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:

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.


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.,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:

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!


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.


Dr. Maureen O’Keefe, DPT

Specializing in pelvic health since 1999

Pelvic Floor Dysfunction PT in Grand Rapids

We provide compassionate, effective and expert pelvic floor dysfunction PT in Grand Rapids

When a person needs pelvic floor physical therapy, not knowing who might treat you for your private problem can be a concern that holds you back from getting the care you need and ending your suffering.

Dr. Maureen O’Keefe has over 20 years experience providing expert pelvic floor physical therapy to men and women who experience any type of pelvic floor dysfunction and pelvic condition.  The wisdom gained over these 20 years has helped shape her into the provider she is.  She has come to understand the human body and human nature in profound ways that inform her treatment.  She has some underlying guiding beliefs that inform the pelvic floor dysfunction PT she offers in Grand Rapids. If you are looking for someone who can treat you with compassion and expertise, contact us to learn more about out pelvic floor dysfunction recovery program.

Dr. O’Keefe’s Guiding principles for life and pelvic floor dysfunction PT: 

  • The Golden Rule is a core value:

treat someone as you would like to be treated. Dr. O’Keefe works very hard to meet your needs and treat you with compassion, respect and lovingkindness.  You will feel her carism from the first phone call.

  • Pelvic Floor Dysfunction is typically a result of a combination of many things:

Identifying what these things are and treating each of them will give you the best results.

  • Partial treatment for pelvic floor dysfunction will not end your suffering and solve your pelvic problem.

Partial and ineffective treatment for pelvic floor dysfunction is, unfortunately, common.  Things such as either appointments being too short and not providing the time to comprehensively treat everything and  lack of skill and experience by the provider cause ineffective treatment to occur.

  • The body will tell you what is going on: look, listen, pay attention.

Ignoring these messages has consequences to your health.  Dr. O’Keefe’s pelvic floor dysfunction treatment program evaluates numerous areas of your body to determine all contributions to your pain.

  • Listen to your patients and they will tell you what they need.

Dr. O’Keefe truly cares about you and listens intently for clues as to what are driving considerations for your pelvic floor.  Your body knows and, with you, she will figure it out.

  • When self-care is lacking everything else suffers.

We must make the time and develop the routines into our daily life.  This is how we can offer our best to others.  Sleep, nutrition, quality relationships and connection to others, stress relief, being good to yourself, physical activitites especially outdoor activities, being kind and spirituality all need to be nurtured.

  • Education is a lifelong pursuit.

Excellence requires continual pursuit of knowledge and reflection on what works, what doesn’t work and what needs to be modified. Dr. O’Keefe is continually reading research, attending webinars, traveling to conferences and seeking out more knowledge to deliver the best, most effective pelvic floor dysfunction treatment available in Grand Rapids and beyond.  Dr. O’Keefe has found that you must be humble to continually pursue excellence; you can never think you know it all and have achieved an end-point.  There is always something around the corner to be learned.

  • Goal setting helps define your “Why”

In physical therapy and life in general, setting goals helps us to be motivated, clear about where we want to go and sets our intention each day to work towards that goal.  Goal setting is an important tool to helping us build a plan going forward so that we meet our goals.  To read a more in-depth article about goal-setting, check this out:

  • The human body is made to move

While sitting may not be inherently bad, prolonged sitting without taking breaks is known to worsen health and can cause some severe pelvic conditions to develop that lead to pelvic floor dysfunction.   Full range of motion of joints, fascia and muscles is best, when possible.  Taking intermittent breaks from sitting is best and these can simply be short episodes of standing, climbing some stairs or walking around for a minute or two.

  • The pelvis holds a lot of power, disruption in this area can create ripple effects elsewhere.

In more than 20 years of treating pelvic floor dysfunction, Dr. O’Keefe knows that this condition causes problems in myriad areas of life.  It may be interfering with your relationships and social outings, stifling intimacy, causing anxiety, contributing to migraines, lost sleep, TM joint syndrome, bowel problems, feet problems and more.

