Physical Therapy Can Stop Bedwetting!

Did you know that physical therapy can stop your child’s bedwetting?

We are expert bladder and bowel pelvic physical therapists right here in Grand Rapids, Michigan and we can help you and your child stop bedwetting.

At Purple Mountain Physical Therapy, here in Grand Rapids, Michigan, we specialize in pelvic health physical therapy and this includes pediatric pelvic health.  We know that kiddos and parents often feel stress when it comes to sleep-overs, the daily changing of sheets, the embarrassment your child may experience, the shame that a child might express.  We are here to help you and your family stop bedwetting by delivering you high quality physical therapy that works!  We want you and your child to have less stress around bedwetting by offering research backed and compassionate pelvic health physical therapy that improves your child’s bladder and bowel control, both daytime and nightime.

Is Bedwetting Normal?

Bedwetting is common and is reported in 16-20% of children up to age 6. After age 6, children do begin to age out of bedwetting, but in some cases issues can persist for years; even into adulthood.  Is there anything that can be done to stop bedwetting?  Yes!  Pediatric bladder & bowel physical therapy can help.

Common does not mean normal.

A typically developing urinary system should hit certain milestones:

~3 months: voiding occurs hourly and is not controlled

1-2 years old: awareness of bladder sensation and control of bladder begins

3 years old: voluntary control of periurethral striated muscles. This means that at this age the child’s muscle tissue and nervous system is ready for continence (toilet training).

4 years old: daytime and nighttime dryness achieved.

Bedwetting beyond age 4 is never normal. If you want to stop bedwetting, you should work with a physical therapist to help your child. In fact, the guidelines dictate this should be provided to your child!

We suggest if your child has this, that you look for a pediatric pelvic health physical therapist who can help you identify contributions to your child’s bedwetting.  We will assess and treat your child holistically to identify what are things that can be addressed to improve the bedwetting.  For example, parents are often surprised, for example, that bedwetting can indicate that your child is suffering from chronic constipation. And if we can improve your child’s bowel habits, then their nighttime wetting can improve.  Because physical therapy can stop bedwetting, our parents usually report to us that the entire household is less stressed!

The International Children’s Continence Society (ICCS) recommends active treatment for bedwetting beyond age 6.

“Treatment is not only justified but mandatory.”  – ICCS Standardization document 2010

The psychological stress that bedwetting causes in a child is well documented.  Beyond age 6, children are reaching the age where they feel different from their peers if they are bedwetting and bedwetting may impact their comfort participating in age appropriate activities, like sleepovers! Bedwetting places unnecessary stress on a child and there is safe effective physical therapy treatment available to help stop bedwetting.

Let’s Repeat The Guideline, in case we haven’t been clear:  Treatment is mandatory for pediatric bedwetting!  And here we are ready to help you and your child stop bedwetting!

Is bedwetting hereditary?

Research does support that a parent who wet the bed is more likely to have a child who wets the bed.  However, we also have research to support that constipation may be the common cause for both the parent and child who both experience pediatric bedwetting.   We know that what is passed on is likely a tendency toward constipation and a bladder that is sensitive to a stretched rectum.

The most common cause of bedwetting is constipation.

A full rectum will squish the bladder and can limit bladder capacity. This can cause the bladder to empty involuntarily when the child is sleeping at night or during the day.

If you, as a parent, wet the bed until 6, 8, 12 years or older, it does not mean that your child will have to do the same! Treating the underlying constipation can cure bedwetting.  As pediatric bladder & bowel physical therapists we know that many parents think that their child is not constipated.  However, when we partner with you to discover and monitor your child’s bowel movement habits, kids and parents find it enlightening to realize that the bowels are not actually functioning as well as they thought.

How can physical therapy help?  We will address constipation & also daytime bladder habits!

The first step in you and your child’s physical therapy journey will be to have an evaluation.  We work closely with parents and children to create a safe and trusting partnership, so that you and your child feel supported, well cared for and hopeful to experience improvements.  Our approach with children is positive, encouraging and rewarding.  We celebrate your child’s success and intentionally motivate your child to achive the goals we create together.  The evaluation will include a discussion regarding your child’s bladder and bowel habits, developmental milestones, diet and other questions.  These things all help us to help you and your child.

Certainly, we will be addressing bedwetting by treating any underlying constipation.  We do not prescribe medications.  Instead, we provide you and your child clear at-home methods to improve constipation while also giving you and your child effective, therapeutic treatment in our clinc.  We provide gentle, hands-on manual therapy to help promote intestinal mobility.  Additionally, we practice with your child effective toileting strategies, which includes not holding in your poop and listening to your body and knowing when to go to the toilet.  In nearly all cases, when constipation is adequately addressed, we can stop bedwetting.  This is because physical therapy works! And we are specifically trained in pediatric bowel & bladder developmental stages and how to treat problems with these.  At Purple Mountain PT, we also can partner with your child’s healthcare team to effectively treat constipation problem, if present.  We will advise you and develop a plan to implement a variety of interventions that have been shown in clinical studies to be important physical therapy treatment components to stop bedwetting.  Our treatment includes behavior modifications, dietary recommendations, pelvic floor retraining through exercises and gentle guidance, manual therapy (external only), and exercise to strengthen the core and hip musculature.

Physical Therapy Pelvic floor muscle re-training to help stop bedwetting.

The pelvic floor is responsible for holding pee and poop in and letting it out. Sometimes when children have developed bedwetting, constipation or urinary problems (such as incontinence, frequency, urgency or holding their pee too long), the pelvic floor muscles get confused and need to be retrained. This means that when the pelvic floor needs to relax in order to empty the bladder or the bowel, it may not be relaxing fully. It also may not be engaging well during the day if your child is experiencing daytime bladder or bowel leaks.

For children, pelvic floor retraining is focused on external treatment so they can learn to tune back into their body and build awareness of the pelvic floor musculature.  We use positive and effective methods to help your child learn the movement patterns and techniques needed to control the bowel and bladder, both for holding things in and for letting things go.

Manual therapy (external only) can be effective to help stop bedwetting and pediatric bladder & bowel problems!

We partner with parents to provide your child therapeutic and effective treatments.  Physical therapy can stop bedwetting and, in doing so, also can improve your child’s self esteem and resolve shame and embarrassment.  Sometimes our treatment includes gentle, hands-on treatments that are directed to your child’s spine, abdomen, pelvis or legs.  To be clear, all treatment for a child is external and gentle.   For example, when stool gets backed up in the rectum it is very common that peristalsis (the coordinated contractions of smooth muscle in your large intestine) gets disrupted. Manual therapy to the abdomen, lower back, and hips can help restore optimal digestion and improve posture to reduce constipation and also calm down an overactive bladder.  We also use exercise that are fun and developmentally appropriate to promote posture, breathing mechanics, and mobility of abdominal tissue and the hips/pelvis.

Children with constipation commonly have weakness in their hips and core musculature that is contributing to their voiding difficulties.

At Purple Mountain Physical therapy we develop individualized exercise programs that address your child’s specific deficits in a  fun and engaging way so that their bedwetting can stop and their bladder and bowel control during the daytime can be optimized, as well!

Behavior modifications that can help stop bedwetting!

In physical therapy, we may work on addressing behavior modifications, such as toileting behaviors.  It is common that we find kiddos who don’t like to use the toilet.  Or sit on the toilet and hold their breath and strain incorrectly.  We are experts at identifying and coaching you and your child for how to effectively gain control of your bowel and bladder so bedwetting can stop and urinary frequency, urgency and incontinence can also resolve.  Here is a link to a booklet about pediatric bedwetting that may be helpful for families to use at home

The Rectum is Important to Optimize to Stop Bedwetting and our physical therapy will help you and your child know how to improve this!

The rectum (the last part of your intestine before the anus) is a sensing organ. When it is functioning normally, it will communicate to the nervous system as it fills and give appropriate sensations to go to the bathroom. When the rectum has been stretched, as in a child who is chronically constipated, the rectum switches from a sensing organ to a storage organ. That means that the delicate signal system from the rectum to the brain has been disrupted. To allow this communication system to heal, we often recommend a bowel program to give your child an opportunity to empty their bowels on a regular basis.

What’s Your Child’s Toileting Frequency?  Our physical therapy will optimize daytime bladder and bowel function in order to stop bedwetting!

We help you and your child become aware of how often they urinate and have a bowel movement and what is normal/optimal.  We address toileting frequency and coach you and your child on how to either increase how often you urinate (if your child holds urine too long) or lengthen times between urinations (if your child urinates too frequently).  Improving daytime urination habits and getting them optimized is crucial to stopping bedwetting.  This is why physical therapy can help!  We address all the things that are playing into your child’s bedwetting.

What’s your child’s toileting postures?  Techniques?  Breathing habits? Pelvic Floor engagment?

Together with the parent, we will likely also assess how your child physically sits on the toilet. We love a stool or squatty potty to help fully empty the rectum. When your child is sitting on the toilet they should be able to sit with their feet slightly wider than hip distance and planted firmly on a flat surface. Their trunk should be upright with hips hinged forward, so that their arms can rest comfortably on their lap. This posture promotes pelvic floor relaxation and complete emptying of the rectum.

A slumped posture can make it more difficult to poop as well! When your child slouches on the toilet, it puts the pelvic floor in a shortened position which may also make it more difficult to have a complete bowel movement.

Does Your Child Strain? Physical therapy can help this in order to stop bedwetting!

Many children try to strain when sitting on the toilet. If you notice your child’s face is turning red or they are holding their breath while attempting to poop, it is likely that their pelvic floor is not functioning optimally. This may actually be making it more difficult for them to have a healthy bowel movement. Having your child attempt to blow up a balloon, blow into a straw, or blow a pinwheel while toileting is a simple way to try to help their pelvic floor work more effectively.

Would Your Child Benefit from Playing an online Game while on the toilet?  Probably not!  It won’t help stop bedwetting and, in fact, is not advised in a physical therapy program.

We know that some kiddos just don’t like to use the toilet!  They avoid it!  The household gets stressed and the parent comes up with a reward system to entice the child to get on the toilet.  Quite often parents give rewars, such as you can play an online game when you are sitting on the toilet.   We’re parents, we get it that  you need to use what works for your kiddo.  However, to have an effective bowel movement, your child needs to learn to tune into their body.  They need to be able to know what it should feel like.  Our physical therapy program for your child may include effective treatments to help your child learn how to listen to their body, so they can actually feel when they should go to the toilet to urinate or have a bowel movement.  We have found that it takes time and repetition for your child to tune into their body. Unfortunately, if they are distracted by a video or game, then this learning simply is not happening.  And, sorry parents, but if you read your phone during your own toileting habits, that is not recommended for the same reasons:  you need to tune into your body and relax, too!

How long should I have my child sit on the toilet?

A potty try should be about 5 minutes. Sometimes it can take that long for the muscles of the pelvic floor to fully relax and let down, which is needed for a poop! However, sitting for too long can lead to straining and negative associations with toileting.

To stop bedwetting, positivity helps!  Our physical therapy works to stop bedwetting, to improve daytime continence and to boost self esteem!

One key to our success with your child is we reward your child and help them to feel motivated to have success!  We love to see a child proud of themselves and we work to stop your bedwetting so you can come back to us to report your success!

We always recommend making bathroom time as positive and enjoyable of an experience as possible. If your child has developed an aversion to the toilet, we may work on progressively increasing comfort and tolerance to the bathroom and the toilet to reduce resistance.

How can I reward my child?

If a reward is used for toileting, we always recommend it happens AFTER an ATTEMPT for a bowel movement. We emphasize attempt because your child may have very little control over whether or not they actually evacuate stool during a potty try, but if they are completing the correct behaviors (detailed above) they are doing everything in their power to be successful on the toilet. That deserves some major kudos!

