How Ab Exercises can Harm your Pelvic Floor

Hi there! I’m sorry I’ve been M.I.A. for the past few weeks! June has been a complete whirlwind for me so far: First, I landed a ghost writing gig, a 200-page book that needs to be completed in six weeks! (My full-time gig is ghost writing/editing books.) And on top of that, my boyfriend’s family came into town and swept us off to Santa Barbara as a special treat for his completing his MBA. Added to all of that excitement was my never-ending job of keeping my temperamental pelvic floor under control, and the end result was me falling terribly behind on many of the important things in my life.

Today I'm playing a bit of catch up, and to help me get back into the swing of things, my good friend from Downunder, Mary O’Dwyer, is weighing in with an informative blog entry. Mary is a physical therapist in Queensland, Australia who has dedicated her life to not only treating pelvic floor dysfunction, but educating other PTs on how to best treat PFD. I asked Mary to write about a topic that I am currently dealing with. One of my self-treatment strategies is regular chocolate intake. Unfortunately three years of self-treating with chocolate has amounted to about 15 extra pounds, most of which seems to have settled in and around my gut. Before hitting the gym, I thought I’d check in with Mary about the best way to get my waistline back. I’m concerned about abdominal exercises because I know how closely related my abs are to my pelvic floor.

Take it away Mary!

Thank you Bonnie! Like Bonnie, most women long for a flat stomach and toned abs. And according to the physical fitness community, all we have to do to obtain that goal is to do repetitions of exercises such as sit-ups, crunches, double leg lifts and so-called “medicine ball rotations.” But, what we’re not told is that each one of these exercises has the potential to harm our pelvic floors. Especially at risk are new mums, women who have undergone pelvic or spinal surgery, women with hypertonic pelvic floor muscles, unfit/uncoordinated, overweight women, and menopausal women.

Let me explain how common ab exercises can harm the pelvic floor:

For one thing, sit-ups, and many other common ab exercises, strongly increase pressure within the abdomen that pushes down on the pelvic floor. One role of the female pelvic floor is to tension and hold up the bladder, vagina and bowel against this downward intra abdominal pressure. If a woman has a weak, uncoordinated or ineffective pelvic floor, sit-ups will force the pelvic floor to bulge down promoting bladder urgency and vaginal prolapse.

Also, regular repetitions of these exercises focus on building strength at the waist in the “Rectus Abdominis” muscles and the “External Obliques,” and can result in an imbalance between outer and inner abdominal muscles. Women who over-exercise these outer abdominal muscles tend to lock their pelvic floor muscles. Holding the waist and pelvic floor muscles constantly tight may eventually cause the pelvic floor to become hypertonic. It’s this excessive tone or tension that can cause a full-blown pelvic floor pain situation.

So, despite popular exercise opinion, abdominals SHOULD NOT be worked in isolation. They are designed to work together in a coordinated pattern when we move along with the pelvic floor. Allow me to explain: With any movement, the pelvic floor, Transversus Abdominis and spinal Multifidus ‘tension’ as an inner cylinder, milliseconds before the outer Rectus Abdominis and Obliques ‘brace’ and hold or move the trunk. Abdominal exercises should encourage this pattern. However, sit ups and other common ab exercises, cause narrowing and hollowing of the waist, instead of bracing and widening with exertion.

For abdominal strength focus on this bracing pattern with

• Lying and seated stretch band exercises
• Four-point kneel, opposite arm/leg holds
• Balance work on a disc or wobble board
• Pilates reformer and mat exercises
• Pilates ring slow squeezes
• Fitball holds with arm or leg movements

If you’re at the gym or in an exercise class a good rule of thumb is to: NEVER PERFORM AN EXERCISE THAT PUSHES YOUR PELVIC FLOOR DOWNWARDS AND BULGES YOUR TUMMY FORWARDS.

G'day all!
Mary

To learn more about pelvic floor health, check out Mary’s book titled: “My Pelvic Flaw: Preventing Pelvic Floor Problems Throughout Life.”

