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.