Dietary suggestions to help stop bedwetting.

Fiber is a major factor in determining stool form and has a huge impact on constipation problems!

95% of Americans do not get enough fiber in their diet.

What is fiber anyway?

Fiber is the part of food that does not digest to create energy. Foods that are high in fiber usually have a lot of crunch or texture to them. Examples of foods high in fiber include: pears, apples, broccoli, carrots, avocado, kale, lentils, and much more!

Low fiber foods are usually highly processed and/or smooth in texture. Examples of low fiber foods include: cheese, candy, white bread, pasta (if not whole grain)

Fiber recommendations for children can vary based on who is giving the recommendations:

  • Upto age five, generally 10-15 grams of fiber/day is recommended.

  • After 10 years old children should be consuming fiber at adult levels, 25-35 grams/day (Williams 1995)

  • 14 g of fiber for every 1000 calories eaten (American Heart Association)

  • Age 1-3: 19 grams; Age 4-8 25 grams; Age 9+ 30 grams (Institute of Medicine)

  • Do you see how confusing this can be?  The range for kids is anywhere from 10 grams/day upto 35 grams/day!  The bottom line is that you can look at your child’s stool consistency and see whether they may be getting too little fiber (which is commonly the problem).

Stool form can be one indicator of whether or not your child has the correct amount of fiber and water in their diet.  However, stool form by itself does not determine if your child is constipoated.  A stool the shape of a banana is generally optimal and easy to pass.  Small or large balls are generally not great.  A child can have the optimal stool shape (banana) but still not be fully emptying their rectum, so it gets complicated to know what is going on.  This is why a pediatric bowel and bladder physical therapist is a good partner for your family to deliver your results that can help stop your child’s bedwetting.

Fluid Intake

Appropriate water intake is essential for health of your child’s bladder and bowel function. Limiting water will not reduce bedwetting or daytime incontinence and in fact can make the situation worse. Maintaining adequate hydration promotes better bowel function and reduces constipation which will help reduce stress on the bladder and reduce bladder leaks.

A good benchmark for water intake is about half of your child’s body weight in ounces.

For example: a child who weighs 46 pounds should drink about 23 ounces of water per day.

However, fluid requirements vary a lot based on your child’s activity level. If they are very active and sweating, they will likely need more water.

A good indicator of adequate hydration is their urine color. A well hydrated kiddo should have urine that is very pale yellow to clear.

What if my child won’t drink water?  Does it all have to be water?

Water is the most ideal source of hydration for kids (and adults!).  For some children there can be a clear correlation between what type of fluid they drank and their bladder function. Watch for trends. Does your child drink apple juice, for example, and then have to urinate frequently?  Or does the bedwetting worsen?  Some other liquids such as milk or highly acidic drinks can be irritating to the bladder and increase the likelihood of urinary dysfunction, including pediatric urgency, incontinence, and bedwetting. Drinks that are high in calories, like sodas, also deliver more calories with very little fiber which can make constipation worse.

For kids who don’t like water, putting a splash of juice in with their water or putting some cut strawberries or lemon in their water can make drinking a little more fun and flavorful without adding too much of the bladder irritants.

The Bottom Line regarding how to stop bedwetting:

Bedwetting is common, but not normal and has known psychological stress on your child and your household.   Bedwetting is often driven by constipation and improper daytime habits for the bladder.  As pediatric pelvic physical therapists, we know how to effectively and positively help your child to learn how to use their bladder and bowel optimally.  We also know how to teach a parent to support your child.  This isn’t easy to overcome, but our expert care brings clarity to a puzzling situation.  Constipation and bedwetting are multifactorial and individualized care is necessary, which is why we take the time to learn about your child’s daytime and nightime bladder and bowel habits. If you are interested in learning more about our pediatric physical therapy to help stop bedwetting, contact us today and we can begin with an evaluation.  Our doctors of physical therapy promise to give you our best!

Peace,

Dr. Maureen O’Keefe, DPT and the Purple Mountain Physical Therapy Team

Bladder Physical Therapy Near Grand Rapids

If you are looking for Bladder Physical Therapy near Grand Rapids and would like the best care available, you have found the right place.

Our patients travel from all over Michigan and surrounding states to receive their treatment with us because we have been doing this for years and our comprehensive and advanced treatment methods work.

Some people call us Pelvic Floor Physical Therapists

Other people call us Pelvic Health Physical Therapists

We may be called Bladder Physical Therapists

We could be called a Pelvic Physical Therapist

Sometimes we are called a Women’s Health Physical Therapist

Other times we call ourselves Specialists in Pelvic Floor Dysfunction

All of these labels simply let you know that we are Doctors of Physical Therapy who have completed advanced post-doctoral training specific to pelvic health, which involves bladder, bowel, intimacy, pain and prolapse related issues.

At Purple Mountain PT because we specialize in bladder physical therapy right here in Grand Rapids and offer difficult-to-find expertise and treatment methods to help your bladder.   As pelvic health physical therapy specialists, we have knowledge about all the areas of the body.  This is because the pelvic floor, bladder and bowel have connections to the hips, spine, thighs, calves and feet, shoulder blades, diaphragm, rib cage and thoracic spine.  Therefore, a bladder physical therapist is truly an expertly trained orthopedic physical therapist who knows the specifics of how to help your bladder.

Bladder physical therapy will help optimize your bladder’s ability to fill up, hold urine without leaking, empty and have no pain!

Our patients come to us with problems related to any portion of the bladder function.  Common complaints we treat include

  • Stress  urinary incontinence:  the involuntary loss of urine when laughing, coughing, sneezing or exercising
  • Urge urinary incontinence:  the involuntary loss of urine because you cannot get to the bathroom soon enough
  • Mixed urinary incontinence:  you have loss of urine that might involve both stress and urge incontinence
  • Insensible urinary incontinence:  Loss of urine simply happens, not necessary related to any activities or having a full bladder
  • Urinary retention:  you cannot empty your bladder at all.  Or you can only partially empty your bladder.  You may need to self catheterize
  • Urinary frequency:  You need to urinate more often than every 2-4 hours
  • Urinary urgency:  You experience sudden urges to urinate and cannot hold it long
  • Nocturia:  A person wakes up at night to urinate. This disrupts sleep.
  • Painful urination:  You feel pain anywhere in your abdomen or pelvis before, during or after peeing.
  • Frequent urinary tract infections:  You keep getting infections and don’t know why.  We find you may have incomplete emptying of your bladder that is related to dysfunctional voiding and pelvic floor dysfunction
  • Slow urinary stream:  you hear other people’s urinations in a public restroom and you are jealous, it sounds so much stronger than yours.  Your stream may stop and start.
  • Straining to urinate:  You must push your urine out, it won’t come on its own.
  • Interstitial Cystitis/Painful Bladder Syndrome:  You have a combination of pain and urinary frequency and urgency.  You may feel miserable.

As Pelvic Health Physical Therapy specialistis, we partner with you to identify how we can best optimize your bladder function

If you are wondering what does a bladder physical therapist do, the easiest way to explain it is that we help restore your bladder’s ability to function.  We do this using a combination of hands-on treatment directed anywhere from your neck to your toes and exercise based treatments designed to optimize the coordination and timing of your bladder control.

Our evaluation and treatment is holistic and designed to address all contributing factors in your bladder dysfunction.  These may include

  • Pelvic floor dysfunction:  including high tone pelvic floor, weakness, tightness
  • Impaired timing and coordination of the pelvic floor muscles
  • Improper breathing mechanics that strain the bladder
  • Low back and hip contributions to your bladder condition
  • Postural contributions to your bladder condtiion
  • Fascia restrictions in viscerosomatic convergence areas related to your bladder.  These include your thoracic spine, lower back, hips, thighs and abdominal wall.
  • Scar tissue that is impairing  your bladder.  This may be related to prior pelvic surgeries, endometriosis, pregnancy or postpartum injuries or trauma.
  • Food sensitivities
  • Bowel contributions:  an unhealthy bowel can set off a bladder and disrupt optimal bladder control.  If you have diarrhea, IBS, constipation or other bowel condition, we would like to partner with you to address this.
  • Non-optimal habits with exercise/fitness/running/jumping that overload the pelvic floor and overwhelm your bladder control system

If you choose to come for bladder physical therapy, we will partner with you and create a therapy plan customized to your body’s needs.

Our patients tell us that this has been the most important thing they have done for themselves.  Purple Mountain Physical Therapy provides expert bladder physical therapy here in Grand Rapids and the results we get for our patients help them live an active and full life again.  By getting high quality bladder physical therapy, they find their mood improves.  Their ability to be active improves.  They feel more like themselves again.  Research backs up our clinical experience, as well. This research article showed that high quality bladder physical therapy improved both quality of life and also reduced severity of urinary incontinence.

We understand that sometimes the idea of starting a new therapy is overwhelming and you don’t even know what to expect.  We wrote an article detailing what to expect at your first appointment, so you may be interested in reading that.

We treat women, men and kids who have bladder problems. And our treatment methods are specific to each person’s needs.  We do NOT simply apply “women’s health” bladder physical therapy treatment to a child or a man.  No, we are trained in the specifics of pediatric needs, male needs and female needs.

Male bladder needs are different than female.  Your pelvis tends towards getting tense/tight and your prostate may be contributing to your problems.

For example, a man’s bladder needs are similar to, but different than, a woman’s.  Our male-specific training gives a male exactly the right type of care.  We know how to rehabilitate a man post-prostatectomy, for example.

Pediatric bladder needs require specific training for kiddos. We offer that!

Pediatric bladder patients often benefit external treatment methods and exercises that may help them practice and learn how to listen to the signal of their body, address underlying constipation and direct their mindfulness to feeling when they need to urinate.  We use positive, encouraging methods with all of our patients and find our developmentally appropriate methods for little ones creates an uplifting and encouraging experience for them.

Women’s bladder needs are also unique.  We understand pelvic organ prolapse, pregnancy and postpartum recovery, female specific challenges across the lifespan.

You will receive customized treatment that addresses your unique needs.  Bladder physical therapy won’t work if we simply gave you cookie-cutter treatment.  At Purple Mountain Physical Therapy, we are devoted to clinical excellence for you, so that you get results.  That’s why we have established that each appointment is upto 55 minutes long, (not shorter than that, like you would get elsewhere), because our clinical experience has taught us that we must give you a full, complete treatment at each visit to get you the results.

If you are interested in learning more, call our office at 616.516.4334.  We are located at 847 Parchment Drive SE Grand Rapids, Michigan; this is near the I-96 and Cascade Road exit.  We have convenient parking and a warm, welcoming staff.  We are here to serve you and meet your needs.

Peace,

Dr. Maureen O’Keefe, DPT

 

Pelvic Floor Physical Therapy for Overactive Bladder in Grand Rapids

If You Think You Have A Small Bladder and You are Always Going to the Bathroom More Often than Every 2-4 Hours, You may Benefit from Pelvic Floor Physical Therapy for Overactive Bladder.  We are Right Here in Grand Rapids and We Specialize in this Condition!

Individuals who have overactive bladder may be urinating as often as every hour, or more.  A good, healthy bladder should be able to quietly fill up with urine over 2 to 4 hours time and then allow you to calmly walk to the bathroom to urinate.  It turns out that Pelvic Floor Physical Therapy for Overactive Bladder should be your first place to start to get treatment!  Yes, it is even in the clinical treatment guidelines that Pelvic PT should be FIRST!

How Do I Know if I have an Overactive Bladder?  What is Normal?