Why it's Hard to Find Doctors Who Know their Way Around the Pelvic Floor

Last week I attended an eye-opening presentation at a top Los Angeles hospital given by one of the most knowledgeable pelvic floor physical therapists in the country. The goal of the presentation was to educate gynecologists affiliated with the hospital about pelvic floor musculoskeletal dysfunction (PFMD) and to show them how physical therapy can be a viable treatment option for PFMD patients. In attendance were male and female doctors both young and old. Wise to her audience, the PT was careful to back up all of her information with evidence-based research. She also did a wonderful job of balancing the info with interesting case studies and jaw-dropping images and diagrams of pelvic floor musculature. (In an upcoming post I plan to share highlights of the presentation.) The PT did a phenomenal job, and the presentation she delivered was fascinating. Equally as fascinating to me was what I learned that night about why so many doctors haven’t a clue about PFMD and the pain it causes. I now have a much better understanding of what PFMD patients are up against as they look to the medical community for answers and treatment.

In his introduction, the doctor who invited the PT to speak candidly admitted that he had not learned about pelvic floor musculoskeletal dysfunction (PFMD) in his medical training. What made the doctor’s statement even more remarkable was that he followed
it by saying that roughly one-third of his patients come to him with complaints that stem from PFMD. Later I learned that his statistic correlates with research that’s been done. So, in effect, one-third of the women who visit their gynecologists have some sort of PFMD issue, and yet, the subject matter is not one that is taught in med school. No wonder so many women have such a hard time getting a proper diagnosis!

As the PT spoke, I glanced around the room to take in the reaction of the audience. I fully expected them to be engrossed in the presentation. I was sure they were all having “A Ha!” moments. I couldn’t have been more wrong. One doctor sitting close to me was busy on his laptop, occasionally he would turn away from his computer screen to fiddle with his Blackberry. Another was busy in the back corner piling refreshments onto his plate. Others just stared blankly at the presentation screen. Finally, my gaze fell upon a small group of young women who were engrossed in the presentation and were looking on with interest. (It turns out these women were physical therapists.)

While I’m sure there were doctors in attendance who were interested and engaged in the presentation, the overall response of the group shocked me. After all, it wasn’t as if the PT was trying to sell them her personal brand of snake oil! She was giving them information on a health issue that impacts millions of women—maybe even answers that could help them treat their current patients who are in pain. And she was savvy enough to present the information in a language they understood—couched in one medical study after another. Every fact she threw out to them was backed up by research. Yet, I got the impression that many of the doctors in the room viewed the information as dubious.

I drove home utterly deflated. I’ve worked as a journalist for a decade and as a result I’ve become a bit of a cynic about the world at large. I think of myself as a positive-thinking cynic, but a cynic nonetheless. But going into that presentation, I had no doubt that the speaker was going to blow her audience away. That I was going to witness an en masse slapping of foreheads as the doctors grasped the gravity of the knowledge that was being shared with them. I was looking forward to a heady discussion after the presentation as the audience posed their pent-up questions.(Only one doctor asked a question. In his question, he implied that physical therapy was not a financial option for his patients and asked for a list of pharmaceutical alternatives.)

The next day I was scheduled to meet up with Dr. Noblett, the urogynocologist that I am collaborating with on a book about PFMD. I told Dr. N about what had happened at the presentation. I was looking for an explanation as to how, in the face of scientific proof, doctors could still doubt the very existence of PFMD and the pain it causes. After all, it’s not like it’s the Dark Ages; we’re in the throes of modern medicine—the PT wasn’t asking those doctors to take a leap of faith, she was merely making them aware of a medical diagnosis that had already been identified and researched.

