Friday, December 28, 2012

What to buy with your Christmas cash!

Now that Christmas is over and you may be returning gifts, think about spending the money you get back on something you could really use. For people dealing with pelvic floor dysfunction, there are some gadgets and items out there that could make your life easier.

Photo courtesy of Arm's Reach Concepts
One item that could prove beneficial for new mothers with pelvic pain is a bassinett that allows access from the side. These bassinetts allow parents who have pain with sitting to care for their child from a sidelying position. Also, moms who are recovering from a C-section can take care of their infant without the strain of having to lift the baby out of their crib.  (Please note that there have been recalls on some bassinetts and this is not a recommendation for co-sleeping.)

Who doesn't love a good book to curl up with in the winter? Books that help you further understand your diagnosis and treatment options can be very empowering tools. For those who suffer from Interstitial Cystitis, I recommend The Interstitial Cystitis Survival GuideFor those dealing with chronic pelvic pain, A Headache in the Pelvis is a great resource and approaches pelvic pain from a male perspective as well, which many books on the subject only discuss from a female point of view. Another great book for women with pelvic pain and other pelvic issues is Heal Pelvic Pain.

Photo courtesy of Squatty Potty

For those people who have chronic constipation and difficulty with bowel movements, the Squatty Potty is a great gadget that allows you to sit in the optimal position for improved ease with bowel movements.

Photo courtesy of Tush Cush

For people who have pain with sitting a cushion is a great option. For those who have tailbone pain or pain in the rectum or anus, the Tush Cush is a good option as it has a cutout to take pressure off the area. A cushion is an item that is very specific to a person's body and type of pain, so this type of cushion may not work for everyone, but there are many cushions out there that can help decrease your pain with sitting.

Although these items might not meet your specific needs, I hope that you'll consider using some of that gift money to purchase something that will make your life easier and better. I hope everyone has had a wonderful holiday season and wish you all the best in the coming new year. Come back in January when I will be talking about resolutions and ways you improve your life in 2013!

Tuesday, November 20, 2012

"POP" goes the bladder

Today's topic is one where the symptoms can increase around this time of year, so you might start to notice that something isn't quite right. Do you ever have a feeling of heaviness or pressure in the vagina that gets worse if you are on your feet for long periods, like when you've been holiday shopping? Are you having more constipation due to rich holiday meals and noticing it feels like something is coming out "down there" when you have to push or strain to have a bowel movement? Wondering what in the world could be going on down there?

The answer could be Pelvic Organ Prolapse, or POP. POP occurs when any of the pelvic organs descend below their normal position in the pelvic cavity.  POP can occur as a consequence of many things, such as chronic constipation, pelvic surgery, obesity, and multiple vaginal births, just to name a few.

So how does this happen? In simple terms, support for your pelvic organs comes from your pelvic floor muscles and ligaments. When pelvic floor muscles become weak, the connective tissue and ligaments have to hold all the weight of your organs. Over time, ligaments may stretch and fail, letting your pelvic organs drop and press down into the vaginal wall.

Depending on what type of POP you have, you may experience different symptoms. Three common types of prolapse are: cystocele (bladder prolapse), rectocele (rectal prolapse) and uterine prolapse.

If you have a cystocele or uterine prolapse, you may experience urinary symptoms such as stress urinary incontinence, or difficulty emptying your bladder. With a rectocele, a pocket forms just above the anal sphincter which can lead to stool becoming trapped, causing pain, pressure, and constipation. With any of these, but especially with uterine prolapse, a woman may experience discomfort with a feeling like something is falling out of your vagina, or just feeling a heaviness and pressure in the vagina. Many women experience discomfort with intercourse due to irritated vaginal tissues or even pain, with many women reporting that they feel like their partner is hitting something inside them.

Often there is little correlation between the level of descent of the organ and the severity of symptoms. In other words, I have seen many patients with a minimal level of prolapse, whose symptoms were very concerning and bothersome, and had a great impact on their quality of life and level of comfort every day.