Individuals who have an overactive bladder experience a strong and sudden urge to urinate.  A healthy, normal bladder fills up quietly and allows you to calmly hold your urine for 2-4 hours.  Individuals with overactive bladder often finish urinating and still feel like they could go again.  Our pelvic floor physical therapy for overactive bladder alleviates these problems.  Our treatment is highly effective and does not involve any medications.  In fact, many of our patients get off of medications because our pelvic floor PT allows their bladder to function normally again.  We think this is a good thing because medications are costly, have side effects and are something people tell us they don’t want to rely upon.

The Harmful Effects of Overactive Bladder

We have great sympathy for individuals who deal with an overactive bladder.  We have had patients tell us that they cannot schedule a much-anticipated trip to Europe because they know they would be on a tour bus for hours and they would not be able to do that without urinary incontinence.  We’ve had patients tell us that they feel “chained to a toilet” and unable to be ambitious with their career because their bladder interrupts their productivity every hour.  We’ve had individuals tell us that they worry their bladder will get out of control and they might wet themselves in front of everyone.  We have had patients to whom this has happened:  complete loss of urine, publically at a party.  The psychological effects of this problem cannot be minimized.  If you go to a urogynecologist, in fact, they will usually question you on how much you perceive your condition is a “bother” in your life.  The answers are usually “quite a huge bother.”

High Quality Pelvic Floor Physical Therapy is an Excellent Treatment for Overactive Bladder.  The American Urological Association (of which we are a member!) has guidelines from 2019 that recommend pelvic floor therapy as a First-Line Treatment for your OAB.

Here at Purple Mountain Physical Therapy, pelvic floor treatment is our specialty. We are experts at treating all varieties of bladder problems, including overactive bladder.  We also treat bladder pain conditions (such as interstitial cystitis), urinary retention, urinary incontinence and nocturia (getting up at night to pee).  When you choose to see us, you are choosing the highest quality of expert care to give you the strongest chance of getting your bladder back under control.  You may be interested to read the treatment guidelines from AUGS.  Here they are!

Will You Be Teaching Me How to Do a Kegel?

No, probably not.  Most individuals that we evaluate are found to have a problem with high tone pelvic floor. This means that their pelvic floor muscles are all tensed up and giving a signal to their bladder and spinal cord that they need to pee.  All.The.Time.  We don’t want to get you doing kegels because they will tense up the muscles some more.

Our treatments are, instead, directed at resolving your underlying pelvic floor dysfunction and myriad other contributions to your condition, such as your hips, back, neck, abdominal wall.  You may read elsewhere online thats you need to be doing kegels if you have overactive bladder.  We could not disagree more vehemently and we are willing to pubically debate anyone who claims otherwise.  We are experts at treating pelvic floor dysfunction and bladder disorders and our clinical experience, coupled with our professional involvement in organizations such as AUGS (the American Urogynecological Society) and IPPS (The International Pelvic Pain Society) and ICS (The International Continence Society) give us unparalleled clinical expertise into treating your condition.

Our holistic treatment addresses any myofascial restrictions from neck to feet and also includes bladder control strategies, bladder training, pelvic floor muscle retraining, fluid management and bowel-directed optimization to address any constipation or diarrhea problems that may be setting off your bladder.

Rest assured, that when you choose Purple Mountain Physical Therapy for your pelvic floor PT for overactive bladder, you will receive customized treatment based specifically on your body’s findings.  We do not provide cookie-cutter treatments that are ineffective.

What Does Pelvic Floor PT for Overactive Bladder Involve? Each Treatment Session Effectively Gives You A “Bladder Balancing Treatment”.

Our treatment is holistic and utilizes multiple clinical principles that help calm your bladder. We have found that other providers do not understand the bladder and are not trained in these treatment methods.  Therefore, if you have failed to improved even though you have seen other providers, please understand that when you choose Purple Mountain PT for your pelvic floor PT for overactive bladder, you are getting care that is entirely different than you have received before.

Every organ has something called Viscerosomatic Convergence; our treatment taps into this to calm your bladder.  Viscerosomatic convergence is most commonly understood for the heart organ.  If someone experiences a heart attack they may feel pain down their left arm.  Thus, the left arm and the heart organ work in partnership.  The bladder organ works in partnership with various areas of your body, including your spine, hips, abdomen and  thighs.  Therefore, we know that we can optimize your bladder if we evaluate and treat these areas.  Our treatment is hands-on, using advanced manual therapy skills to address fascia, muscles, joints and tissues that have relationships with your bladder.

Will You Mostly Be Treating My Pelvic Floor?

The term “pelvic floor therapy” is actually misleading.  No, your treatment is never isolated to your pelvic floor.  In fact, our holistic care is the ONLY way we have to get your feeling better. If we limited your treatment to your pelvic floor, we know your overactive bladder will not change that much.  Instead, our holistic care directs treatment to all the areas related to your bladder.  We treat your back, hips, thighs, posture, abdominal wall, scar tissue (including cesarean scars overlying the bladder), visceral mobility (do you have endometriosis that may be contributing to your overactive bladder?  We treat this!).

However, we do need to treat your pelvic floor muscles.  As we stated, they usually have high tone and spasm and need to be retrained to calm down.  A 2016 study found the pelvic floor muscle training reduced symptoms and complaints related to overactive bladder and also increased quality of life.  That’s our goal: to boost your ability to enjoy your life.  We have found that people tell us that their anxiety or depression ease as their bladder control improves.

By providing you holistic and comprehensive pelvic floor therapy for your overactive bladder, you will find that your bladder progressively improves its ability to fill up quietly, hold urine and calmly empty.

Our Pelvic Floor Treatments Are Research Proven to Help Overactive Bladder

The main symptoms of overactive bladder include urinary frequency, urgency and leakage.  Some individuals also experience pelvic pain and lower quality of life.  It is common for our patients to come to us with lower abdominal pain or some discomfort or awareness of the urethra.  They also may have pain with intimacy.  Some patients have on and off low back and they find this improves, also.  We know that one known contributor to ongoing chronic low back pain is pelvic floor dysfunction; therefore, if you have overactive bladder, we will treat you pelvic floor dysfunction and low back pain.  We expect all of these symptoms to improve with our pelvic floor PT for your overactive bladder.

Am I A Good Candidate for Pelvic Floor PT for My Overactive Bladder?

Yes.  If you have overactive bladder, pelvic floor PT is actually one of the first places you should start.  In fact, of all of your therapeutic options, pelvic PT gives you the best chance of resolving urinary leakage and the problem of running to the bathroom all the time.  If pelvic PT cannot help you (which is rare) then you would go back to your urologist and talk about other options, which may include Botox injections, medications, surgery for sacral nerve stimulation.   If you truly are having trouble getting results from pelvic PT then we would want you to pair your pelvic PT treatment with mind/body care so that you can calm your nervous system and implement different habits/techniques to react to your bladder.  Results are not overnight, but we do find that our patients experience improvements in the first few appointments.  Each appointment builds on the progress from the prior appointment and we partner with you to find the best path forward.

There is High Quality Help for Your Overactive Bladder.  You Don’t Have To Live with This!  If you are interested in receiving an evalution for your condition, call our office today at 616.516.4334 and we would consider it an honor to be part of your healing journey!

Peace,

Dr. Maureen O’Keefe, DPT

Founder Purple Mountain Physical Therapy

On a Mission to resolve pelvic floor dysfunction, enhance quality of life and help women, men and kids optimize their well-being.

 

Pelvic PT for Testicular Pain (Orchialgia) in Grand Rapids

Are You Feeling Frustrated by Ongoing Testicular Pain?  Have You Seen Your Physician Providers and Found They Are Unable to Resolve Your Pain?  Well, Pelvic PT for Testicular Pain (orchialgia) is Your Next Best Step Towards Feeling Better.

First, let’s get our terminology down. Orchialgia is the medical term for testicular pain and is defined as general pain in and around the testicles.  This pain is termed chronic orchialgia” if it has persisted for more than 3 months.  The discomfort may not be isolated to the testicles, it may also be the entire scrotum, the groin, the perineal area, the penis or the inner thighs.   A person can have numerous causes for testicular pain such as trauma, tight pants or underwear, reaction to bouncing around too much, compression related to sitting for prolonged periods, prolonged arousal, infections, vasectomy, nerve related pain.  There are other things that may cause testicular pain that should be ruled out by your urologist or other physician.  These are things such as diabetic neuropathy, kidney stones, retractile testicle (testicle ascends into the groin) and hernia.  In our patient’s cases they do usually do not have these things.  Instead, they have myofascial (muscles & fascia), nerves and joint contributions causing their pain.  Our high quality pelvic PT for testicular pain right here in Grand Rapids, Michigan properly rehabilitates you holisticially ( we treat your spine, hips, legs, pelvic floor) so that you can resolve orchialgia.

Pelvic Floor Dysfunction and Pain are Associated with Chronic Scrotal Pain!

We feel we need to say this again.  Pelvic Floor Dysfunction and Pain are Associate with Chronic Scrotal Pain.  Full Stop.  If you are reading this article because you have chronic testicular pain, please know that you likely have pelvic floor dysfunction.  And that pelvic floor dysfunction is very treatable and we will be able to reduce your pain.

This is well published in the medical research, but, unfortunately, urologists are not in the habit of referring patients to pelvic PT for testicular pain, so you are usually left on your own to figure this out.  Most Men Find Our Clinic by Googling and Stumbling Upon Us.

What are Your Treatment Options? Why Would Pelvic PT help Testicular Pain?

Well, we help testicular pain because you have muscles and nerves and blood flow and joints and habits that are contributing to your pain and we assess and treat all of these things so you can feel better.  Usually the men who come to us have seen their family doctor and may also have seen a urologist.  Those providers rule out more serious causes of the pain and treat anything they find.  The men who come to us often have been told that there is nothing wrong with them and are often diagnosed with “idiopathic testicular pain”, which means “we don’t know the cause of your pain.” There are no infections.  There is no testicular torsion (testicular torsion causes sudden, severe pain).  There is no unusual growth.  There is no epididymitis (this begins as mild pain that increases gradually).   Thus, the men are left with nearly nothing to help them.  They try support cups or antibiotic medications, but still have pain.   That’s where we come in.

A Pelvic PTs Experience Treating Testicular Pain

Our experience has been that we can help you!  The men we see are usually skeptical when they come to PT.  Usually they’ve been on our website and something we have written has piqued their curiosity but has not convinced them that we can help them.  What they’ve read has given them a glimmer of hope and they come for their pelvic PT evaluation looking for some answers.  Frankly, we’ve seen so many men with this condition, we can tell you that you are often angry at the medical system, frustrated by your condition, feeling hopeless and skeptical of anyone or anthing that tells you that you can get better.

Pelvic Physical Therapy for Orchialgia Can Be Very Effective!

Chronic testicular pain has been studied because it has been known to be difficult to treat in urologic practices.  It stumps urologists and they know they often cannot get rid of your pain.  Unfortunately, they don’t consistently follow what the research has shown:  pelvic PT for testicular pain works!   One study, published in the Canadian Journal of Medicine, demonstrated that more than 50% of men with testicular pain benefitted from pelvic floor physical therapy and were able to get off of pain meds.  Our professional experience has found that the vast majority of our patients are able to have reduction in their pain through our high quality pelvic physical therapy.  Our evaluations and treatment are holistic and address the numerous muscle, fascia, joint and nerve restrictions that are contributing to this pain.

Multi-Modal Treatment May Help You!

We are members of the International Pelvic Pain Society and through our active participation in that professional organization, devoted to helping people who have chronic pelvic pain, we know that multimodal treatment is the gold standard for treating anyone with pelvic pain.  This means that you may also benefit from having a team of providers who can help reduce your pain.  Quite often with chronic pain something in your nervous system happens that is called Central Sensitization.  Central Sensitization means that your central nervous system (brain and spinal cord) is upregulated so that it very easily puts you into pain. Treating central sensitization is something we do and we also like you to see other providers, such as a physiatrist or psychologist who can be on your team to calm down your system.