After my rant, Dr. Noblett, who is one of the wisest, most thoughtful people I know, told me a story about two doctors who presented their theory that bacteria can cause stomach ulcers. They were laughed off the stage, she recounted. Now, their theory is widely accepted and antibiotics are a common treatment prescribed to patients suffering with ulcers. The doctors unveiled their theory, not in 1780 or 1880, but in the 1980s. So, even though medicine has come a long way, human nature remains pretty constant. It always takes time for new ideas in medicine to catch on, she explained, but if they’re backed by evidence, catch on they will. Dr. Noblett explained that her specialty, urogynocology, is a relatively new one. And it’s really the advent of this new medical specialty that has steered more attention to the musculature that supports the pelvic organs. And Dr. N made me realize that important strides have been made and are being made in the understanding of PFMD. On top of that, there are wonderful doctors and physical therapists who are driving the progress, and each year more are joining the cause.

Recently, I spoke to the PT who gave the presentation. I asked her if she was surprised by her audience’s response. She said it didn’t surprise her at all. This wasn’t the first time she’d given this talk to a group of doctors. She knew beforehand that she was up against a tough crowd. But, she said, if she only gets through to one, then it’s completely worth the trouble. Now, I have no doubt that with folks like this PT on the case, the medical community will for sure come around.

In the meantime, I’m hoping I can do my tiny part on this blog to help folks bypass the doctors who haven’t figured out their way around the pelvic floor and get to those that are pelvic floor pros. The post below this one is the beginning of a list I am putting together of docs that know what’s up when it comes to PFMD. As I continue on with my research for the book, I’ll be adding additional doctors. Also, check out the resources I’ve included in the post that can help you find a doc who’s down with PFMD in your area!

If you know of a doc that deserves a place on the list, please leave her/his name in the comment section and I’ll add her/him to the list!

Scroll down to see the list!

List of Doctors Who Know Pelvic Floor

Below is a list of doctors that I have come across in my research for the book I am working on about pelvic floor musculoskeletal dysfunction. I will continuously be adding new names to the list as I come across doctors in the know during my research for the book. If you know of a doctor who deserves to be on the list, please add his or her name in the comment section and I will be sure to add him/her to the list.

DISCLAIMER: THIS LIST IS MEANT TO ACT ONLY AS A STARTING POINT. IF YOU ARE THINKING OF VISITING ANY OF THE DOCTORS ON THIS LIST, I STRONGLY ENCOURAGE YOU TO CONDUCT YOUR OWN RESEARCH ON HIM OR HER BEFOREHAND.

Dr. Karen Noblett: UCI Medical Center, Orange, California: 714-456-2911

Dr. Felicia Lane: UCI Medical Center, Orange, California: 714-456-2911

Dr. Jerome M. Weiss: The Pacific Center for Pain and Pelvic Dysfunction, San Francisco, California: 415-441-5800

Dr. J. Thomas Benson: Urogynecology Associates, Indianapolis, Indiana: 317-962-6600

Dr. Mary Pat Fitzgerald: Loyola University Health System, Chicago, Illinois: 1-888-LUHS-888

Dr. Howard T. Sharp: Salt Lake City, Utah: 801-581-7640

Dr. Sangeeta Mahajan: Cleveland, Ohio: 216-844-3941

Dr. Kimberly Safman: (Pain Medicine, Physical Medicine and Rehabilitation) Newport Orthopedic Institute: Newport Beach, California: 949-722-7038

Dr. Colleen Fitzgerald: Rehabilitation Institute of Chicago: 1-800-883-3931

Dr. Andrea Rapkin: UCLA Health System: 310-794-7274

A resource that can help you find a doctor in your area who is knowledgeable about PFMD:

The International Pelvic Pain Society: www.pelvicpain.org: this organization provides this page where you can type in information to find a doctor in your area—even if the only bit of info you type in is the name of your state, click on the “find provider” button and it will search its database for doctors in your state.

