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POP: Getting Those Pesky Organs to Stay Put!

This past weekend I received several messages related to pelvic floor dysfunctions that are not being taken at face value. “Well you’ve had kids”, “it’s all in your head”, “this is a psychosocial problem not  a physical problem”. I have said it before and I will say it again, women need to be listened to, trusted, and most importantly, respected when they bring problems to healthcare providers, family, and friends. Although it may seem helpful to say that “this is something that happens when you have had kids”, it can be less than helpful AND is often not the case.

Pelvic Organ Prolapse (POP), is becoming a more well known topic of discussion in various mom groups, and in particular postpartum fitness groups. A large part of the impression I get as I am tagged, mentioned, and participating in these various forums is there seems to be significant panic associated with POP. People become paralyzed, hyper vigilant, and fearful of movement (also known as Kinesiophobia). So let’s break it down to dispel some of the hysteria that seeps into many pelvic health related issues.

Your top three organs that prolapse are (typically) your bladder (cystocele), your rectum (rectocele), and your uterus (uterine prolapse). Although most commonly occurring after child-birth, even those without children can have POP. Let’s focus on pregnancy and post-partum phase.

During pregnancy your uterus grows from approximately 5cm in size (which would hang out below your pubic bone), to what seems impossibly large to house the tiny little growing miracle (all the way up to the rib cage). This feat in and of itself does a few things, but thinking of organs specifically – they get moved, pushed and pressed all over the place because there just isn’t room.

How is this possible? Imagine your organs are like little boats at the dock. The boats (organs) wouldn’t do well in inclement weather (movement) if they were tied tightly or cemented to the dock; instead they have ropes (ligaments) to attach and hold them in a relatively stable position relative to the dock (abdominal wall/pelvis/ribs), and the other boats. Your organs aren’t cemented in place either, they essentially float being guided by ligaments, general positioning and support from other organs and the pelvic floor, as well as all the other connective tissue. So, when you are pregnant and the uterus is forging its way through the pelvic and abdominal cavity, everything else is able to move into new positions to compensate.

 

Once baby is born (vaginal or C-section), the organs suddenly have a lot more space to move around in – their ligaments and fascia have stretched, and there is no longer a tiny human occupying the extra space. As everything settles into a ‘new normal’, if everything is coordinating well, the organs will be situated in a similar position to pre-pregnancy with some slight variance. If the pelvic floor isn’t able to support, or other muscles around the rib cage are having difficulty relaxing, we can get changes in pressure that contribute to pushing these organs down and create POP and various symptoms.

What do we watch for? Feeling of heaviness, falling down or falling out, pressure, discomfort, or bulging, difficulty inserting a tampon, or keeping a tampon in, are all common complaints of POP.

There is much that Pelvic Floor Physio can do to assist with POP, and in many instances resolution of symptoms is possible.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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What YOU want to know about the Pelvic Floor: Part 1

Q: How do I know if I should see someone?

A: There are many different signs or symptoms that children, women and men can watch for to know if they should be seeing a pelvic floor therapist. Some of the big things to think about include:

  • leaking (urine or feces)
  • urgency and frequency (many trips to the bathroom, or getting to the bathroom and voiding small amounts)
  • pain with intercourse
  • pressure in the pelvic floor
  • feeling like things are falling down or falling out
  • needing to ‘lift’ the pelvic floor or ‘help down there’ to void the bladder or evacuate the bowel
  • inability to increase activity due to any symptoms
  • low back, pubic symphysis, hip or SIJ pain
  • recurring tightness of the hips and pelvis
  • you have been pregnant
  • you have delivered a baby (vaginally or via c-section)

… and this isn’t necessarily an exhaustive list, just the first things that come to mind for clientele that frequent the clinic. Essentially if you feel there is something that is ‘off’ or ‘wrong’ within the pelvic floor, abdomen or pelvis, seeing a pelvic floor therapist may be of benefit.

 

Q: Do you recommend that all women see a pelvic floor physio? Or just if they are “leaking”?

A: There are a great many symptoms that can be indicating factors for pelvic floor dysfunction that doesn’t have anything to do with leaking in particular. To answer this question in short: yes. In long, I would say that many women would benefit from a pelvic floor assessment regardless of their “leaking” status, especially for women who have had children, or anyone who experiences pain with intercourse.

A big reason for the general answer of “yes” is the fact that what we know about pelvic floor is not necessarily functional working knowledge. Rather, most women ‘know’ they are supposed to do ‘kegels’, and yet no one has taken the time to explain or ensure that they are being done correctly. What we know about kegels is that they are meant to strengthen the pelvic floor, and most women describe that they imagine SQUEEZING the pelvic floor. As my clients know, the pelvic floor to work functionally needs to LIFT UP and IN, not squeeze, as well as RELAX down and out.

Just because you aren’t leaking, doesn’t necessarily mean that the pelvic floor is functioning well. Just the same as even though many people do not have knee pain, they often have weakness or tightness that could be addressed to prevent issues arising in the future.

