Purpose Statement

This blog is intended to educate women on issues that affect women. Although we are all healthcare professionals, we are not here to give medical advice. Rather we hope this will encourage women knowing that help is available and give them the courage to seek help.

Sunday, December 18, 2011

Pregnancy and Posture

An important part of having a healthy pregnancy is maintaining good posture. During pregnancy, your body produces special hormones that lead to physical changes in almost every part of your body. One of those changes can affect the ligaments that hold your bones together which can cause loosening of your joints and lead to pain. Postural changes which occur during pregnancy can have an effect on many areas of your body but a common complaint is low back and pelvic pain. As your baby grows and your uterus expands, your low back will typically get a more pronounced curve as your center of gravity is shifted forward. This can also cause a ripple effect of changes all the way up the spine. To compensate for postural changes some of your muscles must work harder to support the body in the upright position and over time they can become shortened and less flexible. Other muscle groups have to work less than they normally do and over time they can become weak. Your abdominal muscles can become stretched as the baby grows which causes them to be less able to contract and keep your back in good alignment.

There are some things you can do to help maintain a better posture and protect your back throughout your pregnancy:

*Always try to stand up straight by imagining that someone is making you taller by pulling a string attached to your head.
*Tuck your pelvis under so that your ears, shoulders and hips are in a straight line.
*Avoid standing in one position for long periods of time. If you do have to stand for a prolonged time, place one foot up on a foot stool to take some pressure off of your back.
*Consider wearing a maternity support belt.
*Make sure your back is well supported in sitting by placing a towel roll or cushion at your low back. If you have to sit for prolonged periods of time, try to get up and walk around every 20 minutes.
*Lying on your side is a good position to take stress off your low back without reducing the blood flow to the placenta and your baby. Place a pillow between your legs to take the strain off your back and a pillow under your abdomen to support the weight of your uterus.

These are just a few of the suggestions for maintaining a better posture throughout pregnancy. More suggestions and information may be addressed in a later blog. If you have additional questions at this time, please talk to your healthcare provider.

Sunday, December 4, 2011


Masked behind the smiles and excitement of December holidays, many women - and men – and children - experience a transformation that makes them irritable, hungry, fatigued and despondent.  Brought on by changes in daylight, Seasonal Affective Disorder (SAD) is a common occurrence in regions that have shorter days in winter and distinct seasons.
While SAD is generally thought of as an adult disorder, the American Journal of Psychiatry reports that children as young as nine may exhibit symptoms.  The cause, according to neuro-scientists, is thought to be changes in the body’s production of serotonin and melanin.

Women who have chronic pain syndrome often are sad (dysphoria) and find little pleasure in life (anhedonia).  As the days grow shorter and light grows weaker, SAD may occur, and it is often said that the individual has “double depression.”

Norman Rosenthal, the Maryland psychiatrist who in the 1980’s first described the cluster of symptoms now called SAD, lists the following as common complaints on his website www.normanrosenthal.com

  • Reduced energy
  • Difficulty waking up in the morning
  • A greater need for sleep
  • Increased appetite, especially for sweets and starches
  • Weight gain
  • Difficulty concentrating
  • Fatigue during the day
  • Withdrawal from friends and family
  • Sadness and depression
Dr. Rosenthal points out that sadness and depression are often the last SAD symptoms to manifest themselves. 

Many women with chronic pain report intense feelings of dysphoria.  Because they are hurting, they feel miserable, think distressful thoughts, and move slower and more cautiously than others.  They describe feeling conflicted about their medications which ease their pain but keep them feeling sedated, lethargic and moody. 

Women with chronic pain and depression must work to treat their blues.  Anti-depressant medication is only a helper.  Making a commitment to change - to be less of a spectator and more of a participant in life helps women become less self-centered. Life takes on a more positive meaning. As one of my clients recently said, “I have to keep myself distracted so I don’t wallow in my pain and misery.”

Some ways to increase distraction and participation are:

  • Practice good hygiene
  • Laugh
  • When tempted to eat unhealthy foods, drink iced water (the colder, the better)
  • Get involved in volunteer work
  • Have a “date” with your spouse once a week
  • Stretch and exercise daily as best you can
  • When feeling stressed, ask yourself, “Is this my problem, or is it someone else’s problem to solve?”
  • Keep track of sunrise times and get up early to take advantage of winter sunlight
  • Use “daylight bulbs” in your home to have full spectrum lighting (www.topbulb.com)
  • Make or purchase a “light box” to help with serotonin and melanin production
  • Have your family help with the housework or hire a housekeeper
  • Go outside, take a walk or a drive and get fresh air
Written By: Rhonda Borman, LCSW

Saturday, November 19, 2011

Don’t ignore your scars.

Do you have an abdominal scar from a surgery like a C-section or hysterectomy? Did you tear during childbirth? Or did you have an episiotomy? As your body heals from surgery or tearing during childbirth, a scar forms. Scar tissue is fibrous connective tissue that develops during the healing process. Your body is unable to re-create healthy, normal tissue so when there is a surgery or trauma, a scar forms.

Abdominal or pelvic scars are usually never problematic. However, if the scar is tight or restrictive it can lead to problems. If a scar binds two or more tissues together, this can cause an adhesion. This prevents tissue (muscle, organs, connective tissue) from moving freely and normally. If this scar is tight and feels “bound down” it can prevent your muscles from contracting properly. This lack of mobility in the area can lead to pain around the scar or in surrounding areas.

If you have had a lower abdominal incision, your abdominal muscles were cut. These muscles are important for lower back support and core/pelvic stability. When the scar does not move well, it may be difficult for your abdominals muscles to contract efficiently. Lack of lower abdominal control can also lead to low back pain or pelvic muscle pain. This can lead to diminished bladder control as well. Have you noticed that you slouch more than you used to? The lower belly muscles are so important to support your spine and maintain “good posture”. Lack of mobility in the scar may be preventing you from standing up tall and holding your shoulder’s back.

The same concept occurs vaginally if you had a tear or episiotomy. The scar should move well in order to contract and relax your muscles correctly. A tight scar vaginally may cause pain with intercourse or difficulty with bladder or bowel control.