So what can be done?

Women with no or very mild symptoms don’t necessarily need treatment, although they should avoid anything that might worsen the prolapse, like lifting heavy objects or straining to have a bowel movement. Those who are overweight may want to discuss a weight loss program with their doctor.

If you think you have a pelvic prolapse condition, and your symptoms are bothering you, you should see your primary care provider or gynecologist. A pelvic examination is the only way to diagnose POP.

Your doctor can discuss some of the options for treating POP with you including:

Physical Therapy
A physical therapist who specializes in pelvic dysfunction can help change the symptoms of prolapse. As I mentioned earlier, their are two areas of support for the pelvic organs, the ligaments and the pelvic floor muscles. A pelvic PT can instruct you how to correctly perform a pelvic floor muscle contraction and instruct you in exercises to strengthen and improve the endurance of those muscles, to support your organs from below. They can also teach you how to integrate breathing and abdominal muscle activity and instruct you in ways to decrease downward pressure on your organs.


In some cases it is necessary to also restore the ligament support to the organ. Pelvic reconstruction surgery may be performed through the vagina or the abdomen. Laparoscopic surgery, in which repairs are made with instruments, including a camera, inserted through a few tiny abdominal incisions, is now also an option. With surgery, the prolapsed organ will be repositioned and secured to the surrounding tissues and ligaments. You should discuss the benefits and complications with your doctor and a surgeon with experience with this type of surgery.

Whether or not surgery is necessary, it is helpful to have strong pelvic floor muscles supporting your organs. In my experience, many patients can improve their symptoms with physical therapy alone, to a level where they are comfortable and are able to forgo surgery. Even if a patient does ultimately go on to have surgery, strengthening the pelvic floor muscles prior to their operation is beneficial.


Another, non-surgical option, is a pessary. A pessary is a small silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor muscles. It is similar to a diaphragm. Pessaries provide support for the uterus, bladder, or rectum and decrease symptoms of prolapse. A pessary may be a good option for women wanting to postpone surgery, or those who might not be good surgical candidates. A pessary is prescribed and must be fitted in a physician's office to ensure proper fit and comfort.

In my practice, I commonly hear women say that they never talked to their doctor about these issues because they just thought that it was the way things were after having children or with getting older. I want you to know that it doesn't have to be that way and there is help out there! Talk to your primary care physician or your OB/GYN if you are having of the issues mentioned here, and find out if any of these options are right for you.

To hear more about this topic, click on the link below where Angela Dobinsky, PT, DPT, BCB-PMD talks to Audrey Baum, WHNP, RNC about POP.

Pelvic Organ Prolapse - Listen on Blog Talk Radio

Wednesday, October 17, 2012

Breast Cancer and the Pelvic Floor

In honor of Breast Cancer Awareness Month, this post is dedicated to those women who have been or are being treated for breast cancer. I want these brave women to know that there is help available for some of the secondary issues they may be dealing with due to breast cancer treatment.

So why would someone being treated for breast cancer need to see a pelvic floor physical therapist?

Well, you see, there is a common link between some causes of pelvic pain and breast cancer, and the culprit is hormones. Hormones occur naturally in the body and control the growth and activity of our cells. Unfortunately, two hormones - estrogen and progesterone- can help some types of breast cancer grow. Some breast cancer treatments reduce or block the amount of estrogen or progesterone in the body. The side effects of this treatment can include vaginal tissue thinning, dryness and irritation as well as weakness. All of these side effects can affect your pelvic floor and lead to a couple of difficult issues...pain with intercourse and incontinence.

Pain, dryness and irritation of the vagina, along with the stress that comes along with undergoing cancer treatment, can lead to dyspareunia (AKA - painful intercourse) and vaginismus (involuntary tightening of pelvic floor muscles). Weakness of the pelvic floor muscles due to treatment can lead to urinary or fecal leakage. These are some pretty major issues to have to deal with while undergoing treatment for breast cancer. The good news is that seeing a pelvic floor physical therapist can help.

