It’s NOT Normal To Pee Your Pants
One thing I hear alllllll the time, whether I am in the clinic or out at one of my kid's sports games is,
"Oh I pee my pants when I do _____________".
When I hear it, it sounds like it's totally normal to pee your pants with that activity. But it's not.
It is not normal; it is common.
Two majorly different things. In reality, it is common that people pee their pants with certain activities like:
-running/ jogging,
-jumping/ hopping
-carrying
-lifting
-coughing
-sneezing etc
It is common because a lot of us are doing the activity wrong. I was at Burn Boot Camp this morning and felt the urge to pee while jumping, and quickly checked my form. I was getting tired and noticed I was sending my boobs pointing in the air instead of pointing forward like headlights on a car. When they are pointing up, my muscles in the front, my abs and front pelvic floor that support my bladder, are not working well. Then I am more susceptible to peeing my pants. I quickly adjusted my form to ribs stacked over top of my pelvis, and my bladder urgency went away. I was able to jump and keep my pants dry.
So, if you are exercising, think about your form. Are your ribs stacked over top of your pelvis to support you? Are you able to adjust your form when you feel the need to pee and get that feeling to go away?
I want to help inform you of quick fixes to try out and hopefully see improvements. If not, I also have a Bladder Leakage course coming for things your can do at home to help support your tissues on days when you are not doing activities that challenge the pelvic floor as much. Stay tuned! I want to make sure I help all leakage issues in the course, so please REPLY to this email if you want yours fixed!!
Thank you! With wellness in your pelvis!
Amanda Fisher, Owner of Empower Your Pelvis
Peeing Your Pants Is Like An Injury
Bladder Leakage is like an Injury
It's your body's way of telling you something.
Imagine…you are in the gym working hard and you pee your pants. It catches you off guard because you are feeling amazing working out.
But when you pee your pants, you feel defeated.
Embarrassed.
Just like when you injure a muscle in your body, time helps to heal tissue.
It typically doesn’t get better after one day of changing something or doing something new.
You might rehab the tissue with exercises or physical therapy.
You might have to modify exercises to keep moving your body.
You may have to change things up to continue to challenge your muscles.
Bladder leakage is the same. It takes time to change tissue.
It doesn’t mean you are a failure.
It doesn’t mean you need to stop working out.
It doesn’t mean you need to stop accomplishing your goals.
It means you need to reflect and fix the problem.
You modify movements, reflect, and learn what did I do, what can I do to improve it, and what should I pay attention to in the future to make sure I can decrease my chances of this happening again.
When I evaluate patients who come in with bladder leakage, I ask what actions are causing the bladder leakage, then I ask about bladder habits and then I look at your functional movements…how do you move.
I also ask if you are taking time to breathe (this can be minimal time) or work on mobility of the pelvic floor throughout the day. Most often, you all are skipping the basics or not doing them enough to change tissue.
If you want some guidance on a quick Bed Time Mobility here you go!
Enjoy the rest of your weekend and if you missed it, here is the HOW TO STOP PEEING YOUR PANTS FREEBIE.
IF you are ready for change, SIGN up to receive upcoming release dates on LEAKAGE LOCKDOWN
The Wellness Collective at Empower Your Pelvis
Did you know inside Empower Your Pelvis...there is so much more?
It has grown to be a space where you can come and fill all aspects of your cup: mental health, lactation, lymphatic work, peds PT and OT and a natural path doc who also specializes in acupuncture!!
Empower Your Pelvis still specializes in pelvic health but now we have additional help where it is needed.
Let me introduce you to some of my favorite women:
Sarah Hartenberger, IBCLC -She is the owner of Nurture Lactation. They see moms and families who need help with infant feeding, regardless of if its formula or breast milk, but do focus more on breastfeeding and the complications that can come with that.
Katie Shipley, DPT- Owner of Nurturing Touch PT-pediatric physical therapist who specializes in treating babies birth to 18 mos. She sees babies for developmental delay, torticollis, and pre/post tongue release.
Katie Glynn, OT-Katie is the owner of Three Blue Birds and specializes in lymphedema & oncology rehab. She treats patients going through oncology treatments, lymphedema, lipedema, post-cosmetic surgery, lymphatic wellness, & any type of swelling general.
Katie Kirkenmeier, LPC-owner of Katie Kirkenmeier Therapy and is a mental health therapist that specializes in trauma, infertility, and perinatal mental health.
Dr. Emily Morse, ND-Owner of Joyspring Wellness and is a naturopathic doctor who focuses on general medicine and women’s health and specializes in acupuncture!
Gabby Scheduler, OT-owner of the Therapeutic Playhouse and a pediatric OT. She sees clients in their home to address a variety of things (social emotional regulation, sensory, picky eating, academics, social skills, sleep, bed wetting, confidence) and runs groups of our EYP once a month.