 

Q: When do you recommend women be seen? During pregnancy? Post-partum?

A: Women can and should be seen whenever they are having issues. Issues are bound to arise during pregnancy and post-partum. So long as there aren’t any contraindications to a pelvic floor exam by the treating physician or OB, assessment during pregnancy is possible as well (after the first trimester). During pregnancy some women will choose to attend an assessment for labor and delivery preparation after 32 weeks gestation to help get a better handle on relaxing the pelvic floor; we do want a baby to come down and out after all!

Post-partum we are able to see women that are painful as soon as they feel up for leaving the house, and specific for pelvic floor assessment approximately 6-8 weeks post-partum. Pelvic Floor Therapy is able to address c-section healing and recovery, as well as perineal healing and recovery. Tearing, surgical incisions, other birth traumas can all be addressed in the post-partum phase.

Q: What if I haven’t had children in a few years but am experiencing problems? Can physio still help?

A: YES YES YES! The absolute best thing about the body is it’s propensity to change. It is never too late to see a pelvic floor physio, 8 weeks, 8 months, 8 years or longer we can always see what changes can be made to help resolve any complaint

Q: What are some signs of a weak pelvic floor?

A: The simple answer for this one is leaking or incontinence. The long answer is – it depends on whether it is loose and weak (not very common) or tight and weak (much more common). Often we equate something being tight or taught with being strong, but this is definitely not the case with the pelvic floor. A tight but weak pelvic floor often progresses through one or a combination of: discomfort or pain with intercourse, constipation or difficulty completely emptying the bowels, discomfort or bruised feeling through the perineum or tail bone, hip tightness and restricted movement, low back pain… and more. One client had neck pain (right by the shoulders) that she had had since her second was born (5 years previous) and nothing seemed to help. Ultimately this client had pelvic floor weakness that was driving her neck pain!

Do you know someone having issues with this area? Maybe they have some of the complaints listed above – share with them! Are YOU someone suffering with these symptoms? Contact us today to get started your path to resolution!

Do you have some BURNING questions you want answered that wasn’t covered? Send them our way and we will get them going in Part 2!

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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Do YOU have TMJ?

Have you heard of your temporomandibular joint (TMJ)? It’s one of the most used joints in your body. Did you know physiotherapy can help with TMJ problems?

Your TMJ, also known as your jaw joint, is used for eating, talking, expressing emotion (both consciously and unconsciously) and breathing.

Pain associated with dysfunction in this area may be felt in the jaw line, cheek, ear, temporal region (side of head) and commonly associated with headaches and neck pain. TMJ problems, or TMJ dysfunction (TMD) can also present as inability to fully open your mouth, pain with chewing, popping/cracking with opening and closing your mouth, and/or grinding/clenching of teeth.

Some of the causes of TMJ problems can be derangement or displacement of a disc between your mandible (jaw bone) and skull, muscle dysfunction, habitual clenching/grinding (bruxism), or trauma to the face and jaw. Common contributing factors to TMD can be stress, anxiety, prolonged opening of the mouth (e.g. during dental procedures), mandibular malalignment or orthodontic work to name a few.

A physiotherapist will assess the TMJ by asking a detailed history, taking observations of jaw alignment, posture, and neck position. They will observe how the individual opens and closes their mouth, looking for abnormal movements patterns, and observe for clicking from the TMJ. The therapist will palpate externally for muscle tone, and to assess the movement of the TMJ. Using gloves an intra-oral assessment will be completed as well to determine how the joint is functioning, and to further assess the myofascial system. The neck is generally assessed as it can commonly contribute to dysfunction in the TMJ.

Following an assessment, a treatment plan and home program will be developed.

Ms. W comes in with complaints of pain through the right greater than left temporal region of her jaw, inner ear on right, frequent headaches and stiffness in the jaw that is often worse in the morning. Recently she has begun to noticing a clicking from her right jaw, especially when she yawns or eats chewier items. Her dentist advised her she likely has TMJ problems and recommended that physiotherapy may help.

The physiotherapist may ask a few of the following questions: How long have you been dealing with this problem? Do you ever find yourself clenching your jaw in times of stress or have you been told you grind your teeth overnight? Any recent dental procedures? Any history of trauma to the face or neck?

As mentioned above the TMJ is one of the most frequently used joints in the body. Most clients who receive treatment for their jaws have been experiencing symptoms for some time, and often did not know that physiotherapy can help. Commonly they have seen their doctor or dentist prior to seeking treatment.

In the case above the individual likely has a longer standing history of clenching, also known as bruxism. Commonly people can do this subconsciously during their sleep, or in times of stress. When frequently clenching the muscles of the face and jaw can become fatigued and become sources of pain. When muscle are held tight for long enough they can start to alter the way the jaw moves, and lead to problems with a disc located between the jaw and the skull.

The physiotherapist will develop a treatment plan specific to Ms. W’s presentation completing treatment specific to the muscles surrounding the TMJ and the joint itself.