A physical therapist that specializes in pelvic floor dysfunction can customize a treatment to address whatever issues you may be having due to cancer treatment. If you are having problems with urinary or fecal incontinence, a PT can instruct you in a rehabilitation program to strengthen your pelvic floor muscles and improve your bowel / bladder control and continence.

If your problem is pelvic pain, a PT can perform manual treatment to release tense pelvic muscles and release trigger points, which are hypersensitive areas in muscle that can contribute to pain. A PT will also instruct you in relaxation techniques and help you to improve your conscious control over your pelvic floor muscles. Therapy may also include education on care for vaginal tissue, appropriate types of lubrication and sexual positioning to decrease discomfort with intercourse.

Another side effect of breast cancer treatment, including chemo and radiation, can be decreased libido. This can be a result of fatigue due to treatment, changes in body image, pain with intercourse, and hormonal changes. A PT can instruct you in an appropriate and gentle exercise program as well as energy conservation techniques to decrease fatigue. They can use other alternative methods to increase your libido as well. A PT may also be able to refer you to a sex therapist that can be helpful in assisting with regaining intimacy during and after treatment.

If you are being treated for breast cancer and experiencing any of these issues, the first step to regaining control of your body is talking to your doctor and finding out if pelvic floor physical therapy may benefit you. Even though you are going through a lot during this time, there is no reason that you should have to suffer with these secondary issues. These problems can negatively affect your self esteem and have serious effects on your quality of life, so please don't suffer in silence!

A special thanks to Angela Wicker-Ramos, MPT, CLT, LANA, my co-worker and friend, for her expertise in this area!

Sunday, September 16, 2012


One of the number one issues that I hear about from my patients who need to strengthen their pelvic floor muscles is that they have trouble finding a way to fit the exercises into their routine. Believe me, I understand. Our days are filled with work and other responsibilities and sometimes, especially in the beginning, you just completely forget about doing the exercises until you are falling into bed.

But the truth of the matter is that you have to decide what is important to you and make a commitment. I think that a lot of people come to me as a physical therapist and expect me to "fix" them. I am not a magician, but what I can do is give you the tools to fix yourself. The catch is that you have to use them!

So how do you make the commitment? I try to motivate my patients by telling them a powerful truth. The patients that I see who come in with the attitude of "I will do what I have to to take care of this problem", get results faster. They don't have the expectation that they will get better in a week, they understand that they will have to put in the work and they do it. One of my coworkers makes a great analogy for her patients. If you went to the gym to get in good shape and look like Cindy Crawford, you wouldn't expect that to happen in a week. These are muscles and it takes time to strengthen, but you have to put in the work.

So how do you work toward making your pelvic floor exercises a habit? Recent research suggests that it takes 66 days to form a lasting habit. That's why I instruct patients to do their exercises every day. I usually see patients who need to strengthen their pelvic floor for a time period that stretches over 90 days. If you do your exercises as instructed, you'll get in the habit during that period. You'll strengthen your pelvic floor muscles and be able to keep them strong!

Here are some tips to get in the habit:

  • Think about why you are doing this - Do you have urinary incontinence that is embarrassing to you? Do you want to be able to exercise or run without having leakage? Do you want to get rid of pads so you can wear thong underware again? These are all reasons that patients have given me and what is important is staying focused on these things to stay motivated. The exercises that I give my patients to do take 10-15 minutes, 2 times per day. Your pelvic floor therapist may assign exercises differently, but isn't it worth 20-30 minutes per day to achieve your goals?

  • Find a time that works for you - f you just plan to do the exercises when you find time during the day, you will not find the time. Commit a certain time of the day to these exercises. This is your time to take care of yourself and work toward your goal of being dry! I have some patients that do them as soon as they wake up in the morning and right before going to bed. Some people do these with the other exercises they do during the day. Often doing the exercises at the same time every day helps you to get into a routine.