How Do I Know If I am a Candidate for Pelvic PT?

If you are suffering from chronic testicular pain and your physicians are not able to improve your pain, we recommend you have a pelvic PT evaluation.  This evaluation will include, with your permission, a rectal exam that assesses your pelvic floor muscles.  We also conduct a discreet examination of all of your external pelvic floor muscles, especially those in the perineal area; quite commonly these muscles have trigger points and problems causing pain.

Men who have a pelvic exam that identifies pelvic floor dysfunction are good candidates for pelvic physical therapy.

Most often, we find high tone pelvic floor, meaning the pelvic floor muscles are in spasms and/or quite tight and this is, quite literally, causing testicular tension.

Your High Tone Pelvic Floor Will Be Gently and Effectively Treated With Our Care

Your Pelvic PT Evaluation for your Chronic Testicular Pain Will Also Include a Full Orthopedic Examination & Treatment of Your Hips, Thighs, Low Back and Thoracic Spine

Some of the nerves that go to your genitals come out of your thoracic spine. We find that our patients who have orchialgia have myofascial and joint restrictions in their thoracic spine that can be impairing their nerves and contributing to pain.  Other nerves that go to the pelvic region come through the front of your abdominal wall or through the back of your buttocks.  We check all of these areas.  It is common that a man who we evaluate has considerable myofascial restrictions in all of these areas.  We must treat these to decrease his pain.

Men, You Likely Have Considerable Tightness in Many of the Joints and Tissues Related to Your Pelvis, Such as Your Hips, Abdominal wall, Thighs and Low Back:

We usually find an assortment of muscle stiffness, guarding and tightness.  Often the inner thighs are filled with connective tissue restrictions.  The hamstrings may be very tight.  The hip flexors are usually quite tense, stiff and unhappy.  We treat all of these myofascial restrictions and we also encourage you to implement a regular exercise routine that we will create with you, something that is do-able for your life.  We need to you enhance blood flow to the area, so cardiovascular/aerobic exercises can help. We also need you to improve your flexibility and fascia’s ability to move, so stretches or yoga or other program at home directed to your fascia would be recommended.  We want you to limit or alter those things that obviously worsen your pain, such as sitting at your desk for hours on end.

What Does A Typical Appointment Involve?

Men with Testicular Pain usually benefit most from our advanced hands-on, holistic treatments.  Usually we do not spend your appointments exercising.  However, exercise and specific movements and stretches are crucial to your feeling better, so we teach you what you must commit to be doing everyday at home.  We have found that your appointment time is best used receiving the hands-on treatment that you cannot do for yourself.  Your treatments may include:

  • Myofascial Release that is directed anywhere we find problems.  Usually this means to your thoracic spine, low back, hips, thighs and abdominal wall.
  • Thoracic and Lumbar fascial and nerve gliding/movement manual therapies and  joint mobilization
  • Abdominal wall myofascial release and trigger point release
  • Treatment to any scar tissue, including scars from hernia surgeries and laparoscopies.
  • Trigger point release throughout your abdominal wall, inner thighs, hip girdles, low back.
  • Pelvic floor downtraining which includes gentle, external & internal work to get rid of the high tone.
  • Pelvic floor rehabilitation to teach you how to optimize how you use these muscles with urinating and bowel movements.
  • Recovery training specific to teaching you how to breathe, relax your pelvic floor and abdominal wall, relax your glutes and open up your hips.
  • Specific, advanced hands-on manual therapy methods to optimize the passageways in which your multiple nerves travel.  Nerves need massive blood flow to function well.  We work to enhance your  blood flow and restore the bound-down and tight tissues in which your nerves have been living.

What Should I Expect After An Appointment?

Patients tell us that they feel better after an appointment.  They say that for the first time they can tell that we are actually working on their problem.  They tell us that what we are finding and educating them about, inherently makes sense to them.  They tell us that they feel hopeful and willing to implement the things we suggest.  They tell us they can urinate better, that their stream doesn’t stop/start as much.  They tell us that after intimacy they might not feel as much pain.  They tell us that their other pains, such as their low back pain or their lower abdominal pain, are feeling less.

How Do I Get Started with Pelvic Floor PT?

We are located in Grand Rapids, Michigan.  Our patients travel to our clinic from all over the state of Michigan and also from nearby states.  This is because we offer exceptional care and expertise specific to the needs of male pelvic pain.  We have advanced training that is male focused; we are NOT simply giving you a “women’s health” treatment.  You will be receiving male-specific pelvic pain treatment.  We wrote an article that details what to expect during your evaluation, you may find that helpful.  If you are interested in being evaluated, please call our clinic and we can get you scheduled. 

If you are suffering from chronic testicular pain, our heart goes out to you. We know it is a lonely and frustrating road. We know this because our many patients over the years have taught us this.  We consider it an honor to help you on your journey to feeling more like yourself again and we promise to provide you with expert care that is trauma-informed, compassionate and results-driven.

Peace,

Dr. Maureen O’Keefe, DPT

Purple Mountain Physical Therapy Founder

Leader of Team of Doctors of Physical Therapy who provide expert care for pelvic health

 

 

 

What To Expect With Your Pelvic PT Evaluation

Feeling Nervous or Uncertain about What to Expect with Your Pelvic PT Evaluation?  Read on and we’ll give you all the details!

At Purple Mountain Physical Therapy, here in Grand Rapids, we provide excellence in clinical treatment for ALL pelvic problems.  Pelvic health has been our laser focus for years.  As a result, we know exactly how to help you and we do this by first listening to you and figuring out what is going on.  You can expect a thorough pelvic PT evaluation that answers your questions and addresses your concerns.

What Does the Evaluation Involve?

With your pelvic PT evaluation you can expect expertise from our Doctors of Physical Therapy.  We begin treatment the first day and never provide you with cookie-cutter, run-of-the-mill, average care. Your care is customized to your findings and your goals.  Here are the steps you can expect with your pelvic PT:

What to Expect Before Your First Appointment:

  1.  Fill Out Your Intake Paperwork Online!  Watch for an email inviting you to do this! You create a login at our secure portal and complete you intake paperwork in preparation for your pelvic PT evaluation.  We are paperless at the office and completing this before the appointment is important.
  2. Our physical therapist will read all of your intake paperwork before your pelvic PT evaluation appointment.  This is crucial, as it helps us begin to formulate a plan for how to treat you and know how to structure your evaluation time so you get the most out of the appointment.  Our therapists glean many ideas and direction for your care from your intake paperwork.

What to Expect When You Arrive for Your First Pelvic PT Appointment:

  1. A Warm Welcome!  We are glad you are here and want to make you feel comfortable and taken care of each moment of your visit!
  2. Our front desk administrator will be there to welcome you and answer any of your questions and tell you how everything works at our clinic.  Important detail to know:  our front desk administrator is here to help you get scheduled and answer any of your questions, so call anytime during business hours and there’s always someone here to answer your questions.  Parking is easy at our clinic, in fact, there are parking spots literally five feet in front of our clinic door!
  3. Our office is sunny, clean and comfortable.  Please arrive a few minutes prior to your pelvic PT evaluation appointment and upon arrival come straight to our front desk administrator to get started.   She will answer your questions and get you checked in.  Afterwards, please make yourself comfortable in our waiting area for a few moments and help yourself to a warm drink.
  4. Our PTs run on time, so you can expect to be seen promptly.  Each pelvic PT evaluation appointment is in a private, comfortable treatment room and lasts upto 55 minutes.  Follow-up appointments are also upto 55 minutes long.
  5. You will see the same Doctor of Physical Therapy each time so you develop a trusting relationship that progressively advances you at each visit.  You and she develop a trusting relationship that is established upon your physical therapist’s insights and assessment of your condition and how your body responds to treatment and your preferences for what you feel is necessary at each visit.  We never bounce you around amongst staff, our patients have experienced that problem elsewhere and it inhibits your ability to get better and to receive a personalized, therapeutic approach specific to your needs.

What To Expect Once We Begin your Pelvic PT Evaluation:

  1. You can expect your treatment to be in a comfortable, private treatment room. You are welcome to bring a family member or person of support.  We will begin by simply talking.
  2. Your pelvic PT will ask you about your goals, symptoms and lifestyle.  We want your treatment to be meeting your goals.  That’s the whole purpose.
  3. Your Goals:  Why are you coming to PT?  What do you hope to achieve through your physical therapy?
  4. Your Symptoms:  We will inquire about any pain, any bladder problems, bowel issues, intimacy related symptoms.
  5. Your Lifestyle:  We love to learn about your day to day habits and activities and what you are presently unable to do because of your condition.  How are your stress levels (because stress greatly influences the pelvic floor, bladder & bowel)?  What exercises do you complete?  What are the movements and postures of your work or day-to-day activities?
  6. Holistic Care: The pelvic floor works in coordination with the hips, core muscles, low back, mid back, rib cage, feet and diaphragm.  Therefore, we will assess and treat these areas because our experience has taught us and research has proven that treating all of these areas holistically is necessary for you to get results.  It is very common that our patients have received care elsewhere that did not work and often the reasons behind this are related to the care was not comprehensive and holistic.  Also, usually, the care is limited in time (they do not give you a full 55 minutes for your appointment) and the care may  not consistently be with the same provider (let’s be honest:  if you bounce between providers there are things missed, lost in translation and/or not advanced effectively).
  7. Trauma-Informed Care   We recognize that you may have experienced any number of traumatic experiences in your life and we are able to meet you where you are at, so that we provide an effective, therapeutic place for you to receive your care.  For some of us, going to the OBGyne is traumatic, so we understand that a pelvic PT may raise your anxiety levels.  Rest assured, we partner with you and work within your comfort zone.  By this, we mean your mind, body and spirit comfort zone and we are continually checking in with you and watching for signs that you are doing well throughout your appointment.
  8. For Children, Parents are included in the Plan of Care and Evaluation:  Our clinic is here to help alleviate the stress and strain in your household, if your child has any bladder or bowel control problems.  We include parents in our pelvic PT evaluation and plan of care so you can expect to be informed of everything we do.  We want to make certain you are fully understanding what we are finding, how you can support your child and that you can be an advocate for your child.  Our Doctors of Physical Therapy know how to expertly navigate a positive, encouraging evaluation with you and your child so your child’s needs are met and you feel less stress.

What is included in an Evaluation?

