surgery - Surgical procedures in the pelvic region or involving the pelvic organs can increase the risk of POP due to the effects on the structural integrity of the pelvis or the removal of space occupying structures (as seen in vaginal vault prolapse)
Pregnancy - Individuals who have had multiple pregnancies, delivered larger babies (>8.8 lbs), or undergone lengthy labor (>3 hours of pushing) may be at heightened risk for POP due to the repetitive or prolonged stresses on the pelvic floor muscles and structures.

So, what can be done about prolapse?

Luckily there is a spectrum of care available to those who are dealing with prolapse, which ranges from conservative management to surgical correction. Common treatments include:

movement modifications and focused breathing for intra-abdominal pressure management
wearing garments that provide perineal body support, especially with prolonged activities or exercise
pelvic floor therapy to gain a better understanding of how your whole body impacts your prolapse symptoms & identify/treat underlying pelvic floor issues including tension, weakness, or discoordination
utilizing a pessary for internal support
And finally, surgery can be utilized to provide permanent support of the pelvic organs

What you can expect at Pelvic Pride.

In pelvic floor therapy we will perform an evaluation from head to toe to ensure we are looking at every system that may be involved in your prolapse symptoms. This means we are looking at things like how your collapsed arches can impact up the chain to your knee, hip, and pelvic floor. We will take a look at your breathing pattern to determine its impact on your ability to manage intra-abdominal pressure.

And of course, with enthusiastic consent, we will assess your pelvic floor to ensure we are addressing any tightness, tension, weakness, or discoordination that may be impacting your prolapse symptoms. We want you to leave with a better understanding of how each part of your musculoskeletal system is impacting your POP as well as the knowledge of tangible changes you can make immediately to help minimize POP symptoms when they happen.

Where to find treatment for POP in Maryland

At Pelvic Pride Physical Therapy & Wellness, our pelvic floor therapists are the experts at treating individuals with pelvic organ prolapse, so you are in the right place!

We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 55: Empowering Patients Through Enthusiastic Informed Consent

Tue, 22 Oct 2024 12:23:35 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 55 we will discuss informed consent, why it matters, and when it should be included in your treatments (spoiler alert: the answer is every session!)

In this episode we will cover:

The three types of consent: written, verbal, and non-verbal
Ways to collect each form of consent
What enthusiastic consent does & does NOT look like
What to do if your patient does not consent
The importance of consent in the medical field
And the importance of consent beyond the medical field!

If you are local to the DMV area check us out!

If you are not nearby, look at this list of our colleagues around the country!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

How to Treat Torticollis in Babies: 10 Proven Ways to Support Your Baby's Development

Thu, 17 Oct 2024 13:18:04 GMT

So, you noticed your baby has a head turn preference or someone mentioned torticollis… Now what? Maybe you do a quick Google search for “how to treat torticollis in babies” and aren’t sure where to start!

First, let’s talk about what torticollis is.

Torticollis is a condition where an infant’s head tilts to one side while their chin points in the opposite direction. This happens when the neck muscles—specifically the sternocleidomastoid muscle—become tight or shortened.

Torticollis can be caused by several factors, including positioning in the womb, difficult delivery, or simply favoring one side while sleeping or sitting. In some cases, it may also occur due to congenital muscle tightness, known as congenital muscular torticollis.

If left untreated, torticollis can affect your baby’s motor development , making it difficult for them to achieve key milestones such as rolling, sitting, or crawling. Because babies are growing so much each day, positive outcomes from therapeutic intervention are usually noticed as soon as a few days after beginning your baby’s personalized care plan!

Here are 10 ways to support torticollis resolution . Keep in mind that, for optimal results, a clinician with specialized experience should be consulted to build a personalized plan to help your little one.

Tummy Time: Increase tummy time to strengthen neck and shoulder muscles, encouraging your baby to lift and turn their head.
Repositioning: Change your baby’s head position during sleep or play to prevent favoring one side.
Gentle Stretching: Perform neck stretches, as recommended by a healthcare provider (Primary Care, PT, OT, etc.), to lengthen the tight muscles.
Feeding Position: Alternate sides during feeding to promote equal neck movement. This is especially equally important for bottle feeding, as it is for body feeding.
Visual Stimulation: Use toys, sounds, or lights to encourage your baby to turn their head toward the less-favored side.
Neck Massage: Gently massage the affected neck muscles to improve flexibility and reduce tightness.
Babywearing: Carry your baby in a sling or carrier to promote an upright posture, which can help with neck alignment.
Purposeful Play: Use your space to your advantage. Place toys all around your baby instead of just in front of them. This promotes looking and reaching in different directions.
Avoid containers (when possible): Try to avoid extended periods in “containers” such as bouncers, swings, car seats (when not in the car). Opt for safe open spaces such as a playpen or blanket on the floor to allow for sensory and motor development.
Occupational or Physical Therapy: Perhaps the most important on the list! Occupational or Physical Therapists, with speciality training, can provide guidance and personalized care plans for navigating your child’s specific muscle imbalances in order to achieve optimal results. Early intervention is key and can greatly determine the lasting effects from potential or confirmed torticollis. Therapy also targets developmental milestones and reflex integration to prevent future delays in motor skills, sensory processing, and cognitive development.

If you are looking for where to start, or have tried these and are not seeing results, our Occupational Therapist has specialized training to be able to help you support your baby during this critical growth period. An OT can assess your baby’s motor skills and provide customized exercises to address torticollis and any developmental concerns.

Where to find infant treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, our occupational therapist, Dani, is an expert in infant development including treating little ones with torticollis, so you are in the right place! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Does Torticollis Cause Plagiocephaly? A Tale of Twists and Turns
Read about our Baby & Me therapy program

Episode 54: Unpacking Prolapse

Tue, 15 Oct 2024 14:11:04 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 54 I will unpack the diagnosis of prolapse and where pelvic floor therapy comes in.

In this episode we will answer all of your questions including:

What is prolapse?
What are the different kinds of prolapse?
How does my pelvic therapist know what tissues are involved?
What can be done about prolapse?
How can a pessary help?
What about surgery?

If you are local to the DMV area check us out !

If you are not nearby, look at this list of our colleagues around the country!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 53: Just Say No to JIC Voiding

Wed, 02 Oct 2024 15:21:16 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 53 we will chat all about ‘just in case’ voiding, why we don’t want to JIC void, and the times that it is actually okay to go ‘just in case’!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 52: The Educated Practitioner: Elevating Pelvic Floor Care

Wed, 25 Sep 2024 12:37:53 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 52 I dive into a *small* soap box about continuing education for pelvic floor providers and the importance of being able to perform internal assessments as well as continued learning beyond the foundational pelvic course.

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 51: Meet the Therapists: An Interview with Dr. Eirika Abbey

Tue, 17 Sep 2024 14:35:13 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 51 I sat down with Dr. Eirika Abbey to chat all about her start in the pelvic floor world, her love of learning and taking classes, and a few fun questions including what she would be doing if she weren’t a pelvic floor physical therapist.

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

What is Neurogenic Bladder?

Wed, 04 Sep 2024 13:23:58 GMT

We are back to answer another one of those "wait, neurogenic what?" questions! Whether you have been Googling your symptoms or were diagnosed by a medical provider, you may be wondering “what is neurogenic bladder?”

In this blog post we explain what neurogenic bladder syndrome is, how additional factors can impact our bladder, the common diagnoses associated with neurogenic bladder, and how pelvic floor physical therapy can help you manage your neurogenic bladder.

What does neurogenic bladder mean?

Neurogenic bladder occurs when you bladder control is impaired due to a brain, spinal cord, or nerve problem/injury that impacts the nerves that control the bladder. Neurogenic bladder is also commonly referred to as Neurogenic Lower Urinary Tract Dysfunction (NLUTD).

Let’s talk anatomy.
The bladder functions through a series of neural pathways and reflexes under a combination of voluntary and involuntary control. The bladder system communicates with the brain via our peripheral nerves and spinal cord, as well as with our pelvic floor muscles to coordinate bladder filling, storage, and emptying.

Our bladder has the capacity to hold between 400-600 mL of fluid (or about 1.5 to 2.5 cups) and when we pee, typically 300-500 mL (or 1.25 to 2 cups) comes out.

As the bladder starts to fill, the detrusor muscle that wraps around the bladder (pictured below) will typically remain relaxed or inactive. At the same time, the pelvic floor muscles, which provide bottom-up support to the bladder, are active to help keep the urethra stay closed while the bladder stores urine.

When the bladder is nearly full, the detrusor muscle will stretch and the nerves from the detrusor muscle will send messages to the brain via the spinal cord to signal the need or urge to head to the bathroom to empty.

When ready to empty, the brain sends messages down the spinal cord to the bladder to signal the detrusor muscle to contract around the bladder. This will create an increase in pressure in the bladder which is stronger than the pressure of the urethral sphincter muscles and urine will start to flow.

With this cycle of the bladder in mind, if there is an injury or dysfunction anywhere along these pathways , such as the nerve connections between the brain and the detrusor muscle of the bladder, there likely can be an impact on the body’s ability to move, store, or empty urine.

What are the ways neurogenic bladder or NLUTD can result in bladder dysfunction?

Overactive

With an overactive neurogenic bladder, the nerves send signals to the bladder too frequently, resulting in bladder spasms and possibly the feeling of bladder fullness when the bladder may only be partially full. This can result in a strong, sudden urge to urinate, a frequent urge to urinate, and/or leakage of urine while trying to get to the bathroom on time.

Underactive

An underactive bladder can be due to an underactive detrusor muscle where this bladder muscle may not contract when needed or may have a weak contraction. When the contraction is weak, the pressure in the bladder may not be strong enough to overcome the pressure of the urethral sphincter muscles which will make it hard to let urine out. This can result in urinary retention, a slow or dribbling stream, and/or the need to strain to empty the bladder.

Combination of overactive and underactive

Over- and under-activity can occur simultaneously for some individuals with neurogenic bladder, possibly resulting in both urinary leakage and retention. This can look like frequent bladder spasms resulting in that sudden urge to go, however weak contractions of the detrusor muscle decreases the bladder’s ability to empty.

Detrusor sphincter dyssynergia (DSD)

DSD can occur when an overactive bladder may be working against closed and/or tight sphincters. When this is occurring, the detrusor muscle will contract to try to empty the bladder, however the sphincter muscles that provide bottom-up support to the bladder at the urethra may remain closed. This lack of coordination between the bladder and sphincters can result in urinary retention .

What do neurogenic bladder symptoms look like?

Our patients that suffer with neurogenic bladder often report:

Urinary Incontinence (leakage of urine) associated with urgency (trying to get to the bathroom on time) or stress on the system (cough, laugh, sneeze, or with activity like standing up or walking)
Urinary urgency or frequency (a strong or frequent need to go, including urinating more than every 2-4 hours during waking hours or 8 times daily, or more than 0-1 times at nighttime)
Urinary retention (difficulty emptying the bladder)
Typically, there is a small amount of urine left in the bladder after emptying of ~50-100 milliliters. You may have urinary retention and/or difficulty emptying your bladder if a medical professional has stated you have an ‘elevated’ or a ‘high PVR’ (PVR - post-void residual), typically >100 milliliters.
Difficulty starting urine stream or weak urinary stream (straining to start a urine stream or to empty at the end of toileting is a common symptom reported)

Bladder symptoms can be impacted by additional factors, such as:

Functional mobility- Are you able to safely get to the bathroom on time to empty?
Arm, trunk, and lower body mobility and dexterity- Any difficulties or discomfort with removing clothing/pants, transferring to the toilet, or maintaining a seated or standing position while trying to empty your bladder?
Schedule constraints- How much time do you have to complete your bladder routine? This can especially be important for folks who complete clean intermittent catheterization.
Dietary changes- What does fluid intake currently look like? This will impact the concentration or dilution of the urine and its impact on the lining of the bladder.
Fatigue- Are symptoms of fatigue impacting your ability to get to the bathroom on time and safely?
Medication side effects- Certain medications may have side effects that impact urinary retention, urgency, and frequency
Comorbid conditions- other diagnoses such as Diabetes or even chronic constipation can impact bladder function and control

What diagnoses are associated with neurogenic bladder?

Neurogenic bladder symptoms can occur due to a number of neurological conditions, including but not limited to:

Traumatic and nontraumatic brain injury
Multiple Sclerosis
Parkinson’s Disease
Spinal Cord Injury
Cerebral Palsy
Spina Bifida

In addition to the listed diagnoses above, we at Pelvic Pride work with individuals navigating other neurologic conditions, including post-concussion syndrome, tethered cord, transverse myelitis, and Guillain-Barré syndrome (GBS), to name a few. Please feel free to give us a call for a free phone screening to learn if pelvic therapy is the right fit for you!

So how can pelvic therapy help with neurogenic bladder?

Most folks may not realize pelvic health therapy can be helpful for the management of neurogenic bladder symptoms! Maybe you’re still experiencing difficulty emptying your bladder after a CVA or traumatic brain injury, or noticing some unwanted leakage of bladder with a sneeze or during exercise or sexual activity.

Your pelvic health therapist should focus on education regarding the root cause of your symptoms and treatment to best support your symptoms with a goal to maximize any intact sensation or motor function. This can include strategies for:

Bladder routine support
Fall risk assessment
Caregiver education and training
Breathing exercises
Lumbo-pelvic mobility & strengthening
Pelvic floor muscle coordination training
Soft tissue mobilization, or hands-on external or internal pelvic floor work

What are the results that someone can expect from pelvic PT?

Great question! Although a pelvic-neuro pelvic health therapist cannot revert, alter, or prevent any pathological nervous system changes due to a progressive or non-progressive neurological condition, our goal is to find treatment techniques and strategies that best support your bladder symptoms, help you improve your quality of life, and gain or maintain control over your bladder!

Common results of pelvic PT include:

Improved daily bladder habits and routine to address urinary symptoms that can be getting in the way of your daily activities, such as getting to work on time, exercising without leakage symptoms, and even sexual function and health
Decreased urinary leakage that may occur with daily tasks including functional mobility like transfers, walking, or trying to get to the bathroom on time
Improved bladder frequency, urgency, and/or emptying ability
Improved awareness and coordination of the lumbo-pelvic musculature, including pelvic floor, abdominals, spinal, and hip muscles, dependent on intact innervation of these muscles
Improved scar tissue mobility and sensitivity if present following a traumatic event
Improved overall knowledge of the anatomy and function of the nervous system (brain, spinal cord, and nerves) and connection with the bladder and pelvic floor musculature

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, Dr. Marlena specializes in the treatment of neuro pelvic floor conditions, so you are in the right place! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 50: A Review of the First 50 Episodes!

Tue, 03 Sep 2024 09:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 50 we are doing a recap of the first 50 episodes!

I love numbers so we are diving into all of the numbers!

All Time Downloads: 1708 downloads

Where You Are Listening From:

Top 5 Continents:

North America
Europe
Africa
Asia
Oceania

Top 5 Countries:

USA
Ireland
Mexico
Canada
UK

Top 5 Cities:

Baltimore, MD
Washington, DC
Chicago, IL
Los Angeles, CA
Albuquerque, NM

Number of Guests: 15 guest episodes (with more on the way)

Top 5 Guest Episodes:

Episode 36 : Chiropractors Meets Functional Medicine with Dr Liz Santangelo
Episode 25 : Beating Burnout: An Interview with Robyn Forney of The Burnout OT
Episode 27 : Maximizing Wellness Thru Massage: An Interview with Heather Conlon of Tranquil Traditions
Episode 28 : Pelvic Therapy with a Fertility Focus: An Interview with Dr. Melissa Thompson
Episode 23 : An Interview with James Rehak of Sobo Strength & Performance

Top 5 Episodes:

Episode 8 : A Tight vs Weak Pelvic Floor
Episode 2 : Pelvic Floor 101
Episode 18 : Soluble vs Insoluble Fiber Types
Episode 24 : Constipation Unveiled: Pelvic Therapy’s Impact on Digestive Well-being
Episode 16 : The Five Types of Urinary Leakage

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 49: Closing the Knowledge Gap Around Diastasis Recti

Tue, 27 Aug 2024 14:04:48 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 49 we will close the knowledge gap around diastasis recti!

In this episode we will discuss:

What is diastasis recti (or abdominal separation)
The prevalence of DRA
Who can experience DRA
How to prevent DRA before it starts
What to do once you have DRA
The idea of ‘safe exercises’ and is that actually a thing
How and when surgery plays a role in DRA recovery

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Does Torticollis Cause Plagiocephaly? A Tale of Twists and Turns

Mon, 26 Aug 2024 19:40:01 GMT

So, maybe you’ve heard the terms “torticollis” and “plagiocephaly” thrown around and wondered if they’re just fancy medical jargon or if they actually go together. ( Spoiler alert: they go together.)

Let’s break it down!

Torticollis: “Stiff Neck Syndrome”

First things first, torticollis is like your neck’s way of saying it’s had a hard day at the office. Also known as “wry neck,” it’s when your little one’s neck muscles are so tight on one side that their head tilts to that side while their chin juts the other way. It’s a twisty predicament, but not a permanent one - thankfully. While some babies are born with torticollis (congenital torticollis) due to their position in the womb (especially common in breech babies), others develop torticollis (positional torticollis) during delivery (especially with forceps or vacuum assisted delivery), or prolonged positioning, such as only feeding on one side or not turning their head while sleeping on their back.

Plagiocephaly: “Flat Head Syndrome”

Now, on to plagiocephaly. This is the condition where baby’s head develops a flat spot, often resulting in a slightly misshapen or lopsided appearance. Think of it as a head that's had a bit too much time on one side—literally. Babies’ skulls are very moldable and quickly shift in shape when spending a lot of time in one position, and especially looking in one direction more than the other. This is why tummy time is so important!

Plagiocephaly is most commonly seen in babies who spend a lot of time on their back with a preference of looking to one side almost exclusively, or spending time on their back without turning their head. It is also common in premature babies and those who spent time in the NICU.

The Connection: Torticollis and Plagiocephaly—A Head-Turning Relationship

Here’s where our twisty tale intertwines: torticollis can definitely lead to plagiocephaly. But why?

Option 1: When a baby has torticollis, they favor turning their head in one direction, especially at rest. This head-turning habit can cause them to spend more time lying on the same side, putting pressure on that spot. Over time, this pressure can flatten one side of the head, leading to plagiocephaly. It’s a case of “I can’t turn my head, so my head physically becomes lopsided.”

Option 2: These babies are often noted as having a preference in which direction to turn their head - so baby may spend most of their floor time (tummy or back) or in ‘containers’ (car seats, swings, bouncers, etc.) with their neck turned so they are always looking in the same direction.

Occupational Therapy to the Rescue

Enter the occupational therapist with a game plan to untangle the knots. We’re here to help correct that head tilt and encourage more balanced head positioning and related muscle symmetries throughout the body. Our toolbox is packed with play-based activities and positioning strategies to elicit the best results. Other tools may include infant massage or parent-led stretching.

The goal is to get the baby's head to turn freely in all directions, reducing the chances of flattening and ensuring a more symmetrical head shape. Hips and arms will also likely be involved in the therapy dance. Treatment focuses on not only improving current presentations but also preventing further flat spots or muscle tension for complete resolution of symptoms.

In summary, yes, torticollis CAN cause plagiocephaly. The twist? Not all babies with torticollis develop head flattening when early intervention is provided. Both conditions can be managed effectively when you have the right people on your team. With timely therapeutic intervention and parental involvement, you can set the stage for a happy, healthy, and head-rotating baby. So, let us work with you to twist and turn that neck to get your little one moving and grooving!

Keep that head up—both literally and figuratively!

Where to find infant occupational therapy treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, our occupational therapist Dani is an expert in infant development including torticollis and plagiocephaly, so you are in the right place! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Read about our Baby & Me therapy program
Find out how OT fits into the world of pelvic floor therapy
Learn more about Dani

The Pros and Cons of Dry Needling

Tue, 13 Aug 2024 17:00:01 GMT

Did your physical therapist mention the option to add dry needling to your care and now you are wondering if you should do it? Anytime you consider starting a new treatment you always weigh the pros and cons right? So let’s go over the pros and cons of dry needling!

First, what is dry needling?

Dry needling is a technique that utilizes a thin needle to release trigger points and decrease tension in the muscle being treated. It can be used alone or in combination with electrical stimulation to treat muscles, tendons, and even scar tissue.

The Pros of Dry Needling

Pain relief

To avoid getting too deep into things we will keep this pretty easy to understand - but humor my anatomy nerd journey just a little bit! So when you have a trigger/tender point or a taut band of muscles, you may also experience pain.

This can occur for a few reasons with a big one being that the trigger point is not getting good blood flow to the area. One of the jobs of our blood system is to bring oxygen to the area and carry away hydrogen ions. This is important because hydrogen ions create an acidic environment in the tissue which irritates the nerves and creates the sensation of pain.

When we introduce a needle to the area with dry needling, we are trying to decrease the trigger point/taut band while also creating micro-trauma to the tissue. When this happens, the body goes into healing mode which brings that oxygenated blood to the area. Blood cells will drop off the oxygen and pick up the hydrogen ions, decreasing acidity in the tissue and decreasing pain.

While we can go way further into the why and how of this, I won’t bore you! So to recap:

Needle > micro-trauma > new blood for healing > oxygen increases in the tissues and hydrogen decreases in the tissue > decreased acidity > decreased pain perception

Improved mobility

When I describe trigger points to my patients in the clinic I use the analogy of a brick wall. The brick wall is the muscle and the bricks are the muscle fibers. When we get a trigger point in the muscle, that is like a few of the bricks in the wall not being in their ideal alignment.

Inside of that muscle fiber are two structures called actin and myosin who overlap more or less depending on if the muscle is contracted or relaxed. Sometimes actin and myosin get stuck overlapping and need some help relaxing.

When we tap the needle into the muscle to treat the trigger point we are getting those muscle fibers to let go/relax and the trigger point decreases, the actin and myosin are in better alignment and the muscle is better able to do its job.

By improving the function of the muscle and decreasing the pain, you can experience an increase in mobility of the muscles and joints that are impacted by the muscle just dry needled.

Avoid surgery or extra medications

Instead of opting for pain medications, steroid injections, or potentially unnecessary surgery, dry needling is a more conservative option for symptom management through the reduction in pain and improved mobility.

I recently worked with a patient who was having numbness and tingling in his neck, shoulder, and arm. After testing to rule out cardiac issues, the findings came back as stenosis. While dry needling will not stop or reverse his stenosis, we were able to eliminate this numbness, tingling, and pain. As a result he is not pursuing more invasive procedures at this time.

Gets to deeper or hard to reach muscles

By utilizing dry needling we are able to get deeper or hard to reach muscles in the body. A common example of this is the gluteus muscles. The gluteus minimus, medius, and maximus have varying degrees of overlap at the outside hip. When we are utilizing various treatment techniques we have to consider the tissues we are treating through.

With something like cupping or instrument-assisted soft tissue mobilization (IASTM), also commonly referred to as Graston or scrapping, we are administering treatment through skin, adipose tissue, fascia, and muscles from the superficial layer to the deep layer. With dry needling we are able to insert the needle past the skin, adipose, fascia, and superficial muscle layers to truly reach that deepest layer.

We are also able to treat muscles that are in a location that is harder to reach due to anatomy like the iliacus muscles inside of the pelvis or the subscapularis (between the shoulder blade and the rib cage). Dry needling gives us the opportunity to treat these muscles with a tool that has a better reach.

Can be performed in conjunction with other treatments

When you opt to add dry needling to your care routine, you are not limited to only dry needling. This is a treatment that can and should be performed along with other techniques to provide you with the best symptom reduction or resolution possible.

Can be performed in a shorter treatment session

Here at Pelvic Pride, after the completion of a thorough initial evaluation to establish care, we offer 30-minute Dry Needling treatment sessions to our patients that are looking for a streamlined dry needling appointment. We can also incorporate dry needling into our full 60-minute appointments, however a shorter session may be appropriate when we are only doing dry needling.

The Cons of Dry Needling

It requires the use of needles

I know that sounds silly but it is important to address that many people have a fear of needles and it is important to consider your feelings around the use of needles for treatment before saying yes.

As someone who has tattoos but hates getting my blood drawn, I completely understand that this is an important factor to weigh when determining if dry needling is a good fit for your treatment.

Soreness is expected

I describe the feeling after being dry needled as the same kind of muscle soreness from a good workout. It typically lasts for 24-72 hours, but you should still be able to do your normal daily routines. Due to the expected soreness, I typically warn my patients to avoid dry needling (especially for the first time) right before a busy weekend or big event.

Bleeding and bruising

Due to the vascular structures in the body, it is a possibility that you may bleed or have bruising after dry needling. We do our best to ensure we avoid these structures which is why we will spend our time thoroughly palpating (touching) the area. This is to help minimize the risk of the needle piercing an artery or vein. If it does, it is not a major concern. We are training to apply pressure after each needle is removed and this helps to minimize or prevent bleeding/bruising.

Important structures may be in the way

Along with thorough palpation to make sure we aren’t going to needle into arteries or veins, we are also aware of not needling into more vital structures.

For those with low back pain, therapists have a limitation in the upper lumbar spine due to the location of the kidneys. With abdominal pain we are cautious around the bladder and GI structures. And for pretty much anything in the thorax we are avoiding the lungs.

This doesn’t mean we cannot treat those areas, it just means we will needle in very specific ways to ensure your safety. This also means you may point to an area of pain to ask if we can needle it and the answer could be no.

Limited access in your area

Unfortunately, not all states allow physical therapists to provide dry needling services. If you are in a state where PTs cannot dry needle, I highly recommend reaching out to an acupuncturist and sharing your treatment goals with them.

Side note: Anytime I share blogs or social media posts about dry needling I get multiple messages about how acupuncture has a treatment method that is very similar to the approach taken with dry needling. I will not speak for acupuncturists and their treatment methods, but I am a big supporter of acupunctures and frequently recommend it for my patients for a variety of treatment goals.

Contraindications of Dry Needling

It is important to recognize that there are limitations to dry needling including instances in which dry needling is not an appropriate treatment option. This can be broken into absolute contraindications and relative contraindications.

Absolute contraindications include a phobia of needles, the inability to consent to treatment, or needling over areas of lymphedema. Consent is a huge part of our ethos at Pelvic Pride and we will never provide a treatment to a patient without explicit, enthusiastic consent. If you have lymphedema and would like to still try needling in a different area I recommend you discuss your desires with your medical providers first to ensure the risk/reward benefit is appropriate and you receive written medical clearance for treatment.

Relative contraindications include the first trimester or pregnancy (when the risk of pregnancy loss is the highest), individuals who are immunocompromised due to the risk of infection, and over areas where an implant may exist. This includes the pectoralis or breast area, deltoids, biceps, buttocks, and calves.

Where to find dry needling treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, Dr. Joy & Dr. Eirika are certified to provide dry needling to our patients, so you are in the right place! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Dry Needling FAQs

Episode 48: The Pros & Cons of Dry Needling

Tue, 13 Aug 2024 14:41:23 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 48 I will cover the pros and cons of dry needling as well as the training required in the state of Maryland to be endorsed by the Board of Physical Therapy to be able to provide dry needling to patients.

In this episode we will discuss:

Pros of Dry Needling
Pain relief & improved mobility
Potentially avoid surgery or medications
Able to reach deeper or hard to reach muscles
Can be performed in conjunction with other treatments
Can be performed in shorter treatment sessions
Cons of Dry Needling
It requires a needle ��
Soreness is expected for 24-72 hours afterwards
Bleeding and bruising may occur, but is rare
There are structures that limit that areas we can needle or the approach we take with needling
Dry Needling is NOT available in all 50 states
Contraindications - reasons we may not be able to needle include:
Fear of needles
Inability to communicate consent for care
Over areas of lymphedema
During pregnancy in first trimester
Immunocompromised individuals due to risk of infection
Over areas of implants including pecs, breast, deltoids, biceps, buttocks, and calves

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 47: Navigating Travel Constipation

183:788774807 (Joy Noble) — Mon, 05 Aug 2024 11:59:20 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 47 I will chat all about why we experience travel constipation and then some tips to make things go a little smoother.

In this episode we will discuss:

The causes of travel constipation including:
Change in routine
Change in diet
Decreased water intake
Change in access to a private toilet (especially if you have to share it with others that you are not used to)
Tips to make things go smoother:
Increase your insoluble fiber
Be mindful of your water intake
Grab yourself some travel Poopouri if you are sharing a bathroom
Bring a travel Squatty Potty or create a makeshift prop for your feet
Try some ILU abdominal massage

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 46: Meet the Therapists: An Interview with Dr. Marlena Allen

Tue, 30 Jul 2024 12:30:39 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 46 I sat down with Dr. Marlena Allen, the first therapist to join Dr. Joy at Pelvic Pride to chat all about her start in the pelvic floor world, how she uses her neuro background to help her pelvic patients, and a few fun questions including what she would be doing if she weren’t a pelvic floor physical therapist.

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

What is Neurogenic Bowel?

Mon, 29 Jul 2024 12:56:07 GMT

Whether you have been Googling your symptoms and stumbled upon it or you saw a medical provider who gave you the diagnosis, you may be wondering “What is neurogenic bowel?”