Is your scar tight or painful? Touch your scar and move it side to side and up and down. If that is painful or if it feels like it does not move well in a certain direction, your scar may need some attention. Fortunately, you can get treatment for a restrictive or painful scar. A physical therapist can teach you how to stretch the scar gently and improve the mobility in the area. Then you will learn exercises to perform to strengthen the area. Talk to your provider or visit www.womenshealthapta.org to find a physical therapist in your area that can help you.

Saturday, October 29, 2011

Vaginal Atrophy

You were prepared for the hot flashes, night sweats, and mood swings that accompany menopause.  Your mother, sister, friends, and even complete strangers have all shared their stories of menopause.  However no one prepared you for the vaginal dryness, irritation, and pain with intercourse that can occur. 
Vaginal atrophy is the lack of vaginal estrogen that leads to thinning and inflammation of the vaginal tissue.  This can lead to decreased vaginal lubrication, vaginal shortening and tightening, and loss of vaginal elasticity.   The structure of the vulvar tissue can change as well as thinning of the labia and fusion of labial tissue.  The bladder and urethra also contain estrogen receptors and can be negatively impacted with the loss of estrogen.    

Symptoms of vaginal atrophy include:

Vaginal dryness

Vaginal or vulvar burning

Vaginal or vulvar itching

Pelvic or vaginal pressure or pain

Pain with intercourse

Bleeding with intercourse

Urinary frequency

Urinary urgency

Leakage of urine

Pain or burning with urination

Recurrent bladder infections

Decreased vaginal estrogen can occur in the years leading up to natural menopause (perimenopause) or after menopause.  Other causes include surgical menopause (removal of the ovaries), chemotherapy and/or radiation treatment for cancer, breastfeeding, and medication induced ovarian suppression.   Smoking also can contribute to atrophic changes by impairing blood circulation and causing oxygen depletion to the tissue as well as reducing the effects of naturally occurring estrogens.

Treatment of vaginal atrophy includes non-hormonal and hormonal therapies.  If you prefer a non-hormonal option there are many over the counter products vaginal lubricants and moisturizers available.  It is best to try a sample size initially to determine if it will cause irritation.  If you desire a hormonal approach, this needs to be discussed with your provider to discuss your options.  If you are experiencing any of these symptoms, please see your provider for an accurate diagnosis and discussion of available treatment options including risks and benefits of each. 

Sunday, October 2, 2011


Sex was intended to be enjoyable, not painful, but for many women that is not the case. Many women silently suffer with a condition called dyspareunia. Dyspareunia is pain before, during or after intercourse. It can have a significant negative effect on the quality of life and may affect as many as 20-50% of all women. Some of the common causes of dyspareunia are injury to the pelvic region during childbirth, endometriosis, pelvic inflammatory disease, infection, adhesions and interstitial cystitis. Psychosocial factors such as depression or abuse can also be causes. Musculoskeletal dysfunction and specifically muscle pain and overactivity of the pelvic muscles is another cause. Overactivity means the muscles do not relax completely. Overactive, nonrelaxing muscles are painful to touch and may lead to spasms preventing intercourse entirely. Pain may be experienced as ache upon penetration, burning or tearing sensation. Depending on the causes, symptoms may be felt at the vaginal opening, inside the vagina or deep in the pelvis.

Treatment for dyspareunia depends on the underlying cause. When pain is caused by a musculoskeletal dysfunction physical therapy can help reduce the symptoms. The pelvic floor muscles and other muscles around the pelvis and abdomen often tighten in reaction to pain. This sets off a cycle that is difficult to break. It hurts, so you tighten up, you tighten up and it hurts more. The goal of physical therapy intervention for dyspareunia is to reduce vaginal pain by reducing overactivity of the pelvic muscles. Treatments may include external and internal pelvic floor muscle massage, relaxation training, strengthening and home exercise program.

Do you avoid intercourse because you know it is going to hurt? Do you suffer through intercourse because you don’t want to disappoint your spouse but never enjoy it like it is intended because it is too painful? If you are one of the many women who suffer from dyspareunia, talk to your doctor so you can discover the underlying cause and get the help you need and deserve. Don’t continue to suffer in silence.

Monday, September 12, 2011

What is Pelvic Organ Prolapse?

Your pelvic organs are held into place by ligaments, connective tissue, and your pelvic floor muscles. Your pelvic floor muscles are a sling of muscles that wrap around your bladder, vagina, and rectum supporting all your pelvic organs. If these ligaments and pelvic floor muscles are stretched and/or weak, the organ may fall out of place, hanging down into the pelvic area. This is called pelvic organ prolapse. Childbirth, repetitive lifting, poor breathing patterns, or hormonal changes can contribute to a pelvic organ prolapse.

If you have prolapse, you might experience pelvic pressure or heaviness in the area, changes in your bowel or bladder when you try to go to the bathroom, and/or urine or stool leakage. Prolapse itself is not painful but it can cause pain in other areas of your body. Some of the ligaments that support your pelvic organs attach to your low back. If you have an organ that is falling down into the pelvic area, it may be pulling on your low back causing low back pain. Also, a prolapse may hang on your pelvic floor muscles causing them to stretch and get weak. This can lead to pain or muscle spasms in these muscles as they work hard to hold the falling organ in place. You might experience discomfort or pain during intercourse because of the prolapse hanging into the vaginal wall.

If it is a minor prolapse, doing kegel or pelvic floor contractions may be enough to support the organ and make your symptoms go away. There are other options to help hold the organ in place such as wearing a pessary. A pessary is a medical device inserted in the vagina to support the organ that has fallen.

If you are concerned you might have a prolapse, talk with your medical provider. You have many options that can help your problem.

Sunday, August 28, 2011

Guys: If Your Woman Has Female Sexual Dysfunction, Do This

EDITOR’S NOTE: When a woman has female sexual dysfunction (FSD) her sexuality can be affected. This, in turn, affects her husband or partner. They both struggle with the physical and emotional problems that are created. This leads to blaming and fault-finding. In this posting, licensed psychologist and certified sex therapist David Yarian, Ph.D. answers questions about common frustrations couples face when a woman has (FSD).