  • The gut and microbiome are leading the way in your health.

Want to feel better? Work on gut health, it is foundational to immune health, brain health and the body functioning well.

  • Managing your stress effectively and purposefully is imperative.

Stress can effect our physiology, emotions, mood, sleep, immune system, gut health, pelvic floor, bladder, bowel and more.  Identifying and mitigating unhelpful sources of acute and chronic stress can help your pelvic floor dysfunction improve.

  • Love is what matters.

While this may sound like being loving to others, and it is, Loving yourself is equally important.  Dr. O’Keefe knows the angst and despair and brokenness that you may feel if you have pelvic floor dysfunction.  Rebuilding your sense of who you are and loving yourself while giving and receiving love from others is an important part of recovery.

We hope these insights give you an idea of what Dr. O’Keefe offers her pelvic floor dysfunction patients.  You will be in caring hands, with a person who prioritizes listening to you and meeting your goals and also helps you define a path forward to meet those goals.  If you have any questions about our pelvic floor dysfunction treatment in Grand Rapids, don’t hesitate to contact us.  We always enjoy meeting you and guiding you toward a path of recovery!


Dr. Maureen O’Keefe

Pelvic Pain PT in Grand Rapids

We provide quality and effective pelvic pain PT in Grand Rapids!

End your suffering!  Get answers today!  You have found the right place!

Not all pelvic pain physical therapy is the same.  You are not a run of the mill person and your condition is not run of the mill.   If you have pelvic pain and you want to end your suffering, you need results and expertise!  That’s what we offer.

What sets Purple Mountain Physical Therapy apart when we treat pelvic pain? 

We care about you in exceptional ways!  From the first moment when you meet us, you will feel the difference!  We offer the opportunity to discuss your condition with our staff, often with our physical therapist, before you come to an appointment.  Our pledge is that from day one you will feel supported, acknowledged and confident that you are in expert hands!  We take care of you and you will feel this care. Our pelvic pain PT in Grand Rapids is a comprehensive program that is focused on helping you to feel better!

We understand pelvic pain!  We have studied it for over 20 years.  We have traveled around the country to attend professional conferences specific to healing pelvic pain.  We have completed extensive and continuous education in pelvic pain physical therapy techniques, pelvic pain rehabilitation, chronic pelvic pain, myofascial pain syndrome, pelvic floor dysfunction, endometriosis, chronic prostatitis, interstitial cystitis, Pudendal neuralgia, trigger point pain, pain neuroscience and more.  This is so we can offer you the best!  Ever feel like your provider has never seen your problem before?  That will not be the case when you are treated by us.

Your evaluation will be more comprehensive than you ever could have imagined!  We conduct an evaluation that is unlike anything you’ve had before.  We use our clinical expertise to pinpoint what we need to assess.  We will assess your many nerves, muscles, joints, organs, blood vessels, skin and fascia so that we know exactly what needs to be treated.   If you need pelvic pain PT in Grand Rapids, you can count on receiving comprehensive and quality care at Purple Mountain Physical Therapy.  Contact us to learn more.

We ask you what your goals are, and our treatment focuses on you achieving them! You are here to get better!  We want your future life to be painfree, active and achieving all of your goals. Goal setting is an important part of recovery from chronic pain and we will design your treatment program to allow you to achieve your goals.  Our plan of care teaches you self-care, exercise, behavioral changes and other important things you can do to feel better.  To learn more about goal setting and self-care, here’s a good resource:

We educate you about your condition and what you can do to feel better!  We have devoted our career to learning how to treat chronic pelvic pain.  When we work with you, we are educating you on what we are finding, why this is a problem, what we see has changed from the last visit and where we expect you to be heading going forward.  Our knowledge is based in clinical expertise and in having treated people just like you for over 20 years.  We are like a trusted guide who can help you get to your destination.  Our patients tell us this, alone, helps decrease their anxiety around their uncontrolled pain.