  1. Pelvic Floor Dysfunction Evaluation begins with us talking: For all of our patients (women, men and kids), we will inquire about symptoms that would be related to pelvic floor dysfunction.  The pelvic floor is a series of muscles that control bladder, bowel and intimacy related functions.  They also serve to support or hold up your pelvic organs.  By learning about your bladder, bowel or (for adults) intimacy related symptoms, we will be able to advise you straight away on things you can do to improve your condition.
  2. Pelvic Floor Dysfunction Evaluation that includes hands-on assessment: Our patients tell us that our pelvic PT evaluation is the most thorough and helpful exam they’ve ever had, including what they get from their physician.  This is because we educate you the entire time and we also go very slowly, muscle-by-muscle, checking each thing that may be contributing to your problems. With your permission, for our adult patients, we gently check all of your pelvic muscles.  Pediatric patients do not receive an internal examination.  The entire time we are working, we are telling you what to expect and what we are finding.  You always have the option to opt out of this, if you don’t feel comfortable.  We provide trauma-informed care and always respect where you are at in terms of being able to experience treatment.  We have SO much to treat (areas from the shoulders to the feet), that if you aren’t ready for a pelvic examination, we have plenty of other things to treat.  Our patients tell us that our examination is the most thorough they have ever received and very educational.  Our examination includes assessing the superficial muscles of the perineum (these get torn often with labor/delivery and contribute to pain with intimacy.  These are also commonly problems in men with pelvic pain, including tip of penis pain, perineal pain and testicular pain) and the deep muscles of the levator ani (these are the muscles you hear about most often, the ones you get told to do a Kegel to improve.).  We also check the accessory pelvic floor muscles, which includes muscles that in a textbook you will read control your hip, but they also are part of your pelvic floor.  Fair warning:  usually kegels are not recommended and can worsen your condition.  We have lots of information on our website about pelvic floor dysfunction, such as this article we wrote.   Here is another resource, from the Cleveland Clinic that gives you more insight into pelvic floor dysfunction.  https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction
  3. Myofascial Assessment: “Myofascial” refers to muscles & fascia.  For bladder, bowel and pelvic pain conditions there are connections between your problem and the muscles and fascia of your shoulder blades, thoracic spine, low back, hips, inner thighs and abdominal wall.  We assess and treat all of these areas and look for problems that are contributing to your symptoms. We are looking for trigger points, muscle guarding, scar tissue restrictions (cesarean scars, hernia surgery scars, laparoscopic scars, low back or hip surgical scars, kidney stone removal scars, etc), fascia denseness/lack of movement, reductions in blood flow to tissues, changes in tissue color (hint: thick, darkened tissues are not well vascularized and optimally healthy).  We provide advanced therapeutic hands-on treatments to address any and all of the problems we find.
  4. Full & Complete Diastasis Recti Abdominus Asssessment (DRA) and Treatment, if warranted:  We check every patient for a DRA, including men and children and, of course, all women including pregnant and postpartum. DRA assessment and treatment is a key specialty we offer our patients.  We commonly find problematic DRAs in our patients.  If you have this, we will let you know the specifics of your problem, how you can help improve it, what you need to avoid doing and how we will build a therapeutic recovery program so you can progressively get this improved.  DRAs influence and can contribute to low back pain, stress incontinence, urinary frequency/urgency, hesitancy with pee stream, hip pain, appearance of a “mom pooch” and more.  If you have this, rest assured, we will get you a full, comprehensive plan to improve this.
  5. Orthopedic Evaluation:  Depending on your symptoms and goals we may assess and treat your posture, strength of your core, flexibility of your muscles, fascia and nerves.  We also assess hips, SI joints, low back joint range of motion & muscle spasms, intervertebral joint motion, alignment of feet, knees and hips, necks, shoulder blades, rib cage mobility, stiffness in your thoracic spine, diaphragmatic and breathing tendencies.  Our doctors of physical therapy have experience treating all orthopedic conditions, such as plantar fasciitis, knee meniscus tears, hip labral tears, gluteal tendinopathy, sciatica, lumbar disc herniations, low back pain, rotator cuff tears, shoulder bursitis, neck stiffness and more.
  6. Nerve Evaluation:  Pelvic pain can be a mystery and there are so many nerves that can contribute to pain.  We know how to assess and treat your Pudendal nerve (and all of its branches), Sciatic nerve, Posterior femoral cutaneous nerve & cluneal nerves, ilioinguinal nerve, genitofemoral nerve, obturator nerve, femoral nerve, peroneal nerve and others. If you are wondering if nerve pain is part of your condition, we can let you know.  Our detailed and specific assessment of your nerve health and passage way through your tissues will inform our treatment plan for you.  Many of our patients have had nerve blocks, steroid injections or PRP injections to various nerves and, yet, still remain in pain; our treatment helps heal nerves and gets you feeling better.  The treatment is directed to optimize the health and blood flow of your nerve and all of the joints and tissues that surround it.  If you have impairment in your nerve, we will let you know what you can do to help improve this and you can expect at every appointment we will be treating this.

Are You Coming to Us Feeling Frustrated, Hopeless or Uncertain about What the Problem is?  If So, You’ve Found the Right Providers for You!

  1. We bring insight into the Puzzle or Confusion of your Problem:  Don’t worry if you aren’t sure what is wrong with you.  During your pelvic PT evaluation, you can expect that it is our job to figure out how we can help you and to partner with you to get you feeling better.  Our clinical experience and high drive for keeping up with research and best practices, allows us to provide you care that is above and beyond what you will get elsewhere.  You can expect to have many of your questions answered throughout your pelvic PT evaluation.
  2. We love challenging and puzzling cases, because we find them very rewarding to partner with you to get you results.  Many of our patients tell us they have had ongoing problems and no one has been able to help them.  Many of our patients don’t know what is the problem.  Many of our patients have failed to feel better in spite of myriad other treatments.  We pledge to give you our best, clinical expertise and to partner with you to get you results.
  3. Our patients comes to us often with a confusing assortment of chronic problems.  We bring clarity to the confusion.
  4. We treat ALL pelvic conditions.  If you are wondering if we have ever seen or treated your condition, even if it is very unusual or complex, chances are high that we have.  We have patients who travel to us from other states.  We have treated individuals who have flown around the world to receive pelvic surgeries and evaluations with top providers for their condition.  Our doctors of physical therapy have many years experience working with major medical centers and expert providers across the country.  We have seen it all and, if we haven’t seen your specific condition before, we have the tools, experience and ability to partner with you to create a plan of care to best help you.
  5. Examples of Common Confusing Symptoms We Often Treat: Urinary urgency, frequency and incontinence, low back pain, pubic bone clicking, SI joint pain, hip/glute pain, anal fissures, vaginal burning, penile pain, constant lower abdominal pain, awareness of the bladder, urinary retention, very slow urinary stream, urinary urge incontinence, adolescent related athletic incontinence, pediatric constipation, pediatric fecal incontinence, bedwetting, tethered cord syndrome, tarlov cysts, constipation, interstitial cystitis, endometriosis, chronic pelvic pain syndrome, pudendal neuralgia, chronic prostatitis, orchialgia, persistent genital arousal disorder, pelvic pressure and pelvic organ prolapse, chronic urinary tract infections, BV or yeast infections, pregnancy related pelvic girdle pain, pregnancy related pelvic congestion, coccydynia, hip labral tears, hip pain after labral repair surgery, chronic prostatitis, post-prostatectomy incontinence and ED, sciatica, pain with sitting, pelvic organ prolapse.  If you have a puzzle of symptoms, rest assured, we can help bring clarity to your path forward because our pelvic PT evaluation identifies the myriad things that are contributing to your condition.  You can expect excellence from us when you receive your pelvic PT evaluation.

By The End of Your Pelvic PT Evaluation You Will Have Much More Clarity and Will Have:

  • Received Treatment
  • Detailed instructions and List of Things to Implement at Home
  • A Clear Understanding of What We Found
  • A Clear Understanding of our Plan and what to expect at the second appointment.

What Do Follow-Up Appointments Include?

Each appointment builds on the prior appointment and gives your body the treatment it is ready to receive.  Our treatment includes any number of interventions such as

  • Hands-on myofascial release
  • Trigger point release
  • Fascial flow & Fascia specific  mobilization methods
  • Nerve optimization hands-on techniques combined with exercise based methods
  • Pelvic floor dysfunction recovery techniques
  • Biofeedback
  • Exercise based training to resolve strength, tightness, weakness and discoordination.
  • Motor control and motor planning training
  • Diastasis Recti Abdominus-specific recovery exercises
  • Postpartum recovery program for return to sport
  • Post-surgical recovery to include rehabilitation of your core and pelvic floor
  • Balance exercises
  • Neural calming exercises
  • Heartrate variability training
  • Osteopenia and osteoporosis-specific training exercises and intervention
  • Chronic pain education
  • Pregnancy related birth preparation
  • Perineal education to avoid perineal traum during labor/delivery
  • Postural alignment and correction exercises and techniques
  • Joint mobilization
  • Deep core stabilization exercises

Our goal for your pelvic PT evlauation is to help you get answers and relief of your symptoms.  Experiencing any pelvic pain, urinary, bladder or intimacy problems is  not fun.  We are here to provide you trauma-informed, therapeutic and expert care to get you back to feeling like yourself.  We hope the detailed information helps you understand what to expect for your pelvic PT evaluation.  If you are interested in being evaluated by one of our doctors of physical therapy who specialize in pelvic health, call our office at 616.516.4334 and we can answer any further questions you may have.

Peace,

Dr. Maureen O’Keefe, DPT

Specializing in pelvic health since 1999.

Expert in complex pelvic floor dysfunction

Member of numerous professional societies devoted to clinical excellence for pelvic health.

Founder of Purple Mountain Physical Therapy

Leader of our Purple Mountain PT team, including our Doctors of Physical Therapy.  We are on a mission to serve our community to reduce pelvic floor trauma, chronic symptoms and dysfunction.

 

 

 

 

 

5 Tips To Ease Pelvic Pain that Won’t Go Away!

If Your Pelvic Pain Won’t Quit, Read on for 5 Tips to Help!

Here at Purple Mountain PT we have a heart for anyone who is experiencing pelvic pain that just won’t quit.  We understand the despair you feel and the lack of answers when you go from provider to provider.   Our Doctors of Physical Therapy have many years experience working with people who, unfortunately, have lengthy and frustrating journeys to finding us and getting the real help they need.

What are Some Common Things That Our Patients Tell Us?  Here’s an example.

Sarah’s Story:   Do You See Yourself in Her Story?  Names have been changed for privacy.

Sarah is a 44 year old female who came to us with lower abdominal pain and vaginal/pelvic pressure that bothered her most days.  It had been going on for the last six years or so, and developed around the time her last child was born.  In those six years she thought her problem was an ovarian cyst, but when the doctor found a cyst she was told that it should simply be monitored and no further treatment was recommended.  She found herself taking ibuprofen more often than she liked and this also caused some issues related to her migraines, rebound headaches.  She developed some back pain and went to physical therapy for this; the PT didn’t help.  At one appointment they had her sit in a chair and march in place and she thought it was a silly exercise that wouldn’t help her, so she stopped going.  The pelvic pressure was worse around her menstrual cycle, but occurred throughout the entire month and was bad enough that she avoided jogging and intimacy.

She found us because one of her friends told her about us, but she had already been to physical therapy for her back and that PT told her that her pelvic floor was fine.

She was skeptical when calling Purple Mountain PT, but when her friend promised her that we were different and more effective, she scheduled an evaluation.  At her evaluation we found that her pain was her main concern and was present just about everyday and often causing her to feel out of shape and unable to workout to get into shape.  We also discovered that she experienced urinary leakage and sometimes urinary urgency.  Her constipation was an ongoing problem, with bowel movements once every 2nd or 3rd day.  Intimacy was not comfortable and was not enjoyable, her libido was gone.

Our examination found that she had a variety of things that we needed to address to help her pain:

  • Myofascial restrictions in her abdominal wall including trigger points in numerous muscles that were contributing to daily pain.
  • Tension and muscle guarding and tightness in her hip muscles, inner thighs and low back.  These were a major source of her problem and needed to be effectively treated with myofascial release, trigger point release, joint mobilization and pelvic and low back alignment methods.
  • Pelvic floor dysfunction characterized by high tone pelvic floor, meaning her pelvic floor muscles were stiff and painful.  These were a big driver of her pain and her urinary urgency and leakage and likely contributing to her constipation, also.
  • The presence of migraines plus the chronic pelvic pain render us suspicious for her having a ramped up nervous system that easily experiences pain.  We use a validated questionnaire to find out if this is the case and it was for Sarah.  Because of this we use a combination of education, neural calming techniques, heart rate variability training and myofascial release and muscle calming hands-on methods to calm down her sensitized nervous system.
  • Inability to exercise is a big problem and something we needed to improve.  We found she was quite weak & often tight in many major muscle groups including her glutes, quads, inner thighs, hamstrings, low back, postural stabilizers in her upper back, abdominals and calves.  Her weakness was from a combination of being sedentary and also from her condition inhibiting the proper firing of her muscles; we needed to retrain the muscles and restore her capacity to exercises.