Rhonda Borman (RB): Men have a difficult time understanding that their partner’s sexual dysfunction has nothing to do with them - it is not their fault. In addition to having the health care provider talk with the couple, what advice can you give to men who need to understand the intricacies of their partner’s problem(s)?

David Yarian (DY): It’s important for couples to work together to navigate the difficult challenges of a pain syndrome. Men often worry they are hurting their partner, and as a result may be tentative in approaching them. They may develop performance anxiety and erectile dysfunction, or choose to avoid sex entirely. I suggest that couples agree to stop what they are doing immediately if there is even the hint of pain. They can then change positions or alter the activity in some way so that there is no pain.

It is vital that the woman commit to speaking up when there is pain. This allows her partner to stop guessing and relax and enjoy intimacy until he is notified that there is pain. There is never any benefit for the woman to "tough it out" or try to endure through the pain. It doesn’t help with the pain, often makes it worse, and leads her to want to avoid sexual activity.

RB: Women with female sexual dysfunction (FSD) often are in a lot of pain. Many times, the woman also has a diagnosis of fibromyalgia or another autoimmune disease. How can relationships grow and deepen when touch is painful?

DY: Communication about the pain is very important. Fibromyalgia sufferers often have better days and worse days. When the woman is willing to keep her partner informed as to her pain status, they can then make informed choices about when to enjoy sexual contact. It is also important that the sufferer be able to differentiate between the kinds of touch that are painful and those that are not. This requires flexibility and creativity on the part of both partners to explore together how to meaningfully connect and not exacerbate the pain.

RD: Men whose partners have FSD resent not having intercourse.  How would you advise the man?  How would you advise the couple?

DY: There are many, many ways to make mutually satisfying love that do not involve placing a penis within a vagina. In our culture we tend to equate "sex" with "intercourse". Willing partners who love each other and desire to give and receive pleasure can use their ingenuity and creativity to express their love to each other. I recommend Marty Klein’s excellent book Let Me Count the Ways: Discovering Great Sex Without Intercourse, available through Amazon.com.

RB: Many men whose partners have FSD say they feel rejected and disappointed? They become emotionally unavailable.  Sometimes this is through anger and lashing out.  Other times it is through withdrawal, internet porn, not coming or staying home, focusing all their attention on their children and ignoring their wives, workaholism or substance abuse.  What can they do instead?

DY: They can begin to talk openly and honestly together about their problems. If they are unable to do so at home, it may help to consult a certified sex therapist who can help them express their feelings and work together to find meaningful solutions. Many times the things we do to avoid painful situations only makes them worse. It is a given that one partner’s struggle with pain or sexual dysfunction has an effect on the other partner. The challenge is to learn how to work together as a team.

RB: Women with FSD who find intercourse painful resent having to perform oral sex so much.  Are their other ideas that will entice their partners?

DY:If the woman feels she "has to" perform oral sex more than she would like, perhaps it’s time to initiate some discussion about the ground rules of the relationship. Many couples are stuck in a kind of mutual isolation, with each partner trying to manipulate the other to obtain what they want or need.

A more egalitarian relationship, where both partners’ needs and wishes are respected, offers an optimal situation for mutual satisfaction. This approach requires communication and mutual respect. It also requires that each partner learn the tools of maturity that help them listen carefully, talk calmly and manage their anxiety.

Marriage offers an amazing crucible for developing maturity and growing up! And, yes, partners can easily find a number of ways to give and receive pleasure that is mutually satisfying and that does not require intercourse. Sex shouldn’t be another household chore!

RB: When a group of men are together touting their sexual prowess, what advice can you give to the man whose partner has FSD?

DY: Find better friends? Change the subject? Realize that these guys are full of it? This is essentially middle-school locker room behavior, and most men have better things to do. It is painful to believe that "everyone else" is having great sex all the time. This is very likely fiction - the truth is we do not know what goes on in other people’s bedrooms. If someone has to brag about their sexual exploits, it probably only reveals their deep insecurity.

RB: Single women with STD’s - especially herpes - have a difficult time dating and finding lasting relationships. How would you advise them?

DY: It’s easy to feel that you are damaged goods, and to worry that you can never find a good relationship. There are several approaches to dealing with this.

First, educate yourself about safer sex, so that you are confident that you know how to protect yourself and your partner. This includes learning how to recognize when you are symptomatic. Then you can resume dating with the confidence that you can be safe. Also, know that many people have STDs and, whatever your worries about the stigma of having an STD, you are not alone. True, some people may not understand and may choose not to continue a relationship. But there are many for whom an STD is not a deal breaker, particularly when you know how to manage your symptoms and protect your partner.

You may wonder how and when to talk about the STD: be sure to talk about it before you are in a sexual situation. As the relationship moves toward exploring sex, make an opportunity to have "the talk." Lay out the facts, including what you know about how to be safe. There’s no need to be overly dramatic or ashamed. Ask for your partner’s understanding and let them know that you are confident about protection.

Finally, there are a number of online dating services that allow persons with herpes to meet each other, thus removing this as a stumbling block. See for example:

David Yarian, Ph.D. is a licensed Psychologist and a certified Sex Therapist in private practice in Nashville, TN. His professional website is www.DavidYarian.com. He recommends books and videos on sexuality and eroticism at www.JoyOfMakingLove.com.

Tuesday, August 9, 2011

Not tonight honey, I have a headache

Do you find yourself always making up excuses as to why you can’t have sex tonight? Is the headache line getting old? Do you rush off to bed early in hopes that you will be asleep before you husband comes to bed? Is your lack of desire for intimacy affecting your relationship? Are you ready for help but have no idea where to start? If yes, continue reading.

Female Sexual Dysfunction (FSD) is a common but treatable problem. FSD encompasses problems with desire and sexual response. There are many issues that can contribute to FSD. Many women will suffer from some form of FSD during their lifetime. For some, FSD is a lifelong issue and for others it is short term and can occur at any point. The first step in correcting FSD is to determine the cause.