In this blog post we explain what neurogenic bowel syndrome is, how additional factors can impact our bowels, the common diagnoses associated with neurogenic bowel, and how pelvic floor physical therapy can help you manage your neurogenic bowel.

What does neurogenic bowel mean?

Neurogenic bowel is an umbrella term used to describe any bowel condition that an individual may be experiencing due to a brain, spinal cord, and/or nerve problem/injury that impacts the nerves controlling and supporting colonic or gastrointestinal (GI) system function.

Our bowels function through a series of neural pathways and reflexes under a combination of voluntary and involuntary control. The gastrointestinal tract is additionally regulated by its own nervous system called the Enteric Nervous System. Further, our GI system communicates with the brain via our peripheral nerves and spinal cord, as well as with our pelvic floor muscles to coordinate bowel filling, storage, and emptying. If there is an injury or dysfunction anywhere along these pathways, this can impact the body’s ability to move, store, or empty feces.

Our patients that suffer with neurogenic bowel often report:

Fecal urgency (a strong need to go) and/or frequency
Fecal incontinence (leakage of stool) associated with urgency (trying to get to the bathroom on time) or stress on the system (cough, laugh, sneeze, or with activity like standing up or walking)
Constipation including irregular bowel movements, incomplete bowel movements, harder-to-pass stool consistency, as well as feeling the need to strain to empty

Bowel symptoms can be impacted by additional factors, such as:

Functional mobility- Are you able to safely get to the bathroom on time to empty?
Arm, trunk, and lower body mobility and dexterity- Any difficulties or discomfort with removing clothing/pants, transferring to the toilet, or maintaining a seated position on the toilet or commode?
Schedule constraints- How much time do you have to complete your bowel routine?
Dietary changes- What does fluid and nutrition, including fiber, intake currently look like?
Fatigue- Are symptoms of fatigue impacting your ability to get to the bathroom on time and safely?
Medication side effects- Are you taking prescription medications such as certain antidepressants and opioid-based pain medications that can impact symptoms of constipation?

Symptoms of bowel dysfunction can also impact other parts of your day-to-day, including getting to work on time, exercising without leakage symptoms, and even sexual function and health.

What diagnoses are associated with neurogenic bowel?

Neurogenic bowel symptoms can occur due to a number of neurological conditions, including but not limited to:

Traumatic and nontraumatic brain injury (TBI or stroke/CVA)- changes to the gut including constipation and fecal urgency are among the most common symptoms with a TBI or CVA. Those who experienced a traumatic injury may also have scar tissue from their injury and/or surgical procedures that can impact the recovery of the GI system
Multiple Sclerosis (MS)- constipation and fecal leakage are frequently reported by those with MS with varying mobility, strength, and balance changes that can impact safety and comfort with a bowel routine
Parkinson’s Disease (PD)- constipation is the most common symptom in both early and late stages of PD. Bowel routine can frequently be impacted by postural, mobility, and cognitive/mood changes.
Spinal Cord Injury (SCI)- establishing and supporting a bowel program is important to those with any level of a spinal cord injury (traumatic or non-traumatic). Timing, toileting transfers and positioning, equipment use, and defecation mechanics all can play a role in a healthy bowel routine.
Cerebral Palsy (CP) & Spina Bifida - constipation and fecal leakage is frequently reported by those affected by CP or Spina Bifida. Commonly, upper or lower extremity spasticity or muscle stiffness changes can impact toileting positioning safety. Caregiver education can be a helpful component to supporting bowel symptoms!

So how can pelvic therapy help with neurogenic bowel?

Most folks may not realize pelvic health therapy can be helpful for the management of neurogenic bowel symptoms! Maybe you’re still experiencing chronic constipation after a traumatic brain injury, or noticing some unwanted leakage of bowel with a sneeze or during exercise or sexual activity.

Bowel routine support- such as suppository or enema use timing, toileting setup and positioning strategies, and fluid and intake recommendations
Fall risk assessment- improving the ability to get to the bathroom on time and safely
Caregiver education and training- teaching and working with your caregiver(s) how to best support you with your bowel routine
Breathing exercises- learn how to improve defecation mechanics with your breath for improved pressure management
Lumbo-pelvic mobility & strengthening- addressing the flexibility and stability of the muscles around your spine, hips, and pelvis for improved pelvic floor muscle tension, ability to get to the bathroom safely and on time, and comfort with toileting positioning
Pelvic floor muscle coordination training- building awareness of our pelvic floor muscles ability to contract, relax, and lengthen our anal sphincters in order to improve bowel emptying ability and bottom-up support to the bowel system, such as during movement and exercise (however dependent on the extent of the neurological involvement)
Soft tissue mobilization, or hands-on external or internal pelvic floor work- addressing any lumbo-pelvic muscular or fascial tension or scar tissue impacting GI motility and bowel emptying

What are the results that someone can expect from pelvic PT?

Great question! Although a pelvic-neuro pelvic health therapist cannot revert, alter, or prevent any pathological nervous system changes due to a progressive or non-progressive neurological condition, our goal is to find treatment techniques and strategies that best support your bowel symptoms, help you improve your quality of life, and gain or maintain control over your GI functions!

Common results of pelvic PT include:

Improved daily bowel habits and routine to address constipation
Improved bowel leakage that may occur with daily tasks including functional mobility like transfers, walking, or trying to get to the bathroom on time
Improved bowel frequency, urgency, and/or emptying ability
Improved awareness and coordination of the lumbo-pelvic musculature, including pelvic floor, abdominals, spinal, and hip muscles, dependent on intact innervation of these muscles
Improved scar tissue mobility and sensitivity if present following a traumatic event
Improved overall knowledge of the anatomy and function of the nervous system (brain, spinal cord, and nerves) and connection with the GI system

It is likely that your pelvic PT will want to communicate with other members of your medical team, including gastrointestinal or neurology, to ‘quarterback’ your care via interdisciplinary collaboration for holistic support and care. Further, your medical team may incorporate additional testing or imaging to learn more about your symptoms (such as anorectal manometry testing to assess the function of the anal sphincters and rectal musculature) and discuss medication management for symptom support, such as prescription or over-the-counter suppositories or enemas for bowel routine management, medications that address spasticity, discomfort, or pain associated with nerves, as well as anxiety and depression.

Curious if you’d benefit from pelvic floor therapy for your neurogenic bowel symptoms?

Complete the questionnaire below to learn more about your current bowel routine and symptoms. A higher score can indicate that you will likely benefit from bowel routine support and from seeing a neuro-based pelvic health therapist!

Where to find treatment in Maryland

Next on Your Reading List

The Ultimate Guide to Pelvic Floor Physical Therapy: The Neurological Edition

Four Reasons An Out-of-Network Pelvic Floor Therapy Clinic is the Best Choice!

Thu, 04 Jul 2024 11:00:00 GMT

If you’ve been looking into pelvic floor therapy you may have noticed a trend: most of them are out-of-network. And the ones who aren’t have SUPER long waitlists.

So do you wait on the really long waitlist or do you put up the money and pay for the out-of-network clinic to get started sooner? Well, the answer is a little more involved than a yes or no. Let’s dive into the four areas that make out-of-network clinics the best choice for many!

First, to set the tone for this whole blog post, I started my career in a private practice that accepted insurance. When I moved to Maryland I worked for a large company who accepted insurance. There are great therapists who work at companies who accept insurance. Typically the issue isn’t the therapist, it is the restrictions placed on them by the insurance companies or the big bosses to be able to make enough money for the company to run. So this is not at all meant as a way to bash on those therapists - they are doing their best! And that isn’t to say that patients who need to go in-network to use their insurance cannot get good care. What it does mean is that patients going in-network need to be aware and advocate for their needs as best as they can or make an informed decision around what to expect with an in-network vs out-of-network clinic. *Steps off soap box*

So like I said in the beginning this can be broken down into four parts:

Expertise
Care
Service
Cost

Expertise

As a specialty pelvic floor practice, our clinicians have advanced training in all areas of pelvic floor therapy. After obtaining our degree and our clinical license, we continue on to take countless continuing education courses in our niche to be able to provide expert care to our patients.

This is in opposition to other physical therapists and occupational therapists who treat a variety of patient populations with some pelvic floor diagnoses sprinkled into their day. At this frequency, these providers have likely taken 1-2 basic classes to get the gist of what to do. We find this leaves too much room for generalization and not enough knowledge to dive deeply into the symptoms’ root causes. At Pelvic Pride we work with patients who have pelvic floor diagnoses or issues all day, every day!

Due to this advanced and continued training, our hands have become incredibly skilled at treating and assessing pelvic floor related symptoms. As in most of the therapy world, our hands are our tools and we use them with each patient. The inverse of this is the common

experience at an in-network clinic where a patient may be left in a room hooked up to a biofeedback machine or with a dilator inserted while their therapist is elsewhere in the clinic working with another patient. (I mean they have to get those billable units somehow - it’s a vicious cycle!)

We pride ourselves on our strong manual therapy treatment methods and our ability to incorporate this in the clinic along with a supportive home exercise program designed to continue the success we are having during our treatment sessions.

Care

If you’ve been to a traditional outpatient orthopedic clinic then you are no stranger to working with rehab techs or aides along with your physical or occupational therapist. This is how clinics are able to see so many patients throughout the day.

At Pelvic Pride you will spend your entire appointment working one-on-one with your pelvic floor therapist. This means every exercise or hands-on technique is performed by your highly educated and skilled clinician. You can ask questions and will get expert answers in return.

To top it off, all of our appointments are performed in private treatment rooms so you don’t have to worry about discussing your pelvic pain, urinary leakage, or pointing to your pubic symphysis pain in front of a crowded gym. I mean we are all for body empowerment and normalizing talking about our symptoms, however we respect that socially that is not the norm. Our patients appreciate the ability to share all of the details without an audience.

Service

Convenience and availability are two key components of service and we strive to make sure we hit the mark on both of these. Our Patient Care Coordinator plays an active role in managing our clinicians’ schedules to ensure no appointment space goes unfilled. We regularly use our waitlist to guarantee that any patient who wishes to be seen can be accommodated as soon as possible in the time slots that best fit their schedule . By doing this, we are able to offer same week, and oftentimes same day appointments to our new patients.

Meanwhile with the in-network clinics you end up sitting on a waitlist, which is the worst! Especially when you’ve been dealing with your symptoms for a while, are desperately looking for answers, or have a time sensitive matter like a pregnancy. Just imagine a wait list so long that you deliver your baby before ever being seen for your pregnancy concern. The convenience of same-week appointments is one of the main reasons people choose to seek care from an out-of-network clinic.

Not only do we want to have enough appointment slots available to you, we also want to have our time available to you. To do this we offer 75-minute long evaluation appointments and 60-minute long follow up appointments. By offering longer appointments we find you have plenty of time to fully share your story and it allows us the time we need to examine every aspect as we get to the root cause of your symptoms. We find this just isn’t possible when clinics are scheduling new patients every 30 minutes. That is hardly enough time to share your story, let alone ask questions too.

The final point of service to highlight here at Pelvic Pride is our inclusive care. While many clinics boast a ‘Women’s Health Program’ or treatment for pregnant moms, new mamas, or women of all ages; we treat EVERY patient with a pelvis. (This means everyone!!) Our patient caseload is generally evenly spaced along the gender spectrum with a specialty program for trans patients seeking care for Gender Affirming Care .

Cost

We recognize that this is likely concern #1 for most people - and we get it! It is important that you are making an informed decision when spending your money. At Pelvic Pride we have transparent pricing which we are happy to discuss when you reach out to inquire about our services. This means no surprise billing at the end of your treatment time with us.

Unfortunately this is not the case with in-network clinics due to the way they work with insurance. While there are a lot of intricacies to this, the big takeaway is that if your insurance benefits are maxed out in the middle of a month (like with a 35 visit limit for PT/OT) but the clinic you are at bills insurance monthly, they may not be alerted that your insurance coverage has been maxed out and you are now on the hook for the cost of care for half a month.

As a reminder for many insurance plans, you will also need to meet your deductible before your coverage starts. This means you are paying out-of-pocket towards your deductible before you switch to your copay or coinsurance. In Maryland, the average out-of-pocket deductible is $1600, which is then followed by an average of $30-$90 copay.

This is why we encourage patients who are concerned about their insurance benefits to ask about their deductible, including if their out-of-network care will go towards their deductible or if they have out-of-network benefits to reimburse the cost of services.

Finally, and this is one of the best parts, your plan of care is based solely on your needs and not dictated by insurance. As discussed above, many insurance plans have a visit limit per calendar year or they will place a limit on the number of visits they approve based on the patient’s diagnosis. At an out-of-network clinic, we are able to decide on a plan of care frequency that best fits your current symptoms and your ultimate goal without being told by insurance that they no longer wish to cover your care. This means you are the top priority at Pelvic Pride, not the insurance plan.

In Review

It is important that you are truly informed when making a decision between an in-network and out-of-network clinic and can see the whole picture of the pros and cons of each. The decision of where to seek care is a personal choice and is not to be made lightly. We hope this information is helpful and provides you with some better background information and the tools you need when deciding on a location for care and advocating for the care you deserve. (Read this blog post to see a list of questions to ask each clinic as you choose the right one for you)

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , including tailbone pain, so you are in the right place! We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

When Can I Exercise After Birth?

Tue, 25 Jun 2024 17:26:19 GMT

Figuring out when you can exercise after birth is tricky!

Do you wait until the 6-week check in? But what if you feel ready to start trying some things earlier? Or what if you don’t?

Will it cause delays in healing? Will it help you feel better soon? We will answer all of these questions and provide you with some safe exercises to do from 0-12 weeks after birth, so keep reading!

Should you wait until your 6-week check in to start exercising?

The short answer: NO! Think about it, you are already squatting, lifting, carrying, rolling in bed, walking around the house - you ARE exercising! It may not be a full blown group fitness class but it is movement and it counts!

The thing to keep in mind during the first four to six weeks after your little one is born is to listen to your body and monitor for bleeding. If you notice an increase in pain, soreness, or bleeding, your body is telling you to slow down.

While we will need to incorporate stretching and strengthening exercises into your daily routine soon, at this point the two main things I want you to focus on are:

Breathing
Posture

Breathing

Managing your intra-abdominal pressure (inside of the diaphragm, abdominals, and pelvic floor as pictured below) is key to provide support to your low back, abdominals, and pelvic floor! When we breathe in the abdominals expand and pelvic floor drops, then as we breathe out the abdominals draw in and the pelvic floor lifts up. It is important to utilize these mechanics to protect your body in the newly postpartum phase.

To do this, remember the phrase “exhale on the effort” or “blow as you go.” This means, you should inhale to prepare then exhale as you go to lift baby up from the bassinet, crib, changing table, floor, etc. This is also true for any object you are wanting to lift, not just your little one, or any exercise you perform.

Posture

There are a lot of new postures you are putting your body in when taking care of baby. Maybe this looks like stooping over the bed to change a diaper, popping out a hip to hold baby, or some variation of poses you will take to feed your little one throughout the day. In all of these postures it is ideal to remember a few things:

Your shoulders should be stacked over your hips - not hunched forward as we often see with lifting or feeding baby
Your hips should be stacked over your pelvis - not jutted out to the side or pushed forward to make a shelf for baby to rest on

Simply focusing on posture can make a big impact on how you feel in your body and after trying these posture changes you will see they are actually much more challenging to maintain than you may think. With that said, give yourself rest breaks and stretch as needed. Two of our favorite stretches are a pectoralis stretch and child’s pose.

Okay so you are thinking: “I hear you on the breathing and posture, but what else can I do?”

Great question! Let’s take a look at ways to move your body and safe exercises to try between week 0 and week 12.

Exercises during Week 0-2
During this time, it is important to listen to your body. Start with gentle movements that feel good for you. If you feel up to going for a walk, start low and slow at about 10 minutes and gradually increase your time to your body’s tolerance. Again, monitor for increased pain or soreness and bleeding, whether you delivered vaginally or via Cesarean.

Looking for more? Try these exercises.

Exercises during Week 2-4

Now is the time to start increasing your walking time or distance, at your own pace. You can continue the exercises from week 0-2 as well as add in more core and leg exercises. Our goal is to start incorporating more standing exercises, as tolerated. Remember, it should not hurt so if it does, take a step back by moving through a smaller range of motion or try less repetitions.

Try these exercises:

Exercises during Week 4-6

At this point, you can start to add in low impact exercises and cardio, as well as increase the exercises above. To do this you can add a resistance band, hand weights, or simply increase the number of repetitions or sets of each exercise.

For a challenge, try these exercises:

Recumbent bike (a stationary bike seat will likely not feel great at this time!)
Elliptical

Exercises during Week 6-8

It is now time to check in with a pelvic floor therapist to assess your pelvic floor muscles and soft tissues to ensure they are coordinating appropriately, that scar tissue is not negatively impacting you, and ensure you are ready for more challenging activities. This is also the time to assess and address any feelings of pelvic pressure or heaviness with your pelvic floor therapist.

Try these exercises:

Power walking for cardio
Increase the resistance bands or weights
Or add them in now if you haven’t felt ready yet but now you are!

Exercises during Week 8-12

The current best clinical guidelines recommend returning to running around 12 weeks (or 3 months) postpartum. If you haven’t already, your pelvic floor therapist should screen you for strength, flexibility, range of motion, balance/coordination, and the ability to transfer load with activities that mimic that of running.

Time for these exercises:

Stationary bike
Return to running

What if I haven’t felt ready to start exercising yet?

That is totally fine! You are honestly not alone. Everyone’s pregnancy is different and everyone’s postpartum journey is different. If you aren’t ready to start exercising yet, don’t sweat it.

Take the tips above and ignore the time frames. Use it as a progression from exercises laying on your back to being on your feet. Focus on breathing, posture, and being a new parent - everything else will fall into place when it is time . And if you feel like you need some extra help, reach out to us at Pelvic Pride, that is why we are here!

Where to find treatment in Maryland

Next on Your Reading List

Exercise photographs are used with permission of PelvicHEP .

Episode 45: How Does Pelvic Therapy Help With Gender Affirming Care?

Tue, 25 Jun 2024 12:38:37 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 45 we end Pride Month with a review on how pelvic floor therapy can help in all of the ways for those seeking gender affirming and gender inclusive care!

In this episode we will discuss:

Common issues related to non-surgical treatment
Creating a safe space for all
Binding
Tucking
Top surgery (feminizing & masculinizing)
Bottom surgery (feminizing & masculinizing)
Scar tissue management
Dilator protocols
Working with birthing dads

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Come for the Fitness, Stay for the Community: An Interview with Rachel Wagner of Fit4Mom Baltimore City

Tue, 18 Jun 2024 12:14:49 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 44 I had the pleasure of chatting with an amazing Baltimore City business owner, Rachel Wagner, who was one of Pelvic Pride’s earliest supporters when we first got started and has been one of our biggest cheerleaders ever since. She has since turned into a dear friend who celebrated 10 years of owning Fit4Mom Baltimore City this summer!

In this episode:

Rachel answers “What is Fit4Mom?”
How Rachel got involved in Fit4Mom as a participant turned owner
Baltimore City’s Fit4Mom growth from 2 instructors and a few class offerings to the multitude of instructors and classes that are offered today!
Community in fitness & connection
Fit4Mom’s ideal client
Empowering moms to listen to their body
The impact of doing group fitness with your peers
Show up as you are and trust the Fit4Mom instructors to support you and take you safely through a workout
All family dynamics are welcome, your first class is always FREE
Catch Fit4Mom Baltimore City in Federal Hill, Canton @ CareFirst (FREE), Patterson Park, & Druid Hill (check out the Fit4Mom schedule for exact locations & times)
Join in for Fit4Mom’s other offerings like Book Club & Mom’s Night Out events

Find Rachel & Fit4Mom:

On Instagram: @fit4mombaltimorecity
On Facebook
Check out Fit4Mom Baltimore City’s website
Send Rachel an Email

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Why Does My Tailbone Hurt?

Mon, 17 Jun 2024 20:49:36 GMT

Even in the day of standing desks, walking pads, and ergonomic chairs, we still get the question: Why does my tailbone hurt?

Which is followed quickly by, “What cushion should I use?” Or “Can you help me?”

The answers are: We will tell you in a little bit, and YES! So keep reading!

So, why does your tailbone hurt? You can most likely thank your pelvic floor and your sitting posture for this.

First, let’s point out the tailbone. (circled in red)

The tailbone, or coccyx, is a triangular shaped bone (composed of a few fused vertebral bones) that is located at the end of the spine. The tailbone is the attachment site of many pelvic floor and hip muscles and ligaments.

All images used with permission from Pelvic Guru®, LLC

as a member of the Global Pelvic Health Alliance Membership (GPHAM)

Due to being a main attachment site of the pelvic floor muscles, tension in the pelvic floor can cause tailbone pain and injury to the tailbone can cause pelvic floor pain. More on that below!

We tend to see tailbone pain as a result of three things:

A fall onto the tailbone
Poor sitting posture
Tight pelvic floor muscles

1. Falling onto the tailbone

Pain as a result of falling onto your tailbone makes sense for most people. Especially for those who live in states where winters are harsh and ice is a common issue. Whether you have fallen onto your tailbone once, or many times, the result can be a displacement of the tailbone (meaning it is bent inward or to the side) or chronic pain at the sacrococcygeal joint (tailbone meets sacrum).

Typically the symptoms heal after some tailbone rest (we are looking at your coccyx cushions), however pretty bad or repetitive falls can create lingering issues due to the new position of the tailbone. Other times, we work with patients who have pelvic floor pain and can pinpoint a certain fall from ‘years ago’ that they never realized may be playing a role in their current symptoms. For these patients we may palpate (touch) the deeper pelvic floor muscles (coccygeus or pubococcygeus) and reproduce their tailbone pain.This indicates that pelvic floor therapy is the best course of action to help eliminate tailbone pain.

Okay, so the fall makes sense, right? But, why the other two?

2. Poor posture

In the therapy world we call this poor sitting posture ‘sacral sitting’ meaning instead of sitting upright with your weight through your sit bones (ischial tuberosities), most of the pressure coming down from the spine goes into the sacrum/tailbone area. As with any prolonged positioning of a joint, it can get achy or painful. Imagine if you sat on the floor for a long time in a criss cross position, your ankles and knees will probably be sore or achy but the time you go to get up. The same thing is happening in your tailbone (sacrococcygeal joint) with prolonged sacral sitting.

To correct for this, try to maintain an upright posture with weight into your sit bones (TOP RIGHT) and/or utilize a lumbar support (like a bolster or rolled up towel - BOTTOM).

3. Tight pelvic floor muscles

Due to their attachments to the tailbone, when the pelvic floor muscles are tight or guarded (contracted) they can pull on the tailbone putting a similar stress through the sacrococcygeal joint (tailbone meets sacrum) thus causing pain. As with any joint, an abnormal stress or pull can start to create symptoms. This is where pelvic floor therapy is again key. We will help to determine which muscle attachments are causing your tailbone pain and then provide you with treatment both in-clinic and for-home to help decrease your tailbone pain.

This will likely include:

Hands-0n manual therapy in clinic to address the pelvic floor muscles, ligaments, and tailbone position
Coaching on sitting posture
Stretches to the hip musculature, especially gluteus maximus
Advice on using a tailbone cushion

So, let’s chat more on tailbone cushions!

Previously, providers would give patients a donut cushion to sit on when they experienced an injury to the tailbone. This is kind of like fitting a square peg onto a round cushion. Due to the placement of the hole, you would have to sit in the center of the donut (see diagram below) which can feel awkward or unstable. Most of us want to sit back on the cushion so we feel more supported but this still places pressure onto the tailbone.

Lucky for us, technology has improved and we now have access to better cushions that feature a tailbone cut out and support so you can sit all the way back in the chair in a more natural position while still leaving room for some tailbone relief.

Our top recommendations for tailbone cushions are Cushion Lab , Tush Cush , & Cushion Your Assets .

In Review
Whether your tailbone hurts due to a fall, poor sitting posture, or tight pelvic floor muscles, pelvic floor therapy is here to cover your tail….bone. We will perform a thorough assessment to ensure we are addressing any cause of your symptoms and have you back to feeling pain free as soon as possible.

Where to find treatment in Maryland

Next on Your Reading List

Episode 43: No One Deserves to Feel Less: An Interview with Ayce Kyptyn

Tue, 11 Jun 2024 12:55:46 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 43 I got to chat with Ayce Kyptyn about his experience with pelvic floor therapy as a trans man, his work in Erotic Blueprints, Bondassage, and his studies in Sexological Bodywork.

What you’ll hear in this episode:

Finding a care provider who is supportive of you and your journey
Create your care team
The right provider is worth the drive
How a patient knows you are inclusive for them
Your website matters!
How providers can get into working with trans folx
The importance of consent in the room to help trans folx (& all patients) to feel more safe
Somatic embodiment & Ayce’s journey with it
Sex, Love & Goop (on Netflix) - Ayce’s recommendation
One thing Ayce wishes people knew: All of you is welcome here!
Find more pleasure in life!

Find Acye:

On Instagram: @ayce_kyptyn
On Facebook
Check out Ayce’s website

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 42: Embodied Wellness is Truly a Journey of Bravery: An Interview with Sam Stuart

Tue, 04 Jun 2024 04:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 42 I got to chat with Sam Stuart about the ins and outs of what makes personal training with Braving Wellness different.

What you’ll hear in this episode:

Sam’s desire to combine embodied movement & trauma-informed personal training with a focus on prenatal & postnatal workouts
The importance of building community through group fitness classes
Who Sam’s ideal client is (spoiler alert: consent and choice are key!)
How Sam adapts when her clients arrive dysregulated and how she can help them navigate the workout their body needs
That said, she also dispels the belief that taking a trauma-informed approach does not mean you won’t make gains in your workouts
The importance of recognizing when a routine or exercise plan isn’t serving you and being ready to make a change
Identifying with trauma is not a requirement for working with Sam
Sam’s intentionality in checking her biases and privileges before starting to work with her clients

Find Sam & Braving Wellness

On Instagram: @braving_wellness
Check out the Braving Wellness website
At 410 Fitness
Or send Sam an email: coachsamstuart@gmail.com

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 41: What’s the Deal with Vaginal Washes?

Tue, 28 May 2024 13:49:35 GMT

Welcome to Pints & Pelvic Floors: The Podcast.

In Episode 41 we do a quick dive into vaginal washes and why you DO NOT need them!

Tl;dl (too long; didn’t listen)

I mean honestly this episode is like 5 minutes so it’s not too long to listen!
Main takeaway: you do not need any fancy vaginal/vulvar washes - the vagina is self-cleaning, the most you really need is water!
Sweat and hair and scents and smells are a normal part of having a body
If you need to wash with something, wash the external vulva only, with a mild softsoap
Avoid fragrances, scrubbing beads, glitters, sprays, or anything targeting you to make you more appealing ‘down there’

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 40: Providing Accessible Holistic Family Support Across the Lifespan: An Interview with Karen Kindig

Tue, 21 May 2024 12:46:49 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 40 I got to chat with Karen Kindig about all things The Womb Room. Baltimore has so many resources and The Room is absolutely a gem for people going through all phases of parenthood.

Tl;dl:

The diversity of providers and classes offered at The Womb Room to support families throughout the lifespan (pro tip: they have classes for grandparents too!)
How Karen started her journey and what led her to owning The Womb Room
A quick shout out to the yoga workshops that Pelvic Pride has the privilege of joining in on (Join us on June 9th for the PREnatal Yoga Workshop & June 23rd for the Pelvic Mechanics for Birth Workshop )
How The Womb Room strives to provide classes that are not cost prohibitive including a list of FREE offerings!

Find Karen & The Womb Room:

On Instagram: @thewombroom_baltimore or @karenkindiglcswc
Check out The Womb Room’s website & class schedule
Visit The Room Room in the Keswick Castle
Or send Karen an email: Karen@WombRoom.mom

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 39: Pelotons & Pelvic Floors

Tue, 14 May 2024 11:59:40 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 39 we did a throwback to April 2021 with a re-record of a Zoom webinar I did about stationary bikes and the impact on our pelvic floor.

Tl;dl:

Due to the anatomy of the pelvic floor inside of the pelvic bones, the biggest area of compromise are the nerves, arteries, and veins
The biggest symptom impacts on the pelvic floor with bike riding (stationary or outdoor) include:
Nerve entrapment (resulting in numbness or erectile dysfunction)
Swelling at the vulva, labia, testicles, or penis
More severe and less common (but still worth mentioning) are penile thrombosis (blood clot), infertility, blood in the urine, spermatic cord torsion, and prostatitis (inflammation) - always consult a doctor about any concerns!
Risk factors for symptoms include:
Poor bike fit/low handlebars
Staying in the saddle (on the seat) too long
Ways to minimize negative symptoms/impact on the pelvic floor include:
Adding some cross training to to your routine (running, swimming, yoga, HIIT classes)
Watch your posture (avoid prolonged anterior tilts - leaning your pelvis forward in which more pressure is felt on the pelvic floor/genitals)
Get out of the saddle 30-60 seconds for every 10 minutes of bike riding
Try a wider seat or padded shorts (this is mostly for those on stationary bikes! Road bikers and mountain bikers have very strong opinions about harder/narrower seats and that is OKAY!)
For our pregnant folx:
Stationary biking is a recommended form of exercise by the ACOG
Tips for bike safety: remain hydrated, don’t allow yourself to overheat, you may need to stay in the saddle during your 3rd trimester thanks to your change in center of gravity due to baby size
Always listen to your body & modify if needed!
When in doubt see a pelvic floor specialist!!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 38: Taking Care of Your Body isn’t Bougie, It’s Necessary: An Interview with Dr. D

Tue, 07 May 2024 09:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 38 I sat down with Dr. D of Thrive Chiropractic to chat about how she got started in the chiro world and what led her to create her home here in Baltimore.