In our next article we will discuss some of the features of our pelvic pain physical therapy program so you can learn more about what sets our approach apart from the rest!

To learn more about our pelvic pain PT in Grand Rapids, call us at 616-516-4334.  We would be happy to answer your questions and determine if we are a good fit to help you end your suffering.


Dr. Maureen O’Keefe, DPT  Doctor of Physical Therapy specializing in pelvic health.

Contact us

Urinary Incontinence Treatment in Grand Rapids

If you are looking for urinary incontinence treatment in Grand Rapids, you have found the right place!  We provide expert physical therapy rehabilitation, based in research proven methods to improve your urinary incontinence.

Coronavirus downtime, bladder control & Deconditioning… Oh My!

Summer in West Michigan is often a favorite time of year to experience everything our beautiful state has to offer! Our community offers many paths for walking and biking, parks to enjoy and rivers for kayaking and boating. But, let’s face the facts that with the coronavirus circulating, since March many of us have had much lower activity levels. Are you now deconditioned? Taking a day off here and there is no problem, but if you’ve been consistently missing your regular run, bike ride, or gym session or notice some aches and pains showing up, you might have deconditioning.

Is my urinary incontinence because my pelvic floor and bladder have gotten out of shape?

It is possible that deconditioning is worsening your bladder control.  But, typically urinary incontinence occurs for more complex reasons beyond simply “I’m out of shape.”   When the coronavirus shelter in place orders were lifted, we heard from more than one person who told us that they were having new problems with bladder control. Their comments sounded something like this “I think I was sitting at home all those months and never had to use my Kegel muscles.” And “I think I was just always near a bathroom for 3 months so I never really had to hold my urine, my bladder got lazy.” Or “I wasn’t walking and now that I am, I just leak urine with every step, it never was like this before.” If this sounds like you, we are here to help you recover your urinary continence!

We provide detailed evaluations to pinpoint the type of urinary incontinence you are having and to identify all of the things causing it, such as weakness, muscle shortness, muscle imbalance, muscle timing and coordination problems, misalignment of the pelvis, low back pain, muscle spasms, poor habits and more!

By asking the right questions and taking a detailed history we learned that some of these women were having stress urinary incontinence (involuntary loss of urine with things like laughing, coughing, sneezing, jumping) and other women were having urge urinary incontinence (inability to hold their urine because of a strong urge to urinate) and some of them were experiencing both problems. If this might be you, please know that physical therapy for urinary incontinence works! You aren’t stuck with this problem. And, doing Kegels isn’t typically the remedy. The control of continence involves a complex coordination of the deep core muscles with breathing, body mechanics and the rest of the core muscles. An overactive bladder, in particular, benefits from specific treatments to teach it to calm down. We are here to partner with you to provide you a step-by-step program to restore your bladder control. One major professional society that leads the way in pelvic health is AUGS.  Here is a link to a straight forward brochure from AUGS that talks about bladder training and pelvic floor muscle exercises.

Reversing Urinary Incontinence with Effective Treatment in Grand Rapids

If you implement the suggestions in that AUGS brochure and you still have urinary incontinence, call us for professional help.  Our urinary incontinence treatment program in Grand Rapids is comprhensive, personalized and detailed so you get results.  You don’t need to live with embarrassing urinary incontinence.  And kegels are often not the right approach for certain types of bladder control problems. We will evaluate you to determine exactly what you need to do to recover.  We educate you on how to get this under control.  We provide expert, hands-on treatments to your back, hips, abdomen and legs because these areas are often contributing to your urinary incontinence.  Working together we can get you back to doing all the things you love!  In Michigan a prescription is not required to see a physical therapist, so if you’d like to learn more about our urinary incontinence treatment program here in Grand Rapids, or our telehealth program, contact us today!


Dr. Maureen O’Keefe, DPT specializing in pelvic health, pelvic floor dysfunction, urinary, bowel and sexual health conditions