Pain with intercourse is a common contributor to FSD. Many women falsely believe that pain with intercourse is normal and therefore never address the issue. The pain can lead to a subconscious or even conscious avoidance of intimacy as a protective mechanism. Often correcting the pain issue will resolve the desire and response issues. Ladies, sex should be enjoyable, not painful!

Hormones can also play a role in FSD. Many women experience issues with sexual functioning during peri-menopause and menopause as well as after pregnancy. The alternating or decreasing hormone levels can cause issues with sexual functioning. Regulating the hormone levels can often improve sexual functioning. All women are not candidates for hormone replacement therefore it is important to discuss this with your provider.

Medications can be another contributor to FSD. Antidepressants, blood pressure medications, and birth control pills are just some of the medications that can contribute to decreased desire and response. These medications however, serve a purpose and should not be discontinued without first consulting with your healthcare provider. Often times changing a medication instead of stopping a medication can resolve the issue.

Relationship issues can halt intimacy right in its tracks. For women, if you are not feeling the love, then neither is he. Consider individual or couples counseling to help improve communication and your relationship and get your sex life back on track.

This is not an exhaustive list of causes of FSD, but simply a starting point. If you are suffering from FSD (Low desire or lack of sexual response), help is available. Contact your healthcare provider or a specialist in female sexual dysfunction and address the issue. The first step is the hardest, but in the end rewarding.

Monday, July 25, 2011


As we mentioned in a previous blog, leaking urine is a very common problem for women. It can be very embarrassing and affect your quality of life. Remember there are different types of incontinence but if you are one of the many women who suffer from urine leakage due to weak pelvic floor muscles then this blog may help you learn what you can do as a first line of defense against leakage. Have you ever laughed so hard that you peed all over yourself? Do you dread allergy season because you know you are going to be keeping the pantiliner companies in business? Do you wet your pants every time you cough? If so, then this may be helpful.

If you haven't had the opportunity to read the previous blog on strengthening pelvic muscles then now would be a good time to do that. Every woman needs to know where her pelvic muscles are and how to squeeze them. The urethra from the bladder goes through the pelvic muscles and in order to prevent urine leakage those muscles must squeeze tight around the urethra. If you want to stop the flow of water in a garden hose, you kink off the hose. Your pelvic muscles should be able to put enough pressure on the urethra to stop the flow. When you sneeze, cough, lift or laugh there is alot of pressure from your abdomen that is put on your pelvic area. If your muscles are weak they can't handle the pressure and they don't do their job very well. Squeezing those muscles before that pressure is exerted on them can help them to function better and have a better chance to prevent leakage.

Many women report a decrease in the amount of leakage when "squeezing before sneezing" or coughing or laughing or lifting. So, the next time you feel a cough or sneeze coming on try to squeeze your pelvic muscles first. Remember these are the muscles you use to shut off the flow of urine. You can also try this before you lift something heavy or as you are laughing. In the beginning this will feel hard for you and you will have to think about it every time you do it but eventually you will start squeezing without ever realizing it. If squeezing is not enough you can also try crossing your legs or putting pressure on the vaginal area. As always, if you have problems with urine leakage we recommend you talk to your healthcare provider and get the help you deserve. In the meantime, don't forget to "squeeze before you sneeze"!

Sunday, July 10, 2011

A pain in the vagina. . . .

Do you have problems inserting a tampon? Is intercourse painful or even impossible? Do you have pain with internal exams? There are a variety of things that can contribute to this problem. No matter what, it is not normal to have pain and you can get help for this.

Remember your vagina is muscles. Just like you can get tight muscles in your neck or back, you can have tight muscles in your vagina. Vaginismus is when you have involuntary muscle spasms in your vagina making insertion of anything painful or even impossible. There are various reasons that pain or tightness in the vagina may develop. It could be from a traumatic past experience that makes it difficult for your body to relax in that area. This traumatic experience may be from sexual abuse, a painful pelvic exam, or pain trying to insert a tampon. One single negative experience can make it difficult in the future for the muscles to relax and this contributes to them spasming. Pain in the vulva/vagina might be from an infection that has irritated the area. Generalized anxiety or stress may also contribute to the problem. Also, hip and back problems may contribute to vaginal pain. Or it could be as simple as it's just the way you were made. Some of us are naturally tighter in our hamstrings or neck; you may be prone to tightness in your vagina.

So what can you do about it? First of all, tell you doctor and have it evaluated. Then find a pelvic floor physical therapist. Most women with this problem have no idea how to relax or tighten their vaginal muscles. You should have voluntary control of these muscles but when you have pain, these muscles tend to have a mind of their own. In physical therapy, you will learn how to coordinate these muscles. The physical therapist will teach you how to relax your vaginal muscles and stretch them so that tampons are possible and intercourse isn't painful. No matter what, please seek help. A pain in the vagina is not something you should have to live with.

Sunday, June 26, 2011

Dating and Your Love Connection

Couples sometimes experience the loss of connection in their relationship. This is especially true when the woman has chronic pain. When these women are touched, they cry out or withdraw, and simple, loving affections such as hugging and gentle massage create misery. Sexual intimacy falters and eventually becomes a distant memory.

Couples who can be honest with each other about changes in their relationship have an excellent opportunity to restore their connection. Open communication is a plus, and couples often struggle with this. Women are frequently taught from childhood to remain silent, to be submissive or to complain, and men learn to sublimate their intimacy interests into work, hobbies or pornography. A passive aggressive relationship may develop where each partner grumbles, “I take it and take it and then I explode in anger."

Seeking couples counseling from a therapist who has an understanding of the effects of chronic pain can help re-establish the connection. Qualified couples’ therapists work as part of the woman’s interdisciplinary team of medical professionals who strive to improve health and quality of life.