What you’ll hear in this episode:

Dr. D’s journey from working in nonprofits to moving to Georgia for chiropractic school
How receiving chiropractic care was a vital part of Dr. D’s care team while navigating life as a gay women during the era of Don’t Ask Don’t Tell
The lead up to opening Thrive Chiropractics in 2014 and how private practice allows Dr. D the flexibility to treat her patients in the way she feels is best (we’re looking at your new parents with little one’s who need adjustments - babies don’t always mold to our schedule!)
Treatment techniques like: Polyvagal Theory & Webster technique
How frequency of care allows our joints, muscles, and nervous system the ability to make and hold change
The accessibility of chiropractic care in terms of finances, time, and treatment options
How chiro is WAY more than neck/back pain and popping joints - if you worry that is all they will do, communicate your boundaries with your provider!

Find Dr. D & Thrive Chiropractic:

On Facebook or Instagram
Check out the Thrive Chiro website
Email Dr D. here
Visit Dr. D at Thrive Chiropractic: 6080 Falls Road Suite 200A, Baltimore, MD 21209
Or give her a call: 443-991-4703

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

How To Find A “Pelvic Floor Specialist Near Me”

Mon, 06 May 2024 16:12:38 GMT

How many times do you think someone Googles “pelvic floor specialist near me?”

The answer: A LOT!

Think about it! How many times have you gone to Google to look up something “near me?” We all do it, and we all do it all the time.

So you look up a pelvic floor specialist near you and then what? Google pops up a list of options. The first one is typically a Sponsored suggestion. Do you click it? Did they pay to be there? Does that mean they are good? But is it an ad? Should I just scroll by? (welcome to my ADHD brain thoughts when I use Google)

Okay so you scroll past the first one (don’t worry they will show up again in the list) and start to look at the remaining options. Some are big corporations, some are small clinics, some are just solo provider names. But how do you choose which practice or therapist to see?!

Well, lucky for you we are going to dive in and answer the question of how to find the best "pelvic floor specialist near me!"

Let’s assume you’ve already put “pelvic floor specialist near me” into Google and found a list of results. You click through their websites, look at the photos of their therapists, maybe you filled out the contact form on a few and avoiding having to call the others. But what should you be looking for when you click through these websites? How do you know the providers are any good?

Let’s start with the basics:

What kind of training did their therapists have?

In each providers’ bio you should be able to see where they have done their pelvic floor training. Be on the lookout for names like The American Physical Therapy Association Academy of Pelvic Health, Herman & Wallace, Pelvic PT Rising, Brooks Institute of Higher Learning, Core Exercise Solutions, Essential Pelvic Health, or The Functional Pelvis, to name a few.

If it isn’t listed, just ask!

Next you want to know a little more about how the clinic works. Give them a call or send a quick email to find out the following 8 questions.

1. How long is the evaluation and follow up appointments?

You want to look for clinics that offer 60 minutes or more for the evaluation appointment and around 60 minutes for follow up appointments. 45 minutes may be okay BUT anything less than that and you will not have enough time to receive the care you deserve!

2. How often will I be seen?

This is totally dependent on each patient, however be aware of clinics that only see you once a month or less, especially when you are first getting started. In the beginning you should be seen weekly to every other week (but weekly truly is best!). If a clinic is so busy that they can only see you every 6 weeks or so, I would question your ability to actually get better due to their infrequent care.

3. Do you perform an internal pelvic floor assessment?

While you should always have the option to either consent or defer an internal assessment, being able to perform an internal pelvic floor assessment is a vital skill set for your provider to have when advertising that they treat pelvic floor issues.

4. Do you perform pelvic floor assessments in standing?

We don't live our lives on our backs! Most of the activities that our patients report their symptoms are worse tend to be in standing, squatting, jumping, or some other form of on their feet. So if you are struggling with pelvic pressure, heaviness, prolapse, or pain that is exacerbated in standing, it is important that your therapist perform an assessment in standing.

5. Do you do more than just kegels?

Be cautious of clinics, especially ones that are associated with your GYN office, that will only give you kegels as an exercise and send you on your way. Pelvic floor therapy is WAY more than just kegels, and honestly for many patients kegels can make their symptoms worse.

6. Do you use things like biofeedback consistently for my care?

Doctors love to write "with biofeedback" on their referrals for pelvic floor therapy. But what does that mean? Biofeedback is typically a device that you get hooked up to and left to watch the lights on a screen grow taller or smaller to "tell" you that your pelvic floor is overactive or underactive. From there it is your job to get your pelvic floor to do the opposite, often without any guidance. It isn't a red flag if your provider uses biofeedback occasionally, and with constant supervision and cuing, however it should not be the whole session, ever session!

7. Will I be seeing the same therapist each visit?

You should know ahead of time if the clinic you are considering working with will keep you with your same provider each session or if you will be bounced around from therapist to therapist. You should always be given a heads up if your therapist is unavailable and be able to consent to being treated by a different provider before your appointment is scheduled.

8. Will I be working with anyone other than my therapist for my sessions?

Especially in bigger practices and hospital-based settings, it is not uncommon for a therapist to be working with multiple patients at one time. This means you may spend part of your treatment session working with a rehab aide or tech, who have little to no training in physical therapy care. This is not skilled care!

Finding a Pelvic Floor Therapist Near You
In the event that you stumbled upon this blog during your search for a pelvic floor therapist and want some help locating one near you, check out this list of Pelvic Pride's trusted providers around the country:

Pelvic Rehab Directory by Herman & Wallace
This directory is associated with one of the top pelvic health educational institutes. Practitioners listed here have completed at least one course through Herman & Wallace.

You are able to search providers by location or name using this directory.

Pelvic Global Directory
This directory is part of a professional membership which allows providers access to continuing education courses, clinical handouts, professional anatomy illustrations, and more. Practitioners listed here are committed to continued knowledge and clinical growth.

You are able to search providers by location as well as specialty and condition by clicking the gear icon on the right, next to the "Search" button.

Pelvic PT Rising Provider Map
This directory is associated with one of the top pelvic health educational groups. Any pelvic health provider is able to join this map. To access the map either clinic on the map itself or the "View on Google Maps" button.

You can sort this map by providers who accept insurance versus cash-based clinics.

Good luck & happy pelvic therapist searching!

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions ! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 37: Oh Sh!t: Which Laxative Do I Need?

Tue, 30 Apr 2024 09:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 37 I give you the rundown of the four types of laxatives and how they work!

Tl;dl:

There are four types of laxatives: bulk-forming, osmotic agents, stimulants & stool softeners.
Bulk-forming: forms a gel in the stool to help it hold water which in turn makes the stool soft and bulky so it’s easier to push out (ex: Metamucil, Benefiber)
Osmotic agents: draw water into the bowel to make the stool softer and increase frequency of pooping (ex: MiraLAX, Milk of Magnesia)
Stimulants: speed up the gut motility (movement of stool through the large intestine) by stimulating the GI tract nerves (ex: Dulocolax, Ex-lax/Senna)
Stool Softeners: draws water in to soften the hard stool to make it easier to pass with less straining (ex: Colace)
Other things that help with constipation include movement, fiber intake, abdominal massage, water intake
Check out Episode 18 : Soluble vs Insoluble Fiber Types to learn more
Click here to subscribe to our newsletter and keep up-to-date with Pelvic Pride

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 36: Chiropractors Meets Functional Medicine with Dr Liz Santangelo

Tue, 16 Apr 2024 09:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 36 I had the opportunity to chat with Dr Liz Santangelo of Santangelo Family Chiropractic about chiropractors and her recent clinic addition of Functional Medicine.

During this episode Dr Liz & I talked about:

Her start in the chiro world (& how she had her first adjustment when she was just a few minutes old)
The impact of chiropractic care on the nervous system and how chiro is way more than popping spines
Each patient’s care should be specific to their needs - not every patient needs the same adjustments as everyone else (or even as the previous session)
Dr Liz’s ideal patient: females between 20-40 years, especially for pre/postnatal care
Infant adjustments are not the same as adult adjustments!
The 3 T’s that impact subluxations: thoughts (mental/emotional stresses), traumas (physical impacts to the body), toxins (chemicals and what we put into/onto our body)
The functional medicine lens that looks at more of the chemical toxins in the body which allows Dr Liz to address another ‘T’ that impacts subluxations

Find Dr Liz:

On Instagram
On Facebook
Online @ www.yourfamilychiropractor.com
Give the office a call: 410-663-8610

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Why Do I Pee When I Sneeze or Cough?

Wed, 27 Mar 2024 21:09:28 GMT

Do you ever find yourself wondering “why do I pee when I sneeze or cough?”

Picture this: it’s a beautiful spring day, you are walking around the park, the flowers are blooming, the birds are singing, pollen is everywhere, you sneeze and out comes some pee. What a way to ruin your lovely stroll!

Or maybe it's flu season, you caught the bug and you are laying in bed miserable. Not only are you coughing and sneezing, but now you are leaking too?! Ugh!!

Don’t worry - if either of these scenarios sound like you, rest assured you are not the only one having this issue. And we are here to explain why you pee when you sneeze or cough.

When someone leaks pee during a cough or a sneeze, we call that stress urinary incontinence. This happens due to a sudden increase in intra-abdominal pressure (the pressure that exists in the space created by the diaphragm, abdominal muscles, and pelvic floor). Physical activities that increase this pressure include

coughing
sneezing
laughing
straining
exercising

While many people believe this is only an issue that pregnant folx experience, leaking pee with a cough or sneeze can impact anyone . However, it is a common symptom during pregnancy and postpartum due to the anatomical, hormonal, and postural changes that occur. Despite being common, it does NOT have to be your ‘normal’ as pelvic floor therapy can be a great place to start treating this pesky symptom!

Let’s dive deeper.

Looking at the image below, we see the anatomy of the respiratory canister. The diaphragm (or breathing muscle) is at the top, the transverse abdominis core muscle wraps like a corset from the front to the back, and the pelvic floor muscles form a supportive sling at the bottom.

When we take a breath in (left), the diaphragm lowers, the abdominal wall expands outward and the pelvic floor moves downward.
When we breathe out (right), the diaphragm relaxes to lift up, the abdominal wall and pelvic floor muscles shorten to return to their resting positions.

All of these components work together to help manage pressure that can occur with daily activity, like a cough or sneeze, and reflect how the pelvic floor and core play an important role in prevention of leaking pee.

So why does leakage with a cough or sneeze occur?

First, imagine having a full water balloon in your hand and you are simply holding it closed. Then someone comes up and pushes down on it. If you weren’t prepared for that, it's likely that some of that water leaked out.

Each time we cough or sneeze, there is increased pressure in the abdominal space that we saw above. Looking at the image below, we see how this added pressure in the abdomen will also add pressure down on the bladder. To prevent leaking pee, we require our pelvic floor muscles to help keep the urethra closed when this increase in pressure occurs.

Leaking pee due to stress urinary incontinence is typically thought to be the result of weak pelvic floor muscles, however this is not always the case. Sometimes the ‘why’ behind leakage is due to a variety of factors outside of the pelvic floor as well.

Common reasons urinary leakage occurs include:

Core weakness - This is especially common for pregnant and postpartum folks due to the stretch of the abdominal muscles from a growing baby. If core muscles are weaker, their ability to help manage pressure along with the pelvic floor muscles is impacted.
Try this fix: exhale on the effort with core exercises. This means be sure to keep breathing when you are doing core exercises with a focus on exhaling during the hardest part of the exercise.

Pelvic floor muscle weakness - If the pelvic floor muscles are weak, they lose their ability to support the urethra and bladder and provide closure at the urethra to prevent leakage.
Try this: Pro tip: this doesn’t automatically mean do more kegels! We have seen plenty of patients who can contract their pelvic floor with a ‘kegel’ in isolation but they struggle to put it together with functional movements - lift, squat, run - this is where pelvic PT comes in. If you aren’t sure if your pelvic floor muscles are weak or not, give us a call to schedule an evaluation and we will figure it out with you !

Pelvic floor muscle tension - On the flip side, if the pelvic floor muscles can have too much tension this impacts the muscles’ length-tension relationship which is PT talk for the muscles are not able to relax fully to then be able to contract again. When a muscle only contracts through part of its range it is not as strong or as efficient as contracting through its full range. Think of this like trying to walk across the room but you can only take half steps instead of your full stride. Yu will still cross the room but not as quickly and it took more effort because you took more steps.
Try this: It’s all about balance! Be sure that you are fully relaxing your pelvic floor muscles and don’t neglect stretching. Not sure how to length your pelvic floor muscles? We can help!

Pelvic floor muscle discoordination - Our pelvic floor muscles typically engage to close the urethra just prior to a cough or sneeze, we call this a ‘knack’. The ‘knack’ however can become diminished during pregnancy, following childbirth, or even if you’ve had a chronic cough or cold. In pelvic floor therapy we will assess this knack contraction and provide you with training to increase your body’s ability to perform it if your coordination isn’t where it should be.
Try this: try to squeeze your pelvic floor muscles before you cough, laugh or sneeze - every time!

Ligamentous laxity - Ligaments provide support in our pelvic area to our bones and organs, including the bladder. When a ligament has laxity, it is too loose which can result in too much mobility of the joints or decreased support of the organs. This occurs during pregnancy due to hormonal changes to allow for a growing baby, as well as hypermobility conditions, including Ehlers-Danlos Syndrome. Laxity in the ligaments that attach to the joints of the pelvis, hips, and spine can decrease ability to support the bladder and may be a contributing factor with urinary leakage due to difficulty closing off the urethra or as a result of prolapse (or dropping of the bladder, uterus, or rectum from it’s normal spot in our body).
Try this: This depends on where your ligamentous laxity is coming from. If it is due to pregnancy, then know this is temporary and it is important to work with a pelvic health provider to learn strategies to minimize the impact of laxity. If it is due to a connective tissue disorder, then we need to be extra mindful as this is not temporary and it is vital that you have strategies to help you cope with loose ligaments.

Inefficient breathing mechanics - A cough or sneeze is considered a forceful exhale and if breathing support is not managed well, this could result in added pressure down on the abdomen and bladder and leakage symptoms. A common breathing pattern that results in this added pressure is called paradoxical breathing. This type of breathing occurs when the chest expands during inhalation and the abdomen is drawn inwards, and then during exhalation the abdomen is pushed outwards. Added pressure on the abdomen can increase pressure on the bladder and contribute to leakage due to the pressure on the bladder being greater than the pressure created by the urethral sphincter.
Try this: work on a diaphragmatic breath instead. Try laying on your back with one hand on your belly and the other on your chest. Take a deep breath and feel which hands moves first and moves most. We want to work on this until you feel the hand on your belly move first and move the farthest. A little movement at the chest is totally okay but it shouldn’t be your main movement!

Postural changes - Postural changes can occur in every body, especially with the way our bodies have changed to adapt to the technology world. We see posture changes with pregnancy due to a growing baby pulling the abdomen forward and in postpartum, with the addition of repetitive tasks like feeding, lifting, and carrying a new baby. Other than pregnancy, postural changes can occur due to injury, surgical procedures, aging, and repetitive prolonged positions, such as sitting at a desk during your workday (think of that ‘end of workday slump’ you may notice). These postural changes may result in weakness of certain muscles, typically the core, gluteal, and back muscles, and decreased flexibility or mobility of certain joints in the spine, hips, pelvis, and rib cage. These changes can impact how pressure is dispersed throughout our canister and may result in added pressure on the bladder during a cough or sneeze due to inefficient positioning of the diaphragm in the abdominal cavity.
Try this: aim for a stacked posture! This means keep the weight in your heels, stack your shoulder over your pelvis and your pelvis over your feet. Be sure your ears are in line with your shoulders so your head isn’t held too far forward.

How can pelvic health therapy help me stop leaking pee when I sneeze or cough?
Pelvic health therapy is a great place to start so we can perform a detailed evaluation to learn more about your specific symptoms, identify the root cause of your symptoms, and develop a treatment plan tailored to you !

A comprehensive evaluation will include the assessment of your:

Spinal, hips, and pelvic mobility
Posture and daily ergonomics
Strength and flexibility of your core, gluteal and hip, arm and scapular, and even knee and ankle muscles
Breathing mechanics
And of course the pelvic floor muscles!
Your therapist can include a standing pelvic floor muscle evaluation to evaluate the coordination and engagement of your pelvic floor in a weight-bearing position as most of our patients report more leakage in an upright position, like sitting, standing, or walking versus lying down

Following an evaluation, your pelvic health therapist will integrate various treatment techniques tailored to your specific symptoms. Common treatment strategies a pelvic health therapist may include:

Improving strength of the ‘kinetic chain’ - this may include targeted strengthening of specific core muscles, like the transverse abdominis and/or oblique muscles, as well as certain gluteal, hip, and scapular support muscles
Addressing pelvic floor muscle weakness and/or tension , and improving pelvic floor muscle awareness & coordination for improved ability to provide ‘bottom up’ support during a cough or sneeze
Looking at breathing mechanics and postural support techniques to improve the ability to manage pressure in the abdominal cavity which will directly impact the bladder
Integrating specific mobility exercises or stretches to improve lumbo-pelvic mobility and the body’s ability to adapt and move during a cough or sneeze to prevent leakage
Improving bladder habits , including fluid management and toileting routine support

Finally, if you feel you need more help addressing your specific needs, we highly recommend working with a pelvic health therapist! Pelvic health therapists are here to listen to your symptoms and identify the best treatment techniques and strategies to support you.

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , including urinary leakage, so you are in the right place! We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 35: Understanding Endometriosis: Insights from a Pelvic Floor Therapist

183:788774807 (Joy Noble) — Tue, 26 Mar 2024 12:13:56 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 35 I provide some insights into the diagnosis of Endometriosis from the pelvic floor therapists perspective. This is all of the information I feel like I say on repeat for my patients as I break down the barriers to quality care and debunk the myths that are being perpetuated by ill-advised medical providers.

In this episode we will answer the following questions:

What is endometriosis? (And what is endometriosis not?)
What are signs of endometriosis?
How can you test for endometriosis?
How and who should remove endometriosis?
How does PT help with endometriosis?

Resources from this episode:

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 34: Oncology Education, Representation, and Inclusion: An Interview with Dr. Alex Hill

Mon, 18 Mar 2024 16:25:50 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 34 I was lucky enough to sit down with one of my favorite pelvic floor therapists, Dr Alex Hill. Alex and I started our pelvic training together in Florida and have ended up living in the same places at the same time from Florida to Maryland before she moved back south. Basically, we were meant to meet!

Tl;dl (Too long; didn’t listen)

In this episode, Dr Alex discusses some of the areas she helps her patients with including:
Radiation fibrosis after radiation therapy which, if left untreated with dilator therapy, can result in scarring/stenosis which will fuse the vagina or anus closed
Lymphedema which can be found in the full body and how important it is to provide safe treatment and education to our patients; especially when considering it’s impact on sexual health
Providers should connect patients with as much support as possible including oncology PT/OTs at the time of diagnosis!
Rehab shouldn’t be an afterthought when it comes to issues related to oncology or general pelvic health concerns. We should strive to be more proactive and less reactive.
In 2020 Dr Alex launched OncoPelvic PT! OncoPelvic PT provides:
Education for patients in the realm of oncology & pelvic floor therapy
Courses for providers to help bridge the gaps of information out there to help patients in the oncology space
Representation of:
Bodies with all different skin tones, scars, stretch marks, foreskins, etc. in all of her education materials
Considerations for patients in various zip codes or different socioeconomic standards
Case studies with diverse patients who are cisgender, transgender, and non-binary to normalize the representation of the patients we are truly seeing in clinic
The current courses Dr. Alex offers are designed to be
Accessible - on-demand so you aren’t burning through PTO
Affordable - not everyone can pay $600 for each CEU course
Ways to work with Dr Alex
Online information for patients
Take her continuing education for providers
Book a coaching session to discuss clinical cases or professional development if you are interested in specializing in pelvic floor or oncology physical therapy

Resources from this episode:

Find OncoPelvic PT online
Follow Dr Alex on Instagram or Youtube
Check out Whitney’s (Alex’s sister) book series here
Watch the super helpful video on how to use a Butler Aid for putting on compression garments
Find a provider near you:
Academy of Pelvic Health
Herman & Wallace
Pelvic Guru (now Pelvic Global)
Oncology-specific provider look up

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 33: Wait, Why Can't I Hover?

Mon, 18 Mar 2024 15:14:01 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 33, I give you the facts on why you shouldn’t hover over the toilet when you go to the bathroom. I get it! Toilets can be dirty, especially in public bathrooms. But I promise you will be okay. Just make yourself a little nest of toilet paper or use one of the toilet seat covers!

Tl;dl (too long; didn’t listen - but I mean come on, this episode is less than 15 minutes long!)

When you hover your pelvic floor muscles cannot fully relax to let everything out.
This is true for both urine and feces!
Not fully voiding can lead into other issues like retention or urgency - don’t let this be you!
Buy yourself some travel toilet seat covers
Here’s the Free People IG post that I reference about the pockets - go for the photos, stay for the comments!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 32: Chiropractic Care From Baby to the Whole Family: An Interview with Dr. Pam

Tue, 05 Mar 2024 10:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 32, I had a chance to chat with Dr. Pam of First Step Chiropractic.

Dr. Pam and I nerded out on anatomy, discussed the “competition” between chiro & PT, and dove deeper into her treatment philosophy. Dr. Pam also broke down the myths around safety with chiropractic care and she came ready with DATA y’all! She knew all the research and numbers and was more than happy to debunk the myth that chiropractic care is unsafe. We wrapped up our discussion talking about how chiropractors are nerve doctors that utilize the bones and muscles to calm the nervous system. As a pelvic floor therapist, this concept made so much sense as we are also working overtime in pelvic PT to address upregulated nervous systems!

Follow Dr. Pam on Instagram to see where she will be popping up next for a yoga class
Check out Dr. Pam at First Step Chiropractic to see her service offerings
If you are looking for a chiropractor near you, check out ICPA .

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 31: The Lowdown on Lube

Tue, 27 Feb 2024 10:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 31, I took a deep dive into the different types of personal lubricants and how to pick the right one for you based on how you plan to use it.

The different types of personal lubricants:

Water-based
Pros: great for sensitive skin; safe with dilators, wands & sex toys; easy to clean and does not stain the sheets/couch/etc; safe to use with condoms
Cons: not great for water play; need to reapply due to it being absorbed quickly
Silicone-based
Pros: long lasting making it ideal for marathon sex; able to last in water (shower, pool, etc); hypoallergenic; safe to use with condoms
Cons: can damage silicone-based toys and dilators as it will break down the material over time creating places for bacteria to hide
Oil-based
Pros: longer lasting; can use with silicone based toys and tools
Cons: will stain the sheets/couch/etc.; can trap bacteria so you need to be sure to clean them well; can cause damage to the latex in condoms making them more likely to break
Other considerations
Additives to avoid: flavored, edible, sensitizing, and numbing lubricants
Household products not to use as lube: baby oil, mineral oil, vaseline or petroleum jelly products, vegetable or canola oil, essential oils, or lotion
With water-based products it is important to consider pH and osmolality
pH: ideally use a product with a pH around 4.5 for vaginal use and 5.5 to 7 for anal use
Osmolality: this means how much one substance is dissolved into another water-based substance. In this case, if a lube has an osmolality that is too high it will draw water from your vaginal or anal tissue creating itchy or irritated feeling in the skin.
The World Health Organization (WHO) recommends lube with an osmolality of less than 1200 mOsm/kg.
KY Jelly - O: 2007, pH: 4.55 (that osmolality is too high!)
Slippery Stuff - O: 26, pH: 6.8
Good Clean Love Almost Naked - O: 282, pH: 4.5
Good Clean Love BioNude - O: 276, pH: 4.4
Sliquid H2O - O: 144, pH: 4.2
Some Pelvic Pride favorites:
Silicone: Uberlube (no parabens, glycerine, or flavors) and you can use if for chafe protection too
Water: Slippery Stuff (no parabens, glycerin, or flavor) or Good Clean Love Almost Naked (no parabens or glycerin), vegan and gluten free - use PELVICPRIDE20 for 20% off

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 30: Bringing a Trauma-Informed Approach to Birth & Beyond: An Interview with Brielle Weber

Tue, 20 Feb 2024 12:54:55 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 30, I sat down to chat all about birth and the pelvic floor from the perspective of a nurse, doula, and student midwife with Brielle Weber.

Brielle and I joined forces in 2020 when she so graciously allowed me to present about the pelvic floor at the start of her prenatal and postnatal yoga workshops through The Womb Room. We have a similar philosophy around listening to your body and advocating for your needs as well as a love for the pelvic floor and bringing awareness to this important set of muscles which has made our working together and this podcast episode so easy. Brielle brings a holistic approach to her care with influences from her time working in public health and with the Peace Corp which we dive into more. In this episode we also talked about everything from breech babies and preventing stalls to fistulas and sliding scale offerings. Brielle truly has so much knowledge and compassion to offer, so be sure to check out all of her links below!

Follow Brielle on Instagram to see where she will be popping up next for a yoga class
Check out Birth By Brielle online to see her service offerings which include birth education, private yoga, and postnatal support
If you want to learn more about the organizations Brielle mentioned head over to Hamlin Fistula Ethiopia or Breech Without Borders
Listen to the Evidence Based Birth episode about breech babies Brielle mentioned

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 29: Abortion Care is Compassionate Care: An Interview with Dr. Kyle Bukowski of Planned Parenthood of Maryland

Tue, 13 Feb 2024 10:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 29, I sat down with Dr. Kyle Bukowski, the Chief Medical Officer of Planned Parenthood of Maryland.

Dr. Kyle and I chat about how important it is for patients to have safe and unrestricted access to abortion and why he loves being able to provide these services at Planned Parenthood. We also reviewed the numerous services that Planned Parenthood offers across Maryland and the DC area that exist outside of abortion care, including emergency contraception, STI testing, UTI treatment, and wellness care.

Check out all of the services offered by Planned Parenthood
Other local abortion providers include Baltimore Abortion Fund and DC Abortion Fund
Be on the lookout for the ballot initiative “ Right to Reproductive Freedom ” on the 2024 ballot for Maryland voters!

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

What Causes Diastasis Recti in Pregnancy?

Sun, 11 Feb 2024 18:59:51 GMT

Diastasis recti (DRA) or abdominal separation is a common occurrence during pregnancy. Research has found that between 27-100% of pregnant people experience DRA by the third trimester. Of that percentage, between 30-70% continue to struggle with abdominal separation after delivery. As a result of this common pregnancy issue, patients frequently seek help from physical therapy to minimize DRA during pregnancy or rehabilitate their abdominals after delivery.

While seeing a pelvic floor physical therapist to address your diastasis recti is key, it is also important to understand the factors that contribute to diastasis recti in the first place.

Before we dive into that, let’s do a quick review of diastasis recti.

Diastasis rectus abdominis - also known as diastasis recti, DRA, or abdominal separation - is the separation of the rectus abdominis (RA) muscles at the linea alba (the connective tissue that brings together the right and left RA - seen below).

A diastasis can occur above the belly button, at the belly button, below the belly button, or the entire length of the rectus muscles, as seen below.

When this abdominal separation occurs, you may observe coning or doming at the abdomen with an increase in intra-abdominal pressure such as lifting a heavy object, doing a crunch, coughing, laughing, or sneezing. It is also likely that you will see this with core exercises such as crunches, planks, dead bugs, or bird dogs.

Okay so now, what causes diastasis recti in pregnancy?

1. Growing a Whole Human!

As your baby grows, your uterus grows too, placing pressure on the abdomen resulting in an increased stretch on the rectus abdominis . You can help to minimize this by performing abdominal stretches (like cobra pose from our Top 9 Yoga Poses ) as well as abdominal massage to help relieve tension and allow for stretching of the muscles and soft tissues.

2. Increase in Hormones

While you experience many hormone changes during pregnancy, one of the most impactful hormones on the musculoskeletal system is relaxin. Relaxin is the hormone responsible for allowing the soft tissue in your body to loosen up so that your joints can shift to make room for your growing uterus. Imagine trying to fit a growing baby in your belly without your rib cage expanding to accommodate your lungs and abdominal organs as your uterus pushes up against the bottom of the diaphragm - ouch! Due to the laxity in the soft tissues from this hormone spike, we can see the soft tissue that connects the right and left rectus abdominis also stretch out - thus DRA.

3. Difficulty with Abdominal Pressure Management

Intra-abdominal pressure occurs within the abdominal cavity with things like bearing down, lifting heavy, or holding our breath. As the uterus grows, the abdominal cavity has less space available making the intra-abdominal pressure increase quicker with certain activities. When this increase occurs, the abdominals work to help to provide stability, however, this pressure will push against the area of least resistance - commonly the linea alba resulting in a diastasis .