Because Sarah’s case is common and, if you are reading this blog, you likely share some characteristics with Sarah, we can offer five tips to help you today.  These are things you can do today that we also suggested Sarah begin on her first day of treatment.

5 Tips To Ease Your Pelvic Pain that Won’t Go Away!

Tip 1:  Practice Diaphragmatic Breathing

The diaphragm is a pathway to calming down high tone pelvic floor and chronic pain.  Learning to effectively breathe with your diaphragm is a key skill that is usually dysfunctional when someone has chronic pain.  This may seem like a simple, useless tip. But, take our word for it and our patients’ word for it:  diaphragmatic breathing is an important skill to help nudge your body out of pain.

Tip 2:  Lengthen Your Pelvic Floor Muscles

This is tricky to learn and, especially when someone has chronic pelvic pain, usually they have very limited capacity to let go of their pelvic floor muscles because these muscles are stiff and tight.  For the most effective results, you truly need hands-on care from one of our Doctors of PT.   But, please give this tip a good, solid try.  Practice makes perfect, so you’ll have to work on it multiple times a day.

Here’s one way you can learn how to melt your pelvic floor muscles:  lie down in a quiet location. Clear your mind.  Soften your breathing.  Relax your abdomen.  Bring your awareness to your pelvic floor area.  Relax your glutes.  Let go of your tailbone, invite it to float back towards the floor.  Soften and open the anus, let go of the back area.  Drop your vagina by fully letting go of it.  Simulate peeing and invite a release/opening of the area where you pee.  Never push these muscles to get them to release.

Tip 3:  Optimize your gut health

This is crucial when trying to resolve pelvic pain.  You must have daily bowel movements that are well formed and without straining.   Look closely at your nutrition and eliminate all foods that might constipate you and/or cause intestinal bloating or distress.  Consider seeing a dietician for expert guidance.  Aim to eat 30 grams of fiber a day, if you can tolerate fiber.

Tip 4:  Optimize your water intake

Because Sarah had some issues with urinary control and urgency, she had slowly reduced her water intake.  This actually worsens bladder wellbeing and can contribute to bladder spasms and ongoing pelvic pain.  For your bladder to be happy you need optimal water intake.  You should be urinating about every 2 to 4 hours and you want your urine color to be light yellow.

Tip 5:  Movement is Needed

With chronic pelvic pain we know that movement is needed.  You must move.  The less you do, the more you hurt.  The challenge is figuring out how much movement is well tolerated and which movements to do.  In general, it is smart to begin with brisk walking and some light stretching.  Think about stretching your hips, low back and legs.  Be gentle with your movements, never forcing a stretch.

Bonus Tip 6:  Prioritize Sleep, Relaxation and Meditation. 

Sleep is how our body restores itself.  You must prioritize sleep, address sleep apnea problems and keep a regular bedtime.  By building relaxation and meditation into your daily routine, you will further nudge your nervous system towards a more balanced and less sensitized state and this will, in concert with everything else you are doing, help you have less pain.  Research has shown us that individuals who have chronic pelvic pain experience higher rates of anxiety, depression and sleep disorders. We also know that multimodal (meaning a team of providers with various clinical expertise) care is best for you.  For a link to an NIH article detailing some important findings related to chronic pelvic pain, click here.  It is common that your team might consist of a physical therapist, counselor, psychologist, sleep specialist, gynecologist, physiotrist and other providers.

For our patient, Sarah, these 5 simple tips got her started with a plan for what she could do at home.

With our skilled therapy, which primarily comprised of hands-on treatments from her shoulders to her knees (because pelvic pain and fascia connections extend throughout the body), bladder calming treatments and parasympathetic nervous system activation, she was able to gradually increase her exercise and daily activities.  We worked closely with her completing specific exercises to teach her how to reduce her pain while also building up better strength and function of her muscles, especially her core muscles, hips and thighs.  While these tips have worked for many of our patients, please keep in mind that you are not our patient and, therefore, this is not medical advice for you.  Everything here illustrates what worked for Sarah and other patients.  Please, if you are having pelvic pain that won’t quit, give us a call so we can customize our recommendations for you.

Peace,

 

Dr. Maureen O’Keefe, DPT and the Purple Mountain PT Team

Vulvar Pain and Pelvic Floor Dysfunction go together.

If you have Persistent Vulvar Pain or Vulvodynia and are looking for an experienced pelvic health physical therapist to help you, you’ve found the right place.

Vulvar pain is a challenging and frustrating condition to experience.  We treat women who come to us after suffering with vulvar pain for prolonged periods.  By the time a woman finds us, she usually has had pain with sex for quite a long time, sometimes has pain with wearing clothing that touches the vulva and may experience worse pain with basic activities, like sitting.  When a person has vulvar pain, pelvic floor dysfunction is typically also present.

We Begin Your Vulvar Pain Treatment with a Detailed Evaluation to Determine Contributing Causes, such as Pelvic Floor Dysfunction

With vulvovaginal pain there tends to be many things going on.  Rarely is there only one problem:  the vulvar pain.  There are usually other things happening and because of this we like to partner with your other providers so that you are receiving comprehensive care.  Some of the other things that we screen for and may be going on include:

  • Other pain conditions, such as painful bladder syndrome, fibromyalgia, irritable bowel syndrome, TM joint disorder or migraines.  Pelvic health PT can help your other pain conditions.  In fact, TM joint dysfunction is so common in pelvic patients that we have a program to evaluate and treat this for our patients.
  • Hormonal issues such as thyroid problems, infertility, blood glucose issues, perimenopause or menopausal status, PCOS.
  • Inflammation:  this is very common.  In our evaluation we try to identify if this person has any signs or symptoms of inflammation anywhere else.  Do they have gut bloating? Tendinitis? Skin conditions?  Allergies?
  • Musculoskeletal problems: This is a primary area for physical therapy to help you.  With vulvar pain there is typically pelvic floor dysfunction.  There also may be myofascial restrictions in the abdomen, spine, hips or thighs.  Underlying biomechanical problems in your hips, back or elsewhere need to be addressed.  Any scar tissue (C-section, hernia scars, other abdominal, back or hip surgeries)
  • Neurologic conditions, either in the central or peripheral nervous system.
  • Neuroproliferation:  this is a big one for vulvar pain.
  • Psychosocial factors:  anxiety, depression, mood, cultural beliefs regarding sexual health, coping style, interpersonal relationships, sexual function

The vulvar tissue is sensitive, keep products away from it that can bother it!

If you have persistent vulvar pain or painful sex, we will talk about nutrition, vulvar hygiene, gut/immune health and exposure to common household chemicals.  Vulvovaginal pain, burning and dyspareunia can have numerous causes, so it is important to see a specialist physician who can check out your tissues and determine what is going on.  Many of these causes have been found to have an inflammatory component, which is why wholistic healing approaches can be warranted.  Doing things that reduce your body’s inflammation, keep your allergies in check, eliminate exposure to household chemical irritants and optimize your gut and immune health can be important components of getting your vulvodynia, vulvovaginal pain, burning and dyspareunia (painful sex) to improve.

It is Spring & Allergies are here!  Might you be experiencing Allergy-Driven Genital pain?

Research has studied this and has found there are connections.

  • One common preservative has been found to be problematic and may be in your body care and cosmetic products. It is commonly used in shampoo, conditioner, hair color, body wash, lotion, sunscreen. Methylisothiazolinone (MI) is a preservative that is found in a wide array of liquid cosmetics, personal care products and cleaning products on the market today. Its function is to inhibit the growth of bacteria.
  • Did you know that occupational exposures (via salon work, housecleaning, yard maintenance etc.) and household hygience habits provide long-term and repeated exposure to MI and are risk factors for developing vulvar pain?
  • Interested in reading the science about MI, here’s a link:
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588120/

What will pelvic floor PT do for my vulvar pain?

We treat you wholistically and work with you to establish goals and determine underlying contributions to your vulvodynia that we can improve.  Because there are many things contributing to your condition, we work very diligently to provide you treatment that identifies and treats these many things.  This means:

  • We assess your fascia throughout your body, because we know there are fascial restrictions that may be far away from your vulva that can be part of your problem.
  • We treat your joints, especially in your back and hips to make certain you have optimal, full range of motion in each joint so that the nerves and muscles that enter the vulva and pelvis have optimal pathways.
  • We treat your pelvic floor, in a very gentle and detailed way.  You have several layers of pelvic floor muscles and we work specifically to determine what is the problem and how to treat them.
  • We treat your connective tissue around your vulva.  This is an important piece, especially if you have Lichen Sclerosus and are developing adhesions that could compromise your clitoris and vaginal opening.
  • We teach you how to stop clenching and holding the vulvar region tight and stiff.   This is a natural consequence of being in pain, but we need to reverse this problem so that the region can restore blood flow, be less clenched and relax.
  • We help you achieve your goals, whether they are to sit without pain, to experience intimacy again, to wear underwear or anything else.
  • We offer an annual pelvic floor wellness check-up for women with chronic vulvar conditions such as lichen sclerosus and vulvodynia.  Especially if you have lichen sclerosus, an annual check up to examine your tissues and advise you on your status and what to do to maintain your pelvic health can be invaluable.  We wrote about our annual pelvic wellness check up here.  Just click here to read more about it.

 How do I find a physician provider who knows how to help me?

Your physician may have very little training in vulvar dermatology and anatomy.  This is true whether your provider is a dermatologist, gynecologist or family medicine practitioner.  Therefore, you need to recognize that if you have persistent vulvovaginal pain you need to go to a provider who specializes in pelvic pain.  This may be a physiatrist, a gynecologist with pelvic pain specialty, a sexual medicine specialist, a vulvodynia specialst, a pain management specialist or a gynecologic oncologist.  The key is to find a provider who often treats women who  have persistent vulvovaginal pain.  That is the question to ask when you schedule your appointment and do your research.  The International Pelvic Pain Society has a provider directory and may be a helpful resource.

If I have vulvar pain, what should I expect my physician to do when I get an exam?

Your physician provider should use a colposcope during your examination.  This is basically like a special magnifying glass to see your vulva and vagina and sometimes there is a computer screen you can watch  so you can see everything at the same time as the physician.  Your provider (& a pelvic health physical therapist) will very gently examine your vulvar area.  We may use a Q-tip applied very delicately in various areas to determine if you have pain and normal sensation.  Where, exactly, you have your pain gives us a lot of clues of what might be causing it.  We like to determine if you have pelvic floor dysfunction in addition to vulvar pain.  In most cases a woman does have both.

Should I get a biopsy?

It is recommended that you get a punch biopsy when you have a lesion or tissue that looks different than expected.  If your tissue does not have any lesions and there is no appearance changes then the biopsy is not recommended.  It is common that some vulvar dermatologic conditions may be misdiagnosed as a yeast infection, vitiligo or herpes and a biopsy will definitively shed light on what condition you have. While recurrent yeast infections do occur, you also may probe your physician if you believe there is something else going on beyond a yeast infection.  Could a biopsy or a good exam determine if there is a an underlying condition going on?

There are various types of conditions that start with the word “lichen”, such as lichen planus, lichen sclerosus and lichen simplex chronicus.  A biopsy helps determine if you have these or other conditions.

Could I have lichen sclerosus?