 

If any of the symptoms described sound familiar, book in for an assessment today!

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Welcoming incoming therapist Kendra Usunier!

As many of you know I, Haylie Lashta, will be going on maternity leave soon, with my last day scheduling clients being June 2, 2017. I have searched for the perfect person to come in to cover for my maternity leave that can also complete women’s health assessment and treatment, and she has been found!

Kendra Usunier BMR(PT), MClSc, FCAMPT will be joining our team starting on May 23, 2017!

Biography

Kendra graduated from the University of Manitoba in 2008 with a Bachelors of Medical Rehabilitation in Physiotherapy. She went on to complete a Masters of Clinical Science in Manipulative Therapy from Western University in 2015.

Since graduating Kendra has worked in Saskatchewan and Manitoba. She returned to Saskatoon in 2012, and is excited to begin working in Warman. Having grown up in a smaller community, she is happy to return to that environment.

Kendra’s primary focus has been orthopaedics and women’s health. She has taken extensive additional training in orthopaedics, becoming a Fellow of the Canadian Academy of Manipulative Physiotherapy (FCAMPT) – an internationally recognized qualification in manual and manipulative therapy. For more information on CAMPT therapists please click here.

In addition to orthopaedics, Kendra has a passion for women’s health and pre-and post-natal care. She has also taken additional courses in treatment of temporomandibular joint dysfunction, acupuncture, pain management, and myofascial release.

Kendra has a passion for ongoing education in physiotherapy, striving to provide the most up to date, evidence based treatment for patients. She assists in instructing muskuloskeletal courses at the University of Saskatchewan and within the Canadian Orthopaedic Division Syllabus.

Kendra enjoys spending time with her husband and daughter, running, playing soccer and doing yoga in her spare time.

Areas of Practice Interest:

  • Spinal Assessment & Treatment
  • Osteoporosis Management
  • TMJ Dysfunction
  • Sports Rehabilitation
  • General Orthopedics
  • Prenatal & Post-partum
  • Urinary Incontinence
  • Pelvic Pain
  • Acupuncture

Kendra’s schedule has been provided and is available for appointments. Contact us to book your appointment today! Don’t want to wait? Cole Digel has availability as early as the week of May 15, 2017.

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Is your NECK causing your arm or shoulder Pain?

Case Study: A client HD came to the clinic after several weeks of shoulder, shoulder blade and arm pain. This pain started in the shoulder and moved down the arm. The client would describe the pain as ‘sharp’, ‘burning’, ‘shooting’, ‘deep achy’, and ‘pins and needles’ depending on what they did. Initially their pain would come and go, but over time the pain would stay for longer periods of time. This client found that sometimes anti-inflammatory medication and massage helped, but it always came back. Since their pain started in their shoulder it was believed that it was a shoulder injury (rotator cuff). After assessment by a physiotherapist it was identified that HD had issues from the neck resulting in shoulder and arm pain. With treatment including home exercises, stretches and programming, the client was able to return to full function and a pain-free state of being!

neck-pain

The story of HD is not uncommon. Often people are not sure where to go for a variety of issues and complaints. Your local Warman Physio is able to provide assessment and treatment of any ache or pain occurring within the body, whether it was caused by an injury or ‘just showed up’ one day.

Physiotherapists are trained to provide assessment and treatment of all the body systems including the muscles, tendons, ligaments, and nervous system to identify what is causing any pain or issue.

Following is a list of conditions that Physiotherapists can help with in the neck and arm:

  • Disc bulges in the neck
    • often causes pain as is outlined in the image above with the red highlighted areas depending on the level the bulge is present
  • Nerve compression or irritation of nerves of the neck
    • pain down the arm with moving the head a particular direction like in shoulder checking
  • Carpal Tunnel syndrome
    • pain and tingling in the hand often upon waking from a night’s sleep to start
  • Rotator cuff injuries
    • pain in the shoulder often with reaching over head or behind the body
  • Tennis/Golfer’s elbow
    • pain on the outside/inside of the elbow often with lifting/carrying

 

How does the neck cause pain in the shoulder and arm?

The body is a complicated group of systems that work together to allow us to complete our everyday tasks. Our neck has 7 vertebra (C1-C7) that go from the base of the head to the base of the neck. Within your neck there are 2 joints at the top and bottom of each vertebra, and most of them are separated by small discs. Our spinal cord is enclosed inside a tunnel within the vertebra. The nerves that go down into the shoulder and arm come out from between the vertebra, through the muscles and down the arm. These nerves then control the muscles (creating movement) as well as sensation (touch, temperature, etc). If something happens to the nerve throughout it’s path down into the arm it can create issues in the movement, sensation, or both!Sometimes it is hard to figure out where pain is coming from – the muscles, joints, nerves, tendons (attach muscle to bone) or ligaments (attach bone to bone). Leave the guess work out of your pain and have it assessed by your local Warman Physio!

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