4. Muscle Weakness or Tightness

Much like the above point, if the abdominal muscles are weak or unable to coordinate to provide stability, increased pressure along the front abdominal wall can result in abdominal separation. Meanwhile, if the abdominal muscles are tight, instead of stretching lengthwise as the uterus grows, they may move towards the sides as the linea alba stretches and provides room for the growing uterus.

5. Poor Posture

We’ve all seen pregnancy posture. As your body shifts to accommodate your center of gravity moving more forward, the abdominals start to work harder. Another component of pregnancy posture that can exacerbate an abdominal separation is the forward (anterior) tilt of the pelvis due to the baby's weight in the uterus . To help minimize this: shift your weight back into your heels, tuck your tailbone under, and engage your abdominals muscles as if to hug the baby. Doing this a few times per day can help as a posture reset and build the brain/body connection to the abdominal muscles.

6. Multiple Pregnancies

Multiple pregnancies that are back to back (less than ~18 months between) can increase the risk of developing diastasis due to lack of time to work on recovery in the abdominals. For some pregnancy and postpartum safe exercises to help address an abdominal separation, especially if you are pregnant again within those 18 months, check out our post: Help Heal Your Abdominal Separation

7. Genetics

Finally, we have genetics - the one thing we truly have no control over. Some people are just predisposed to increased elasticity in our soft tissues or the number of muscle fiber types that can impact the strength of the muscles in our body. If you have genetics that tend towards increased elasticity or weakness, working with a pelvic floor therapist may be key in helping you address strength and stability during pregnancy as well as discussing outside supports to protect your abdominals as your baby grows.

Fortunately, pelvic floor physical therapy has been found effective in helping to manage the above factors throughout pregnancy that influence the possibility of developing a diastasis recti . At pelvic floor therapy, we will work through lengthening, strengthening, and coordinating your abdominal muscles; guide you through safe movements and ways to modify movement to protect your abdomen while keeping you as active as possible.

Reference:

Fei, H., Liu, Y., Li, M., He, J., Liu, L., Li, J., Wan, Y., & Li, T. (2021). The Relationship of Severity in Diastasis Recti Abdominis and Pelvic Floor Dysfunction: A Retrospective Cohort Study. BMC Women's Health, 21, 68.

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , including diastasis recti, so you are in the right place! We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 28: Pelvic Therapy with a Fertility Focus: An Interview with Dr. Melissa Thompson

Wed, 07 Feb 2024 12:25:40 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 28, I sat down with

my friend Dr. Melissa Thompson, owner of Flow Physical Therapy and Wellness

in The Woodlands, Texas.

Dr. Melissa takes a unique approach to treatment through the incorporation of her advanced training in fertility and menstrual health as well as her expertise in pelvic floor physical therapy. She truly brings a full body approach to her care and even partners with her husband and co-owner at Flow PT to ensure each patient gets the best care possible. We had a great time talking about just how much our menstrual cycle can be telling us about our health and the importance of looking at this ‘fifth vital sign’. Lucky for all of us, Dr. Melissa offers virtual visits for her expertise on fertility and menstruation. To see her in-person, head over to Flow Physical Therapy in The Woodlands.

Find Dr Melissa on Instagram: @drmelthompson
If you are in Texas, visit Dr Melissa in-person at Flow Physical Therapy and Wellness
If you are interested in fertility help, reach out to Dr Melissa here

Have a question or suggestion for an episode?

Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

The Ultimate Guide to Pelvic Floor Physical Therapy: The Neurological Edition

Sun, 04 Feb 2024 19:23:10 GMT

When you are diagnosed with a neurological condition, physical and occupational therapy become an important part of your rehabilitative journey. While you’ve likely worked on your strength, mobility, and fine motor skills to aid in improving how you walk, your posture, and other activities of daily living, chances are no one has discussed another important aspect of your care - your pelvic health. As a Doctor of Physical Therapy and neuro-pelvic health specialist, I am here to provide you with the ultimate guide to pelvic floor physical therapy for those with neurological conditions.

In this blog, we’re going to break down everything you need to know about pelvic floor PT and how it can help you in your recovery whether your goals are to maximize your quality of life or regain function during your rehab process.

Below you will find the answers to the following questions:

What is the pelvic floor?

Why does the pelvic floor need therapy if I have a neurological condition or diagnosis?

What neurological-based pelvic health diagnoses can be treated in pelvic PT?

What does neurogenic bladder and bowel mean?

How can sexual health and function be impacted by a neurological diagnosis?

What other implications does a neurological diagnosis have on my pelvic floor health?

What neurologic diagnoses are treated in pelvic floor therapy?

What goes into becoming a neuro-pelvic health specialist?

How do I find a pelvic floor therapist who specializes in neurological conditions?

What should I expect at the pelvic floor evaluation?

What about at the follow-up visits?

What are the results that someone can expect from pelvic PT?

Can I use my insurance?

I noticed a lot of pelvic therapists are out of network, why is that?

How do I know if I need pelvic PT?

What is the pelvic floor?

The pelvic floor consists of three layers of muscles that attach to the bottom of the pelvis from the pubic bone (in the front) to the tailbone (in the back). There are also muscles that wrap around the urethra, the genitals, and the anus, some that connect into ligamentous structures to provide support, and one on each side that also serves as a hip rotator. These structures can be observed in the drawings below.

Image used with permission from Pelvic Guru®, LLC as a member of the Global Pelvic Health Alliance Membership (GPHAM)

The pelvic floor muscles serve a variety of functions including:

Support of the abdominal contents, reproductive organs, bladder & rectum
Sphincter control around the urethra to keep urine in, when needed, and anus to keep gas and stool in, when needed
Urge suppression through the pelvic floor and bladder connection to decrease the need to go to the bathroom more frequently (did you know going to the bathroom every 3-4 hours is the norm? Unless you are pregnant or over 65, if you go more frequently you should see a pelvic therapist!)
Sexual appreciation through strong and well coordinated muscles as this is necessary for achieving orgasm (muscles that are too tight or won’t relax may impact your ability to orgasm)
Stabilization along with the abdominal muscles and in coordination with the diaphragm during things like coughing, laughing, sneezing, running, jumping, lifting heavy objects, and just moving our body around day to day

The pelvic floor muscles, like any skeletal muscle in the body, serve these functions through a series of complex pathways and reflexes in our nervous system. Keep reading to learn more!

Why does the pelvic floor need therapy if I have a neurological condition or diagnosis?

Great question! To answer this question, let’s start with a brief review of the anatomy and role of our nervous system. The nervous system consists of the brain, spinal cord, and peripheral nerves (nerves that run through your body, all the way to your fingers and toes). Your nervous system’s main function is to send messages from various parts of your body to your brain and from your brain back out to your body, to tell your body what to do. These messages regulate your thoughts, memory, learning, and movements, including balance, posture, strength, and coordination.

With a neurological condition, the sensory and motor communication between the brain, spinal cord, peripheral nerves, and subsequently, the muscles throughout the body can be impacted. Just like you may have previously experienced, or continue to experience, strength, sensation, and coordination changes to the arms, legs, trunk, and face, the pelvic floor muscles can also be weak, tight, stiff, or discoordinated due to an injury to the nervous system.

This may lead to things like leaking urine or feces, frequent or urgent need to use the bathroom, urinary retention or urine stream changes, sexual dysfunction, pain, or difficulty with pelvic exams or using menstrual products. These symptoms may be new following the onset of your injury or diagnosis and may change or intensify with the course of your condition depending on the chronicity, episodic, or progressive nature of your neurologic diagnosis.

With that said, pelvic floor therapy is here to help support and maximize your pelvic floor muscle function no matter where you are in your journey! Pelvic floor therapy may include working on the strength, flexibility, coordination, and awareness of the pelvic floor muscles to improve, support, and best maintain function of your bowel, bladder, and sexual health.

What neurological-based pelvic health diagnoses can be treated in pelvic PT?

As noted above, an injury or insult to the nervous system - whether to the brain, spinal cord, and/or peripheral nerves - can play a significant role in bowel or bladder health, and sexual function.

At Pelvic Pride we treat the following pelvic health diagnoses specific to a neurologic condition:

Neurogenic Bowel

Fecal incontinence (leaking stool)
Fecal urgency (a strong need to go)
Constipation

Neurogenic Bladder

Urinary Incontinence (leaking urine)
Urinary urgency or frequency (a strong or frequent need to go)
Urinary retention (difficulty emptying the bladder)
Having an ‘elevated or a high PVR’ (PVR - post-void residual) can indicate urinary retention and/or difficulty emptying your bladder which is a common symptom reported by individuals affected by a neurologic condition.
Difficulty starting urine stream or weak urinary stream

Neurogenic Erectile Dysfunction and other Sexual Health Changes

Difficulty achieving orgasm
Incomplete orgasm
Difficulty achieving or maintaining erection
Premature ejaculation
Pain with sex

Other pelvic health diagnoses may also impact someone with a neurological condition or may have been present prior to a condition’s onset, including pelvic pain, pelvic organ prolapse, and any difficulties associated with pregnancy and postpartum, including diastasis rectus abdominis.

For a comprehensive list of diagnoses we treat please check out the Conditions We Treat .

What does neurogenic bladder and bowel mean?

Neurogenic bowel and bladder is an umbrella term used to describe any urinary or bowel condition in individuals who lack control due to a brain, spinal cord, and/or nerve problem/injury.

The bowel and bladder functions through a series of neural pathways and reflexes under a combination of voluntary and involuntary control. The gastrointestinal tract is also regulated by its own nervous system called the enteric nervous system. Further, our bowel and bladder communicate with the brain via our peripheral nerves and spinal cord, as well as with our pelvic floor muscles to coordinate bowel and bladder filling, storage, and emptying. If there is an injury or dysfunction anywhere along these pathways, this can impact the body’s ability to store or empty urine or feces.

Those that suffer with neurogenic bladder or bowel may report urinary or fecal urgency, frequency, constipation, leakage associated with urgency or stress on the system (cough, laugh, sneeze, or standing up), weak urinary stream, small urine volumes, urinary retention, urinary hesitancy, and frequent nighttime urination.

So how can pelvic therapy help with neurogenic bowel and bladder?

Your pelvic health therapist will offer strategies for bowel and bladder routine support, toileting setup and positioning strategies, fall risk assessment, caregiver education and training. During your therapy sessions you will also work on breathing exercises, lumbo-pelvic strengthening, and pelvic floor muscle coordination training. Our goal is to help you become as independent as possible and gain or maintain control over your bodily functions.

How can sexual health and function be impacted by a neurological diagnosis?

Sexual function requires appropriate interaction between multiple pathways, including our neurological, hormonal, vascular, and psychological systems. A neurological condition can directly impact the brain centers associated with sexual libido/desire, and the spinal cord and nerves needed to communicate signals regarding sensation, motor, and vascular changes for genital engorgement, arousal, and lubrication. Our pelvic floor muscles also play an important role in sexual health, including blood flow, tissue engorgement and erection, lubrication, and orgasm. A person with a neurologic condition may report impaired arousal or lubrication, diminished or absent orgasm, sensation loss or changes, erectile dysfunction, or premature ejaculation.

Your pelvic health therapist will offer:

techniques for sexual routine support, setup and positioning strategies
partner(s) education and training
energy conservation techniques
adaptive/assistive equipment and tool recommendations
stretches
breathing exercises
strengthening
soft tissue mobilization
hands-on external or internal pelvic floor work

In addition, your pelvic health therapist may discuss other important components to sexual libido, desire, and arousal, including erogenous zones - certain places on the body that have a heightened sensitivity and can elicit a sexual response when stimulated (think lips, neck, nipples, and inner thighs to name a few). Finding strategies to elicit areas of the body outside the genitals and pelvic floor musculature that may have intact or improved sensation can be beneficial to maximizing your sexual health goals.

What other implications does a neurological diagnosis have on my pelvic floor health?
Bowel and bladder and pelvic floor muscle health and function can also be impacted due to medication side effects, impaired mobility including difficulties with getting to the toilet in time or managing doffing clothing, cognitive changes, dietary changes, spasticity (or stiff muscles), and fatigue.

Like bowel and bladder health, sexual function can additionally be impacted by mobility difficulties, muscle weakness or stiffness impacting postural stability and comfort in certain positions, bowel and bladder control issues, fatigue, tremors, cognitive changes, as well as concurrent conditions, including hypertension, anxiety, and depression.

What neurologic diagnoses are treated in pelvic floor therapy?

Neurogenic bowel, bladder, and sexual dysfunction symptoms can occur due to a number of neurological conditions, including but not limited to:

Traumatic and nontraumatic brain injury (TBI)
Stroke (CVA)
Multiple sclerosis (MS)
Parkinson’s disease (PD)
Spinal cord injury (SCI)
Cerebral palsy (CP)
Spina bifida

Keep reading to learn more about how the pelvic floor muscles may be impacted specific to each diagnosis!

In addition to listed diagnoses above, we at Pelvic Pride work with individuals navigating other neurologic conditions, including post-concussion syndrome, tethered cord, transverse myelitis, and Guillain-Barré syndrome (GBS), to name a few. Please feel free to give us a call for a free phone screening to learn if pelvic therapy may be a right fit for you!

Traumatic and Non-Traumatic Brain Injury

Following a TBI or non-traumatic brain injury such as a stroke, individuals commonly report changes to the urinary system (retention, leakage, and a weak urine stream) and gut (constipation, fecal urgency). Catheterization is common following a TBI or stroke to assist with emptying of bladder and may or may not continue to be part of a person's daily bladder routine depending on severity of injury and course of recovery post-insult. Individuals can also experience changes in the strength and sensation of the genital tissue and pelvic floor muscles thus impacting sexual arousal, erection, and orgasm. Further, TBI’s are commonly associated with additional bodily injury, including spinal, pelvic, or extremity fractures, organ damage, and potential scar tissue from surgical procedures which commonly affect bowel, bladder, and pelvic function and healing. Pelvic health PT can assist with finding techniques to improve independence and safety with toileting routines, offer caregiver education and support, and strategies to support return to sexual health.

Multiple Sclerosis

Those affected by Multiple Sclerosis (MS) may report changes to the urinary system (urinary urgency, frequency, leakage, retention, and straining to empty) and gut (constipation, fecal leakage). Catheterization is common to assist with emptying of the bladder when urinary retention or difficulty voiding is reported. Sexual function may also be impacted (decreased libido, erectile dysfunction, incomplete or absent orgasm, lack of lubrication) and can be affected by secondary factors including fatigue, muscle spasticity and weakness, hormone changes, as well as mental and emotional changes including depression.

In conjunction with any disease-modifying therapy treatments a person with MS may be navigating with their medical team, a pelvic health therapist can be another helpful member of your team! Pelvic therapists can assist with

finding techniques to improve symptoms of constipation
independence and safety with mobility to/from bathroom to decrease the risk of falls
energy conservation strategies to address fatigue
pelvic floor muscle training which may assist with urinary leakage
strategies to support sexual health such as positioning education to improve comfort
toy or equipment recommendations as vaginal vibration may improve orgasm and sexual arousal

Pelvic therapy will also discuss pregnancy, birthing, and education on postpartum preparation, as changes in relapses and symptoms can occur during pregnancy or postpartum. Pelvic floor therapists can also be on your medical team to support overall symptoms depending on disease progression.

Parkinson’s Disease

Individuals with Parkinson’s Disease may commonly report changes to the urinary system (urinary urgency, frequency, and leakage as bladder inhibition is reduced due to decreased dopamine levels) and gut (constipation being the most common symptom in both early and late stages of the disease). Individuals may also notice sexual function may be impacted (decreased libido, erectile dysfunction). Pelvic health PT can assist with finding techniques to:

improve symptoms of constipation
establish voiding schedules
urge suppression to ‘buy the bladder time’ for independence and safety with mobility to/from bathroom
equipment recommendations
offer caregiver education/support
provide strategies to support sexual health.

Spinal Cord Injury

Following a spinal cord injury, whether traumatic or non-traumatic in nature, individuals commonly report changes to the urinary system (retention, leakage, recurrent UTIs, and decreased bladder urge sensation) and gut (constipation, fecal leakage), as well with sexual function (changes in sensation to genital region and pelvic floor muscles, difficulty with arousal, incomplete or absent orgasm, erectile dysfunction). A patients’ symptoms will vary based on the level and severity of their injury. Catheterization is common to assist with emptying of the bladder for long-term management following a spinal cord injury.

Pelvic health PT can assist with finding techniques to:

improve bladder routines including discussion of equipment or orthosis support
improve constipation and establish/support your bowel program
improve independence and safety with mobility to/from bathroom
offer caregiver education and support
provide strategies to support sexual health, including
positions for improved stability and comfort
toy or sexual enhancement device recommendations
discussion of maximizing intact sensation areas, such as erogenous zones, for arousal and orgasm

Cerebral Palsy & Spina Bifida

Individuals with cerebral palsy (CP) commonly report neurogenic bladder changes (urinary retention and leakage most commonly due to spastic bladder), neurogenic bowel changes (constipation, fecal leakage), decreased mobility, communication difficulties, and side effects of certain mediations. Pelvic health PT can assist with finding techniques for:

improved toileting positioning due to lower extremity stiffness or spasticity
bowel routine support recommendations
timed voiding
offer caregiver education and support
review movement and positioning for improved sexual function

Individuals with Spina Bifida may commonly report changes to the urinary system (urinary retention, urgency, frequency, and leakage) and gut (constipation, fecal leakage). Catheterization may be utilized to assist with emptying of the bladder. Sexual function can be impacted by changes in genital and pelvic floor muscle sensation depending on the level of injury, symptoms such as urinary leakage during sexual activity, and daily routines and needs, including catheterization and bowel programs. Pelvic health therapy can assist with finding techniques to:

improve symptoms of constipation
fluid recommendations
independence and safety with mobility to/from bathroom
equipment recommendations
offer caregiver education and support
review catheterization and bowel routine schedules for improved sexual function

What goes into becoming a neuro-pelvic health specialist?

Pelvic health physical and occupational therapists have their initial base coursework and training from their respective physical and occupational therapy graduate programs. From there, therapists complete additional coursework and training in order to specialize in pelvic health therapy, which includes external and internal pelvic floor muscle assessment and treatment. Pelvic health therapists can then take additional coursework in the education, evaluation, and treatment of individuals navigating pelvic health difficulties associated with a neurological condition.

In addition to traditional coursework, a physical therapist’s background and experience can play a role. As an example, prior to joining the Pelvic Pride team, I specialized in working with individuals with neurological diagnoses, including TBI and Stroke, in a hospital setting to improve function and mobility prior to transitioning to the pelvic health speciality, and continues to apply this knowledge in my pelvic health practice.

How do I find a pelvic floor therapist who specializes in neurological conditions?

If you’re looking for a pelvic floor therapist in your area (and you are not local to Baltimore, MD where Pelvic Pride is located), then we suggest checking out the following directories to find a pelvic therapist:

If you are located near Baltimore Maryland, we’d love to help you here at Pelvic Pride .

Keep in mind, not all pelvic health PT/OT’s work with the neurological population in pelvic health. If you are looking specifically for a provider who can help with a neurological condition, I advise that you call the specific practice or facility to inquire further, prior to booking.

Here are a few questions that may be helpful to ask when looking for a neuro-pelvic provider:

Does your facility treat conditions like neurogenic bowel, bladder, and/or erectile dysfunction as a result of a neurological condition?
Does your facility have pelvic health therapists trained in working with a person with a neurologic condition?
What is the accessibility of your facility or clinic? This may include discussing wheelchair accessibility, parking, bathroom accessibility, and equipment accessibility.

What should I expect at the pelvic floor evaluation?

While each clinic is different, at Pelvic Pride we allot 75 minutes for your evaluation. During this time we want you to share your story and explain your symptoms, tell us about any providers you have seen and share any testing that has been completed already. (Be sure to fill out any intake paperwork ahead of time and put down as much information as you feel comfortable sharing as this will help make sure you don’t forget anything.)

As you go, your provider should ask questions to gather more information and start to better understand your symptoms and their possible causes. Once this portion of the evaluation is done, you will move into the hands-on assessment. This may include assessing the range of motion, flexibility, strength and/or soft tissue restrictions of various areas from head to toe (depending on what brings you to therapy). This may also include a hands-on pelvic internal examination.

Doing an internal examination will give your provider more information about your pelvic floor muscles including if they are tight, weak, coordinated, or struggle to relax. It is important to note that while an internal assessment is helpful, it is never required and your enthusiastic consent should be gained by your provider prior to performing an internal exam. If you wish to defer the internal assessment, there are plenty of other options that your provider should offer you instead.

Once the assessments have been completed, your provider should review their findings and guide you in some treatment options which may include things you can do at home before your next appointment.

What about at the follow-up visits?

Keep in mind that it may take a few visits to complete all of the evaluative assessments needed, therefore your first few sessions may be a mix of assessment and treatment. Once your provider has finished their evaluation testing, your sessions should focus on education regarding the root cause of your symptoms and treatment to best support your symptoms with a goal to maximize any intact sensation or motor function. This may include bowel and bladder routine support, toileting position strategies, fall risk assessment, caregiver education and training, as well as stretches, breathing exercises, strengthening, soft tissue mobilization, or hands-on external or internal pelvic floor work.

If you want to learn more check out our blog post on The 3 Treatment Methods of Pelvic Therapy .

What are the results that someone can expect from pelvic PT?

Great question! Although a pelvic-neuro pelvic health therapist cannot revert, alter, or prevent any pathological nervous system changes due to a progressive or non-progressive neurological condition, our goal is to find treatment techniques and strategies that best support your symptoms and help you improve your quality of life.

While each patient presents differently, things we typically may see with our patients who have neurological diagnoses include:

Improved daily bowel habits and routine to address constipation
Improved urinary or bowel leakage that may occur with daily tasks including functional mobility like transfers or walking, trying to get to the bathroom on time, or during sexual activity
Improved urinary frequency, urgency, and/or retention
Improved sexual function including improved orgasm, erectile function, and positional support
Decreased pelvic, low back, or hip pain and tightness and conservative support techniques for spasticity management
Improved mobility and decreased pain or stiffness associated with potential scar tissue as a result of a traumatic event
Improved awareness and coordination of the lumbo-pelvic musculature, including pelvic floor, abdominals, spinal, and hip muscles, dependent on intact innervation of these muscles
Improved overall knowledge of the anatomy and function of the nervous system (brain, spinal cord, and nerves) and connection with the bladder, bowel, and genital structures

It is likely that your pelvic PT will want to communicate with other members of your medical team, including urology, gastrointestinal, neurology, to ‘quarterback’ your care via interdisciplinary collaboration for holistic support and care. Further, your medical team may incorporate additional testing or imaging to learn more about your symptoms (such as urodynamic testing to assess bladder function) and discuss medication management for symptom support, including medications that can address spasticity, discomfort or pain associated with nerves, or anxiety and depression.

Can I use my insurance?

Insurance companies do not look at pelvic floor therapy as a different type of therapy than standard physical/occupational therapy. So, if you have coverage for those services then yes, insurance will pay for pelvic floor therapy, BUT…

There are big limitations placed on physical/occupational therapy by the insurance companies in the form of visits limits (your plan will dictate how many sessions they cover), denial for certain diagnoses (they feel PT/OT is ‘experimental’ treatment for certain diagnoses), and the decision to discontinue coverage for PT/OT if they determine it is no longer medically necessary. We also recognize that living with a neurological condition can be a lifelong journey and may be episodic and/or progressive in nature and recognize that patients may require ongoing therapy to help manage their chronic symptoms, which insurance does not like.

I noticed a lot of pelvic therapists are out of network, why is that?

While looking for pelvic floor providers, it will not be uncommon to find that many are considered ‘out-of-network’ meaning they do not have a relationship with insurance companies. This means the patient will pay for their sessions at time-of-service and can submit receipts to insurance for reimbursement. This is the model we offer at Pelvic Pride as we feel it allows the provider to work with the patient and determine the best plan of care for their symptoms, without the limitations we previously discussed from insurance companies. This also prevents the issue of a surprise bill at any point in your care (this typically occurs when the insurance stops paying or the visit limit is reached however the therapy clinic does not realize this until the patient has been seen past those limits, then the cost is put onto the patient). At Pelvic Pride, you will know up front what the cost is each time and you will never get a big bill at the end.

Do you want to dive into this a little deeper? Read our blog for more on Why Choose A Fee-For-Service Physical Therapist .

How do I know if I need pelvic PT?

Excellent question! Luckily we have a quick screening tool for that. Read through the 10 questions and keep in mind, if you say ‘yes’ to 3 or more questions, it is likely you have pelvic floor dysfunction and would benefit from seeing a pelvic health therapist.

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , including neurologic conditions, so you are in the right place! We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Maximizing Wellness Thru Massage: An Interview with Heather Conlon of Tranquil Traditions

Tue, 30 Jan 2024 11:00:33 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 27, I am joined by our suitemate, Heather Conlon of Tranquil Traditions.

Episode 27 Recap:

If you have been into our clinic you may have noticed there are two businesses inside: Pelvic Pride & Tranquil Traditions. We have found that the juxtaposition of pelvic health therapy and massage therapy has been a beautiful marriage of care providers to help with full body wellness all under one roof.
We discussed the journey of moving out of our previous spaces in the same building and finally settling into our beautiful new clinic space together.
Pregnancy massage: Heather discusses the offerings available for pregnant folx including her secret weapon - the pregnancy pillow - that allows pregnant folx to safely lay face down in a pillow designed with cutouts for your belly and breast tissue.
Other services at Tranquil Traditions include: Swedish massage, deep tissue massage, myofascial massage, pregnancy massage, hot stones, bamboo massage, cupping, facials, body treatments.
Upcoming offerings include LED light therapy, microchanneling & dermaplaning coming in February
All services are tailored to the client desires - this means anything from relaxing to targeted treatment. Your therapist will complete a thorough intake to ensure your comfort level with various body parts including glute tissue, inner thighs, scalp, face, feet, etc.
Massage is not just a luxury - it is part of whole body wellness. Due to this, Tranquil Traditions has priced their services to ensure as many people as possible can afford to get these important services.
Check into your insurance plan to see if they will reimburse for massage therapy - Tranquil Traditions will provide you with a superbill. You can also use your HSA/FSA to pay for massage services.
Find Tranquil Traditions
Online at https://www.tranquiltraditions.com/
On Instagram @tranquil_traditions https://www.instagram.com/tranquil_traditions/
On Facebook https://www.facebook.com/tranquiltraditionsspa
In-person in Federal Hill at 37 W Cross Street

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 26: Why Seeing a Cash-Based Provider is Better!

Tue, 23 Jan 2024 14:14:04 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 26, we discuss why seeing a cash-based or out-of-network provider may be better in the pelvic health world than seeing a provider who is in-network with your insurance.

Episode 26 Recap:

You get more one-on-one time with your provider who is an expert in the field!
No more spending half of your session with a rehab tech or aide who has minimal to no training in therapy. They are typically motivated and want to go to therapy school but they do lack the expertise when guiding you through exercises to pick up on areas to cue for better form or execution of the exercises.
Your medical care is being decided on by a medical profession , not your insurance company.
It is not uncommon for the insurance company to deny coverage because they don’t think it is medically necessary without considering the nuance behind each patient’s story as well as the length of time that they have been struggling with these concerns. The need for care and length of care should be a conversation between patient and provider - NOT provider and insurance company.
You are not locked into treating only one “issue” at a time.
Many clinics and/or insurances will only pay for one ‘episode of care’ at a time. Meaning you cannot be seen for a shoulder concern and your low back pain in the same session. They have to be two different cases, seen on two different days. But with a cash-based clinic it is your time to spend however you want to! So if we need to work some on your neck and shoulder and spend the rest of the time addressing incontinence, we will!
There is no surprise bill at the end!
We have set prices and you will know them before you walk in the door. There is no risk of your insurance benefits being used up without everyone’s knowledge or the insurance deciding to start denying coverage on a whim, leaving you with a surprise medical bill all because you signed a paper on day one saying you’d pay anything that insurance didn’t.

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

How Much Should I Be Peeing?

Thu, 18 Jan 2024 19:24:43 GMT

You may be wondering 'How much should I be peeing?' after you take what feels like your millionth bathroom trip of the day.

When we ask our patients how much they are peeing, our patients provide a range of answers from every 30 minutes to once every 12 hours. Yikes! I can imagine if you polled your friends you’d get a similar response. This is because some people are peeing way too much, and others are holding it way too long. So how do you know what is normal… or the ‘right’ answer? First, let’s figure out why we are hearing such a wide range of answers and then we will get to the actual answer to the question.

To get us started, let's chat about what it looks like when we pee.

Our bladder has the capacity to hold between 400-600 mL of fluid (or about 1.5 to 2.5 cups) and when we pee typically 300-500 mL (or 1.25 to 2 cups) comes out. As the bladder starts to fill the detrusor muscle (pictured below) will stretch and send a signal to the brain resulting in an urge to pee. Typically, the first sensation to pee occurs when the bladder is about one-third to halfway full, however that feeling can be quieted for a little longer to allow the bladder to continue filling. During this time, the pelvic floor muscles, which provide bottom-up support to the bladder, are subconsciously active to help keep the urethra closed so the bladder can keep storing urine. When the bladder is truly full, there is a second, likely stronger feeling like you need to urinate that signals it’s time to head to the bathroom. In a perfect world, we wait for that strong need to pee rather than going too soon when we get that first small signal.

