Category / Pelvic Physical Therapy

time lapse photography of flowing waterfall
by Dr Maureen Mason

Physical Therapy: Concierge Care

Outside of the realm of busy medical clinics, with a passion and joy for providing physical therapy, I am Open for Concierge Care in Bay Park, San Diego. Lifestyle Medicine frames my practice. I investigate, evaluate, guide, coach, and instruct patients with multiple methods to help them reach towards, and achieve their primary goals. This includes helping individuals to steer themselves towards their best possible function. And while readers may think of physical therapy as musculoskeletal medicine with exercise prescriptions and stern treatments from aggressive providers (sorry fellow PT’s but we sometimes have a bad rap), P.T can be more inviting, enjoyable, and an incredible journey of discovery and recovery, resilience and growth.

What do I treat? What does it involve? Here are some “diagnoses” I have worked with over the past year, some with a few sessions, some with 10 or more sessions over several months:

Spine, hip, and leg pain, with prior aggravation from PT, health care provider

Post menopausal urinary incontinence, (teacher)

Male with urinary incontinence after prostatectomy, (business executive)

Pubic symphysis, sacroiliac pain, incontinence, and weak core postpartum, (athlete)

Pelvic organ prolapse: rectocele, and pelvic pain, (health care provider)

Rib and hip pain, low back pain (performing artist)

Foot pain, fibromyalgia, overactive bladder, possible long covid, (holistic health provider)

Abdominal, spine, testicular pain in (male health coach)

Post breast cancer surgery wellness, fitness, pelvic rehabilitation, (business administrator)

Post motor vehicle accident spine care, pelvic care for pain with sex:dyspareunia, (analyst)

You see a variety here-really it is orthopedics, neuro, ms skeletal, motivational interviewing (where you are at, and what you want, and see possible, and may benefit from shifting towards or away from), trauma sensitive care, and then manual therapy, myofascial work, movement practices, and meditation, with a dash of nutrition and sensory-somatic enrichment practices. This is lifestyle medicine, it is wonderful as the possibilities are endless in optimizing and creating healing recipes for you.

Connect with me via telehealth or in person :Schedule via the jane app:

https://centralstationwell.janeapp.com/account

testimonials from clients

“Nobody else found that pain, how it is connected to the other areas” H.S

“I came to you because I knew you would not hurt me” H.M.

“I am doing the movements you showed me, and my walking is better, and less leg pain too.And I am getting better at relaxing now “P.M.

Looking forward to your health and healing, Dr Maureen

by Dr Maureen Mason

Pelvic Organ Prolapse

What, Why, and How to find help?

Reserve a telehealth or in-person visit with me for information and practical help now.

Pelvic Organ Prolapse, known as POP, is a condition that women may experience.

POP is a lowering, or descent of the pelvic organs and their support systems (the muscles, and ligaments) in the pelvic area.

It is present in 20% up to 65% of women and is more likely to occur, after menopause, ages 65 and up. POP can be present at any age, but not cause any trouble. Medically speaking, it is “asymptomatic”.

Most conditions are mild and symptoms do not cause much bother.

However, there may be a bulge beyond the vagina leading to distress and bother, such as difficulties with bladder and bowel storage and emptying, and problems with sexual health and fitness as well. Annoying sensations which can be experienced by women with POP can include feelings of pressure, heaviness, and discomfort in the pelvic area, as well as changes in bladder, bowel, sexual, and fitness functions. These symptoms can come and go depending on how much exertion is needed for daily work and fitness, and the women’s ability to have awareness of manage the pressure in to the pelvic floor.

Ideally, the pelvic floor muscles engage or turn on with optimum force to match the required strength, such as lifting a child, a suitcase, or a barbell.

The reasons why POP develops can include:

  • genetics with a tendency towards looser ligaments and muscles
  • vaginal or cesarean childbirth, involving myofascial stretching
  • birth of a large baby, over 8 1/2 pounds
  • chronic coughing, chronic straining, with pressure downwards into the pelvis
  • lifestyle and fitness activities with pressure downwards into the pelvic with an inability to counteract these pressures well. (Some lift heavy items and workout with no POP)
  • hormonal changes with nursing, and with the menopause transition, aging, with increasing incidence from youth to older years
  • surgeries and injuries to the support systems in the pelvic area
  • obesity

How you can help to reduce the downward pressure into the pelvic area:

  • learn how to control your core muscles
  • learn specialty pelvic exercises for fast, and slow, sustained contractions, which are needed for different types of activity. You may be able to exercise to your full capacity with a progressive program to match your needs.
  • learn hypopressive exercises which use all the breath and the ribcage to help lift the pelvic region, organs and pelvic floor muscles
  • see a pelvic therapist, who can help you fire up your pelvic floor muscles, provide manual and visceral therapy to release stiffness and scar tissue.
  • use intermittent decompression exercises, which eliminate gravity and use gravity assistance.
  • use specialty pelvic health equipment to help your prolapse
  • learn partner communication to help comfort and pleasure with intimate activities

Medical Help can Include:

  • Screening by a gynecologist or urogynecologist.
  • Surgery may be an option for care, and you want the best preparation to achieve surgical success.
  • Medical instruction in the use of a pessary, a support device, and hormone replacement therapy.