Despite having chronic pain, continuing to have fun together is an important factor in maintaining closeness. Equally significant is planning a weekly “date,” where couples commit to creating an enjoyable time. Listed below are ideas clients have offered over the years as modified dates which are fun and yet respect the woman’s need to find comfortable positions which minimize pain:

Drive-In Movies
Drive-In Restaurants
Camping which includes using chaise lounges or cots
Short walks
Home dates including

Indoor picnics
Playing board games
Romantic dinners
Playing or learning a musical instrument(s) together
Reading to one another, especially humorous books
Creative movie dates
Listening to music and sharing thoughts on what you hear

Sunday, June 12, 2011

Tolerating Incontinence

“Oh my, please don’t make me laugh or I will seriously pee my pants”!  Or here’s one, you pull into the driveway and the urge to pee suddenly hits and you do the potty dance all the way into the house.  Do either of these sound familiar?  Did you know that you don’t have to live with incontinence?  That’s right I said you DON’T have to live with incontinence!   Leaking urine is common but it is not normal.  Unfortunately often women are too embarrassed to discuss their leaking issue. When they do get up the nerve to tell their provider, they are told that leaking urine is the normal part of the aging process or “You have had children, what do you expect”.   Neither of these is accurate.  Just living with incontinence or using sanitary pads are not the only available options.  There are treatment options available and you do not have to tolerate living with incontinence.
When determining treatment options we must first determine the type of incontinence.   There are 4 different types of incontinence.
Stress incontinence is leaking urine with exertion such as laughing, sneezing, coughing, jumping, running, ect…  This is usually caused by muscle weakness.
Urge incontinence is leaking urine with a sudden, strong urge to urinate, but unable to get to the bathroom on time.  This can occur with a stimulus such as pulling into the driveway, hearing running water or keys jingling.  This is usually caused by an abnormal bladder contraction or an abnormal sensation.
Functional incontinence is the inability to get to the bathroom because of physical or mental impairment.
Overflow incontinence is leaking urine when the bladder remains in a constant full state.   The bladder reaches a tipping point where it overflows and leaks urine. 
Urge and stress incontinence are the most common types of incontinence and where we will focus most of our attention today.  It is possible and very common to have more than one type of incontinence. Often urge and stress incontinence occurs together and is referred to as mixed incontinence.
So, now we know the types of incontinence, what do we do about it?
As explained in 2 previous blogs, breathing exercises and strengthening the pelvic floor muscles are excellent options that can help with all 4 types of incontinence.  
Behavioral Retraining is changing a person’s behavior to resolve incontinence.  For example, if you typically leak urine after not voiding for 4 hours, you would work on changing your voiding habits to void every 3 hours to prevent incontinence.  Or if you get up in the mornings and do other things before voiding, but then leak before you can get to the bathroom, you would then void as soon as you get out of bed.
Diet can also contribute to incontinence.  Often times we consume many foods that are known to irritate the bladder.  Foods such as soda, tea, coffee, alcohol, citrus products, and spicy foods are all known dietary irritants.  If you suspect diet may be contributing to your incontinence, keep a food diary noting what you eat and your symptoms.  Start eliminating items such as coffee for a week or two and note your symptoms.  Compare your weeks and determine if your symptoms have improved or stayed the same.
Pelvic floor physical therapy (PT) is another great option for treating all 4 types of incontinence.   PT is not only kegal exercises, but is a detailed approach to conditioning all of the muscles that work together to maintain continence.   
About now you are probably thinking, “I just want a pill” or “I thought surgery would fix my problem”.  Well let’s talk about both.
There are several different medications available for treating urge incontinence.    These medications are not effective in treating stress incontinence.   This is because the medication works to decrease the abnormal bladder sensations or to decrease the abnormal bladder contractions that cause the incontinence.
You may be familiar with most of the medications which include Detrol LA, Enablex, Vesicare, Toviaz, Sanctura, Ditropan, and Oxybutynin.  If you have tried one in the past and you did not see improvement in symptoms, consider trying a different medication.  Although all the medications are used to treat the same types of problems, many of them work differently and you may find that trying a different medication relieves your symptoms.  A prescription is required to start these medications, so if you believe you have urge incontinence, please see your provider to discuss your treatment options.
Stress incontinence is usually treated with conservative options, such as pelvic floor exercises or with surgery.  The surgery is often referred to as a “sling”.  The procedure involves placing a small strip of your body’s tissue or a synthetic material, also called mesh, under the bladder neck or the urethra to provide support. 
If you have mixed incontinence, correcting stress incontinence with a sling at times will also improve urgency and urge incontinence.  However surgical correction would not be indicated for urge incontinence only.
The last treatment option we will touch on today is Interstim Neuromodulator.  This is essentially a pace maker for the bladder and is placed around the low back or buttock area.  This is used to treat urgency, frequency, urge incontinence, and urinary retention (the inability to empty the bladder).  This is an excellent option to consider if you have failed other treatment options.
The Interstim process has 2 phases.  The first phase is simply a test phase to determine if the Interstim is a good option for you.  You wear the test stimulator for 3-7 days and if the urinary symptoms are significantly decreased or resolved, you then proceed to the second phase of having the permanent Interstim placed.  We will discuss Interstim in detail in a future blog. 
If you have incontinence and have just been living with it, as explained above, you do not have to live with it anymore.  Please see your provider to discuss treatment options.  If you are told there are no treatment options available, seek out a specialist.  You are not alone!  Help is available!

Saturday, May 28, 2011

How to Strengthen Your Pelvic Muscles

Muscles in your pelvic floor can get weak just like any other muscle in your body. Some of the common reasons these muscles get weak are aging, inactivity, pregnancy, childbirth and hormonal changes. There are other factors such as obesity, chronic cough and chronic constipation that put constant pressure on the pelvic floor and cause it to weaken over time. A weak pelvic floor can not function optimally and you may begin to experience urine or fecal leakage, organ prolapse (this is where the pelvic organs such as the bladder and uterus start to fall down because the muscles are too weak to hold them up where they should be) and decreased sexual response.

If you are not currently experiencing any of the above problems, now is the time to start exercising your muscles to prevent future problems. On the other hand, if you are currently experiencing symptoms of pelvic floor weakness or pain, then I would suggest you talk to your doctor or women’s health physical therapist. If you are not doing the exercises correctly they may not be beneficial or could possibly aggravate your symptoms.