So now let’s take a look at why you may be peeing too much.

‘Just in Case’ Voiding

These are the patients that tell us they are peeing every 30 minutes to one hour (and sometimes even more frequently). They are constantly looking for a bathroom and often admit to going ‘just in case’. The issue with going too frequently is that we train our bladder and our brain that we have less capacity to hold urine.

By going to the bathroom ‘just in case’ we are not letting our bladder fill up to that 400-600mL range. As a result, the bladder detrusor muscle learns to send the signal for the need to pee earlier which results in peeing more frequently.

How to treat 'Just in Case' Voiding: To help decrease peeing too much, we recommend limiting going to the bathroom ‘just in case’ and trying to let your bladder fill more before going to the bathroom. However, if this doesn’t seem to be working, seeking out a pelvic health therapist for individualized help is the next best step! At Pelvic Pride , we will work with you to identify strategies to gain control of bladder, help decrease the frequency of voids, and support overall bladder health so you aren't peeing too much.

Bladder Triggers

Have you ever experienced a strong, sudden urge to urinate when hearing the sound of flowing water ? Or maybe when you are pulling into your driveway or putting the key in the front door ? We call this the ‘key in the door’ phenomenon where the brain may associate specific environmental triggers with the need to urinate. This strong, sudden urge to go can feel very intense, stressful, and is likely associated with leaking pee as a result of trying to get to the bathroom on time.

How to treat bladder triggers: We are here to help you identify any environmental bladder triggers you may have, find strategies to help reduce the bladder stress response that can lead to leaks, and help you take control of your bladder!

Bladder Irritants

If you have seen a medical provider (like your primary care provider or a urologist) about urinary frequency and urgency you were likely given a list of foods and drinks to avoid. They are items that are known to irritate your bladder lining and create a strong urge to void. The most common bladder irritants are:

Caffeine
Carbonated beverages
Alcohol
Citrus foods and drinks
Tomato-based foods
Spicy foods

The issue with cutting out these foods is that this is not a fool-proof way to get rid of urinary urgency/frequency and oftentimes these symptoms are more complex than just cutting something out of our diet.

Most patients who suffer with urinary urgency and frequency, or even urinary leakage, will start to limit their water intake under the guise that less water in the bladder means less urine to leak/pee out. Unfortunately, limiting water will not be helpful and may actually make the symptoms worse. Urine is acidic in nature, and if we drink less water, the urine can become more acidic which will irritate the bladder lining. When irritated, the bladder does not like to store urine as long which can lead to peeing more often to try to get rid of it, further adding to urgency and frequency symptoms.

How to manage bladder irritants: We recommend staying hydrated to dilute the irritants you are consuming so that you can continue to enjoy these things and your bladder will stay happy too! Keep in mind, hydration is a balance. Just because you may drink a few cups of coffee per day, does not mean you should add a few bottles of water per day too. Start slow, sip your water (don’t chug), and gradually build up to half your body weight in ounces of plain water per day (so someone who weighs 150# should ideally drink 75 ounces of water).

Finally, let’s chat about those who are not going to the bathroom frequently enough.

We often hear this from our patients who are teachers and nurses, or others in a profession or life phase where they do not have easy access to the bathroom when they need to go. As a result of repetitively holding urine in the bladder for several hours, the bladder can become stretched thus decreasing the efficacy of the detrusor muscle to spasm and signal the need to go pee.

How to make sure you pee enough: Much like those who go too frequently, we can help to reduce this issue and improve your bladder function such as timed voiding and increasing awareness around the bladder’s signal to pee.

So how much should I be peeing?

We recommend urinating every 2-4 hours or about 5-8 times per day , and only 0-1 times at night (those who are over the age of 65, are pregnant, or are taking a diuretic medication will experience increased nighttime voiding).

We know this information can be overwhelming and difficult to sift through. If you feel you need more help addressing your specific needs, we highly recommend working with us at Pelvic Pride so we can create a plan customized to you! We are here to listen to your symptoms and identify the best treatment techniques and strategies to support you.

Typical treatment techniques to help make sure you are peeing enough include:

Evaluation and treatment of the pelvic floor musculature (and the muscles around the pelvic floor) as pelvic floor muscle tension is typically associated with symptoms of urinary frequency and urgency
Research has found that hands-on muscle relaxation treatment effective to improve "urinary symptoms while avoiding medications and more invasive therapies" (1)
Supporting bladder routines which may include specific fluid recommendations, urge suppression strategies, or bladder emptying techniques
Nervous system downtraining strategies to improve overall stress levels and stress responses associated with bladder symptoms

1. Adams, S. R. MD, Dessie, S. G. MD, Dodge, L. E. ScD, MPH, Mckinney, J. L. PT, MS, Hacker, M. R. ScD, & Elkadry, E. A. MD. (2015). Pelvic Floor Physical Therapy as Primary Treatment of Pelvic Floor Disorders With Urinary Urgency and Frequency-Predominant Symptoms.Female Pelvic Medicine & Reconstructive Surgery, 21(5), 252–256. https://doi.org/10.1097/SPV.0000000000000195

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , including urinary frequency, so you are in the right place! We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 25: Beating Burnout: An Interview with Robyn Forney of The Burnout OT

Tue, 16 Jan 2024 11:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 25, I sat down with my friend Robyn, founder of The Burnout OT.

Episode 25 Recap:

Robyn and I worked together in the big box therapy world before we both made some changes and ended up where we are today. A big part of the shift for both of us was BURNOUT. Robyn is taking her knowledge and skills to help rehab professionals beat burnout and continue to enjoy their careers.

She has some awesome content already available (including her FREE Quick Start Burnout Recovery Guide ) and has more exciting things planned for the future including courses and coaching.

Give this episode a listen and go check out all that Robyn has to offer:

The Burnout OT Website
Follow The Burnout OT on Instagram

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 24: Constipation Unveiled: Pelvic Therapy's Impact on Digestive Well-being

Tue, 09 Jan 2024 11:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 24, we discuss how to define constipation, including a way you wouldn’t expect and then dive into how you can keep things moving along.

Episode 24 Recap:

Constipation is defined by having a BM less than 3x per week, difficulty voiding stool AND… not feeling completely empty after a bowel movement.
Take a look at the Bristol Stool Chart to see how your stool measures up - keep in mind we are aiming for #4 and #5 poops!
There are a variety of treatment options for constipation including:
Medications & supplements like laxatives, fiber, and magnesium
Enemas & suppositories
Dietary fiber (check out Episode 18 about soluble vs insoluble fiber)
Movement
Water (it’s not the complete answer but it’s a piece of the puzzle!)
Abdominal massage (ILU massage)
Pelvic Floor Physical Therapy: We will assess your muscles for tightness, coordination of pelvic floor muscle contraction AND relaxation, and ensure the brain and pelvic floor are communicating as they should be!

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 23: An Interview with James Rehak of Sobo Strength & Performance

Tue, 02 Jan 2024 13:33:19 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 23, I sat down with James Rehak, owner of SOBO Strength & Performance in Locust Point.

We started with the reason James got into strength training, followed his story through his college years and ended up smack in the middle of a pandemic. From that, SOBO Strength & Performance was born. Follow along as we chat about the offerings of SOBO and get on the list for their two newest (to their team) trainers!

You can find James and SOBO Strength & Performance here:

Email: sobostrong@gmail.com
On Instagram: @Sobostrong
Website: sobostrong.com
1104 Hull St Baltimore, MD 21230

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 22: Our Year in Review - 2023

Tue, 26 Dec 2023 16:27:44 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 22, I will hit all the major highlights of 2023 including a review of the various things we did this year, in large part thanks to our awesome community of patients, providers, and supporters!

Episode 22 Recap:

We hit one full year in the building & Dr Marlena celebrated one year at Pelvic Pride in October.
We were able to help 215 new patients this year and hit over 1500 patient visits this year. We are so thankful for everyone who placed their trust in Pelvic Pride for their pelvic floor therapy needs.
Community events this year included :
Silver Sponsor of the Baltimore Birth Festival
Continued prenatal & postnatal yoga workshops at The Womb Room with Brielle, and introduced Pelvic Mechanics for Birth in October (perfect for all birthing people regardless of planned delivery method)
Donations for Q2 retail (lube, wands, dilators, belly bands, etc) was donated to The Pride Center of Maryland
Food Drive for Baltimore Safe Haven Food Pantry (to be donated at the start of the year)
Professional community outreach :
3 part series for Gender-Inclusive & Trauma-Informed Care in June for the APTA NY Student Special Interest Group
We got to offer the same talk to Columbia University & New York Medical College (PTs, OTs, OB/GYN med students, etc were in attendance)
Dr Marlena completed her training in transgender care and has been doing awesome treating patients pre- and post op
Joined Mark Goldberg on the Erectile Dysfunction Radio postcast to discuss how a strong pelvic floor helps with a stronger erection
Pints & Pelvic Floors: The Podcast launched in July 2023!
In 2024 we will welcome guests onto the podcast and share even more information for our podcast community & Baltimore community
Our admin team grew!
Delia held down the fort February - April of this year
Mel joined us for the summer and they absolutely killed it at spreadsheets and helping to get us organized!
Sam joined the team in June & still continues to keep Dr Marlena & me going every single day - we wouldn’t function without her!!
Workshops AT Pelvic Pride will officially launch in 2024
Return to Running Postpartum - January
Diastasis Recti Workshop - TBA in February
Postpartum ABCs - likely in late February or early March
The Word of the Year for 2024 is…
COMMUNITY

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 21: Seven Must-Ask Questions When Choosing a Pelvic Floor Therapist

Tue, 19 Dec 2023 14:52:48 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 21, I will review the seven questions you don’t want to miss when deciding on a pelvic floor therapy clinic and provider.

Episode 21 Recap:

Here are seven ‘must-ask’ questions for choosing a pelvic floor provider:

Where did the therapist(s) get their pelvic floor training from?
How often does your therapist(s) work with patients who have my same/similar condition(s)?
How long is each session? How much of that will I spend with my provider?
Does your clinic utilize techs, aides, or students during patient care/treatment?
Are your therapists trained to do internal examinations & will they perform one during my evaluation?
Will the therapist(s) utilize any tools during treatment such as dilators or biofeedback devices? Will I be left unattended during their use?
Does your clinic offer gender-neutral bathrooms?

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 20: Our Go-To Grounding Techniques

Tue, 12 Dec 2023 10:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 20, I will review six grounding techniques that will hopefully come in handy for you over the holiday season.

Episode 20 Recap:

Here are six grounding techniques to help you out when you are feeling anxious, maybe your body is feeling out of control, or you can tell you are dissociating from the present.

Feet on the floor - put both feet flat on the floor to create connection and a strong base of support. Give this a try outside with bare feet on the earth.
Fist clench and release - tighten your hands into fists and feel the tension in your muscles, then soften your hands and feel that tension leave the body
Washing your hands or ‘washing’ your body of a situation - whether you physically wash your hands or metaphorically wash yourself of a situation, hard conversation, or removing your work clothes to leave your work day behind, this action can be a nice way to remove the feels associated with any situation you need to be free of
4-7-8 Breathing - this is a familiar one for many of those in therapy, breathe in for 4 seconds, hold that breath for 7 seconds, exhale for 8 seconds. This technique requires you to focus on your breathing and distracts the mind from the issues that may be creating an upregulated sensation in your body
Box Breathing - create a ‘box’ with your breath, breathe in for 4 seconds, hold for 4 seconds, exhale for 4 seconds, hold for 4 seconds, and repeat. Take this one step further and trace the box with your eyes (keep your head and neck still with this one) while you are creating a box breathing pattern
Body Scan - take a moment to check in with your body and determine if you are holding tension in any of the common areas. Take a deep breath in and on your exhale, let go of tension in your jaw, shoulders, belly, buttocks, and pelvic floor.

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

The Ultimate Guide to Pelvic Floor Physical Therapy: Everything You Want or Need to Know

Sun, 10 Dec 2023 19:07:15 GMT

Thanks to social media , pelvic health therapy has gained a lot of attention. But how many times have you said “I saw it on TikTok so I’m not sure how true it is?" Well I am here to provide you the ultimate guide to pelvic floor physical therapy, written by a Doctor of Physical Therapy and pelvic health specialist with 10 years of experience, so you can rest assured that this information is coming from an expert!

Throughout this guide we will answer the top questions we get asked about pelvic floor therapy on the regular and provide links to extra resources in case you want to learn more!

Below you will find the answers to the following questions:

What is the pelvic floor?

Why does the pelvic floor need therapy?

Why have I never heard about pelvic floor therapy?

What kind of symptoms or diagnoses do you treat in pelvic floor therapy?

Who can benefit from pelvic floor PT?

When should I see a pelvic therapist?

Do I need a referral to see a pelvic floor PT?

What training is involved in becoming a pelvic floor therapist?

How do I find a pelvic floor therapist?

What should I expect at the pelvic floor evaluation?

What about at the follow-up visits?

Is pelvic floor therapy awkward?

Can’t I just do kegels?

What about those shorts or that chair that does kegels for you?

What kind of results can I expect at pelvic floor therapy?

Can you dry needle the pelvic floor?

What if my physician doesn’t think PT will help?

Can I use my insurance?

I noticed a lot of pelvic therapists are out of network, why is that?

How do I know if I need pelvic PT?

What is the pelvic floor?

The pelvic floor consists of three layers of muscles that attach to the bottom of the pelvis from the pubic bone (in the front) to the tailbone (in the back). There are also muscles that wrap around the urethra, the genitals, and the anus, some that connect into ligamentous structures to provide support, and one on each side that also serves as a hip rotator (and now this song makes more sense “the hip bone's connected to the knee bone” - it’s all connected!) These structures can be observed in the drawings below.

Image used with permission from Pelvic Guru®, LLC as a member of the Global Pelvic Health Alliance Membership (GPHAM)

The pelvic floor muscles serve a variety of functions including:

Support of the abdominal contents, reproductive organs, bladder & rectum
Sphincter control around the urethra to keep urine in, when needed, and anus to keep gas and stool in, when needed
Urge suppression through the pelvic floor and bladder connection to decrease the need to go to the bathroom more frequently (did you know going to the bathroom every 3-4 hours is the norm? Unless you are pregnant or over 65, if you go more frequently you should see a pelvic therapist!)
Sexual appreciation through strong and well coordinated muscles as this is necessary for achieving orgasm (muscles that are too tight or won’t relax may impact your ability to orgasm)
Stabilization along with the abdominal muscles and in coordination with the diaphragm during things like coughing, laughing, sneezing, running, jumping, lifting heavy objects, and just moving our body around day to day

Why does the pelvic floor need therapy?

Similar to how you may experience tightness in your neck and shoulders, have weak hip muscles or even sustain an injury, the pelvic floor muscles can also be tight, weak, or injured. This may lead to things like pain, difficulty with pelvic exams or using menstrual products, leaking pee or poop, frequent or urgent need to use the bathroom, pelvic heaviness or prolapse, and sexual dysfunction. Common pelvic injuries include tearing or complications with vaginal delivery or a fall onto your tailbone.

Since the pelvic floor muscles are skeletal muscles, just like the vast majority of the muscles in the body, you are able to stretch and strengthen them as well as work on coordination, downtraining, and desensitization to restore optimal function of the pelvic floor muscles.

Why have I never heard about pelvic floor therapy?

Great question! While pelvic floor therapy has been around for at least 30 years, the field and our skill set has been growing and evolving ever since. Physical therapy was historically viewed as an ancillary service to physician care, but physical therapy (and more recently occupational therapy) has moved to a doctorate level education, gained direct access (more on that later), and has become a first stop for many patients when seeking the care they need.

Throughout my professional experiences and recent work presenting pelvic health therapy to other providers, I have learned that many medical providers are not taught much about the physical therapy profession during their schooling, and pelvic floor therapy is almost never mentioned as a treatment option. Because of this, many providers won’t even think to recommend pelvic floor therapy for many conditions. This means that patients must become their own advocates when asking their providers about pelvic floor physical therapy.

What kind of symptoms or diagnoses do you treat in pelvic floor therapy?

The short answer: we treat anything related to pee, poop, sex, pain, pregnancy, postpartum, and gender affirming care.

The long answer:

Urinary Issues

Urine leakage
Urgency/frequency to urinate
‘Just in case’ voiding
Urinary retention/difficulty emptying your bladder
UTI-like symptoms

Bowel Issues

Constipation
Diarrhea
Pain while voiding bowel
Abdominal pain due to bowels
Difficulty or straining to go

Sexual Issues

Pain during intimacy (including superficial/deep penetration)
Incomplete or inability to orgasm
Decreased sensation during intimacy
Pain or difficulty with erection/ejaculation
Premature ejaculation

Pain Symptoms

Genital pain (including vaginal opening, deeper inside of the vagina, along the shaft and into tip of the penis or testicles)
Abdominal pain
Pelvic girdle pain
Pain resulting from endometriosis, adenomyosis, PCOS, interstitial cystitis, and more
Low back and hip pain
Pelvic heaviness or prolapse

Prenatal & Postnatal Issues

Leakage during and after pregnancy
Pubic symphysis or sacroiliac (SI) joint pain
Round ligament pain
Diastasis Recti management during pregnancy & recovery after delivery
Low back or upper back pain
Labor & delivery preparation including breathing techniques, positioning, and perineal massage
Scar tissue resulting from perineal tearing or delivery via cesarean section
Postnatal pelvic floor assessment
Return to exercise or return to running postpartum

Gender Affirming Care

Presurgical consultation for vaginoplasty
Postsurgical care after gender affirming top or bottom surgery including scar tissue massage, pain management, range of motion and strengthening
Support with dilator protocol post-vaginoplasty

For a comprehensive list of diagnoses we treat please check out the Conditions We Treat .

Who can benefit from pelvic floor PT?

EVERYONE! We know most people assume that pelvic floor therapy is just for those who have had babies. While that isn’t incorrect, it’s also not the full picture. Everyone has a pelvic floor which means everyone can experience issues. We frequently treat people of all genders for a variety of symptoms (as can be seen above). Pelvic floor issues don’t just happen to people who have had babies. We have young patients experiencing pelvic pain, we have patients who never had babies have prolapse, we have penis-owners have urinary leakage and many more presentations just like this that may not fit the mold of what one might think of with pelvic floor therapy.

When should I see a pelvic therapist?

This depends on if we are taking a proactive or a reactive approach. For those that like to be proactive, we suggest establishing care with a pelvic floor provider who can perform a comprehensive exam to determine if you have any pelvic floor dysfunction related to tightness, weakness, or discoordination. Think of it like your yearly physical, just for your pelvic floor.

If you are taking a reactive approach, then if you are experiencing any of the symptoms we mentioned above, it is time to get to a pelvic health therapist. Some of the most common things we see patients for that they think is normal but in fact is an issue include going to the bathroom more than every 3-4 hours; leakage of any kind, at any time, whether you’ve had a baby or not; any kind of pain; UTI-like symptoms that may actually be due to a tight pelvic floor; and constipation, including if you feel like you don’t fully empty when you have a bowel movement. Keep in mind, this is not an all inclusive list but it’s a start.

Do I need a referral to see a pelvic floor pt?

Nope! The good news is that physical therapy now has direct access in all 50 states, DC, and the US Virgin Islands. ‘Direct access’ means you can go to a physical therapist without a referral from your doctor. Each state has their own rules around how long direct access lasts before needing a signature from a physician, so be sure to look up the rules in your state . In Maryland, we have unrestricted access meaning your care won’t be cut short if you don’t have a physician to sign off on your plan of care.

Why is this important? Because you no longer have to wait to see your provider, ask for a referral, hope you don’t get dismissed, and then schedule an evaluation with a pelvic floor therapist. Instead, you can schedule your pelvic floor evaluation as soon as you want! It is as easy as

Look up a pelvic floor therapist
Call or fill out an inquiry form
Schedule an appointment

What training is involved in becoming a pelvic floor therapist?

You may not have noticed, but most of the time throughout this blog post we have used the terms “pelvic floor therapist” and “pelvic health therapist.” This is because both physical therapists (PTs) and occupational therapists (OTs) can be pelvic floor providers. So even though you may see pelvic health PT or pelvic floor physical therapy more commonly used, rest assured that OTs can treat the pelvic floor and they are really good at it!

Unfortunately, we don’t learn a lot about the pelvic floor in PT school. In my case, we had a very short lecture but that was enough to peak my interest. So after graduating from PT school and passing boards, there is extra training through continuing education courses to specialize in pelvic floor therapy. These courses typically include didactic and hands-on learning. Unlike medical school, we are not provided models for classes like this which means we are both the patient and the therapist - learning all of the manual techniques needed to treat the pelvic floor with our own body and that of our lab partner. There are a variety of courses that can be taken, but at the minimum providers will take around three foundational pelvic floor courses to start treating the pelvic floor which cover urinary issues, bowel issues, and pelvic pain. Additional courses should be taken to learn about pregnancy and postpartum, gender inclusive care, pediatric pelvic therapy, and more complex pain conditions.

If you want to hear more about the training that goes into becoming a pelvic floor therapist give this podcast episode a listen!

Now the important thing to highlight here is what sets apart a pelvic health physical therapist from a general physical therapist: internal pelvic floor assessment. While a patient may decide not to consent to an internal assessment, it is important that the therapist has the ability to perform an internal examination and treatment as this provides different information about the pelvic floor muscles and their function.

How do I find a pelvic floor therapist?

Like many things, one of the best ways to find a pelvic floor therapist that you can trust is through word of mouth. Ask trusted friends, post in a neighborhood Facebook group, or give Google a shot & take a look at their reviews!

Another great option is to check out these resources for finding a pelvic provider near you:

If you are located near Baltimore Maryland, we’d love to help you here at Pelvic Pride .

What should I expect at the pelvic floor evaluation?

Once the assessments have been completed, your provider should review their findings and guide you in some treatment options which may include things you can do at home before your next appointment.

What about at the follow-up visits?

Again, we feel like time is so important, therefore we offer full 60-minute follow up appointments, one-on-one with your provider. At Pelvic Pride we don’t change providers unless it is requested or we discuss how that may be helpful (for instance Dr. Joy does dry needling and Dr. Marlena may incorporate that into your plan of care at some point by having Dr. Joy join one of your therapy sessions, with consent of course).

If you want to learn more check out our blog post on The 3 Treatment Methods of Pelvic Therapy .

Is pelvic floor therapy awkward?

While some patients may feel awkward at first, we do our best to make it as un-awkward as possible! Keep in mind that as pelvic floor providers we are very used to seeing vulvas, vaginas, penises, testicles, and anuses. We have seen it all from completely waxed, to neatly trimmed, to au natural and we welcome your body exactly as it is! Every pelvic region is different and we want you to feel comfortable showing up in yours. On top of that, we are the experts in helping to treat these areas so we are very knowledgeable about what is normal and what needs to be addressed. All that to say, there is no need to apologize for any part of your body (I promise we don’t care if you don’t shave!). You also don’t need to apologize if you’d like to take things slow and work up to the more hands-on or internal examination.

Can’t I just do kegels?

Sure, but it likely won’t fix your issues! Many of our patients report they have no idea if they are doing them right anyway. And the thing with kegels is knowing if you need to do them and then if you are doing them correctly. Oftentimes patients have tight pelvic floor muscles so doing kegels will just feed into that tightness - doing the opposite of what your body needs.

Trust me, there is definitely a time to strengthen. But when we strengthen your pelvic floor we prefer to do this with functional movements instead of just kegel exercises. Even if you started with a tight pelvic floor, once your muscles are relaxed/lengthened, it is important to work on coordination/strength. To do this, your pelvic therapist will likely combine pelvic floor muscle engagement with other strengthening exercises such as bridges, squats, lunges, core engagement exercises or even heavier lifting movements. This will serve you well as you interact with your environment and perform daily activities to help prevent leakage or pelvic pressure/heaviness symptoms.

What about those shorts or that chair that does kegels for you?

So the issue with these devices is that they can also feed into pelvic floor tension/tightness and result in pelvic pain. Functionally we rely on a maximal contraction of the pelvic floor to provide the support we need when living life (think laughing, jumping, coughing, sneezing, lifting, exercising, running, etc). Things like the kegel chair or the shorts create artificial contractions (and in the case of the kegel chair they boast “supramax contractions”) and while that isn’t the worst thing, it is not the most ideal either. Helping the body reconnect the muscles and the brain through things like electrical stimulation is handy, however it does require appropriate assessment beforehand to ensure the devices will not make the symptoms worse. Our society has become a fan of the quick fix and unfortunately the pelvic floor doesn’t respond to quick fixes :)

What kind of results can I expect at pelvic floor therapy?

While each patient is different, things we typically see with our patients include:

Elimination of leakage
Improved bowel habits
Decreased pelvic pain and tightness
Minimized or elimination of pelvic heaviness or prolapse symptoms
Elimination of painful sex
Preparation for labor & delivery to prevent stalls and minimize risk of tearing
Improved connection to your body after c-section delivery as well as improved mobility and decreased pain in your abdominal scar tissue
Improved strength and coordination of abdominals after diastasis recti

Can you dry needle the pelvic floor?

Yes, you sure can! Dry needling to the pelvic floor can be an effective way to treat those stubborn trigger points or get to deeper pelvic floor muscles (we’re looking at you Obturator Internus). It’s important that your provider is certified in dry needling as there are a lot of important structures in the pelvis that they need to be mindful of as they perform dry needling in this area.

Never heard of dry needling or curious to learn more? Check out our Dry Needling FAQs blog post.

What if my physician doesn’t think PT will help?

Oof… this question will get us up on a soap box real quick! The greatest thing about physical (or occupational) therapy is that it is non-invasive. We work on restoring functional movements and finding the root causes as we help you navigate your rehab. We are a lower stakes treatment option compared to putting medication in your body via a pill and/or injection or surgical intervention. We also help to quarterback your care by connecting you to different providers who bring their expertise to your treatment plan.

The second half to this answer brings us back to our point above about direct access. You do not need your provider to write you a referral for therapy at this time. (Keep in mind some insurances may require a referral for reimbursement of services). This means you get to make the decision for yourself to see a pelvic floor therapist if you feel that may be the best treatment for your symptoms.

Can I use my insurance?

At Pelvic Pride we often see patients who have chronic pelvic floor issues that started 10+ years ago. These patients will not make significant change within 6-8 visits and oftentimes require ongoing therapy to help manage their chronic symptoms, which insurance does not like. Insurance also doesn’t tend to pay for wellness care so for those that choose to see a pelvic floor therapist for proactive treatment, insurance won’t always pay.

I noticed a lot of pelvic therapists are out of network, why is that?

Do you want to dive into this a little deeper? Read our blog for more on Why Choose A Fee-For-Service Physical Therapist .

How do I know if I need pelvic PT?

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , so you are in the right place! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 19: Pelvic Pride’s Holiday Gift Giving Guide

Wed, 06 Dec 2023 19:53:20 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 19, I will review our holiday gift giving guide and give you a little more information on each product and why we love it!

Episode 19 Recap:

For the Pregnant One:

Intimate Rose Pelvic Wand - use code JOY1 for $5 off
baobei Maternity Shorts
Baby Belly Band by Cabea
Squatty Potty - use code HC-PelvicPride20 for 20% off

For the New Parent:

Thrive Perineal Ice Packs
Thayer’s Witch Hazel
Medicine Mama’s VMagic Vulva Balm - use code JOYNOBLE for 10% off
frida mom Peri Bottle

For the Frequent Flyer:

uberlube Travel Lubrication
Cushion Lab Car Seat Cushion & Back Relief Lumbar Pillow
Travel Porta Squatty - use code HC-PelvicPride20 for 20% off

For that Someone Special:

Personal Lubrications
Uberlube
Good Clean Love - use code PELVICPRIDE20 for 20% off
Slippery Stuff
EVA by Dame - use code JOYNOBLE for 10% off
Ohnut - use code PELVICPRIDE7 for $7 off
“Come As You Are” by Emily Nagoski - support your local bookstores!

For those that Menstruate:

Thinx Period Panties
Squatty Potty - use code HC-PelvicPride20 for 20% off
Flex Menstrual Cup or Disc

For the One with Pelvic Pain

Intimate Rose Vaginal & Anal Dilators - use code JOY1 for $5 off
Go Love CBD Intimate Serum - use code PELVICPRIDE for 10% off
Intimate Rose Vibrating Pelvic Wand - use code JOY1 for $5 off

Check out the Pelvic Pride Holiday Gift Giving Guide on Instagram

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 18: Soluble vs. Insoluble Fiber Types

Tue, 14 Nov 2023 10:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 18, I discuss the difference between soluble and insoluble fiber in our foods and how this impacts our digestive health, just in time for the holiday season.