For more information on exercise, pressure management, and POP:

Chapter 8

References
womenshealth.gov/pelvicorganprolapse 3.28.23
Bo K, Angeles-Acedo S, Batra A, et al, International urogynecology consultation/Conservative treatment of a patient with pelvic organ prolapse; Pelvic floor muscle training, IUJ 2022,:33
Crowle A, Harley C, Biotensegrity focused therapy for pelvic organ prolapse: A nonrandomized prospective clinical case series, Journal of Women’s health physical therapy 2021, 45(3).
Hage-Fransen MAH, Wiezer M, Otto A, et al, Pregnancy-and obstetric-related risk factors for urinary incontinence fecal incontinence, or pelvic organ prolapse later in life; A systematic review and meta-analysis, ACTA Obstet Gynecol Scand 2021:100
Weintraub AY, Glinter H, Marcus-Braun N, Narrative review of the epidemiology, diagnosis, and pathophysiology of Pelvic Organ Prolapse, IBJU 2018,:46(1)

by Dr Maureen Mason

Perinatal, Perimenopausal Self- Care, and Pelvic Health

True/False
Similar changes can happen in the pelvic floor muscles in the perinatal time frame as well as the perimenopause time.
Answer:True!
Hormone changes can have a profound effect on the pelvic floor muscles and women need to know how to navigate these life stages.

Pregnancy and birth can alter the function of the pelvic floor muscles (PFM), while the demands for lifting, carrying and and other aspects of infant and toddler care create increase challenges.

Pain with se*ual activity (dyspareunia) is common, but shocking to those who are not prepared for this.(It is temporary for most).

PFM work with postural muscles for “trunk control” and these muscle groups are weaker in most postpartum women at 8 months.

Women need a program, and plan instead of being expected to “bounce back”.

The direct impacts of pregnancy and birth on muscle integrity, abdominal and pelvic organ positioning, and bladder and bowel functioning can create symptoms that impact quality of life. (I know-I had challenges, totally unexpected!)

Depressed,Mother,Holding,Her,Baby,,Tired,And,Stressed.,Postpartum.

Perimenopausal changes from declining estrogen, progesterone and testosterone can alter PFM function as well.

Specific changes can entail reduced PFM strength and elasticity, less lubrication, tendency to dryness and increased urinary tract infections (UTI), and dyspareunia.

In association with PFM weakness, pelvic organ prolapse (POP) can occur, or worsen, requiring medical screening and treatment.

Modern media portrays the negative side of this life phase, perimenopause and menopause, however it can be a vibrant and fruitful phase of life well.

Women need to have self care and lifestyle habits for health, if not already in place, to help pelvic health, and overall health.

Adding a few new positive health practices per month can create renewed energy, focus, quality sleep and sustainable fitness, and help with the aforementioned pelvic health challenges as well.

True/False
Perinatal and Perimenopausal pelvic floor muscle problems are easy to fix with kegel exercises.
Answer: False!

Healthy,Group,Of,Mature,People,Jogging,On,Track,At,Park.

Research studies find that women often have an incorrect effort and may breath hold, bear down, and contract global muscles (ie gluteals, adductors, abdominals) vs. the PFM.

Verbal instructions such as “do kegels” do not work for accurate PFM contractions for many women.

We should not be “clenching” the PFM  all the time  (more on that in another post).

There are many methods to train the PFM that can help them work with other core muscles during activities.

If possible, have a session with a Pelvic Health Physical Therapist and learn the multitude of ways to optimally relax, contract, and co-contract with other muscles when needed.

Targeted strategies for bladder health, dyspareunia, POP care and  fitness training can help meet your lifestyle goals and optimize your function.