Lichen sclerosus (LS) is a particular condition where the tissue changes its texture and architecture, tends to get whitish, it may appear crinkly or waxy.  You may have fissues and loss of your labia minora.  You may experience fusion of the tissue over the clitoral hood.  Narrowing of the vaginal opening can occur with this, so tearing may be present during intercourse and sex is generally painful.  More than 30% of people with lichen sclerosus also have an autoimmune disease such as thyroiditis, pernicious anemia, vitiligo and alopecia areata.  If a person has LS there is a 3-6% risk of developing vulvar squamous cell carcinoma, so it is important to do self checks using a mirror so you are familiar with what your vulvar skin looks like and is important to see your provider regularly.   Steroid treatment should be reserved until after a biopsy result comes through because some of these conditions benefit most from steroid treatment, whereas other conditions don’t benefit from steroids and they are actually not good for those conditions.  Clobetasol is the treatment of choice for lichen sclerosus and should be used continuously, as prescribed and optimal use of Clobetasol is the best way to reduce vulvar cancer risk. Once the active disease has been resolved then the adhesions that are narrowing the opening at the vaginal area can be removed.  There is research being performed on the use of platelet rich plasma to treat lichen sclerosus, so that is something to keep your eye on.  Fractional CO2 laser has also had some research for treating vaginal atrophy and LS.

Vulvodynia and persistent vulvovaginal pain is frustrating.  Pelvic PT can help you!

We help women overcome their vulvar pain.  If your provider doesn’t seem to understand your condition, give us a call.  Having helped individuals with persistent pelvic pain for more than 2 decades, Dr. O’Keefe can offer you a pelvic health physical therapy wholistic evaluation and treatment approach that is likely quite different & more comprehensive than what you are currently receiving.  If you are wondering if we may be able to help you and want to learn more, contact us at 616-516-4334 to schedule a free phone consult so we can learn about your condition and see if we think we can help you.  Located in Grand Rapids, Michigan, Purple Mountain Physical Therapy is a specialty pelvic health clinic founded by Dr. Maureen O’Keefe, DPT.  Dr. O’Keefe provides unique and advanced services that are compassionate and patient focused and help get you back to feeling like yourself again. If you are interested in learning more about what we offer call 616-516-4334.

Peace,

Dr. Maureen O’Keefe, DPT

How Do You Feel About Your Postpartum Recovery? Would Pelvic PT help you?

Being Pregnant and Postpartum can be an Overwhelming Experience and Definitely Changes Our Body! Pelvic Floor PT is a Key Component of Your Postpartum Recovery.

Each of us will experience our unique emotional reactions to the changes in our body!  You don’t have to know all the answers.  Expert help from a pelvic floor PT will take your postpartum recovery to the next level!

How do these changes in your postpartum body make you feel?  What do you think about your body now?  If you are struggling with disappointment in your pregnant or postpartum body, I can help you get back to feeling more like yourself when you join me to complete a postpartum PT recovery program.  Pregnancy and the postpartum period carry a risk of low back pain, pelvic girdle pain (such as SI joint pain, pubic bone pain, coccyx pain), painful sex, pelvic floor dysfunction, diastasis recti abdominus and urinary incontinence.  This is quite a long list, actually, of unfortunate things that you be experiencing as a result of being pregnant.  The good news is that working with me you will get a comprehensive evalution and treatment program to ensure you get your  body back into top form.  Pregnancy changes our posture, breathing, abdominal wall, pelvic floor, bladder, bowels and sex life.  I can help you recover all of these things!

What should your postpartum recovery program look like and include?  Pelvic floor PT help you get your body back and return to an active life!

  • Check you for a diastasis recti abdominus and develop a program of recovery from this
  • Evaluate and treat every muscle of your pelvic floor to determine how each one is working and to get each one to come back to function.
  • Teach you how to recover optimal breathing function, which was disrupted when you were pregnant and the baby moved your diaphragm.  Recovering breathing is crucial to recovering your pelvic floor function.
  • Take you through a progressive exercise program to restore your pelvic floor strength, coordination, function and speed.
  • Address your posture, especially increased midback hunch, tight shoulders, forward head and tilted pelvis.  Pregnancy changes your fascia and postural alignment and we look at this and help you correct it.
  • Optimize your pelvic organ suppport, a very important part of addressing pelvic organ prolapse
  • Strengthen your back and abdominals so you can confidently lift your baby and everything else you need to lift.
  • Get you back to higher level activities including jumping, skipping and running.

Research confirms that exercise and hands-on care for pregnant women can help their low back pain

Exercise (any exercise on land or in water), may reduce pregnancy‐related low‐back pain and any exercise improves functional disability and reduces sick leave more than usual prenatal care. Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy‐related pelvic pain, and osteomanipulative therapy or a multi‐modal intervention (manual therapy, exercise and education) may also be of benefit.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001139.pub4/full#:~:text=minor%20and%20transient.-,Authors’%20conclusions,more%20than%20usual%20prenatal%20care.

Pregnancies and a live baby were hard to come by in my experience.

I was one of the healthiest people I knew.  I was fit and active.  I was a physical therapist and knew how to help women through their pregnancy.  I had a regular cycle and zero clue that becoming a mother would take years of tears, pregnancy losses, hopelessness and digging in.  I had to discover wholistic ways to facilitate fertility, I had to work on stress/mind/body/spirit.  I had to call on my faith to get us through this.  I did just about everything under the sun to facilitate becoming a mother.  If you have experienced infertility you know what I’m talking about.  Yep, I did everything.  Everything.

My postpartum experience wasn’t so peachy, either.  I had to do extensive pelvic floor PT, abdominal wall recovery and rebuilding my strength and conditioning.

In my first 30 days postpartum I had emergency surgeries and spent ten hellish days in the hospital.  My family was amazing and scared to death for me.  It is not an exaggeration to say it looked like I wasn’t going to make it.  The will got drawn up in the hospital bed and the priest came.  It was a serious and dangerous and God-awful experience.  I had two kids under two years old who were not allowed at the hospital.  My family and friends were amazing and provided around the clock care for our kids, with my husband shuttling between the hospital and the two locations where our kids were staying.  My family wanted to touch base with me or my husband each hour to see how I was doing, because it seemed to change rapidly and would go downhill fast.  We were desperate to get me stable, but the roller coaster had begun and it was decidedly out of control.  And, remember, I was one of the healthiest people I knew!  I was an athlete, super healthy eater, had come to pregnancy after completing years of wholistic healing.  And. Still. It. All. Went. Wrong.  Until it went right!  Yay!  Eventually I stabilized and got to go home, exhausted and uncertain if I would be able to take care of our two kids.  And my body was a wreck.  My pelvic floor was a disaster (so many surgeries and my labor and delivery had done a number on me), my abdominal wall had a huge diastasis recti abdominus, all of my body muscles had atrophied.  I remember looking at my calves when I was in the hospital and shedding a tear at how atrophied they became.  It happened so quickly, over a matter of two weeks.  My OBGyne  said “well, you’ve lost all of your pregnancy weight and then some.”  And I remember replying “It is all atrophy.  I will weight lift and get it back.”  And I did.  It took a long time & a lot of discipline to recover my abdominal wall and pelvic floor and to get strong again.  But I did it, with the help of pelvic PT and my clinical background in how to take a woman through a safe and progressive postpartum recovery program.

Now you know a bit about how I got to be the person I am today.   I have been through an epic pregnancy and postpartum recovery and found a path forward that is authentically grateful, happy, strong and whole!  And I offer this wisdom and understanding to my patients.  I know  my patient’s pregnancy and postpartum experiences feel like a huge challenge to them.  May feel overwhelming.  May feel hopeless, like you are stuck with urinary incontinence or a “mommy pooch.”  I am proof positive that this is not the case.

Working with individuals who are experiencing pregnancy or are postpartum is a calling for me!  I love it!

I offer these women an insight, grace, clinical expertise, understanding and joyfulness for their pregnancy.  I had to complete intensive postpartum PT recovery.  Because of the nature of my labor and delivery and postpartum complications I had serious work to do to recover my pelvic floor, abdominal wall, strength, conditioning and function.  I did the hard work.  And, I know the commitment it takes to reach your goals.  It doesn’t happen overnight and it takes real insight and expertise to provide postpartum pelvic health physical therapy to a woman.  It is an honor to work with women who are pregnant and postpartum.

I have advanced training in providing pregnant and postpartum women pelvic floor PT and designing a postpartum recovery fitness program.

And my training dates back to the 1990s!  So, I’ve been studying and treating pregnancy and postpartum recovery for more than 2 decades!  Many pregnant women come to me experiencing miserable pelvic pain.  It might be their SI joint hurts, or their pubic bones are grinding everytime they move their leg, or they cannot roll in bed without back pain.  Or it might be that they are experiencing urinary incontinence or pelvic floor muscle spasms or a diastasis recti.  I can help all of these conditions!  How lucky am I?  It is truly an honor to help women during their pregnancy and postpartum periods.

I offer compassionate, patient-focused wholistic treatment for people who are suffering from pelvic conditions!  Are you interested in addressing your postpartum recovery?  Call Today for Information on our Program.

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Oh no, I am having stress incontinence! What natural treatments can I do?

Stress Incontinence: Natural and conservative treatment options to improve your urinary control!

We often work with women and men who experience stress urinary incontinence and are looking for natural treatments, rather than medications or surgery.  The age, backgrounds and lifestyle of these patients vary wildly and, no, not everyone is experiencing the urinary leakage because they had a baby (this is obvious for men, but it can be assumed women only experience stress incontinence due to childbirth).  The good news is that there are natural and safe options you can undertake to improve your stress incontinence, that do not involve surgery nor medications.  This article will review your options:

Stress Incontinence Basic Overview:

When speaking of stress urinary incontinence we are talking specifically about the involuntary loss of urine that occurs with some activities that put pressure on your bladder and urinary control system.  Most often you hear about leaking happening with laughing, coughing and sneezing because these activities cause a large increase in intra-abdominal pressure.  When you have increased intra-abdominal pressure, the bladder control mechanisms must be able to tolerate and respond to this intra-abdominal pressure to avoid leaking urine.  With stress incontinence, the system is overwhelmed and urine readily escapes.  We commonly treat individuals who experience stress incontinence with activities such as walking, getting up from a chair, moving in and out of a car and bending over to pick something up.  Regardless of whether your stress incontinence occurs with higher level activities (jumping, running, jumping jacks) or more benign daily activities (walking, changing positions, bending over), all of the suggestions in this article can help you.

Female vs Male Stress Urinary Incontinence, Key Differences:

Female Stress Urinary Incontinence

Stress incontinence is something that can occur in young, female athletes who’ve never had a baby.  All the athletic moves such as jumping and quick directional changes can place a lot of force through the abdomen and genitourinary system and for some young athletes, their body cannot manage this.  It is common when we work with women that their stress incontinence dates back to their youth.  They often remember losing urine when having a fun laughing attack in their youth or when playing their high school sports, for example.  Following pregnancy, a woman’s pelvis and pelvic floor muscles change and an unfortunate consequence for many women is stress urinary incontinence.  Many women have heard of or know friends who have undergone surgery for their stress incontinence, but most women we know would prefer to avoid surgery and instead are looking for natural treatments for their stress incontinence.  This article details the research proven, natural treatments.  For an overview regarding stress urinary incontinence in women, here’s an article: https://www.nafc.org/female-stress-incontinence

Male Stress Urinary Incontinence

In men, the most common reason for their stress urinary incontinence is having a prostate procedure, usually a prostatectomy but also following a TURP (transurethral resection of the prostate).  Post-prostatectomy incontinence rates vary in research, but can be as much as 80% of men.  About 6-8% of men who have a prostatectomy will experience longstanding stress incontinence, but rest assured that there are things you can do to help this, including physical therapy.  Research shows that about 30-40% of men will experience stress incontinence following TURP, but typically it will resolve.  Unfortunately, for 0.5-1.0% of men following TURP, their stress incontinence does not go away, after 6 months.