  • Set a reminder- I tell patients to set an alarm on their cell phone to remind them when to do their exercises. Set it for a time when you usually have a few minutes to do them. Even if you don't do them at that second, you have been reminded to do them soon. Even better than this is getting an app for your phone. There are apps available for Iphones and android phones that remind you to do your exercises and have timers when you are holding contractions so you don't have to count! Some of these apps include their own pelvic floor exercises, so check with your physical therapist to make sure that these exercises are right for you.

Check out these apps to find one that works for you!

Tuesday, September 4, 2012

How Do You Poo?

Yes, I asked it. It's a topic no one wants to talk about. Even though there is a children's book out there called "Everyone Poops," grown-ups just don't want to discuss it. Studies have shown that people would rather talk about sex than their bowel movements. Apparently, to poo is taboo. It's crazy! We all know that every one has to, yet no one wants to fess up to it. And its unfortunate, because difficulty with bowel movements, or constipation, is one of the most common gastrointestinal complaints in the United States. In fact, more than 4 million Americans have frequent constipation, so you are not alone!

Constipation is a symptom that has different meanings to different individuals. Most commonly, it refers to infrequent bowel movements, but it may also refer to a decrease in the volume or weight of stool, the need to strain to have a movement, a sense of incomplete evacuation, or the need for enemas, suppositories or laxatives in order to maintain regularity.

And just because you are not going every day, does not mean you are constipated. For most people, bowel movements can occur from three times per day to three times per week.

So what affects your bowel movements?

Diet - The average American diet includes 12 to 15 grams of fiber per day, although 25 to 30 grams of fiber and about 60 to 80 ounces of fluid daily are recommended for proper bowel function.

Exercise - When you don't move your body as much as you should, your bowels become less stimulated and you may find that you eliminate less frequently.

Position - Believe it or not, the current toilet seat is a relatively new invention. It was developed during the Industrial Revolution by people who thought it was much more dignified to sit on a throne rather than squatting. However, many doctors at the time were worried about this causing health problems because it went against nature. If you have ever felt, as many do, that after you have evacuated, there is still something left, here is the reason:

The anal canal is not straight when we are seated and bowel evacuation when seated results frequently in obstructive constipation. If you get into a relaxed, full squat position, the anal canal straightens.

Now, I'm not suggesting you should go squat in the woods whenever you need to have a bowel movement. There is an easier way to get in a squatting position while still on the comforts of your throne. The solution is raise your knees. By getting your knees in a position where they are above your hips, you are mimicking a squatting position. I tell my patients to use a stool or even a stack of telephone books (really what else are you using those for?), but a company has come out with a convenient and more attractive solution that you don't have to hide when company comes over. It's The Squatty Potty! Check out their great video.

As a pelvic floor physical therapist, I educate my patients about everything that I've shared with you here and more. If a patient also has pelvic floor dysfunction, I may treat them with biofeedback, which is a retraining technique that helps you learn how to coordinate the muscles appropriately so that you have a successful bowel movement.

If you have problems with your bowel movements, talk to your doctor. This is an important conversation to have and remember everyone poops! Even your doctor!  There are other things that can contribute to constipation that you should discuss, including medications that you are taking. Take control of your health and discuss your options and whether seeing a pelvic floor physical therapist could be beneficial for you.

Friday, August 24, 2012

Urinary Fairy

So has anyone else seen these commercials for the Poise pads featuring Kirstie Alley? She appears in the bathroom at a party after a woman starts laughing and has an "oops!" moment. The Poise fairy talks about how 1 in 3 women have light bladder leakage or "LBL" and with all her fairy wisdom, gives you a solution to your problems....pads.     

Well, the truth is that "LBL" is a term that the marketing industry came up with that sounds better than the medical term for the same condition, which is....urinary incontinence. In this case, stress urinary incontinence. So call it what you will, LBL or SUI, these are the names for the condition where you are losing urine without meaning to during physical activity, such as coughing, sneezing, laughing, or exercise.