So, how do you exercise those muscles? Well, first you need to know if you are using the right muscles. Many people try to use their abdominals or hip muscles and aren’t actually contracting their pelvic muscles. One way to identify these muscles is to try to stop your urine flow in midstream. If you have weak pelvic floor muscles this will be difficult but these are the muscles you would use to stop the flow. Only try this a time or two to get an awareness of these muscles. It is not good for you to do this regularly because it can lead to other urinary issues.

You can do these exercises anywhere and anytime but in the beginning you may want to do them lying down so you can concentrate more. Start with these 2 exercises:

1. Squeeze your pelvic muscles and hold for 10 seconds (if you can’t hold it for 10 seconds then start with less and work up to 10 as you get stronger). You will want to squeeze as you exhale. This is a great time to practice your deep breathing as instructed in our last blog. After you squeeze for 10 seconds then you need to relax for 10 seconds to give your muscles a quick break. Repeat this process 10 times and try to do this 3 times a day.

2. Remember in our previous blog on anatomy we talked about 30% of the muscle fibers in the pelvic floor are fast twitch fibers. The way we exercise these is to squeeze but don’t hold. So this time you will squeeze and let go. Repeat this 5-10 times. I like to call these the “red light exercises”. How easy it is to do a few of these while you are stopped at the red light!

Remember, be patient and don’t get discouraged. It takes time to strengthen a muscle but it is worth your time. Consult your healthcare provider if you have any questions. Happy exercising!

Sunday, May 22, 2011

Do you know how to breathe?

This may seem like an odd question but most women don’t know how to breathe correctly. Have you ever watched a little baby sleeping on their back? They look so peaceful; their little bellies just rising and falling. As you get older and are exposed to the stressors of life we start to take more shallow breaths, using our upper chest. You stop taking those deep relaxing belly breaths that we took as babies.

So what is deep breathing? Deep breathing is breathing lower into your rib cage using your diaphragm. The diaphragm is the breathing muscle. It is a large domed shape muscle that sits under the rib cage, wrapping all the way around to the back. When you breathe in, the diaphragm flattens into the abdomen. This causes the belly to rise and the rib cage to expand out to the sides. Your shoulders and neck should stay relaxed. Your upper chest will move some but the majority of the movement should be in your belly and lower rib cage area. As you breathe out, your belly should fall and rib cage should go in. Make sure you don’t push your belly out as your breathe in; think about your lower belly gently expanding as you take that breath in. As you breathe out, make sure you exhale all the air out. Your exhalation should be longer than your inhalation. Try counting to 5 breathing in but then count to 10 as you breath out.

Practice your deep breathing lying down, maybe before you go to bed. Think about your lower belly staying soft and relaxed. When you get really good at your deep breathing, you may begin to feel your sit bones opening up or spreading as you breathe in. As you breathe out, they should slightly come back together.

So why is breathing so important? Deep breathing oxygenates your muscles and improves the blood flow throughout your body. Taking deep breaths is also calming to your body and lowers your heart rate. If you suffer from pain, taking deep breaths is a great tool to help manage your pain. Deep breathing is crucial to relax the pelvic muscles if you suffer from pelvic pain. If you suffer from incontinence, breathing is essential to engage your pelvic floor muscles correctly. We may not need to take deep breaths all day every day but it is SO important to be good at it and practice occasionally throughout your day.

Sunday, May 15, 2011

Family Culture

A young artist I know is creating a retrospective of the 1960s. As she describes each photograph, I am reminded of how far women have come in their ability to talk about their health and their sexuality. Over the past 50 years, times have changed enough that women of today are desensitized to advertisements on female nutrition, exercise, menstruation, birth control and menopause. Teenage girls are free to use words like "period," "pregnant," "condom," "tampon," "vagina" and "penis" without embarrassment, and adult women confidently describe vaginal dryness, yeast infections and hot flashes.

Though times have changed, each of us carries from our pasts our health legacy. What did you inherit? Is it a family history of breast cancer? At what age? What was the treatment? What was the outcome? Is it a legacy of hysterectomy? Heart disease? Incontinence? Gallbladder disease?

In addition to inheriting a health history, we inherit an emotional health history as well. In Toni’s family, for instance, all the women had hysterectomies around age 50 because in 1947 Grandma died of uterine cancer. As Toni approached 50, she was insistent that she have a hysterectomy, too, although her gynecologist assured her that her body was healthy. Through counseling, Toni realized that her wish for a hysterectomy had more to do with "fitting in" with the women of her family than it did with her health.

Toni’s case is an example of how the women of our families convey to their images of sexual health to us. Some families teach the girls in a natural way about good sexuality, common sexual problems and ways to maintain sexual health. Others are the opposite. Young adolescent girls are shocked to find they are bleeding vaginally and are frightened that something is wrong with them. Some brides are taught to have sex with their husbands no matter how painful or demanding it is. Others learn that you never discuss sexual issues with anyone, including the doctor. And yet, others learn that women are subservient to men, and the family focus is on the males and their satisfaction, while devaluing the females.

What is your emotional health culture?


To discover more about your emotional health legacy, draw a family tree and after labeling the family members, write down what you know about:

their health history
their sexual history
how their health and/or sexuality affected their behavior
how other family members reacted to them
what has been taught to you
what are your perceptions about your own emotional health history