How the prostatectomy or TURP causes urinary incontinence:

Why does a prostatectomy cause stress incontinence?  It is because your anatomy is changed because the radical prostatectomy removed a number of your urinary control mechanisms and may also damage some of the nerves.  The prostate itself provides a degree of urinary control, so its removal compromises your ability to control your urine.  Normally, you have urinary sphincters that are muscular bands at the base of the bladder & prostate.  These sphincters are important and keep you from unexpectedly losing urine.  They remain shut, tightly, to prevent urine from leaking.  When you pee, these sphincters relax and dilate so that your urine flows.  With a prostatectomy the prostate is removed and your sphincters are also part of the process.   Surgically, the bladder is connected to the urethra (in the area where the prostate used to be).  Anecdotally, our patients sometimes tell us that they do perceive their urethra to be shorter after their prostate has been removed.  Just about all men have some amount of urinary leakage immediately following their procedure, but with physical therapy and specific strengthening exercises you can improve urinary control.

I don’t want to leak urine all the time!  What are my natural, conservative treatment options for stress incontinence?

There are numerous things you can do to help your stress urinary incontinence.

  1. Bladder retraining and fluid intake balance

When we are talking about stress incontinence natural treatments one of the first places to start is to look at bladder retraining, behavioral changes and fluid intake.  A physical therapist can help you learn how to retrain your bladder and can troubleshoot and advise you on your fluid intake.  We often find that individuals are scared to lose urine so they unnecessarily empty their urine prematurely, which can in the long-run not work in their favor.  Ideally, your bladder is strong and able to fill and hold a normal amount of urine, without experiencing bladder spasms, urgency and frequency.  We also see people have vast problems with their fluid intake.  Some people avoiding drinking, so they are dehydrated.  Other people sip and drink water all day long, which for some people makes it hard to hold your urine.   In some cases fluids like caffeine can worsen bladder control.  A PT can help you figure out what would be the most strategic fluid intake for your circumstances.

  1. Weight Loss is a great natural treatment option for stress incontinence

Yes, losing weight is shown to reduce stress incontinence!  Do you have an extra 5-10 pounds on you (Or more?).  Extra weight places more strain and pressure through the bladder, urethra and pelvic floor.  Losing even 5 pounds can have a beneficial effect on your stress incontinence.  While losing weight can feel like a challenge, the rewards it brings are totally worth it. And, if you are serious about implementing natural treatments for your stress incontinence, this one is a big one to accomplish!

  1. Pelvic floor muscle training with a pelvic physical therapist

When an individual experiences stress incontinence your pelvic floor muscles typically are not functioning properly.  Research has shown that pelvic floor muscle training can improve your symptoms.  It has also shown to help for pelvic organ prolapse symptoms, which is a condition common to women, and something that contributes to stress incontinence.  Training your muscles does take time, research seems to show it takes 3-6 months of consistent work to get the benefits you are looking for.  So, the trick is to be consistent and make the commitment to doing your exercises.  Training these muscles is the ultimate natural treatment for stress incontinence.  Seriously, if you have stress incontinence these muscles are always dysfunctional and you must address this.

What exercises should I be doing to train my pelvic floor muscles? 

Working with a pelvic health therapist you will learn a wide variety of exercises clinically shown to help improve urinary control.  Exercise is nature’s gift, as it is a natural treatment for stress incontinence that has no unpleasant side effects, like you would experience with pharmaceuticals and surgery.  There is not one exercise to do and, definitely, doing a “kegel” is not what we are talking about.  Stress incontinence occurs when your bladder control is overwhelmed by abdominal pressure that is generated through your movements.  We will assess the symphony of muscular coordination that should be occurring.  We also look at your movement patterns and see if your strategies are optimal for promoting bladder control.  When we help you train your pelvic floor muscles we also coordinate your breathing, abdominal wall, pelvic floor, glutes/hips and thighs and we address speed and timing.

Why we do NOT recommend you do Kegels:

We don’t recommend that you just try to work on Kegels or pelvic floor muscle training on your own at home; stress incontinence is a bigger problem than just getting a kegel to be stronger.  In fact, most people we see who have stress incontinence cannot perform a kegel properly.  They do it all wrong and in some cases can worsen the problem!  They are often bearing down on the muscles, even when they think and perceive they are correctly tightening the muscles.  Other times the muscles are already too stiff and tight, so kegels can worsen your stress incontinence.  Another problem we see is the lack of correct coordination between your abdominal wall and breathing with your pelvic floor muscles.  Additionally, in men, we see a tendency to recruit the wrong muscles when they do kegels such that they are unlikely to get much benefit to help their incontinence.  We also see, in both women and men, a tendency to “cheat” using your glutes and thighs, which does you no good and, in fact, can give you a false perception that you are helping yourself.  We also see people who commonly have a problem in their abdominal wall that can contribute to your stress incontinence.  This problem, a diastasis recti abdominus (DRA), is a widening of your linea alba that causes a disruption in your body’s ability to transfer load through your trunk, thus rendering it easier to lose your urine.  Before we begin pelvic floor muscle training, we assess you for a DRA and if this is a problem you have, then we treat that as well.    Working with a pelvic health PT will give you the best chance of improving your stress incontinence and we can teach you what to be doing at home so you can add these things to your workouts.

  1. Pessary, an option for women.

A pessary is a small item that is custom fitted by your physician for your anatomy and is inserted in your vagina.  Pessaries come in many different shapes and sizes to help correct your anatomy when you have a pelvic organ prolapse.  Combining a pessary with behavioral changes and pelvic floor muscle training, as described above, was found to have better improvement than only wearing a pessary.  Put another way, a pessary all by itself might not eradicate your stress incontinence, but if you also work on improving your pelvic floor awareness, strength and coordination while making some behavioral changes, you have a better chance of meeting your goals.  Just as most women are comfortable using a tampon, a pessary is something a woman can learn to insert and remove by herself.  Getting fitted for a pessary happens at your doctor’s office, preferably a urogynecologist who is specially trained in measuring your prolapse and fitting you for a pessary.  In one study, 73% of women who were given a pessary were happy enough with it to continue wearing this after one year.   If you have a pessary, usually there are regular follow ups with your physician to ensure everything is going all right with it.  How often you have a follow up depends on your physician’s preferences and your body, menopausal status and other considerations.  Sometimes follow up checks for your pessary would be every 3 months, other times it could be every 6 months or once a year.  Based on my experience as a pelvic health PT, I find that pessaries are under-utilized and not well known.  They are, in fact, an excellent natural treatment for stress incontinence and most women, can adapt well to wearing one.  You don’t even feel it, once it is inside you and fitted well.

  1. Address and improve your constipation

Improving urinary control can happen when you get your bowels regulated.  Individuals who have extreme constipation may face stool impaction and this has been shown to worsen urinary control.  Additionally, straining to have a BM is a strain on your pelvic floor muscles, the exact muscles that are needed to be in tip-top shape to maintain continence.   For any person I am working with who presents with issues related to stress incontinence, I always assess and help them with their bowel regularity.  Getting your bowel movements optimized is a natural treatment for stress incontinence and, for some people, can be an “easy win” towards getting their urinary control improved.

There is hope! You can improve your stress incontinence if you undertake the above tips!

The bottom line is that stress incontinence, although a frustrating and common condition in both women and men (following prostate surgeries), is not normal and can be improved with targeted efforts.  By implementing a combination of efforts listed in this article you can improve your constipation.  Do you need to lose a few pounds?  Cut back on your caffeine?  Retrain your pelvic floor, breathing and core muscles? Improve your constipation?  Get a pessary?  These are many natural treatments for stress incontinence that can help you, so please do not assume you are stuck with this problem.  Dr. Maureen O’Keefe, DPT offers expert and customized care specific to your body, your movement patterns, your muscular dysfunction and your bladder.  If you feel you would benefit from expert, directed guidance to help you improve your stress incontinence, call us today at 616-516-4334.  We always enjoy answering your questions and helping you determine your next best steps!

Peace,

Dr. Maureen O’Keefe, DPT

Pelvic Floor Specialist in GR

Looking for a Pelvic Floor Specialist in GR?  You’ve found the right place!

You deserve to receive your care from an experienced pelvic floor specialist who can help you get the best results.  When an individual has pelvic problems, we understand your apprehension and concerns with finding someone who can help you.  Dr. Maureen O’Keefe, DPT is a pelvic floor specialist physical therapist here in GR and treats men and women, helping them achieve their goals and recover from their pelvic condition.  In particular, Dr. O’Keefe specializes in the diagnosis and treatment of abdominal and pelvic conditions that involve pain, bladder, bowel and intimacy problems.

What can a Pelvic Floor Specialist do for you?

We empower our patients with safe, effective and natural techniques to help improve and manage all pelvic conditions.  This means we evaluate and treat pelvic floor dysfunction, abdominal wall problems, low back pain, SI joint pain, hip pain, pelvic pain, nerve pain, bladder and bowel conditions and painful intimacy.  Our pelvic floor specialty care can relieve pain, address boney pelvic alignment issues, recover core muscle coordination, restore bladder and bowel function, get you back to intimacy without pain and increase strength, mobility and function. 

Who We Help

We help women and men with any pelvic condition involving bladder, bowel, sexual dysfunction and pelvic pain.  Sometimes the people we help have already been to other providers to treat their condition and they are still suffering, so they come to us looking for expertise and another approach.  Because we are pelvic specialists, we comprehensively treat your condition with an approach that works to wholistically and naturally get you recovered.  We bring over 20 years experience to your condition and we are actively engaged in keeping up with the latest developments in clinical research, so you have the best chance of getting better!

What type of conditions do our pelvic health specialist PTs treat?

Musculoskeletal pain:

  • Low back pain, stiffness, spasm, herniated disc, degenerative disc disease, spinal stenosis and sciatica
  • SI joint pain (both men and women, pregnant and not pregnant)
  • Symphysis pubic pain (men and women, pregnant and not pregnant)
  • Tailbone pain (coccydynia.  Again, men and women throughout the lifespan.  It is common after a fall and following labor/delivery)
  • Hip Pain, clicking, stiffness, labral tears.

Bladder, Bowel and Sexual concerns:

These pelvic symptoms may stem from a variety of things, such as:

  • Pelvic Floor Dysfunction:  this is routinely found in just about every patient we treat.  We are expert pelvic floor specialists and we provide you with peace of mind.  Our evaluation will be very educational to you and will let you know whether you have pelvic floor dysfunction or not.  And, what you can do about it, if you have it.
  • Pregnancy and postpartum related pelvic changes
  • Chronic prostatitis, endometriosis, PCOS, interstitial cystitis
  • Posture and lifestyle factors such as excessive sitting, exercise overload, high stress, poor sleep quality.
  • Surgery (C-section, hysterectomy, bladder suspension, pelvic reconstructive surgery, hernia surgery, hip labral repair surgery or other abdominal or pelvic surgeries)
  • Trauma (physical trauma and emotional trauma can influence pelvic floor dysfunction and pelvic conditions)
  • Diastasis recti Abdominus (also known as abdominal separation):  we are experts at evaluating men and women for this condition and helping you heal this, if you have it.

If you are experiencing any pelvic condition, live in the West Michigan or GR area and wonder if seeing a pelvic floor specialist might help you, please call us today at 616-516-4334 for more information.  We are happy to answer your questions and determine if you are a good fit for our pelvic floor specialty care.  Stop the angst of not knowing what is going on and call us today to find out if we might be able to help you.

Peace,

Dr. Maureen O’Keefe, DPT

Specializing in pelvic health since 1999