While I agree with the Poise fairy that having the right pad can be important when you have urinary leakage, I want to let you in on a little secret...there is another more important fairy out there who you need to be talking to! The Urinary Fairy! 

Okay, so that may not be the technical term for a pelvic floor physical therapist, but potato, potato. A pelvic floor physical therapist can do the most magical thing of all! They can help you to get rid of the problem!
With SUI, the pelvic floor muscles, which support the bladder and urethra, are weak and not able to prevent urine from flowing when pressure is placed on the abdomen, like when you laugh or take a Zumba class or pick up your child. Risk factors for SUI include:
  • Being female
  • Childbirth
  • Getting older
  • Obesity
So what can a Urinary Fairy do for you? Physical therapy for this particular issue involves strengthening of the pelvic floor muscles by doing pelvic floor exercises. Some people have been told by their doctors that they need to do Kegels, which are pelvic floor exercises named after the doctor who came up with them. Some of my patients come in and say that they tried Kegels and they didn't work, but I compare that to someone telling you that you should go to the gym and exercise versus having a personal trainer. A pelvic floor physical therapist can examine you to determine if you are doing a pelvic floor muscle contraction correctly and if not, instruct you in how to do so. I like to tell my patients that I have Kegels on steroids...a whole arsenal of pelvic floor exercises to get your muscles in tip-top shape, to stop you from having those "oops!" moments. Patients typically see a significant decrease in their urinary leakage in 8 to 12 weeks. So wouldn't you rather talk to a Urinary Fairy and get rid of the pads once and for all?

P.S. Check out this video from my fellow urinary fairy about how to do a pelvic floor contraction properly!

Thursday, August 16, 2012

So, just what is your pelvic floor?

The pelvic floor is a group of muscles whose job it is to aid in urinary and bowel continence and to support the contents of your pelvis, such as the bladder and uterus. Most people are unaware that they even have these muscles because they function pretty much independently, doing their job without you having to think about it. It is when something starts to go wrong with the pelvic floor muscles that people find out that they have them and they are not functioning properly.
In its simplest form, pelvic floor dysfunction – aka, when something goes wrong- can usually be broken down into two categories.
1: pelvic floor muscle weakness
2: pelvic floor muscle tension.
With weakness, typically this will show up as incontinence or leakage of urine or bowels.  
Tension of pelvic floor muscles may present as constipation, pain with sitting, tailbone pain or pain with intercourse.

Pelvic floor dysfunction is kind of an umbrella term that covers many diagnoses.  If you have issues with your pelvic floor, talk to your doctor about physical therapy as an option for treatment. 
 To find a physical therapist near you who specializes in pelvic floor dysfunction, please refer to the following websites:
American Physical Therapy Association (APTA) Section on Women’s Health:
Herman and Wallace Pelvic Rehabilitation Institute

Come back next week when I will be diving in to more specific diagnoses related to the pelvic floor!

Wednesday, August 8, 2012


I'm Cody McNeely, PT, DPT. I specialize in physical therapy for pelvic floor dysfunction. I work in Austin, TX as a therapist at Sullivan Physical Therapy, a clinic specializing in pelvic floor dysfunction. I graduated with a Doctorate in Physical Therapy in 2010 from the University of Kentucky. I love my job and I find it very rewarding to be able to help people who are having issues with some of the most basic functions in life, such as urination, bowel movements and sexual intercourse. I've seen how difficulties in these areas can negatively affect a person's life and I like that I can help change that. My blog is an opportunity for me to reach out and help others beyond the patients in my practice and I hope that the information you find here helps you. My hope is that I can share my knowledge and experience in an informative and fun way. A few times a month I will be posting new information, my thoughts and observations about pelvic floor conditions and technology that can benefit those dealing with pelvic floor dysfunction.