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.

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!