Episode 18 Recap:

There are two types of fiber found in our food: soluble and insoluble

Soluble Fiber: dissolves in water to slow digestion and aids in decreasing diarrhea or softening hard stools
Fruits (apples, citrus)
Vegetables (turnips, carrots, sweet potatoes)
Legumes (beans & lentils)
Some grains (oats & barley)
Insoluble Fiber: doesn’t dissolve in water, sweeps the colon and helps to speed up the movement of waste in the colon which helps to decrease constipation & hemorrhoids
Leafy greens & zucchini
Flax & chia seeds
Whole grains & brown rice
In pelvic floor therapy we focus on the impact of stool consistency and constipation on the rest of the pelvic floor and bladder. We discuss fiber types from a place of navigating the whole foods we are eating first, then look to a supplemental fiber if needed (like psyllium husk). A deeper dive into this area is best addressed with a dietician/nutritionist.
Other benefits of soluble fiber including improved cardiovascular health, diabetes management, and weight control - these are areas that should be discussed with your primary medical provider
As we head into the holiday season, keep these differences in mind when building your dinner plate and be sure to include a mix of both types of fiber

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 17: Bladder Irritants & the Holiday Season

Wed, 08 Nov 2023 14:25:39 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 17, I discuss how to manage the top bladder irritants during the upcoming holiday season to keep your bladder happy.

Episode 17 Recap:

Top bladder irritants:
caffeine
carbonation
alcohol
artificial sweeteners
citrus
tomato based foods
spicy foods
Not all of these foods/drinks are going to be YOUR irritants. Each of them can affect people differently so test it out and figure out which of these bother your bladder before you decide to eliminate them.
I don’t typically have my patients cut them out completely - instead I have them drink more water
Water is key in helping to dilute these irritants in the bladder to keep it happier
Don’t forget - sip your water, don’t gulp it! Chugging a whole bottle of water does not work inside your body the same as slowly sipping it over time. Your body will process all the extra water out as waste if you consume it too fast.

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 16: The Five Types of Urinary Leakage

Mon, 30 Oct 2023 21:01:10 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 16, I review the five different types of urinary leakage and how pelvic floor therapy can help.

Episode 16 Recap:

The five types of urinary leakage:

Stress incontinence
Urge incontinence
Mixed incontinence
Functional incontinence
Overflow incontinence

Pelvic floor therapy will look for issues related to the musculoskeletal system including muscle weakness, tightness, coordination issues, and the kinetic chain as well as bigger underlying pathology such as an enlarged prostate or a neurologic condition.

Resources/Links from this episode:

Episode 8: A Tight vs. Weak Pelvic Floor
Episode 15: The Four Pillars of Pelvic Health
Blog Post: The Five Types of Urinary Leakage

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 15: The Four Pillars of Pelvic Health

Tue, 24 Oct 2023 13:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 15, I review the four pillars of pelvic health and how they are key to taking a whole body approach in your care.

Episode 15 Recap:

Stress: your body often holds stress as tension, especially in the pelvic floor muscles!
Sleep: key to regulating hormones, decreasing inflammation, and allowing for tissue repair
Movement: hello blood flow (& oxygen)! Also helpful to lubricate your joints and keep your bowels regular (goodbye constipation!)
Nutrition: you aren’t what you eat but what you eat impacts who you are and how happy your pelvic floor area is ��

Resources/Links from this episode:

Shanté Cofield’s Instagram (for all things brand strategy & online business)
Lex Lancaster’s Instagram (for all things business tech)
The Three Treatment Methods of Pelvic Health Blog & Podcast (in case you need a refresher to compare this to the “Four Pillars”)
The Four Pillars of Pelvic Health Blog
Soluble vs Insoluble Fiber Handout (see below)

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

The Four Pillars of Pelvic Health

Tue, 24 Oct 2023 12:49:22 GMT

At Pelvic Pride we talk a lot about taking a whole body approach to our treatment. This doesn’t just mean assessing a patient from head to toe, it also means considering other factors that impact someone as a whole person as we aim to discover the underlying ‘why’ to their symptoms. We ask about daily habits, work activities or the things that fill their day, and the impact of the environment on their symptoms. These questions can be fit into what we call the four pillars of pelvic health: stress, sleep, movement, and nutrition. Each area has an impact on how we feel in our body and impacts our body’s ability to heal. Let’s take a look at each pillar and its impact on the pelvic floor.

(You can also check out our podcast episode on the four pillars of pelvic health!)

The Four Pillars of Pelvic Health:

1. Stress

We are all too familiar with stress. Maybe it's a tough day at work, or an upcoming personal event. Other times it is physical stress on the body like a long weekend of house chores or training for a marathon. While some stress is necessary for survival, too much bad stress can negatively impact the pelvic floor.

As we hold onto the bad stress our nervous system starts to become upregulated (read: ON FIRE! ). This is felt when you start to notice that you are becoming irritable very quickly. Maybe you seek out quiet, want to escape the clutter, or even start to feel hypersensitive to the way things feel on your skin. Yep! Those are the signs that your nervous system is moving towards fight-flight-freeze-fawn . As a result the pelvic floor muscles start to guard (or tighten up) as to protect your body from harm (we are looking at all your who joke that you are tight asses). While there may be no actual harm occurring, the body will hold onto that stress anyways - just in case.

The pelvic floor isn't the only place we see this happening. Many people hold stress in their neck and shoulders while others may hold it in their jaw by clenching their teeth. Well, guess what? The jaw and the pelvic floor are very related, so if you clench your teeth, chances are your pelvic floor is clenched too.

So what?! When we clench our muscles we are not allowing blood flow into the area which is key for healing, bringing oxygen to the tissue, and keeping the pelvic floor muscles functioning optimally by fully relaxing and engaging through their full range of motion.

How do I fix it? Try doing body scans throughout the day. Take a deep breath and slowly scan down your body and let go of what feels tight: relax your jaw, shoulders, belly, butt, and pelvic floor muscles . If things feel engaged or tense, channel your inner Elsa from Frozen and let it go.

2. Sleep

Ah, sleep! For some this is the best part of the day. For others it is a dreaded time of laying in bed, struggling to fall asleep and counting down the hours until morning. This is because sleep is a vital part of survival. In fact, we can survive longer without food than we can without sleep .

While we sleep our body is in a restorative state aimed at five key areas:

Increased blood flow throughout the body which carries oxygen and nutrients to the muscles for recovery
Hormones released during deep sleep help to aid in healing, muscle repair, and new tissue growth
Prolactin is released to reduce inflammation throughout the body
Cortisol levels are reduced therefore the stresses in our body are reduced (cortisol is the stress hormone that can result in a decreased immune system and increased blood pressure)
Proteins are produced by the body to help build new cells for healing and tissue repair

So whether you are recovering from a pelvic floor surgery, have recently delivered a baby, have a chronic pain or inflammatory disorder, or have been under an increased amount of stress lately, sleep is clearly an important factor when considering your road to recovery.

This is why we will discuss your sleep habits and address various areas including your fluid intake and bathroom trips around your bedtime routine, the positions and supports (like pillows) you utilize when laying down to sleep, and how to cultivate a restful environment for improved quality of sleep such as avoiding screen time 30 minutes before bed, using a weighted blanket, or listening to a meditation prior to falling asleep .

3. Movement

Physical therapists are the movement experts, so you know we love chatting about this pillar! Movement improves circulation, promotes metabolism (how we convert food and drink into energy), regulates our bowel and bladder function, impacts our strength and endurance, and can play a major role in mental and emotional health.

As you can see from the above pillars, blood flow and energy are big players in our overall tissue health and movement is one more way we can promote these two areas. Movement also has a big impact on the health of our bowels. This is because our abdominal muscles lay directly over our gastrointestinal (GI) tract and when we move our abdominal muscles we are helping to improve the motility of our gut. (motility = the movement of stool through the GI tract)

So between keeping blood flowing, lengthening and strengthening pelvic floor muscles, and keeping our stool moving through the body, movement is a valuable addition to your routine. Don’t worry, you don’t have to love exercise to still get the benefits of movement for your pelvic floor. We love discussing how movement can look different for every person and does not necessarily mean you need to head to the gym. Instead you can try adding in a couple yoga poses or stretches to break up your workday, go outside for a walk or bike ride , lean into an at-home strengthening routine, or even some focused breathing techniques to stimulate the vagus nerve for rest-digest-repair.

4. Nutrition

Finally what we ingest each day certainly has an impact on all systems of the body. As pelvic health therapists, we frequently work with patients who are navigating bowel and bladder difficulties that can be impacted by nutrition. This often looks like constipation, fecal urgency/leakage, or urinary urgency/frequency/leakage. Additionally, we support individuals who may be navigating chronic diagnoses that can be impacted by nutrition, such as irritable bowel syndrome (IBS), SIBO, and fibromyalgia, to name a few.

In pelvic floor therapy we can assist with identifying nutrition strategies that best support your symptoms and rehabilitation course of care. This may include:

Incorporating different fiber types (via whole foods or OTC fiber supplements) to improve the consistency of bowel movements for an easier go
Reviewing foods or drinks that may be irritating your bladder and causing urgency/frequency (we’re looking at you seltzer)
Discussing other potentially beneficial approaches such as an elimination diet and looking into inflammatory foods (with the support of additional providers who are skilled in this area)

We also recognize the importance of a collaborative approach to best support our patients and work to ‘quarterback’ your care in any way we can, including providing resources for gastroenterologist, nutritionist, and/or dieticians if we find that could be another important perspective for your care.

Hopefully now you can see why your providers may ask questions that seem to go beyond your exact symptoms. When we ask questions about your stress, sleep, movement, and nutrition we are trying to gather information that draws a bigger picture as to why you are experiencing the symptoms that bring you into pelvic floor therapy. Sometimes the smallest tweaks to your routine can lead to a faster or more complete rehab process.

Tl;dr

The four pillars of pelvic health are:
Stress: your nervous system is on fire so your muscles squeeze to protect
Sleep: your body needs sleep to repair and recharge
Movement: keep that blood pumping, muscles moving, and gut happy
Nutrition: what you eat matters!

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , so you are in the right place! We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 14: Return to Running Postpartum

Tue, 17 Oct 2023 15:13:43 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 14, I review the most recent guidelines on Return to Running in the postpartum period as well as how you can work with a pelvic floor therapist to further evaluate your readiness to return to running.

Episode 14 Recap:

The earliest recommended time to return to running is 3 months postpartum
You should consult a pelvic floor therapist if you have any of the following when attempting to run or exercise:
Urinary or fecal leakage or urgency
Pelvic pressure or heaviness
Pain with intimacy/intercourse
Core weakness or diastasis recti (abdominal separation)
Low back and hip pain
You should return to your medical provider if you experience bleeding after exercise or running
At pelvic floor therapy we will look at:
Your pelvic floor muscles strength and endurance
Your ability to manage load transfer and impact
Your lower body strength
Other factors to consider before returning to running
Psychological impact such as postpartum anxiety and postpartum depression
Scar tissue mobility
Implications of breast/chest feeding in regards to the hormone relaxin
You should start with a graded running routine that mixes walking with running/jogging and consider cross training as well

Resources/Links from this episode:

Blog : Return to Running Postpartum
Return to Running Guidelines
Return to Running Workshop: Register Here

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email ( info@pelvicpride.com )

Let’s connect on Instagram!

Pelvic Pride Physical Therapy & Wellness: @pelvicpride
Dr. Joy: @drjoy_pelvicpt

Episode 13: Inclusivity is More Than a Rainbow Flag

Tue, 10 Oct 2023 13:35:09 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 13 I review a few reasons you can’t just slap a rainbow flag on your clinic and call yourself inclusive.

Episode 13 Recap:

Inclusivity is more than a rainbow flag or an ambivalent “I don’t care who you love, I can treat you.”
To be an inclusive clinic you should consider the following:
Staff should be trained to communicate appropriately with ALL patients and know how to not misgender, dead name, or use micro aggressions
Intake paperwork should have places for pronouns, gender identity, preferred name, and gender neutral terminology as appropriate
Gender neutral bathrooms or signage to let patients know they can use whatever bathroom they identify with or feel safe in
Inclusivity is not limited to the LGBTQIA+ community, it also means seating for people of all sizes, different anatomies, handouts with people of different skin tones

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email ( info@pelvicpride.com )

Let’s connect on instagram: @pelvicpride & @drjoy_pelvicpt

Return to Running Postpartum

Mon, 09 Oct 2023 13:00:00 GMT

Does the thought of running after you've had a baby sound daunting? Don't worry you are not alone!

Many people don't know where or how to start, others aren't sure if their body is ready to move like that. Keep reading to learn the latest on returning to running in your postpartum stage!

Traditionally, there has not been much research regarding return to exercise as a postpartum individual. In turn, there has been limited guidance for the best way to return to an activity postpartum, especially something as high-impact as running. Due to this increase in demand from our bodies, postpartum individuals need adequate time to heal and recover. Fortunately, a recently published research review led by UK-based physiotherapists discusses exercise guidelines aimed to assist healthcare providers and postpartum individuals return to running. Great news!

This review emphasizes the importance of the kinetic chain (aka that our joints and muscles connect together to move our bodies), in regards to our spine, core, hip, and pelvic floor’s mobility, coordination, and strength, when creating an individualized return-to-run program. They additionally highlight the importance of considering pelvic floor symptoms when returning to exercise to create the best possible outcome for each person.

These guidelines are free for public access- check them out here ! (Or keep reading for a quick summary of the guidelines. You can also listen to our podcast episode about return to running postpartum here !)

This graphic shows how the muscles connect the spine, pelvic floor, hip, and knee.

How soon can I run after delivery?

This is one of the most frequently asked questions we receive from our patients! Several of our postpartum individuals are 'cleared' to return to exercise at their 6-week postpartum OBGYN visit. Typically this clearance is issued due to a lack of issues from a medical standpoint, however this does not reflect the continued tissue healing that is occurring nor does it take into consideration if your system is ready for a high-impact activity like running (this applies to any high-impact activity, including high-intensity interval training and jumping/plyometrics).

Per the review guidelines above, it is recommended to wait until at least 12 weeks after giving birth to initiate a graded return-to-running program, and only as long as there are no signs of pelvic floor muscle impairment (see our list below). We recognize that everyone heals at their own body’s pace and while some patients feel ready to return earlier, others may need more time to feel physically, mentally, emotionally, or energetically ready to return to higher level activities. Further, it is absolutely okay to not feel ready to return to a high-intensity activity like running at the 3-month mark, and it is normal to allow your brain and body more time for healing and recovery.

So how do I start a running program?

Begin slow! Start with a gradual return to cardio via lower-impact exercise like walking. Once you feel ready to add in running, try to incorporate intervals of walking and running as you test the water and build your endurance up.
Try not to progress or change several variables in your exercise routine at once. This includes frequency, duration, intensity, and terrain of your runs.
Cross-training is an important component of tissue healing and lumbo-pelvic support which can optimize outcomes with return to high-impact activities such as running.
Utilizing an interval training program such as Couch to 5k can be a helpful place to start if you are feeling overwhelmed or afraid to start.

Signs and symptoms that may indicate pelvic floor impairments that should be addressed:

Leaking urine or feces, at any time but especially when running
Heaviness, pressure, or bulging sensations in the perineal or vaginal region, at any time but especially when running
Joint or muscle pain, including to the pelvis, hip, and/or low back areas, at any time
Difficulty emptying bowels or constipation
Pain with sex or insertional activities

Additional risk factors:

When reading through the literature while designing the return to running guidelines, the authors also paid particular attention to the following as signs to be considered when returning to running:

Being less than 3 months postnatal
Pre-existing pelvic floor issues or lumbopelvic dysfunction
Delivery via cesarean section or perineal scarring with vaginal delivery
Currently breast- or chest-feeding
Pre-existing hypermobility conditions (e.g. Ehlers-Danlos)

If you find you're experiencing any of the above pelvic floor symptoms we encourage you to work with a pelvic health therapist to create a treatment plan tailored to you and your exercise goals. Your pelvic floor therapist will complete a comprehensive evaluation of your core, hips, spine, and pelvic floor looking particularly at your mobility and strength as well as perform an assessment aimed at determining your body’s ability to perform the necessary movements for safe and successful return to running. After this assessment, your therapist will provide you with specific recommendations and establish a cross-training program to optimize your postpartum recovery journey!

tl;dr

The ideal time to return to running is 3 months postpartum
Don’t do too much, too soon! Start slow, add gradually, and be mindful as you increase the duration and intensity of your program
If you are experiencing any pelvic floor symptoms, see a pelvic health therapist to address these issues and help you reach your goals
Keep in mind, all postnatal individuals can benefit from seeing a pelvic health therapist within the first 6 weeks post-delivery for prevention, management, and support

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , including return to running postpartum, so you are in the right place! We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 12: So Who Do You Treat?

Tue, 26 Sep 2023 13:16:51 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 12 I will give you the longer version of my elevator pitch to the question ‘so what do you treat?’

Episode 12 Recap:
We treatment patients with issues related to

Pee - retention, pain, urgency, frequency, leakage
Poop - constipation, pain, abdominal pain/bloating, leakage
Sex - pain, fear, scar tissue, related diagnoses that impact intimacy
Pregnancy - reactive & proactive care to keep you moving and comfortable as well as labor/delivery prep
Postpartum - pain related to new parent tasks, postural awareness, recovery care for any type of delivery, return to activity/exercise
Gender Affirming Care - pre-surgical clearance evaluations, post surgical recovery including scar tissue management, dilator use, and return to activities

Episode Resources:

Check out Episode 4: Do Penis Owners Have a Pelvic Floor?
Check out Episode 11: What I Learned at PelviCon 2023

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email ( info@pelvicpride.com )

Let’s connect on instagram: @pelvicpride

Episode 11: What I Learned at PelviCon 2023

Tue, 19 Sep 2023 16:20:02 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 11, I will give you a rundown of the top takeaways from each presenter at PelviCon this year!

Episode 11 Recap:

Endometriosis, interstitial cystitis, pudendal neuralgia are commonly seen together in patients with pelvic pain
600k hysterectomies are performed each year; 80% for benign reasons like pain
Prehab is important for patients undergoing hysterectomies
Health is more than physical which is why we may ask about:
Sleep/rest/recovery
Movement/fitness
Work or daily activities that contribute to the household
Parenting/caregiving
Relationships
Nourishment
Pleasure
Sexual shame isn’t a YOU problem, it is a society problem
Anal pleasure isn’t just for gay men and should be discussed with patients as appropriate if that is something they are interested in
Erectile dysfunction has many causes and they should all be explored including musculoskeletal factors when treating
Be aware of hard doming/coning with diastasis recti - we will help you monitor and manage this
Abdominoplasty may not result in a perfectly flat stomach, it is not the easy or lazy way out, and you cannot always avoid surgery with conservative management
Don’t be afraid of pessaries - they may be super helpful and even temporary
A tight pelvic floor can absolutely cause stress incontinence
Pelvic floor therapy can help with fertility including
Improving pelvic blood flow to reproductive organs
Optimize sexual function
Relieve stress and anxiety with downtraining to nervous system
Post surgical rehab to restore normal pelvic function
Addressing scar tissue and adhesions
Address PF pain dysfunctions that may impact use of transvaginal US during egg retrieval
It is important to consider religious and cultural impact on pelvic floor therapy

Today’s Pint:

100% will have one tonight :D

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email ( info@pelvicpride.com )

Let’s connect on instagram: @pelvicpride

The Five Types of Urinary Leakage

Sat, 16 Sep 2023 20:04:43 GMT

You may recognize that urine leakage sensation following a bad winter cold, possibly when out on a run, or even when trying to get to the bathroom on time. At Pelvic Pride, we educate our patients that urinary leakage is common, but does not have to be your ‘normal’! Let’s dive in further.

What is urinary incontinence?

Urinary incontinence (UI) is any undesired urine leakage during the day or night that can range from a few drops to enough to wet your clothing. Urinary leakage can impact any person with a bladder, and can be associated with a history of:

Pregnancy and childbirth (including delivery via Cesarean section)
Chronic urinary tract infection (UTI) symptoms
Surgical or medical procedures in the abdomen, hip, pelvic, or genital tissues/structures
Post prostatectomy surgery
An underlying medical condition, such as diabetes or neurological condition

To prevent urinary leakage, we rely on the pelvic floor muscles. These muscles run from the pubic bone (front) to the tailbone (back) in your pelvis and form a bowl- or hammock-shape at the base of the pelvis to help provide ‘bottom-up’ support to the urethra, bladder, and colon.

One key function of these pelvic floor muscles is to provide sphincteric control around the urethra and anus. If for any reason these muscles aren’t able to ‘do their job’, it could result in that leakage sensation such as with a sneeze, going for a run, while trying to get to the bathroom in time, or while simply walking or changing positions.

Urinary leakage (incontinence) can be categorized in five different ways:

1. Stress incontinence:

Leakage that occurs with movement, exercise, or anything that places excess pressure on the bladder, like a cough, laugh, or a sneeze. This may occur with physical activity such as running or with daily activities like lifting, squatting, or reaching. Stress leakage is typically associated with pelvic floor muscle weakness as the muscles may not be able to provide the ‘bottom-up’ support and sphincter control to the urethra and bladder during moments of added pressure through our system.

2. Urge incontinence:

Leakage that often occurs before reaching the bathroom due to a sudden, strong urge to empty the bladder. Urge leakage typically is linked to pelvic floor tension and/or weakness, and individuals may also experience urinary frequency, bladder spasms, or ‘UTI-like’ symptoms, such as urinary hesitancy, pain or burning with the urine stream, and difficulty emptying the bladder.

3. Mixed incontinence:

Some individuals may experience a combination of both stress and urge leakage as described above. This has been deemed ‘mixed incontinence’ by the medical world and requires a mix of treatment approaches to address how our pelvic floor manages increased stress as well as intense or frequent urges to go.

4. Functional incontinence:

Leakage that occurs due to external or environmental factors and not directly related to the bladder or pelvic floor muscles, including difficulty reaching the toilet on time due to mobility or balance difficulties, muscle weakness which may impact clothing management, environmental barriers or obstacles including rugs or furniture, or other cognitive-communication difficulties.

5. Overflow incontinence:

Leakage that occurs due to over-filling of the bladder because the bladder is unable to effectively empty. This can lead to frequent urination and the release of only small amounts of urine at a time. It may also be associated with urinary hesitancy, a weaker urine stream, or straining to empty the bladder. This type of leakage may be associated with a neurological condition; a blockage impacting the bladder or urethra, such as an enlarged prostate; or because the bladder muscle can’t work effectively enough to squeeze the urine out.

So how can pelvic health physical therapy help?

Great question! Urinary leakage may be occurring for a variety of reasons and can extend beyond the pelvic floor muscles so it is imperative to perform a whole body assessment to determine your specific causes of leakage. To do this, we start by listening to your story and how your symptoms are impacting your daily activities, work, exercise, and/or sleep. From there, we can perform assessment measures, such as strength, coordination, and mobility/flexibility of the muscles and soft tissues of the pelvis, back, hips, foot, and ankle ( yes, even the ankle! ), to help determine why your leakage may be occurring.

Once we’ve gathered this information we will start treatment to see which techniques may best support you and your symptoms. [Read more about pelvic floor treatment methods here .]

Based on how your symptoms present and the evaluation findings, your treatment may focus on pelvic floor muscle relaxation/lengthening to assist with any tension of the pelvic floor, muscle strengthening and/or coordination training to improve the ‘bottom-up’ support to your bladder and urethra by the pelvic floor muscles. Your pelvic floor therapist may also integrate treatments such as:

Flexibility and strength exercises of the core, hips, and back
Pressure management and awareness with breath strategies
Posture awareness including toileting positioning and task-specific ergonomics, such as workday setup and/or exercise mechanics
Lifestyle or daily habits, including daily fluid intake, sleep, stress, movement routines
Bowel health education due to the direct impact your bowels can have on your bladder due to the fact that these organs live next to each other in the pelvis (think how constipation and stool in the rectum may physically impact bladder due to being neighboring structures)

As you can see above, there are a variety of reasons you may be experiencing urinary leakage, therefore an individualized approach from your pelvic floor therapist will be important as symptoms can present differently from person-to-person. This individualized approach is also important due to the differences in how each patient connects with and responds to the various treatment methods. Ultimately, our goal is to help you gain control over your symptoms and assist you with getting back to the activities you love!

tldr;

There are five main types of urinary leakage: stress, urge, mixed, functional, and overflow
Performing a whole body assessment is key in determining why you are experiencing leakage
An individualized treatment approach ensures each treatment method is working for your symptom presentation

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , including urinary leakage, so you are in the right place! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Episode 10: How We Work with Birth Trauma

Tue, 12 Sep 2023 10:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 10 we will discuss how we work with patients who have experienced birth trauma.

Episode 10 Recap:

Birth trauma can be stored in our muscles, scar tissue, and fascia
Stored trauma tends to let itself out in various ways including through tears - and that’s okay!
Enthusiastic consent around our assessment and treatment is a key component of working with us at Pelvic Pride
We start slow and meet you where you are as we begin to incorporate hands-on treatment, when you are ready

Today’s Pint:

Pumking by Southern Tier

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email ( info@pelvicpride.com )

Let’s connect on instagram: @pelvicpride

Episode 9: What's the Deal with Kegels?

Tue, 05 Sep 2023 10:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast.

In Episode 9 we will discuss kegels, what they are, and if they worth doing.

Episode 9 Recap:

Kegel: a lift and squeeze of the pelvic floor muscles
Don’t do 100 kegels a day
Don’t stop your pee on the toilet
Do perform pelvic floor strengthening with function in mind
Be sure to strengthen the muscles around the pelvic floor too

Today’s Pint:

Still no pints - in batching content mode!

Resources/Links from this episode:

Listen to Episode 8: A Tight vs. Weak Pelvic Floor

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email ( info@pelvicpride.com )

Let’s connect on instagram: @pelvicpride

Episode 8: A Tight vs. Weak Pelvic Floor

Tue, 29 Aug 2023 13:00:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast.

In Episode 8 we will discuss the difference between a tight vs. weak pelvic floor.

Episode 8 Recap:

The signs of a tight pelvic floor and how symptoms manifest
The signs of a weak pelvic floor and how symptoms manifest
The importance of assessment to figure out if your pelvic floor is tight or weak

Today’s Pint:

Dreaming of a Pumpking by Southern Tier

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram: @pelvicpride

Episode 7: Our Clinical Ethos

Tue, 22 Aug 2023 18:37:44 GMT

Welcome to Pints & Pelvic Floors: The Podcast.

In Episode 8 we will discuss the difference between a tight vs. weak pelvic floor.

Episode 7: Our Clinical Ethos

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 7 we will discuss our clinical ethos at Pelvic Pride.

Recap of our Ethos:

We believe in an inclusive, safe, judgment free space
We believe in one-on-one care that takes a whole body approach and considers biopsychosocial factors
We believe our plan of care should be both intentional and functional
We believe pelvic therapists are facilitators, not fixers
We believe that the patient’s goals are our goals
We believe the best clinic environment comes from a team approach
We believe patients should feel seen, heard, and empowered

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram: @pelvicpride

Episode 6: The 3 Treatment Methods of Pelvic Therapy

Tue, 22 Aug 2023 16:17:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast.

In Episode 6 we will discuss the 3 treatment methods of pelvic floor therapy.

Episode 6 Recap:

Direct Treatment: hands-on or directly impacting/mobilizing the pelvic floor muscles
Indirect Treatment: treating the tissues around the pelvic floor including the lower extremity, abdominals, diaphragm, and spine
Nervous System: working on downtraining an on-fire nervous system through breathing, meditation, acupuncture, etc as well as retraining the pelvic floor and brain communication floor therapy

Today’s Pint:

Natty Boh

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram: @pelvicpride

Episode 5: What to Expect at the Evaluation

Tue, 08 Aug 2023 19:12:59 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 5 we will discuss what to expect at a pelvic floor therapy evaluation appointment.

Episode 5 Recap:

What to expect on the intake paperwork
How long an evaluation should be and what will be discussed during the first visit
The spectrum of initial assessment options from most clothed to least clothed including a pelvic floor exam
Reviewing your findings and discussing the plan moving forward
How many visits you may need for pelvic floor therapy

Resources/Links from this Episode:

Read the Top 9 Yoga Poses for the Pelvic Floor

Today’s Pint:

Bloodline by Flying Dog

Have a question or suggestion for an episode? Email us at joy@pelvicpride.com

Interested in becoming a patient at Pelvic Pride?

Visit the Pelvic Pride website
Give us a call: 410-941-9512
Send us an email: info@pelvicpride.com

Let’s connect on instagram: @pelvicpride

Top 9 Yoga Poses for the Pelvic Floor

Tue, 08 Aug 2023 17:49:46 GMT

As physical therapists we collect a lot of “tools” for our therapy tool box. Some of them are physical tools like cups, massage balls, or Theraband. Others are treatment techniques like dry needling, visceral mobilization, or myofascial work. Each tool we collect has a purpose to help the pelvic floor in one of the three types of pelvic floor treatment ( read more about that here ). When developing your plan of care for therapy we are working to find just the right combination of these techniques to help address the issues that brought you to pelvic floor therapy. One of our most commonly used tools at Pelvic Pride is yoga .

Yoga can help improve flexibility, increase blood flow, cultivate a better mind-body connection, reduce stress, and downregulate the nervous system - aka put out that fire ! We utilize yoga poses with our patients to hit on all of these benefits and to empower our patients with actionable tasks to do when they are not in the clinic with us. As we have incorporated yoga poses into our practice, we have narrowed it down to these top nine favorite yoga poses for the pelvic floor.