These organizations also have searchable databases of doctors; however, you must first become a member in order to search them:

Society for Urodynamics and Female Urology: www.sufuorg.com

National Vulvodynia Association: www.nva.org

Slippery Stuff, Foam and Hogwash

Hi there! I’m sorry I’ve been a bit absent of late. I’ve had a sore noggin thanks to allergy season, and was taking a little break from the computer. Thanks to some good rest and a box of Claritin, my noggin is ready to do some bloggin’. (I’m truly sorry, but there was no way I could resist that one!)

Today, I’d like to share a couple of super-cool self-treatment discoveries with you:

Discovery Number One: Slippery Stuff: A couple of weeks ago, I was really bummed to learn that my favorite lubricant was no longer on the market. It was called FemGlide and was water-based and super-gentle for sensitive gals like me. Every other lubricant I’ve tried in the past has irritated my parts. My big ole 16 oz bottle of FemGlide was like an old friend. Whenever I used it, whether it was to self-treat or to insert a suppository, I could always depend on it to add its lovely cooling sensation to the mix. The good news is: FemGlide has simply been repackaged and is now sold to individuals as “Slippery Stuff.” IMPORTANT: THE SLIPPERY STUFF/FEMGLIDE EQUIVALENT IS THE BOTTLE WITH THE BLUE LABEL. Apparently the company that manufactures FemGlide (Cooper Surgical), now only sells it to doctors and clinics. Luckily one of its distributers (Wallace O’Farrell) pays to have it repackaged and relabeled and sells it to individuals as Slippery Stuff (Blue Label!). This may seem much ado about a little goop, but self-treatment and my suppositories are important to my improvement. It would be uncool if I didn’t have a lubricant I could trust to not irritate my areas.

Discovery Number Two: Foam Roller DVD: I have what’s called “the typical pelvic pain posture,” which means I am sway backed and also have a bit of scoliosis (my mother is a beautiful, petite, 4 foot, 9 inch Italian woman who brags about being 90 lbs when she was pregnant with me; I often wonder if the cramped quarters caused my little fetus self to develop into wonderful crooked me.) These “special” traits of mine add up to tight back muscles, which are no good for my temperamental pelvic floor. So, an important component of my self-treatment is using my trusty foam roller to stretch out my back. But, for some reason, I can never remember how to do all of my foam roller moves. Last week I found a workout DVD online that is devoted 100% to foam roller exercises! It’s called Keli Roberts: Flexibility for the Inflexible. It’s really helped me with my foam rolling routine.

Click here if you’d like to order some Slippery Stuff!

Click here if you’d like to order the foam roller DVD!

Lastly, I am still plugging away on the important blog entry about finding a doc who knows his/her way around the pelvic floor. I’ve postponed it a bit, not only because of my noggin’ trouble, but also because tomorrow I am going to a lecture at one of the top hospitals here in Los Angeles. The lecture will be delivered by one of the most knowledgeable pelvic floor PTs in the country to a roomful of gynecologists affiliated with the hospital.

Julie has asked me to share my story with the audience after she has finished her talk. I will be like a living visual aide! I’m terribly nervous about it as public speaking is a big fear of mine, but I’ve figured out a strategy for keeping cool. When I first came down with all this pelvic pain stuff, I was bounced around from doctor to doctor. I told one of the doctors that I had been told that my pelvic floor muscles were in spasm and I needed to see a PT. He basically told me that that was a lot of hogwash! So, I’m going to pretend that the room is full of Dr. Hogwashes and fantasize that I’m setting them straight about my pelvic floor spasm and my need for physical therapy.