Monday, May 9, 2011

Interstitial Cystitis

It is a just another normal day except for this nagging need to urinate every 30 minutes, feeling a constant urge to urinate, and now having pain with urination.  Uh Oh sounds like another UTI.  This is the fourth time this year you’ve had these symptoms, so you must have another urinary tract infection (UTI).  Or is it a UTI?  The symptoms are the same as the previous three times.  Every other time you went to your provider, gave a urine sample and left with a prescription for a UTI.  Not a UTI, what else could it be?  It could be a condition called Interstitial Cystitis or Painful Bladder Syndrome.
Interstitial Cystitis (IC) is an inflammatory condition of the bladder that can mimic a UTI.  The symptoms of a UTI and IC are often the same however the urine culture is negative for an infection with IC.  IC is characterized by frequent urination (>8 times per 24 hours), urinary urgency (sudden or constant desire to urinate), pain or burning with urination, pelvic pressure, pelvic pain, and pain with intercourse.  You may experience only 1 or 2 of the symptoms or all of the symptoms.  The symptoms can come and go or remain constant.  IC symptoms can be triggered by certain foods, stress, allergies, and sex. 
Approximately 4 million people have interstitial cystitis with the majority being women.  Diagnosing IC can be challenging as the symptoms can mimic other diseases and syndromes.  IC is not clearly understood and it is often misdiagnosed or undiagnosed. Often patients see several different providers before obtaining an accurate diagnosis.  The good news is that IC is gaining more attention among medical providers and being diagnosed more readily.  Once you are given a diagnosis of IC there are treatment options available to help the symptoms. 
If you are experiencing any of the above symptoms and suspect you may have interstitial cystitis, I encourage you to seek help.  If you are not sure who specializes in IC in your area, please visit http://www.ichelp.org/ and click on Find a Provider to receive a list of providers.
In future blogs we will go into more detail about IC, symptoms, and treatment options.

Saturday, April 30, 2011

Pelvic Floor Anatomy and the Role of Physical Therapy

One of the first things I do when I sit down with someone in my office is talk about pelvic floor anatomy. You would be surprised how little most women know about what’s down there. In our future blogs we will talk a lot about problems that can occur in the pelvic floor so it is important that you understand what we are talking about when we refer to this area. So…here we go!

What is the pelvic floor? It is all the muscles, nerves and tissues that attach to the front, sides and back of the pelvis. There are 3 layers of muscles in the pelvic floor. These muscles have 5 functions:

1. Support- acts as a sling, or hammock, to hold up the organs such as the bladder and uterus as well as the vaginal and rectal walls.
2. Sphinteric- closes the openings of the urethra, vagina and rectum to prevent urinary and fecal incontinence. Yes ladies, we do have 3 holes down there!
3. Sexual- assists with orgasm and blood flow.
4. Stability- helps support the spine and hips.
5. Sump-pump- acts as a lymphatic pump to prevent congestion in the pelvis.

The muscles in the pelvic floor are voluntary muscles, meaning we control them consciously. There are 2 types of muscle fibers in the pelvic floor:

1. Fast twitch- “sprinters”- make up 30% of the muscle fibers.
2. Slow twitch- “marathoners”- make up 70% of the muscle fibers.

Are you holding that Kegel contraction when you exercise? If not, you are only exercising 30% of the muscle fibers. We will discuss more about how to do a correct Kegel contraction in a future blog.

This may all be a review for you or perhaps this is all new information. Either way, I hope you now have a better understanding of how God designed you and what is really going on “down there”. When things are going smoothly most people don’t give their pelvic floor muscles much attention but when there is a problem in the pelvic floor, it deserves some attention.

The focus of my practice is pelvic floor rehabilitation. Many people have never heard of physical therapy specifically for pelvic floor dysfunction. Some physical therapists have received specialized training in the treatment of conditions which affect the pelvic floor. Treatment is individually designed after a thorough evaluation. Some of the common conditions addressed by physical therapy are pelvic pain syndromes, urinary or fecal incontinence and vaginal pain syndromes. Some common treatment options include specialized exercises, internal and external manual techniques, biofeedback, bladder retraining and modalities for pain management.

If you feel pelvic floor physical therapy is something that might benefit you, talk to your doctor. You can also utilize the American Physical Therapy Association website link to find a women’s health physical therapist in your area

Saturday, April 23, 2011

Normal bladder function

I often hear women say, “I have a pea sized bladder. . . I have to go to the bathroom all the time!” or “I have to get to the bathroom right when I feel the urge or I will wet my pants!” A lot of women think that these bladder problems are normal but they are not! So what is normal bladder behavior?

The bladder is located in the lower abdomen right behind the pubic bone. The bladder is a muscle that changes shape as it fills with urine and can fill up to 400-600ml (half a liter of coke). The urethra is a small tube that starts from the floor of the bladder and exits the body. In women, the urethra is about 1.5 inches long and is next to the front wall of the vagina. The opening of the urethra is located between the clitoris and the vaginal opening.

Normal voiding is urinating once about every 3-4 hours or about 5-7 times a day. Night time urination is about 0-1x. After about 3-4 hours your bladder fills with enough urine (about 150-200ml) to activate a stretch reflex in the wall of the bladder. The bladder muscle, called the detrusor muscle, starts to contract and sends a message to your brain that says “I gotta go.” You make a conscience decision to go to the bathroom at that moment or delay it for a while. Muscles around your bladder, called the external sphincter, stay tight so your bladder or detrusor muscle does not push the urine out. If you choose to go at that moment, you should be able to calmly walk to the bathroom and sit on the toilet. The sphincter muscles around your bladder then relax so you can urinate. No straining or pushing is necessary because the bladder is doing the work for you and all your body has to do is relax.

If you choose to delay going to the bathroom, the urge will slowly go away as your sphincter muscles stay contracted around your bladder. Your bladder will continue to fill with more urine and a little while later you will get your second urge. This contraction of your bladder is stronger and more intense; it gets your attention a little more. You might choose to go at this point. You should still be able to stay calm and not be running to the bathroom! The sphincter muscles stay contracted so that no urine leaks out on the way to the bathroom. Again, you should be able to calmly pull down your pants, sit on the toilet, and then the sphincter muscles relax so your bladder can empty.

The sphincter muscles prevent urine leakage with sneezing, laughing, coughing, or exercising as well. These muscle stay tight around the floor of the bladder so that increased pressure from above does not push urine out or cause leakage.

I hope that your bladder habits are similar to above. If not, there are options to help you gain more of a normal bladder pattern. Please consult your doctor for advice.

Sunday, April 17, 2011

The Secrets Women Keep

Sally was asked to keep her first secret when she was eight years old. Her mother was planning a surprise party for her father, and with her solemn promise to stay silent, Sally was let in on the planning.

The next year, her neighbor and friend, Henry, suggested they play "doctor." Since he was a year older, he took the role as doctor first. She remembers uneasily lying on a grubby towel in his dimly lit garage, as he tapped and probed her body. Then they changed places, and she examined him. When her mother asked if she had fun playing at Henry's house, she nodded her head but gave no further description. While Sally was privately glad that her curiosity about boys' bodies had been satisfied, she felt too ashamed to talk about it.