Check in for the bladder care, bowel care and and yoga/fitness offerings on this site, your Centralstationwell.com

Schedule with me in San Diego, in person or via Telehealth as needed,

858 598 4915

Mason Home Fitness, Central Station Well

4241 Jutland Dr Suite 103

San Diego CA 92117

Warmly,

Maureen

ps The Pelvic Rehabilitation Guide Across the Lifespan

is now available on Amazon; This textbook has health pearls for the

general public seeking pelvic health information and treatment strategies, as well

as content for health -care professionals. Need to know information. Health care aware, health literacy.

by Dr Maureen Mason

The Secret World of Pelvic Physical Therapy

Everybody has…a pelvis, with so many functions “down there”.

Pelvic health problems are often not reported to health care providers, and suffered in silence. There is a big list of pelvic health conditions and associated problems that can be addressed by physical therapy.

I started off in Physical Therapy (PT) to work with sporty things, simple pain problems, and the MUSCULOSKELETAL system. I saw a few “high groin strains” nobody else would treat (gasp, near the “privates”, working near the groin makes many PT’s uncomfortable!). I attended to musculoskeletal treatment of the adductor (inner thigh muscle), hamstrings and hip flexor muscles and these patients recovered well. And I thought the muscle system ended when you reached the pelvis!

And then the postpartum moms with neck, back, hip and pubic pain began to appear on my schedule, some of whom had bladder leaking, which I knew nothing about. And then the big HMO director asked me to take a course on BLADDER TREATMENT and the course instructor Kathe Wallace teased us at each break asking if we REALLY NEEDED TO GO or were going “just in case”. So I found out you can have a sense of humor and really help people with “private” problems.

I began to provide pelvic rehabilitation with bladder continence and urgency treatment programs. I talked about “winking” the pelvic muscles at a lecture I gave for the therapy staff, only to be winked at by colleagues after that talk. Well, the eye is a sphincter or a circular muscle, and the pelvic muscles have sphincters at the outlets, as well as deeper sphincter-like supports. (Note: it’s not all about tightening or “winking). This further developed my sense of humor with the topic of pelvic PT.

And then the HMO MD’s began to send me PELVIC PAIN cases, which I knew little about, and began self -study and a search for more courses. This is a huge topic, pelvic pain! And then the BOWEL problems began to show up for evaluation, with constipation, or loss of control, fecal incontinence, and that required several courses to understand the foundations and to provide care programs.

PELVIC ORGAN PROLAPSE is another problem that is in the arena of hidden problems, and it involves mild to severe hernia like changes in the support of the pelvic organs, and can be often helped by pelvic PT. The bladder, uterus, bowel or all three can be lowered in the body after pregnancy and birth, with some women noticing changes in pressure (a bulge sensation)and in pelvic functioning.

SEXUAL HEALTH problems also began to be referred for care, with pain, discomfort, and all the relationship concerns this created for the patients and required specialty course work to develop screening, evaluation, and treatment protocols.

Conservative care in the medical treatment of pelvic health concerns with bladder, bowel, pain, and sexual dysfunction is appropriate for those without “red flags”, indicating more serious conditions. Severe pain, inability to eliminate or total loss of control of bladder or bowel and other factors require immediate medical attention.

Conservative care with PT does the least harm, and involves full health history screening, physical examination and impairment assessment, habit training, muscle synergy, assessment, functional control of tightening and relaxing, fluid and fiber management, and nutritional training. Biofeedback, real time ultrasound, electrical stimulation, manual therapy, and progressive therapeutic exercise programs are standards of care. Some patients may receive treatment before, or after surgeries to support optimum function.

Pelvic health is vital health, with natural body functions ideally comfortable at rest and in motion. As a pelvic health specialist, I have devoted the majority of my career to providing care in this area, including education, empowerment, yoga for pelvic health, and all aspects of physical therapy.

This blog is an adaptation of a talk I provided at the Academy of Integrative Health and Medicine’s annual conference. That conference in 2017 led to a request by Handspring Publishing for me to write a book on Pelvic Rehabilitation, which is in the works for 2021 publication. Stay tuned for brief blogs that will be developed more in the textbook!

References

Bo, K, Berghmans B, Morkved S, Van Kampen M, Evidence based physical therapy for the pelvic floor, Churchill Livingstone 2015

Faubion S S, Shuster L T, Bharucha A E, Recognition and management of nonrelaxing pelvic floor dysfunction, Mayo Clin Proc 2012, 87(2), 187-193

Menon H U, Handa V L, Vaginal childbirth and pelvic floor disorders, Women’s Health 2013, 9(3)

Ramanayake R P, Basnayake B M, Evaluation of red flags minimizes missing serious diseases in primary care, J Fam Med Prim Care 2018, 7(2), 315-318

Resources

https://aihm.org/page/vision/

Patient Education

https://www.handspringpublishing.com/our-authors/maureen-mason

https://hermanwallace.com

https://hollyherman.com

https://kathewallace.com