Rock and Foam Roll!
Bonnie

A Pain-ic Attack

In this entry I’d like to chat about something that happened to me recently—something I bet many who have experienced chronic pain can relate to. About two weeks ago, I woke up with a headache. I was a bit annoyed as I had a ton of writing to do, and it was one of those headaches where opening your eyes hurts. Because I rarely got headaches, I didn’t have any of the usual headache remedies in my medicine cabinet. I had several bottles of super-potent, put-hair-on-your-chest nerve and muscle pain meds--some I had to stop taking because they had me walking into walls-- but not one single bottle of aspirin! So, I borrowed a couple of aspirin from a neighbor and tried to go about my day. Each night, I went to sleep certain the headache would be gone in the morning. But, one week went by and the headache showed no signs of letting up. That's when I clicked into panic mode. I mean I really panicked. I began scouring the Internet for information on headaches—symptoms, treatments, natural remedies; I spent a fortune at the drugstore on different headache, allergy and sinus meds; I made lists of specialists in my area, but worst of all, I began to worry. I was filled with a feeling of dread. Was I about to get dragged on another chronic pain ride? Would my head feel like this for the rest of my life? Would I have to learn to write/drive/read/cook/exist around my aching head in the same way that I had to figure out how to work around my pelvic floor issues? I was consumed with fear. Then I went to the doctor, and chatting with him sparked my memory; it was this time last year that I had gone to the eye doctor because I had been having headaches—at that time, I had assumed the headaches were due to eye strain because I was way overdue on updating my glasses. Now, I was having the same headaches--just in time for allergy season. The doctor advised me to take an over-the-counter allergy med, and said I would most likely feel better after taking it for a week. Well, so far I’ve taken one dose, and I already feel better. I can’t help feeling embarrassed by how much I overreacted. But I’m going to give myself a pass. My Mom nearly drowned when she was a kid. As a result, she has always been afraid of the water. I suppose I experienced something similar with my headache pain. Before my pelvic floor went haywire, any time I had a pain, it either went away on its own or an all-knowing doctor would scribble out a prescription that would nip it in the bud. I guess dealing with a chronic pain situation for three years can leave a person shell shocked when it comes to pain. But, here’s the thing: I know that my body is a complicated machine with tons of pieces and parts. I realize that things will go wrong here and there, and I don’t want to get frozen with fear each time. So, I’m taking a lesson from my headache experience. I’ll file it away, and the next time I have an ache or a pain, it won’t be the end of the world, but a situation I can face with calm and perspective.

What's my Pelvic Floor for?

Hi there! Welcome to Tuesdays with?! Today our very special guest blogger is blogging all the way from her home in Australia! Her name is Mary O’Dwyer. Mary is a pelvic floor PT with more than 30 years of experience treating women’s health issues. She’s dedicated her life to not only treating pelvic floor dysfunction, but educating other PTs on how to best treat PFD. Mary is also the author of a wonderful book titled: “My Pelvic Flaw: Preventing Pelvic Floor Problems Throughout Life”. Mary, you have the floor—pardon the pun.


Much of our present epidemic of pelvic floor problems is underpinned by a general lack of knowledge about this most central part of our female body. What did your mother tell you about preventing leaky bladders, prolapse, correct bowel and bladder habits, exercise after birthing, pain with intercourse etc? Not much because women just don’t have the correct knowledge to pass onto their daughters. So, I thought today I’d answer a few questions about the basic functions of the pelvic floor.

What’s the role of your pelvic floor muscles? Your pelvic floor muscles have about four major roles:

• Your muscles tension to close the sphincters to keep you continent.
• Your muscles tension and hold up your bladder, vagina and bowel against the downward intra-abdominal pressure happening every time you lift a child, cough, pull down the lat. bar at the gym or run.
• Your pelvic floor automatically tensions with your deep abdominal muscles to provide stability for your lumbar spine when you move. Research shows a high correlation between pelvic floor problems and spinal problems.
• Your pelvic floor muscle strength is related to the strength of your sexual response, sensation and orgasm.

Are all pelvic floor’s the same?

No way! So far, apart from the normally functioning floor, I have identified four different types—as I continue this aspect of my research, I may isolate additional types, but to date, here’s what I’ve found:

• The Weak Pelvic Floor: this pelvic floor has no idea of how to tension, may have been damaged during pregnancy or childbirth, experienced neural damage from straining to open the bowel, been damaged from continued heavy lifting or an injury. The owner of this floor has a poor idea of how to tension the muscles which may be slack and stretched. The owner may even bear down instead of tensioning upwards. Thinking about the levels in a building, this floor sits in the basement.