Each of these poses were chosen to help provide direct and/or indirect relaxation to the pelvic floor muscles. Keep in mind the goal for these poses are relaxation, stretching, and letting go in and around the pelvic floor. You will not be tightening or actively engaging muscles during these postures and you should not experience pain during these poses. If you struggle to get into or maintain a pose try the modified version we’ve described. Once you've settled into each pose, hold this posture for 5 deep breath cycles.

If you get a chance to try these poses out send us a quick message and let us know what you think!

Where to find treatment in Maryland

Next on Your Reading List

Episode 4: Do Penis Owners Have a Pelvic Floor?

Tue, 01 Aug 2023 19:21:51 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 4 we will answer the question: “do penis owners have a pelvic floor?”

Episode 4 Recap:

Do penis owners/men have pelvic floors?
How much of the genitalia we need to touch/assess
How penis owners are affected by urinary, bowel, and sexual issues just like vagina owners (but with their own spin)
How erections and ejaculation is impacted by the pelvic floor
Why the prostate and testicles matter in pelvic floor dysfunction

Resources/Links from this episode:

Listen to Episode 2

Have a question or suggestion for an episode?

Email me!

Interested in becoming a patient at Pelvic Pride?

Learn more about Pelvic Pride here
Give us a call
Reach out to our Patient Care team

Episode 3: Becoming a Pelvic Floor Therapist

Tue, 25 Jul 2023 20:01:27 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 3 we will chat about the training that goes into becoming a pelvic floor therapist and why I went into pelvic therapy.

Episode 3 Recap:

The education and training that goes into becoming a therapist
Why I became a pelvic floor therapist
Why internal hands-on assessment and treatment is important
Specializing within the field of pelvic floor therapy
Why you can’t “just see your ortho PT” for a pelvic floor issue

Resources/Links from this episode:

Listen to Episode 2

Have a question or suggestion for an episode?

Email me!

Interested in becoming a patient at Pelvic Pride?

Learn more about Pelvic Pride here
Give us a call
Reach out to our Patient Care team

Episode 2: Pelvic Floor 101

Tue, 25 Jul 2023 19:55:57 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In Episode 2 we will answer the question “what in the world is the pelvic floor?” and why we should care about our pelvic floor.

Episode 2 Recap:

The structures and function of the pelvic floor
How the pelvic floor impacts bowel and bladder health
The difference between a tight, weak or tight & weak pelvic floor
Common symptoms of pelvic floor dysfunction
How our body holds stress or trauma in the pelvic floor

Resources/Links from this episode:

Read The Body Keeps the Score

Have a question or suggestion for an episode?

Email me!

Interested in becoming a patient at Pelvic Pride?

Learn more about Pelvic Pride here
Give us a call
Reach out to our Patient Care team

Episode 1: And So It Begins

Tue, 25 Jul 2023 19:46:00 GMT

Welcome to Pints & Pelvic Floors: The Podcast. In our inaugural episode, we will introduce you to the structure of P&PF by answering the following questions:

Who am I?
What is Pelvic Pride?
What is Pints & Pelvic Floors?
Why start a podcast?
What should you expect in future episodes?

Resources/Links from this episode:

Pelotons & Pelvic Floors on Youtube
Work From Home Posture: What a Pain! on Youtube
Pints & Pelvic Floors: Painful S3X! on Youtube

Have a question or suggestion for an episode?

Email me!

Interested in becoming a patient at Pelvic Pride?

Learn more about Pelvic Pride here
Give us a call
Reach out to our Patient Care team

The 3 Treatment Methods of Pelvic Therapy

Tue, 18 Jul 2023 14:31:44 GMT

"So what does treatment look like?"

Excellent question! And one we are asked in almost every single evaluation appointment. When it comes to establishing a pelvic health therapy treatment plan of care, we individualize each one because while the diagnoses may be the same, the way symptoms present can differ vastly from person-to-person. As we work through a plan of care we also make changes based on how each patient connects with and responds to various treatment methods. At Pelvic Pride, we emphasize the variety of ‘tools in our toolkit’ when designing each patient’s plan of care. The purpose of this is to empower our patients with the information needed to decide which treatment methods feel best for them and their bodies, as well as to acknowledge that it's okay to change their mind at any point in their plan of care.

For example, as a pelvic health therapist, we can integrate hands-on manual therapy treatment within the pelvic floor muscles via an internal approach, however this may not feel like the best treatment option for each individual and that's absolutely okay!

We commonly integrate various treatment methods to work toward your goals that do not involve internal pelvic floor treatment, including but not limited to, external hands-on and off manual therapy approaches to the muscles and tissues surrounding the pelvic floor structures, stretches and exercises, breathwork, addressing the nervous system, as well as education and developing your home program.

To help our patients understand what exactly we will be doing in pelvic floor therapy, we divide our treatment methods into three main categories:

Direct,
Indirect, and
the Nervous system

Direct Treatment

Direct treatment is exactly what it sounds like - treatment focused specifically on the pelvic floor structures including the muscles, ligaments, bones and joints associated with the pelvic girdle. This is where our skills as pelvic health therapists really sets us apart from other physical therapists in the field. We undergo extensive training to understand the anatomy (what exactly is down there) and biomechanics (how it works) to be able to treat the pelvic floor muscles directly via internal methods.

If your provider is not doing an internal assessment (unless you’ve declined consent which is 100% valid!) then they are doing you a disservice!

Image used with permission from Pelvic Guru®, LLC as a member of the Global Pelvic Health Alliance Membership (GPHAM)

Above: pelvic floor anatomy including pelvic floor muscles, ligaments, connective tissue, bones, joints, nerves

Direct treatment may include

hands-on stretches and trigger point release
focused pelvic floor relaxation/gentle bearing down
training for home use of a pelvic wand &/or dilators
pelvic floor muscle coordination training

It is imperative to provide this treatment in a way that best serves you and your symptoms, meaning we may be providing direct treatment in a variety of positions. This could look like a standing, kneeling, or hands and knees assessment to determine how your pelvic floor muscles are managing pressure when you are doing the activities that bring on your symptoms.

Trust us, most patients don’t come in and say “You know when my prolapse symptoms are the worst? Laying down in bed” or “I leak constantly when I am sitting on the couch” - it’s when they are moving around, changing positions, exercising, preparing a meal, or laughing with friends. Don’t worry we won’t make you stand up and laugh but we will definitely discuss performing an assessment in a different position if we find it is clinically relevant. And we know these assessments may sound awkward but we promise it’s not as bad as it sounds and can give us such great information to help guide your treatment.

Indirect Treatment

Indirect treatment focuses on the muscles, joints, and connective tissue that surround the pelvic floor and oftentimes share fascial connections with the pelvic floor musculature. These neighboring muscle groups work closely with our pelvic floor to manage pressure (so we can do things like squat or lift without leaking, pressure or pain) and support our pelvis, spine, and abdominal organs. You will likely see other pelvic providers on social media telling you things like “the abdominals and pelvic floor muscles are best friends” and they aren’t wrong! So if the abdominal muscles are tight they may feed into a tight pelvic floor, or vice versa. We also commonly find patients with shortened inner thigh muscles also experience tension or pain in their superficial pelvic floor muscles.

Image used with permission from Pelvic Guru®, LLC as a member of the Global Pelvic Health Alliance Membership (GPHAM)

Above: musculature and connective tissues surrounding the pelvic floor

So to ensure our treatment is well rounded we will include assessment of the thoracic & lumbar spine, inner thigh & outer hip muscles, the abdominals, and/or the diaphragm. This treatment type may additionally integrate specific stretches, yoga poses, exercises, and mobility-based routines. So when we say there is more than just kegels in pelvic floor therapy - this is what we mean!

Research has found that strengthening hip musculature can help improve intravaginal squeeze pressure - so instead of doing 1000 kegels why don’t we do a more well rounded exercise routine. (Tuttle, 2020) Plus most people have weakness in their gluteus medius muscles anyway so it’s a win-win!

The Nervous System

Along with shortened, guarded, painful, or even weak pelvic floor muscles we typically find that our patients’ nervous system is ON FIRE! Meaning their nervous system (made up of your brain and nerves coming from the spinal cord all the way out to your fingers and toes) is upregulated - or the threshold that it typically takes to perceive pain/danger has been lowered to the point that the slightest thing can trigger their symptoms. When our nervous system is in this state, many systems can be impacted including bladder and bowel health (like urinary urgency/frequency and constipation), our ability to return to movement and exercise, as well as how our body perceives pain.

Image used with permission from Pelvic Guru®, LLC as a member of the Global Pelvic Health Alliance Membership (GPHAM)

Above: the paths of the peripheral nervous system including innervations in and around the pelvic floor

Pelvic floor therapy plays a key role in calming the nervous system from this heightened state of fight-flight-freeze-fawn back to its safe baseline of rest-digest-repair. We utilize multiple treatment methods to help encourage this 'grounded' state, including diaphragmatic breathing, mindfulness, vagus nerve stimulation, graded exposure, as well as discussing how 'big picture' items may be impacting your symptoms, including stress, sleep, nutrition, and daily movement.

Your pelvic health therapist may integrate treatment techniques from each of these types of treatment during your in-person sessions as well as incorporating them into your individualized home program to uncover which treatment methods may work best for you. With that said, it may take a few sessions to complete all evaluation measures, continue to discuss your story and symptoms, as well as navigate these treatment approaches to work toward your short-term and long-term goals.

Pelvic health therapy is a collaborative effort and further, a method that works well for one person may not be the best fit for the next. Your feedback at each step is crucial to helping us determine what treatment methods are working and which ones could use some adjustments.

In Review

Pelvic health physical therapy expands beyond a 'one-size-fits-all' approach. As pelvic health therapists we are here to listen to YOUR story and understand your priorities for your care to ensure the plan we implement is focused on YOU. If you have any questions regarding the information above or if pelvic health treatment is best for you, please feel free to reach out to us at Pelvic Pride.

Tuttle LJ, Autry T, Kemp C, Lassaga-Bishop M, Mettenleiter M, Shetter H, Zukowski J. Hip exercises improve intravaginal squeeze pressure in older women. Physiother Theory Pract. 2020 Dec;36(12):1340-1347. doi: 10.1080/09593985.2019.1571142. Epub 2019 Feb 1. PMID: 30704364.

Where to find treatment in Maryland

Next on Your Reading List

Painful Sex

Mon, 14 Jun 2021 21:17:07 GMT

“You just need to use lube”
“Drink a glass of wine first… you need loosen up a bit”
“Just take a shot first”

Those are three of the most common phrases I hear my patients repeat in the clinic from their providers ! That is absolutely ridiculous!!

Repeat after me:

YOU DO NOT NEED MORE LUBE!
YOU SHOULD NOT NEED TO BE DRUNK TO ENJOY SEX!
PAINFUL SEX IS NOT NORMAL! ( unless you are into pain during sex and have consented to it - no kink shaming allowed in this house)

Fun fact: the phrase “painful sex” is Googled 17,000 times per month! Seventeen THOUSAND! That is way too many times.

The common diagnoses you may find if you conducted that search are

Dyspareunia
Vulvodynia
Vaginismus
Vulvar Vestibulitis
Erectile Dysfunction
PGAD (persistent genital arousal disorder)
Pelvic Inflammatory Disease
Endometriosis
PCOS (polycystic ovarian syndrome)
Interstitial Cystitis (IC)

The list goes on. But what does it mean??

It means something is causing pain - but what? And where is that pain occurring? And what does it feel like?

The most common descriptors of painful sex that I hear in the clinic are: sharp, stabbing, rubbing, raw, sandpaper, pinching, poking, needles, tearing, burning, and shooting. Occasionally I will hear “it feels so deep that it [a penis, finger, toy] could come out of my belly button or mouth.” Who in the world would want to keep having sex if that is what you are experiencing during the act? The good news is that many of the causes for painful sex can be treated with pelvic floor physical therapy!

That means it is time to search out that magical unicorn of a therapist who has specialty training in the pelvic floor and can work on your body on both the outside and the inside. No, not the inside like the brain (but we definitely recommend working with a mental health therapist as well). I mean the inside like inside your pelvic floor... Yep! With your consent, we put our fingers anywhere we medically need to to assess your muscles and connective tissues so that we can give you the most well rounded care.

So now that we know what it could feel like, let’s cover when and where you may feel this. Pain with sex may be experienced with light touch, during the start of penetration, with deeper penetration, with erection and/or with orgasm. You can experience these pains on the outside muscles/skin, inside the vaginal or rectal canal, deep into the cervix, at the base or shaft of the penis, at the tailbone, in the bladder, in your abdomen, and/or in your back or hips.

What in the world is causing all of this?!

Often times pain during sex can be a result of:

tightness/muscle spasms of the pelvic floor
nerves (pudendal neuralgia vs pudendal nerve entrapment)
scar tissue (after surgery or child delivery)
inflammation of the pelvic glands
previous injuries to the pelvic region
dryness due to menopause/breastfeeding
as a result of a medical condition (endometriosis, PCOS, lichen sclerosus, Peyronie's disease, prostatitis, UTIs, yeast infections)
Anxiety or past trauma that is manifested as pelvic pain (cue that mental health therapist - they are crucial!)

At this point it can seem overwhelming but I promise you with the right care team, these symptoms can be managed and can even be completely resolved depending on the exact causes of your pain. Medical treatment for painful sex may include medication, physical therapy, acupuncture, and talk therapy. Medications include either oral or topical/suppositories to address inflammation, nerves, muscle spasms, hormone imbalances, and/or dryness.

In pelvic floor physical therapy we will have thorough discussion about your symptoms to ensure we can uncover as much relevant information as possible. Then we will perform an examination to identify the cause(s) of your pain, typically a combination of the things we discussed above, which may take a few visits. After this we will start to address the tissue issues with a combination of hands-on work by your therapist, education, exercises/stretches, and home self treatment (if desired by the patient).

Things you can do to help with the pain you experience is to talk to your partner(s) about what you like during sex and make changes with your approach to intimacy. Start by talking about the things that feel good to your body and the things that don’t feel good.

If you aren’t sure, start by exploring your body alone in a quiet and relaxing space. Once you have decided the types of touch and places you like touched, you may be better able to relay this to a partner.

Keep in mind sex is not just penetration (penis/finger/toy into vagina/rectum). You can still be sexual and have sex with your partner by performing things like oral sex or mutual masturbation.

The end game in therapy is that we help you to achieve your goals related to painful sex. We will use any combination of providers and of things discussed above to help you get there.

Luckily we also have a few tools up our sleeves that can help you out at home. These are some of my favorite tools to help treat pain with sex. Before you start using any of these tools, please consult with a pelvic floor therapist to ensure you are using the right tool and that you are using it correctly. (Please note: Each link shared below is an affiliate link.)

Pelvic Wand : Intimate Rose makes an amazing pelvic wand that is now available in three options: original, vibrating (great for desensitization) and hot/cold (so soothing!). While either end can be inserted in the vaginal or rectal opening, most people find the narrower end more tolerable rectally and the wider end is best for the vaginal opening. Some people do prefer to start with the narrow end in the vaginal opening and work their way to the wider end. Use JOY1 for $5 off your order.

Dilators: Intimate Rose and Soul Source both make great dilator sets in a variety of sizes. These tools are ideal for working on an all over stretch especially with scar tissue postpartum or to help decrease muscle spasm. Starting with a size that is tolerable to insert, slowly work your way up in size until you have reached the desired size (typically the size of a partner or toy you would like to use). [Work with you therapist about a specific dilator plan]

Intimate Rose : Use JOY1 for $5 off your order.

Soul Source: Use 53225 for 5% off your order.

OhNut: The OhNut is the perfect tool if deep penetration is your Achilles heel! The OhNut is super stretchy so it’s comfortable to wear and can be used on either a partner or a toy. Use the OhNut as a bumper to prevent deeper penetration and decrease the fear of going too far. Start with three rings and adjust up or down from there as needed. Use PELVICPRIDE7 for $7 off your order.

Where to find treatment in Maryland

Next on Your Reading List

Pelotons & Pelvic Floors

183:788774807 (Joy Noble) — Wed, 14 Apr 2021 14:42:32 GMT

A few weeks ago I had an opportunity to host a webinar about the effects of stationary bikes (such as a Peloton) on our pelvic floors. If you’d like to go back and watch that click here . However if you are someone who prefers to read about what we covered, then this blog post is for you!

Let’s start with a quick disclaimer: all information is intended for educational purposes only and is not intended as medical advice.

When COVID hit and the world shut down our exercise routines required a pivot . And cue the Peloton bike. In 2020, Peloton reported having 4.4 million members and with 11K reviews averaging 4.8 stars I think they are here to stay. That means a lot of people (all with pelvic floors) are loving their new routine, but that also means a lot of room for dysfunction.

The biggest pelvic floor issues that stationary bike riders report are:

Nerve entrapment:
Numbness in genitals
Erectile dysfunction
Vulvar symptoms:
Pain in the vulva and vaginal opening
Swelling in the labia
Penile symptoms:
Blood clot in the penis
Infertility
Blood in urine
Prostatitis (inflammation)
Torsion of the spermatic cord

Wait… but why?!

It all leads back to anatomy! The locations of the nerves, arteries and veins of the pelvic floor are in just the right place to be compressed on a bike seat. Quick review : nerves bring sensation and motor (movement) to the muscles and skin, arteries bring new blood/oxygen to the tissues, veins bring blood away from the tissue, lymphatic system brings other fluids out of the area.

Risk factors that research has found to lead to these issues include:

Poor bike fit and too low handlebars
Minimal position changes/staying on the seat too long
Increased body weight

Handlebars

When your handlebars are too low, your body will tilt forward at the pelvis to grip the handlebars. This anterior (forward) tilt of the pelvis causes increased pressure through the nerves, arteries, and veins of the pelvic floor.

Position Changes
Sitting on the bike seat too long keeps compression through these important structures which leads to nerve and blood flow issues. One study found that when your heart rate reaches 60-65% of your ‘Max Heart Rate’ the penile oxygen is decreased up to 84% within 20 minutes of sustained sitting. Ouch!

Body Weight
For people looking to their Peloton workouts for weight loss, this is probably one of the most frustrating risk factors. I hear this from patients frequently: “it hurts to workout, but I need to workout to lose weight so my body doesn’t hurt”. It's a vicious cycle. So take this risk factor with a grain of salt and focus on the changes you can make to relieve the compression on your pelvic floor.

How do I fix it??

Watch your posture!
Make sure your handlebars are higher than your seat so you don’t lean forward and compress the nerves, arteries, and veins.
Stand Up!
Give your pelvic floor a 30-60 second break every 10 minutes of cycling.
Your Seat Matters!
Try a wider seat to better distribute pressure and weight, wear padded shorts or try a seat cushion. Peloton even has a recommendation for a cushioned Schwinn seat for their bikes.
Cross Train!
Try running, swimming, yoga, or some of the other classes Peloton has to offer so your pelvic floor gets a break from sitting.

But what if I'm pregnant?

You are in luck! The American College of Obstetrics and Gynecologists (ACOG) recommends stationary bike riding as a form of exercise for pregnant people.

Things to keep in mind:

Stay hydrated
Do not allow yourself to overheat
You may need to stay seated in the 3rd trimester due to change in center of gravity from your growing baby
Listen to your body! You will know what is too much.

Try using the Borg Exertion Scale to monitor the intensity of your ride. ACOG recommends staying between 13 to 14 or 'somewhat hard' . You can also try the “talk test.” If you can carry on a conversation while you are exercising then you are likely not over-exerting.

Stationary bikes have been around for a long time and with their boost in popularity from COVID and Peloton they are likely not going away anytime soon. Do not be afraid of your bike, just be smart about using it.

In review:

keep your handlebars higher than your bike seat
don’t lean forward
give your pelvic floor a 30-60 second rest every 10 minutes during your ride

Tldr: if you have pain, numbness, tingling, urine leakage, swelling in your genitals from riding a stationary bike, you need to see a pelvic floor physical therapist ASAP!

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , including pelvic pain, so you are in the right place! We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

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Postpartum: When Should I See a Pelvic Floor Physical Therapist?

183:788774807 (Joy Noble) — Wed, 18 Nov 2020 22:35:30 GMT

Did you know in other countries seeing a pelvic physio (physical therapist) is the standard of care ? At that magical 6-week follow up appointment, patients are automatically sent to see a pelvic floor physical therapist to perform an assessment of their pelvic floor, low back, hips, and core musculature. During this time, we are able to discuss any significant findings (think weakness, pain, scar tissue restrictions, abnormal movement patterns) and begin a treatment plan designed to get you back to the things you love to do .

For many, this is the first time they are seeing a pelvic floor physical therapist and will be exposed to the knowledge physical therapy has to offer. Sure, we may hear about kegels all the time, but are you doing them correctly ? (hint: probably not). What about the scar tissue that occurs with tearing during a vaginal birth or as a result of delivery via c-section? Do you know what to do if you have pain from scar tissue? Some people experience issues at their pubic symphysis (front pelvic bone) or sacroiliac joint (base of the spine) which leads to pain or difficulty with movement such as walking, bending, lifting, climbing stairs, and more.

Many people just assume these issues will get better with time or even worse, that this is just what is to be expected after delivery . NOPE! While it is true your body changes during pregnancy and after delivery, many of the symptoms you may be experiencing are not “the new normal” .

If you are 6-weeks postpartum and have

pain with movement
pain with sex
pain with urination or bowel movements
leakage of any kind (pee or poop)
a heaviness in your pelvis (or feel like something is falling out)
a strong urge to go to the bathroom
pain to the touch at your scar tissue
fearful of movement (or feel broken)

then it’s time to see a pelvic floor physical therapist!

These things are common, but they are NOT normal . Many people experience the list of symptoms above, so please realize you are not alone . These are not a new part of you that just comes with having a baby – there is help available by clinical experts . Pelvic floor physical therapy can certainly help address every one of these issues.

So the short answer is: You should see a pelvic floor physical therapist around 6 weeks after delivery!

It is not uncommon that we see patients even earlier though, if they are navigating issues after delivery, have questions about their recovery, or want some help with new pains or discomforts as a result of caring for a new little one. If that is the case we see patients around 2 or 4 weeks postpartum, either in-person or via telehealth if getting out of the house is a barrier.

So what if you do not have any of these issues? Great! But maybe you are still curious to learn more about your pelvic floor and just make sure everything is working like it should . Go see a pelvic PT! Even if we only meet for one visit, this is a great time to learn a few tips and tricks to keep your pelvic floor happy , ask any questions you have, and establish a relationship with a pelvic floor physical therapist. At the very least, we are able to get a base line measure of your body and how it functions so as things start to change over the next year (and beyond) we have something to look back at and compare things to. Keep in mind your body is always changing after delivery from producing breast milk to stopping the production of breast milk, as your muscles and bones and joints start to settle into their new form, things change. If these changes cause discomfort for you or limit you from doing the things you love, you will already have a pelvic therapist you trust who can help you through this.

If you have more questions about this please feel free to reach out to me. If you need help finding a pelvic floor physical therapist near you check out this Pelvic PT Directory.

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions , including postpartum care, so you are in the right place! We are conveniently located in the Federal Hill neighborhood in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

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Why Choose a Cash-Pay Pelvic Therapist

183:788774807 (Joy Noble) — Thu, 01 Oct 2020 00:24:32 GMT

That’s a great question! I’m sure many have asked this question when running across physical therapists who decide to set up their practice as an out-of-network provider. When establishing our physical therapy practices we must decide: Will we take insurance or not? It is becoming more common in many specialties in the medical field to bypass the red tape of insurance and have our patient’s pay us directly. But I promise you, it is not a decision made purely on money. When we decide to set up our businesses as out-of-network providers we are doing this fueled by our desire to help our patients in the way that feels clinically best.

You may be asking yourself now: why wouldn’t you take insurance? Isn’t that why so many people have insurance – to use it at places like physical therapy? Sure! But not everyone has insurance and having to follow the strict (and often arbitrary) guidelines of insurance is more of a headache than it’s worth. As a consumer (or patient in this case) we always look to see what is the value? Do we get enough value from the service to be worth the money?

The big answer as to why we don’t take insurance for payment comes down to three things:

skilled one-on-one time with your therapist
Medical care decided on by your medical provider, NOT your insurance, and
transparent billing

One-on-one time with your therapist

As a provider, I have worked for a private practice as well as some big-name box PT companies - all who took insurance and all with similar underlying issues. In these models I was given 45-60 minutes to work with a patient for a new evaluation and 30-45 minutes to work with a patient for follow up treatment sessions. I also was required to double book patients and hit certain productivity (billing) requirements. In both of these scenarios - double booking and productivity requirements - the patient is not the primary focus for the company, it was about money.

When a therapist is double booked they are splitting their time and attention between two different patients. This means while they may be doing some hands-on manual therapy with one patient the other doing exercises. But are they doing them correctly? Are the right muscles engaging? Is it painful? Is it too easy? Can’t they be doing this at home without a therapist? Then from the money side, double booking allows providers to appropriately bill for two patients at the same time thus making more money than seeing one patient. As for the productivity requirements, providers are encouraged to hit those productivity numbers by adding on billable modalities (think electrical stimulation, ice, heat, etc) which do not require their attention to administer but will make the company money while the therapist is working with another patient.

With a fee-for-service or cash pay model, we are able to schedule our patients for longer sessions and devote all of our time and attention to the patient in front of us. At Pelvic Pride, we schedule our initial evaluation appointment for 75 minutes and our follow up appointments for 60 minutes. This means plenty of time to tell your story, work through all concerns, thoroughly evaluate, treat, educate, and guide you through the therapy process. We never double book and productivity requirements don’t exist.

Medical care decided on by your medical provider, NOT your insurance

Did you know that your insurance company may be involved in dictating if, when, and how long you can receive medical care. Most insurance plans have a visit limit for physical therapy services - sometimes per calendar year, other times per incident (diagnosis). Either way, this visit limitation can restrict a patient’s ability to receive care or receive care covered by insurance. For example, many Blue Cross plans come with 35 visits per calendar year, which is not enough to help someone recover from an ACL surgery, a total knee replacement, or chronic low back pain. In this case, a patient may stop therapy just shy of completion or at a crucial moment - like getting ready to return to sport. On the pelvic floor side of things, many diagnoses are not covered by insurance at all. So even though you have insurance coverage for physical therapy visits, your specific issue may be denied coverage, regardless of if the research supports pelvic floor therapy as a gold standard of care or not.

Your care should not be dictated by your insurance company - EVER. Your care should be a conversation between you and your medical providers, and that is it! Your providers are the ones sitting in the room, listening to your story, assessing your symptoms, and we are the ones who have the medical training to be able to decide what the best care is.

But what happens when your insurance company decides not to pay?

Do you realize that on Day 1 you sign a paper that states you agree to pay for any dates of service not covered by your insurance?

That’s right, you agree that anything the insurance company decides to deny, you will pick up and pay whatever amount the clinic is billing. You can be smooth sailing, going to PT and paying your copay (or coinsurance, etc) each time, and then insurance decides it’s time to stop coverage and you will get no warning. Sometimes this may be a specific code they don’t pay for, or a diagnosis code, or maybe you saw your chiropractor and PT on the same day so they only pay for one of those providers for that date. The possibilities are endless but each of these scenarios can land you with a surprise medical bill that up to this point you thought was already paid for.

So what’s the point?

Your therapy should be based on 3 things:

Skilled one-on-one time with your therapist
Medical care decided on by your medical provider, NOT your insurance, and
Transparent billing

With this model, you are empowered to be an active participant in deciding how your care looks. We will communicate our findings and what we think in clinically relevant while also taking into consideration your goals, needs, schedule, etc. So when deciding if a fee-for-service model is right for you, take some time to consider these points, gather as much information as possible, and empower yourself when choosing the right practice for you.

Where to find treatment in Maryland

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Pints & Pelvic Floors: The Introduction

183:788774807 (Joy Noble) — Sun, 06 Sep 2020 18:54:00 GMT

About two weeks ago I held the first Pints & Pelvic Floors meet-up/virtual happy hour/education session. If you would like to go back and watch it you can find that video here . In case you were not able to make it or prefer to read through what we discussed rather than watch the video, you will find the recap below. I hope you learn a few things and will join us for the next Pints & Pelvic Floors event when we will cover Polycystic Ovarian Syndrome (PCOS), Endometriosis, & Interstitial Cystitis.

Pints & Pelvic Floors: The Introduction

This is an inclusive and safe space. I will be using inclusive language throughout my talks to ensure I am speaking to everyone. If at any time you are confused as to what I am referring to please ask for clarification. If I misspeak please feel free to correct me, however I will try to be cognizant and I apologize in advance. I am continuing to learn, grow, and better myself daily.

I have seen this model for meet ups play out in a few ways but the greatest driving force for me with Pints & Pelvic Floors is to start having the conversations we wish we were having. Whether it’s:

the things we wish we knew about back in school when we got our periods
how to navigate consent and sex for pleasure
what we truly like and don’t like about sex
what to really expect when we are expecting
what treatments were available after delivering a baby
and much more

But this isn’t just for cis females – this group is for cis men too, and transgender people and non-binary people, and anyone who wants to know more about their pelvic floor. We will discuss erections, pooping, painful diagnoses and surgeries – literally anything else you want to know about. The topics are truly never ending and I hope they grow and change as this group becomes more defined. I want to bring together the talks you have with close friends, adult sex education, and evidence based information to create a better informed and self-advocating public .