During her adolescence, Sally and her group of girlfriends shared many secrets. They gossiped about who had a crush on which hunky football player and which girls were having sex. They texted their opinions of their teachers and how gross they thought it was that their parents still "dated."

Then, at 18, Sally began keeping the first biggest secret of her life. She was date raped on her graduation night. Sally felt so ugly and tainted. Her body ached, but her spirit hurt worse. She felt small and confused. She thought no one would believe her. And so she stayed silent.

At 25, Sally married Chuck, a nice, hardworking guy, who treated her well and shared her dream of a nice house and two children. By thirty, their dream was fulfilled, and Sally knew she should be happy and content. Instead, she felt restless, empty and unfilled. As was her habit, she remained silent.

Then, Sally met Zeke, and they innocently began talking. The attention made Sally feel alive again. Soon they were meeting for lunch and for drives in the country. Sally knew they were having an emotional affair, and she felt dirty and ashamed, but Zeke's compliments nourished her emptiness. She wanted to tell her husband how unfulfilled she felt in their marriage or to confide to her mother or a girlfriend how alive she felt when she was with Zeke, but this secret needed to be kept.

Social psychologists believe that women hold secrets for several reasons. The first is to be obedient. Sally’s mother told her not to tell her father about the surprise party, and she was expected to obey her mother and comply.

A second reason women hold secrets is to cover feelings of shame and/or guilt. Social mores or norms set standards which are expected to be followed. Going outside of them creates finger-pointing and accusations. Many girls who participate in childhood sexual experimentation as well as many women who are victims of sexual abuse or rape are blamed instead of the perpetrators. Their families ostracize them or make fun of them, and they maintain these secrets to protect themselves from further accusation. This feeds into the third reason secrets are kept.

Sharing comments and actions together creates secret pacts that allow girls and women to have a sense of belonging. If Sally’s adolescent girlfriends found out she had broken their confidences, they would no longer be her friends. Because fitting in with this group of girls was important to Sally, she kept mum about the targets of their gossip.

A fourth reason women and girls stay silent is because of fear. Girls and women, especially in abuse situations, are threatened by the perpetrator. They are told that if they tell anyone about the abuse, it will result in further harm or death to her or to members of her family, pets or friends.

Lastly, women keep secrets to maintain status quo. They are taught that "rocking the boat" is wrong. They come believe that their lives should be lived certain ways and that others must never see anything short of perfection. As a result, many women live empty or secret lives as their way of keep others - especially their husbands or partners - happy.

If you are reading this blog and having strong feelings about the secrets you are keeping, you may want to speak with a trusted health care professional or a psychotherapist. They follow rules about maintaining confidentiality and can give helpful guidance. Consider making an appointment. Life is too precious to be lived in shame and fear.

Sunday, April 10, 2011

Is this blog for you?

If you are wondering what on earth this blog is about and could it possibly be for me, well then keep reading and answer the below questions as you read.  If you answer yes to any of the below questions, then this blog is for you!
Have you ever laughed so hard you had to cross your legs to keep from peeing your pants?  Do you fight to keep from sneezing for fear of leaking urine?  Do you carry a change of clothes because coughing necessitates a wardrobe change?  Do you pull into your garage and run towards the bathroom knocking everyone and everything out of your way, just to “get there in time”?  Have you considered purchasing stock in sanitary pads just to recoup your loss?  If yes, then this blog’s for you!
Do you know where every bathroom is within a 10 mile radius of your home?  Take it a step further; do you know where every clean bathroom is and which ones to avoid?  Do you dream of sleeping through the night without getting up several times to urinate?  Have you ever had a nickname such as “tiny bladder” or “princess pee pants”?  Are road trips your worst nightmare?  If yes, then this blog is for you!
Do you avoid intimacy with your partner for fear of pain?  Have you tried to bring up this issue with your doctor and were told “just have a glass of wine before sex; it will help you to relax”?  Have you always just assumed that sex was supposed to be painful and you only participate because it is your “womanly duty” and think to yourself “chocolate is definitely better”?  Do you have constant pain in the pelvic area that interferes with your daily life?  Do you have the world’s largest dress and skirt collection because just the thought of wearing pants worsens your pain?  If yes, then this blog’s for you!
Do you wonder why you have no desire for your partner anymore?  Has it been so long since you have thought about intimacy much less initiated intimacy that you wonder if the last time you had sex was this decade or last?  Do you have an excuse list a mile long for avoiding intimacy with your partner, but in reality you are “just not in the mood”?  Does your partner bring you aspirin before bed stating “I know you’re not in the mood, you have a headache”.  If yes, then this blog is for you!
Ladies I want you to know there is help for all of these issues.  Leaking urine is not normal!  It is common, but not normal.  You should not be expected to live with leaking urine, regardless of age.  Pain with sex is not normal and no, a glass of wine is not a cure-all. Decreased desire or low libido is a very common problem but it doesn’t mean you have to live with it.  You should not be expected to live with constant pelvic pain and no the pain is not just in your head.  With all of the above issues, there is help available.   There is no magic wand or cure all pill, however help may be in the form of behavioral changes, seeking medical advice, participating in physical therapy, or counseling, both individual and couples.  If you are in the Middle Tennessee area, we are here to help.  If you are outside of Middle Tennessee, we have placed links that will help you find providers in your area that specialize in treating the above issues.
We hope you enjoy this blog.  If none of these issues apply to you or even if they do, please pass it on as it may apply to a friend, family member, or even that irritable coworker whose mood may be improved if she only knew help was available.

Monday, April 4, 2011

Coming Soon

We are excited to introduce this blog to you.  Blogging will begin April 10, 2011.  We will post a blog every 1-2 weeks, so please check back often to see if any new blogs have been posted. 
We will be blogging about all types of issues that affect women.  If one topic does not apply to you, keep checking because you never know when you will read one that you feel like was written just for you.  Please feel free to share this blog with friends and family. 

Thank you for giving us a few minutes of your time!