• The Uncoordinated Pelvic Floor: researchers have shown the pelvic floor and deep abdominal are the first muscles to tension milliseconds before we move. The owner of this floor may have learned to switch on the strong waist muscles first due to overuse and incorrect abdominal exercises, so their pelvic floor switches on after the waist muscles. When this owner exercises, lifts or coughs they have learned an incorrect pattern of strongly switching on their waist and rib cage muscles to do the action. So, this pelvic floor may travel from the basement up to first floor in the attempt to overcome the strong intra- abdominal pressure down onto the floor.

• The Overly Tight Pelvic Floor: this pelvic floor becomes switched on too frequently at too high a level of contraction. If you bend your fist to your shoulder to hold your biceps tightly clenched, this keeps the biceps contracted. Imagine how dysfunctional your biceps would become if you held you biceps clenched for hours on end. The owner of this floor is likely a gym junkie or elite athlete and has developed dysfunction in their core muscles due to the high level of muscular tension. The owner of this floor typically holds too much tension at the waist and ribs like a self-imposed muscular corset and has an abnormal breathing pattern due to the constant waist tension. Prescribing strength exercises for this pelvic floor will only aggravate the owner’s symtoms.

• The Chronically Painful Pelvic Floor: This owner has learned a pattern of continually holding tension in their pelvic floor as a learned response to stress, and tension. Since the muscles surround sensitive nerves and blood vessels, these structures are constantly irritated by this ongoing tension. This owner walks around with their floor held up at the second floor and with periods of added stress even draws it up to the third floor. This excessive muscular tension is the breeding ground for pain producing trigger points. Add to this an injury or a triggered immune response and the brain misreads nerve signals and upgrades them to intense pain that’s out of proportion to the condition or injury. Prescribing strength exercises for this floor will also aggravate symptoms. In addition, to having their trigger points treated, the owners of this type of pelvic floor needs to learn the skill of letting go of tension before gently coordinating pelvic floor muscle action.

Most women I treat with pelvic floor problems have never learned to correctly tension and coordinate their pelvic floor and core muscles with everyday bodily functions and activities. Their brain literally does not recognize the action of these muscles or they may have learned an incorrect pattern.

Click here to read more about Mary!

Put your Pelvic Pain on Ice

The burning is definitely the aspect of my pain that is the most difficult to deal with. Give me throbbing over burning any day of the week! Although the pain meds I take help a great deal with the burning, during a flare up or after a long day of work, it breaks through. Aside from the ouch factor, burning pain is really distracting! For me it's as if a fire alarm is going off in my brain. I’ve found that the single best way to put out the fire is ice. The great thing about ice is that it’s a cool remedy for both muscle pain and nerve pain. While burning pain is often classified as nerve pain, muscle pain can also present as a burning sensation.

In the past, I would ice only when I had a flare up or after a long day of work when the burning was intolerable. Now I ice pretty much on a daily basis. Of all the strategies I deploy to conquer my pelvic pain, icing is the only one that gives me that “ahhhh” feeling. It never fails to instantly turn down the volume on my burning. I ice at different times of the day depending on what my pain is up to that day. I find that I can get up to two-three hours of relief from intense burning if I ice for an hour or more. So, oftentimes I’ll ice right after I’m finished working for the day and that way I can enjoy my evening.

Below are two important icing tips:

Never just place an ice cube directly onto your skin; doing so can damage skin tissue. Either wrap the ice in a towel or throw some cubes in an ice pack. When I ice, I use one of those good old fashioned ice packs. I find that they do a good job of molding to the area and reaching all of my hot spots.

Apply the ice for 15-20 minutes at a time. Then remove the ice and allow feeling to come back to the area before reapplying.

Stay cool,
Bonnie