By now I have probably used a term that confused some of you and you may be thinking “what’s a cis female?” Cisgender or ‘cis’ is the term used for a person whose gender identity matches their sex assigned at birth. I would identify as a cisgender female (or cisfemale for short). There is also transgender which is used by people who have a gender identity or expression that is different than the sex assigned at birth. Gender and sexual identity is a spectrum – not a binary as it is commonly referred to (female vs. male). We are not ONLY either female or male. People can identify in multiple ways including cisgender, transgender, gender nonconforming, gender non-binary, and gender queer.

So let’s start with the basics: anatomy! In each photo you will see the binary term for each structure (female or male) followed by an optional non-binary term in parenthesis to keep the language as inclusive for all as possible.

Now that you have seen images of the two typical anatomical layouts we could be born with at birth, let’s get into the aspects that pelvic floor physical therapy can help with. When it comes to physical therapy we work on the muscles, joints, bones, and other soft tissues that help connect things and keep us upright and moving. In reference to our genital and reproductive anatomy, pelvic floor physical therapy focuses on the pelvic floor muscles and their functions.

The pelvic floor muscles can be divided into the outside layer and the inside layer. All together they serve four functions:

support
sphincter
suppression
sexual response

The pelvic floor muscles lay at the bottom of the pelvic bowl and help support your urinary and reproductive organs from falling out. Failure to provide this support could lead to prolapse. The superficial muscles wrap around the urethra and rectum/anus to provide closure which prevents leakage of urine and fecal matter. The pelvic floor muscles also work with the brain and bladder to help decrease the urge or need to go to the bathroom. Lastly sexual response – having a properly functioning and strong pelvic floor can heighten your sexual response. So as if the thought of things falling out or leaking pee and poop isn’t enough, hopefully the knowledge that strong pelvic floor muscles can improve your sexual response will be enough to convince you it’s time to pay more attention to your pelvic floor and ensure it is doing its job .

Now here is where I find it imperative to address pelvic floor

Myth #1: Everyone should do Kegels.

You may think that when I say you need a functioning and strong pelvic floor this means I’m telling everyone to do Kegels. This is not the case . Not every person I work with in physical therapy needs to be stronger – some of my patients are having painful sex or leakage because their pelvic floor muscles are too tight or over engaged. This is why it’s important to recognize if you have issues with your pelvic floor: maybe you pee a little when you laugh with friends or are working out, maybe you have pain with penetrative intercourse, putting in a tampon, or with ejaculation, and maybe it’s just the constant need to pee – these things are common but not normal . If any of this describes you, or you have something else that doesn’t seem normal please see a pelvic floor physical therapist. Not every physical therapist can treat pelvic floor issues – just like you don’t want your family doctor doing open heart surgery. If you need help finding a pelvic PT near you just ask me and I’ll help out!

Myth #2: I should pee before I leave home just in case.

Nope! This actually disrupts your bladders ability to fill to a normal point before you get the urge to go. Think of it this way: if an item you want costs $500 but each time you save up $100 and spend it you will never get the satisfaction of buying that $500 item. If your bladder can hold roughly 500 mililiters of urine but you pee each time you have only 100 mililiters of urine, you never get that satisfying bladder void but you also train your bladder to think it can only hold 100 mililiters. Now you will start getting the signs to go to the bathroom sooner and you will not pee out very much.

Myth #3: Pelvic Floor issues are only for women.

See the images above of the pelvic floor. We all have pelvic floor muscles, we all have bladders and rectums, we all pee and poop. Anyone can have issues with their pelvic floor, their ability to void urine and stool, and if they are sexual, issues with their sexual health. Pelvic floor issues can happen to everyone!

Myth #4: Leakage is normal – especially after a baby or menopause.

Not true! While each of those times in a person’s life may increase the chance of it occurring, leakage is not normal. Our pelvic floor should function in such a way as to prevent leakage with exercise, laughing, coughing, jumping, and any other movements you want to make. If you are leaking urine or stool please see a pelvic PT.

Myth #5: Prolapse & abdominal separation (diastasis recti) require surgery to fix.

Again, this is false! Not all prolapse and not all abdominal separations require surgery. Both of these conditions can be considerably improved with strengthening, proper management of intra-abdominal pressure (think the way we breathe while lifting a heavy object or proper positioning and breathing during bowel movements), and increased knowledge of the condition. Before you agree to go under the knife, consult with a pelvic floor PT to determine if you can successfully achieve your goals without surgery. (My favorite example here is a patient who did not want surgery and only noticed her prolapse when she ran. She was fitted for a pessary by her GYN and only wore it when she ran. In PT we discussed ways to prevent making the prolapse worse during the rest of her day. She was able to avoid surgery because she was now able to manage her symptoms and meet her personal goals.)

Myth #6: At 6 weeks postpartum everything is fixed & you can return to normal.

Oh gosh if only this was true! While tissues are well into healing by 6 weeks, some parts may not feel fixed, and your new normal is very different from your old normal. Give yourself grace and realize each person’s birth story is different and each body is different therefore each recovery is different.

Myth #7: C-sections save you from having pelvic floor issues like leakage and prolapse.

Also not true! Having a c-section does not automatically rescue you from these issues. Pelvic floor dysfunction and prolapse have many causes – child delivery is only one of them. With a scheduled c-section and no pushing, you may have the benefit of avoiding the prolonged downward pressure onto the pelvic floor muscles that occurs with a vaginal birth. However, the pelvic floor muscles are still supporting the weight of your baby throughout your pregnancy and things can get weakened. Even if you have a c-section, you should see a pelvic PT after delivery to perform an evaluation of your low back, hips, and pelvic floor.

Myth #8: Straining to pee or have a bowel movement is normal.

Nope, not even close!! Both of these activities should occur without straining. If you struggle to start the flow of urine or completely empty your bladder you may have tightness in your pelvic floor muscles that are contributing. As for bowel movements, straining is the last thing we want. Try using a squatty potty, keeping a slight arch in your low back, and coordinating breathing out with passing stool to decrease the need to bear down or strain.

Myth #9: Having pain with sex is just part of life.

False! Sex should not be painful. Let me repeat that: sex should not be painful! No matter what your genitalia looks like you should not experience pain with penetration, pain with orgasm, pain with ejaculation, nor pain with touch. Common causes for painful sex include muscles that are too tight or guarded, scar tissue (especially at the vaginal opening), sex positions that cause deeper contact or stretching to various areas of the pelvic floor. If you have pain with sex please see a pelvic PT to address what could be causing the issue.

And there we have it: the recap of the first Pints & Pelvic Floors meetup. The big takeaway point here is know your body and know what is normal. If you think you may have any of the things we discussed above or questions about your pelvic floor get to a pelvic floor physical therapist. Don’t know where to find one? Try looking here .

If you enjoyed this information then join the Pints & Pelvic Floors Facebook Group & attend the next Pints & Pelvic Floors meet up on Wednesday October 21st @ 8pm EST on Facebook Live .

*Please be aware the above information is intended for educational purposes only and is not meant to serve as medical advice.*

Where to find treatment in Maryland

At Pelvic Pride Physical Therapy & Wellness, we specialize in the treatment of ALL pelvic floor conditions ! We are conveniently located in the Roland Park & Federal Hill neighborhoods in Baltimore MD. Fill out our contact form & our Patient Care Specialist will reach out to you ASAP!

Next on Your Reading List

Pelvic Floor Resources

183:788774807 (Joy Noble) — Mon, 10 Aug 2020 22:45:53 GMT

Hi friends! I’ve decided to share some of my favorite resources for the pelvic floor. They include books, websites, blogs, and tools to help support anything from the normal function of your bowel and bladder to the dysfunctions you may be dealing with. They also include sex and sexuality and hopefully you will find them useful. I will update this blog as I find more items that are useful in my physical therapy practice. ( Please be aware some of the links below are affiliate links. I only support companies that share common values and support all people.)

General Pelvic Health Information

Pelvic Guru (Website & Provider Tracker)

This is a great place to find a provider near you to support your needs with a focus on all things pelvic floor. The list of professionals on this site is extensive and covers anything from physicians and therapists to doulas, trainers, sex counselors, and more.

Pelvic Health & Rehab Center (Blog)

Pelvic Health & Rehab Center’s founders Stephanie Prendergast & Elizabeth Akincilar, along with their team, run a fantastic blog and cover SO many topics. Type what you are looking for into the Search Bar – I am sure they have a blog post about it.

Bodies (Podcast)

Bodies is a “feminist documentary podcast” hosted by Allison Behringer which dive into medical mysteries people are dealing with daily. Having listened to the first season and currently working on the second I can tell you I have treated patients who fit into each episode’s topic. Take a listen and see if one of the stories resonates with you. I find that the more we listen the more we hear people who sound just like us and then we don’t feel so alone.

Medicine Mama's Apothecary (Organic Skin Care)

Medicine Mama's carries a variety of organic skin care products including VMagic which helps to "replenish moisture, balance pH and rejuvenate intimate skin."

Use code JOYNOBLE for 10% off your order.

Pelvic Floor Dysfunction

Kegel Trainer PFM Exercises (App)

How many times have you heard “There’s an app for that!”? Well I am here to tell you there is an app to remind you to do your Kegels. This app lets you set reminders as well as customize the cues you will receive. Get the paid version to be able to customize your pelvic floor exercises. I find the free version is a great start to establishing a habit of doing Kegel exercises.

Heal Pelvic Pain by Amy Stein (Book)

This is the first book I ever read about pelvic floor dysfunction. Amy Stein provides a comprehensive approach to helping your pelvic pain symptoms through stretching, relaxation, massage and nutrition.

Pelvic Pain Explained: What You Need to Know by Stephanie Prendergast & Elizabeth Akincilar (Book)

From Pelvic Health & Rehab Center, Stephanie and Elizabeth have written a book that is easy for patients to understand while still providing excellent information to therapists. This book covers just about everything and provides patient stories throughout. I find myself oftentimes pointing patients in the direction of this book and referencing a specific testimonial I think may resonate with them.

The Interstitial Cystitis Solution by Nicole Cozean & Jesse Cozean (Book)

This book provides a comprehensive approach to helping patients treat their IC symptoms. By utilizing a holistic and multi-disciplinary approach, Nicole & Jesse have provided the best standard of care for patients with IC including physical therapy, diet and lifestyle, medication, and more.

Soul Source Dilators (Tools)

This is my go-to for pelvic floor dilators for my patients who are following a dilator protocol for post operative vaginoplasty. They have an awesome selection of products for your pelvic floor needs. Use code 53225 for 5% off your order.

Soul Source | Amazon

Intimate Rose Dilators & Wands (Tools)

Intimate Rose has amazing quality dilators that you can buy in sets or individually. I also love their wand for trigger point release which can be used either vaginally or rectally. Intimate Rose also offers vaginal weights and a list of other products for your pelvic floor. Use code JOY1 for $ 5 off your order.

Squatty Potty (Tool)

With a slogan of “The #1 way to #2” what else is there to know? This genius reworking of a step stool provides you the ability to obtain a squatted position while seated on the toilet. This allows your pelvic floor muscles to obtain the optimum position for having a bowel movement. Whether you suffer from constipation or not, a squatty potty is an excellent tool to have in each bathroom!

Squatty Potty | Amazon

Menstruation

Period Tracker (App)

This is one of those apps I am so glad I have and use in the most bizarre times like when the doctor’s office asks “what was the start date of your last cycle?” How the heck am I supposed to know! This app is perfect for tracking your cycle as well as when you are intimate and any symptoms you are having day to day. I often find myself relating some of my patient’s symptoms back to their menstrual cycles. With Period Tacker! you can track your cycle, intamcy, mood, and any symptoms you are trying to keep track of in one convenient place.

DivaCup (Tool)

This has seriously changed by period experience. As someone who has a heavier flow, I have absolutely loved using my DivaCup and have not had to buy tampons in over two years. It takes some getting used to but I promise this was only about two or three days when I first got it. Now, once it is in place I forget it’s even there. I am able to travel, work a 12 hour day, or sleep through the night without worrying about leaks. I highly recommend a menstrual cup!

DivaCup | Amazon

Thinx (Tool)

Oh Thinx, where to even begin! These have been a serious life saver. I have worn my Thinx for a busy work day when I don’t have time to stop and worry about my period. I have worn them on a long day of flying, during workouts, through the night, and so much more. Thinx are an amazing alternative to our standard period products and just like with my Diva Cup and tampons – I have not bought pads in over two years. While at first they may seem bulky, I swear you totally forget about them. The pairs I have are first generation and the felt similar to a bathing suit bottom but once I got moving I didn’t even notice. Since then, the technology has improved. The best part about Thinx for me is that they are made for everyone! Women are not the only ones who menstruate and Thinx gets that.

Sex & Intimacy

Savage Lovecast (Podcast)

Dan Savage is an author and sex-advice columnist runs the Savage Lovecast – a podcast about all things sex. He covers everything from relationship advice to monogomy, kink, gay rights, consent, and literally SO SO much more. This is truly a great podcast to open your heart and mind to new ways of thinking, dip your toe into worlds you may not know much about, and maybe find the words to advocate for things you want in the bedroom.

Slippery Stuff Lubrication (Tool)

This is the lubrication I use in clinic and highly recommend to patients. It is water based, safe, does not stain, and is free from scents or flavors to help decrease adverse reaction.

Slippery Stuff | Amazon

Go Love CBD Lubricant

The CBD in this lubrication is great for those who would benefit from its calming effects for pelvic floor muscle relaxation.

Use code PELVICPRIDE for 10% off your order.

Eva II (Tool)

The Eva II vibrator is perfect for partnered sex! It fits in the vulva and provides clitoral stimulation to the wearer during penetrative sex. This is ideal for the 75% of people who are unable to orgasm without the help of hands or toys during intercourse. Use code JOYNOBLE for 10% off your order.

OhNut (Tool)

Another fantastic tool for painful sex! The OhNut is a modular ring set that slides onto the penis or dildo to decrease the depth of penetration during sex. This is ideal for people suffering from painful sex during deeper penetration. The OhNut allows you to explore more positions with the peace of mind that penetration will not be too deep while still allow pleasure for all partners involved. Use code PELVICPRIDE7 for $7 off your order.

Resources for Puberty, Sexual Health, and Relationships for those under 18

It’s Perfectly Normal by Robie H Harris & Michael Emberley

Wait, What? A Comic Book Guide to Relationships, Bodies, and Growing Up by Heather Corinna, Isabella Rotman & Luke Howard

Sex is a Funny Word by Cory Silverberg & Fiona Smyth

@sexpositive_families on Instagram

I hope you find these resources helpful. Please feel free to reach out if you have any specific questions or don’t see something listed here but need a recommendation. The above post does contain affiliate link - let me know if you have any questions.

Where to find treatment in Maryland

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Welcome to Pints & Pelvic Floors

183:788774807 (Joy Noble) — Thu, 23 Jul 2020 14:22:55 GMT

Alright friends, let’s talk about the fun stuff …. SEX education! Remember that class back in high school? Maybe you got separated by ‘girls’ and ‘boys’ ( what a terrible concept! ) and if you grew up in the South like I did, it was abstinence-only education. [Because that’s effective *she says sarcastically*] Putting aside unwanted pregnancy (seemingly the only goal of sex-ed), we must consider the importance of learning about sexually transmitted infections, obtaining consent, sexual pleasure, differences in sexual orientation and gender expressions, our normal body changes and how to identify abnormal changes, and so much more. I could literally go on and on about the information I get to educate patients on daily. I could tell you all about the common misconceptions we have about our bodies when it comes to the anatomy and function of our pelvic floors (i.e.

"leaking pee after having a baby is normal" – its not!

"sex hurts for some people" – not normal!

"starting my urine stream takes a while" – it shouldn’t!

and so on...

If I went into all of it here that would totally take away the whole reason I am writing this post. With so many common misconceptions and a plethora of professions who can help educate us, let’s grab a pint (or glass of wine, a soda, some water, truly whatever makes your little heart happy) and join me for Pints & Pelvic Floors .

The goal of this gathering is to bring a new topic to the table to discuss each month. I will ask for your input on topics you want to know more about as well as people and professions you want to hear more from. We will start this thing virtually (thanks COVID) but will hopefully find a home bar or brewery to host each time (or possibly it will be rotating – who knows!). I will lead the conversation with evidence-based information supported by professionals that address physical, mental, and social health . I would love for this to be interactive and will open it up for Q&A at the end, but questions will be encouraged throughout. Keep in mind there are no stupid questions and chances are if you are thinking it someone else probably is too. You can always email questions ahead of time if you wish to remain anonymous. This is to be a safe space for all gender expressions, sexual identities, races, education levels, etc. So don’t be an asshole – you will be banned from participating .

Logistics: I will announce the topic ahead of time to allow you to send in your questions. We will meet via Facebook Live at 8pm EST for approximately an hour. The more questions you ask the more we will discuss, we will try to cap it at 2 hours.

Join the Facebook group for updates, to submit questions, to vote on dates and times, and other discussions, as necessary. If you are a professional and would like to host a chat or join in on a topic please reach out to me at joy@pelvicpride.com with the subject line Pints & Pelvic Floors.

UPDATE 1/21/2024: Pints & Pelvic Floors has pivoted its format to a podcast ( check it out here ). You can still join the Facebook page to ask questions or email me with questions or episode ideas.

Where to find treatment in Maryland

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Dry Needling FAQs

183:788774807 (Joy Noble) — Mon, 06 Jul 2020 12:22:09 GMT

Currently dry needling by a physical therapist is allowed in over 39 states + DC! It is the hope of numerous physical therapists (and patients) that all states allow PTs to provide dry needling services in the near future. Along with the list of conditions that dry needling can help with, comes a list of questions from patients. Below are the top 10 frequently asked questions about dry needling that are asked by our patients.

#1: Is it the same thing as acupuncture?

NO! On the surface it may look the same but it is certainly different. (Disclaimer: I am a physical therapist trained in Dry Needling (DN), not an acupuncturist) .

With DN our goal is to decrease pain and improve muscle function . We achieve this by isolating trigger points in the muscle, introduce a needle to this spot to ideally create a twitch response and release the trigger point. This will help to decrease pain as the muscle in and around trigger points is found to be more acidic which muscles and nerves don’t like. With needling we achieve increased blood flow/oxygen which helps promote healing and decreases acidity in the area. Releasing trigger points in this manner can also result in better muscle activation. .

Typically, acupuncture is classified as Eastern medicine that is said to work through placing needles along specific meridians to restore the Qi or energy flow.

#2: Does it hurt?

Can I go with the stereotype of “it depends on your pain tolerance” ? If you are educated on expectations beforehand it is very tolerable, but I am going to break this down further for you as there are a few parts to this question.

Part one: Insertion - The needle is very fine (the standard thickness is 0.30mm) and it is housed inside a small guide tube similar to a thick straw. This guide tube will be placed on your skin so ideally you will feel the blunt tube more than the quick prick of the needle. Often times, patients do not feel the needle go in at all.

Part two: The actual needling - This is normally the most uncomfortable part, but that is due to the twitch response. I always warn my patients they may feel a pretty intense twitch depending on the size and sensitivity of their trigger points. This may be “painful” because it is startling the first time you feel it, but once patients get used to it they often remark that it’s truly not as bad as they thought.

The things to remember while you are being needled:

keep taking nice, full breaths
feel free to give us feedback of what you are feeling and where you are feeling it
you are in control the whole time - you can stay stop, you can tell us slow down or pause if you need to breathe throughout

While we are highly skilled professionals, occasionally we may hit a small artery or even a nerve. I promise we palpate like crazy to avoid these before we start needling you!! But if we needle either of these, you may feel more discomfort. Again, keep giving us feedback because it helps us realize when we may have hit one of these two structures.

Part three: The aftermath - you will feel like you had a good workout the day of and the day after. Normally the areas we needle are a little tender afterwards. Use ice or heat for 10 minutes at a time to help reduce this soreness.

#3: Are there risks involved?

We touched on this a little bit yesterday, but yes, as with all interventions there are risks. For dry needling, we have a few we will discuss:

The most minor risk is that we hit an artery or vein resulting in bleeding that stops in just a few seconds. We may also hit a nerve which results in the feeling of numbness and tingling shooting from the spot we are needling, but will resolve when the needle is moved from the area and no longer contacting the nerve.
Infection is another very unlikely risk as your therapist should use a sterile technique. A study was performed on patients administering their diabetic insulin injections through clothing and the incidence of infection was less than 2%. With dry needling we are making it safer by needling directly into skin - never through clothing and using sterile needles with gloved hands.
Probably the most serious but again unlikely risk is a pneumothorax. This occurs if the therapist happens to puncture your lung with the needle they are using. This brings me back to we spend A LOT of time palpating to make sure we are in the safe zone and will not hit your lungs. If you do experience shortness of breath after needling in the shoulder or trunk it is advised you seek immediate medical attention to determine if you are experiencing a pneumothorax. (From the instructors during my training it has been advised that you would have to hit the lung multiple times to cause this much damage and while a patient should still go to the ER you will likely only be held overnight if your lung has collapsed more than 50% - the point is this is VERY rare). With these things in mind, you should feel fully educated before consenting to dry needling and have confidence in your therapist that is needling you. If you do not feel comfortable with them performing this procedure, then please do not go through with it. In my experience the benefits are great while the risks are minimal. We are board certified, licensed professionals with certifications to perform this technique - we take all steps possible to minimize the risks while treating any patient!

#4: How long do the needles stay inserted?

For normal trigger point needling, the needle is not placed in the area for long - typically 10-12 passes of the needle through the muscle before it starts to dull and the needle is less effective. So let’s clarify - the needle is “tapped” into the body going through the skin, fascia, and into the muscle. We keep the needle in the muscle layer and piston the needle in this layer to release the trigger point. These 10-12 passes are not the needle coming out and going back into the skin 10-12 times. However, we may try a few passes in the area we have isolated the trigger point and need to back the needle up a little and redirect. You will not feel anything with this, but it may take a few seconds longer. I rarely have one needle in for more than 30 seconds. This is very different for scar tissue which we will address in a few days.

#5: Can you needle a nerve or a joint?

The short answer is NO. There is one school of thought that discusses needling nerves, but more often than not the institutions that we receive our Dry Needling Certifications through do not endorse needling nerves . This is due to the pain involved and the ability to easily irritate this area and cause more pain than when we started. As for the joint, this is not a contractile structure and no part of the joint should be needled. The muscles around the joint can be needled and often times provide a feeling of relief in the joint, but we are not sticking a needle into the joint.

#6: Can you needle my scar?

Yes, scar tissue can be needled. Scar tissue can impede the normal movement of skin, fascia, muscles, and even organs (if they are involved in the scar tissue i.e. uterus with C-section). Think reaching overhead and feeling a pull in your low belly with that C-section scar; or sitting in a chair and feeling a pull in the scar on your knee.

There are methods of needling scar tissue that involve inserting needles around the scar then twisting the needles to cause the scar tissue fibers to wrap around it to allow for mobilization of the tissue. Once these needles are placed we may leave them in place a little while, twisting a little more every few minutes. We can even get them in place and then provide a manual stretch to the skin around the needles to help encourage movement in all directions.

#7: Will I be able to resume normal activity afterwards?

Absolutely! We highly encourage movement after needling! Drink plenty of water, stretch the needled muscles, and keep them moving to decrease the soreness and to improve their firing pattern. Remember that trigger points can cause movement dysfunction. Once we have released the restrictions and the muscles are moving better, we want to reinforce this new happy and appropriate movement pattern . Keep you activities within reason though, I would not necessarily advise running 6 miles or going to the gym to lift a lot of heavy weights right after. Make sure to ask your physical therapist any questions you have about what you can and should do after dry needling.

#8: What kind of training does it take to be able to Dry Needle?

This varies largely by state and program, but in general it takes from 40-100 hours of training followed by a written and practical examination to obtain certification . During these courses, we receive a very thorough review of the anatomy, study referral pain patterns that common trigger points can create, and learn the appropriate methods to provide needling services to our patients. This includes isolating the trigger points via palpation, finding the best hand positioning to safely administer the needle for treatment, and ensuring we are not going to hit major nerves, arteries, veins, or the lungs. When we attend these courses we are both the therapist and the patient and have been needled in every muscle we will needle you in. Most commonly, therapists who are certified will carry the designation Certification of Dry Needling (CDN) or Certified Manual Trigger Point Therapist (CMTPT).

#9: Is Dry Needling available in all 50 states & Washington, DC?

NO! Unfortunately Physical Therapists are not able to perform dry needling everywhere. According to the most recent information from the American Physical Therapy Association there are 34 states allowed to Dry Needle, 7 states that are prohibited: California, Florida, Hawaii, Oregon, New Jersey, New York, Washington; and 9 states where the laws are silent on physical therapists performing dry needling: Connecticut, Indiana, Massachusetts, Michigan, Minnesota, Missouri, Oklahoma, Pennsylvania, Wisconsin. There is currently legislation in many of these states working to change these decisions and allow dry needling. Take a look into your home state if you are in one of the states that cannot dry needle to see how you can help!

#10: Will insurance pay for Dry Needling?

Maybe. As of 2020, CMS (part of the Department of Health and Human Services) added Dry Needling CPT codes (medical codes that are used to report medical procedures and services to entities such as health insurance companies) which separates dry needling out as its own billable code. In current practice, I have not seen many insurances that will pay for the new Dry Needling codes however this does not mean they aren’t out there. Along with the addition of these codes, many PT practices are charging additional fees to be dry needled in clinic . These fees can range anywhere from $30-$50 each visit to be dry needled (and in some places this is on top of your copay or co-insurance if you have one.) With these new changes the price of dry needling from an insurance based practice and a private pay practice can be similar. This makes seeing a private practice PT more advantageous as you will get one-on-one skilled care directly from a therapist and do not have to share your time with another patient or work with a rehab tech.

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Diastasis Recti: How to Heal Your Abdominal Separation

Thu, 28 May 2020 18:57:14 GMT

Let’s talk about Diastasis Recti (aka abdominal separation) and ways to safely heal your abdominal separation at home without an expensive gym or major surgery!

First off, you might be thinking "diastasis what?!" You aren't alone in that feeling - many people who are told they may have an abdominal separation think the same thing.

Diastasis Recti Abdominis (DRA) is the separation of the two rectus abdominal muscles (six pack ab muscles) along the middle of the abdominal wall. This occurs when the abdominal muscles are stretched in the middle at the linea alba (a connective structure for each layer of the abdominal muscles to attach to). The linea alba serves to provide structure and stability to the abdominal wall and trunk through its attachment of abdominal muscles.

It is common for pregnant folx to experience an abdominal separation - in fact, a recent cross-sectional study found the prevalence of DRA to be 57% . (1) However, abdominal separation can also occur without pregnancy, in men and even in infants.

As seen in the graphic below, this separation can happen anywhere along the abdominal muscles/linea alba. Typically it will decrease with time and safe, appropriate exercises but occasionally it will require surgery to put these muscles back together in the middle.

While the research behind defining a DRA is always evolving, in clinic it is still commonly defined by distance between the two rectus abdominis muscles and the depth of the gap between these two muscles. There is a variety of measurements for this gap found in literature, with the most common separation distance being greater than 2 cm . (2) It is best practice to have a clinician check you for a diastasis recti prior to beginning an exercise routine.

Once you have been cleared to return to exercise, it is time to start thinking about what kind of movements you will be doing. If you have a new baby this means a lot of lifting. Managing intra-abdominal pressure (pressure in your abdomen/belly) with movement is very important!

The graphic below helps to show that the diaphragm makes the top or ceiling, the abdominal muscles create the walls to the abdomen, and the pelvic muscles create the floor to contain all of our abdominal contents. As we breathe in, the diaphragm will lower down increasing the pressure in the belly.

We need to be able to safely manage this pressure without it pushing against our weak spot - our Diastasis Recti. Our recommendation: start with diaphragmatic breathing (Exercise #1 below). Each exercise after that will build on this diaphragmatic breathing to help increase abdominal muscle strength and decrease your abdominal separation .

Don't forget this is just the start. From here exercises will need to be progressed into sitting and standing as these are our most functional positions. We must be able to manage our intra-abdominal pressure and engage our abdominal muscles in standing and walking to return to full function and heal our abdominal separation.

For more information or to see videos of these exercises check out Pelvic Pride on Instagram .

Please keep in mind it is always best to seek clearance from your OBGYN that you can safely resume exercise. This information is not intended to diagnose or treat and is for educational purposes only. If you have questions about any of these exercises please consult your healthcare professional. If you

need help finding one in your area please reach out to us!

Kaufmann, R.L., Reiner, C.S., Dietz, U.A. et al. Normal width of the linea alba, prevalence, and risk factors for diastasis recti abdominis in adults, a cross-sectional study. Hernia 26, 609–618 (2022). https://doi.org/10.1007/s10029-021-02493-7
Qu E, Wu J, Zhang M, Wu L, Zhang T, Xu J, Zhang X. The ultrasound diagnostic criteria for diastasis recti and its correlation with pelvic floor dysfunction in early postpartum women. Quant Imaging Med Surg. 2021 Feb;11(2):706-713. doi: 10.21037/qims-20-596. PMID: 33532270; PMCID: PMC7779936.

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