Please click their links above to find out more information and let me know if you have any questions!!
With Wellness in your Pelvis-
Amanda Fisher, DPT
Kansas City, MO
How To Care For Your C-Section Scar: A Comprehensive Guide to Postpartum Healing
How To Care For Your C-Section Scar: A Comprehensive Guide to Postpartum Healing
Embracing the journey of motherhood often involves learning to handle the aftermath of a C-section, where incision scars become a part of the experience. This blog post aims to empower mothers with the knowledge and tools necessary for optimal healing, ensuring a more comfortable and confident postpartum recovery.
Section 1: Immediate Care For Your C-section Scar
Caring for your C-section scar begins with addressing inflammation and preventing scar tissue build-up. To achieve this, regular icing of the incision is recommended every 2-3 hours for 10-12 minutes during the initial five weeks post-C-section. I bought frozen bags of peas and placed a clean dish drying towel/ flour sack towel over it to created a barrier between the cold and the skin. When the peas thawed out, I just tossed them back in freezer to refreeze and use again later.
The use of compression garments (my favorite is Bao Bei Body) (use code empoweryourpelvis for a discount) after birth is my favorite type of support for c-section and vaginal birthing moms. It is something I strongly suggest them purchasing PRIOR to delivery to have ready to go.
Silicone scar sheets further aids in reducing pain, swelling, and promoting normal wound healing. I do not suggest our patients use these until their doctor has told them their scar has healed. Usually around 8 weeks to 6 months is an ideal time for the silicone sheets to be used as seen in research.
Important: You should be keeping an eye out for infection within your c-section scar. Most postoperative infections are discovered 4 to 7 days after surgery. I have seen this happen to patents of ours in the clinic, so call your doctor immediately if you notice any of the following:
Discharge (white, green, brown, or yellow fluid) Hardening of tissues
Fever
Tenderness
Redness
In my professional opinion, I would rather you be safe than sorry. It is always best to call your doc with what you are noticing than to think you will give it time.
Section 2: C-section Scar Tissue Desensitization
Many c-section moms experience sensitivity or numbness around their scar, which can cause discomfort. This happens when nerves are cut during the c-section. C-section scar tissue desensitization is a simple yet effective technique involving textures of varying softness. Fabrics like cotton, silk, felt, and even rougher materials like jeans or sandpaper are gently rubbed against the skin around the scar area. This is not to be done on top of the scar until after your doc releases you. This can be done 1-2 times a day starting a week after the C-section, helps reduce sensitivity and restore sensation. This is a gentle pressure with the fabrics across the tissue. Similar pressure as if you were petting your dog. Creating a basket of fabrics for easy access during nursing or feeding sessions is a convenient way to incorporate this into your routine. Since I was feeding my baby often throughout the day, I could easily remember to grab a piece of fabric out of the supply cart next to my recliner and touch my tissue.
Section 3: C-section Scar Mobilization
Scar tissue is like an ice berg. We can see the incision on top, just like the ice above water. But it’s hard to see what’s happening below. Scar tissue has no boundaries and will latch on to anything. Think of scar tissue like roots of a plant. Roots will shoot out and grow in all directions. Because of this, it is important to work on the scar tissue (tissue above and below the scar too) to make sure sit is moving in all directions to prevent pain, complications, and improve the scar's appearance. Scar tissue can bind to internal organs, impacting future pregnancies.
I recommend my new moms start this by setting a timer for 1-2 minutes every other day and then increasing it to 3-5 minutes if they can find the time to do so. I also like to have my patients start this around 4 weeks postpartum. Click HERE for a FREE download with pics to show you how to do it!
In conclusion, the journey to healing your C-section scar is a personal and ongoing process. Regardless of when your C-section took place, taking the time to follow these steps can significantly contribute to your well-being and recovery. Embrace the opportunity to care for yourself, and remember, it's never too late to prioritize the healing of your C-section scar. Best of luck on your recovery journey, ladies!
Top Ways to Prep and Recover After A C-section
Image from my second csection.
Top Ways to Prep and Recover After A C-section
Many expectant mothers may find themselves unprepared for what comes with having a C-section birth and the recovery process. Your healthcare provider will provide you with information for prepping and post-op like: how to move safely, options to bottle and breast feed and so on.
Having had three C-sections myself, here are some of the top things I wish I had known for my own c-sections:
Accept Help: Recognize that a C-section is a major surgery, and the recovery demands assistance. For the initial two weeks, lifting anything heavier than your baby is discouraged. Seek support from your partner, friends, or family to handle daily tasks, such as watching the baby, cooking meals (no shame in DoorDash), grocery shopping (I love that delivery is now an option) , house cleaning (ask for help with laundry and cleaning toilets 😉), and babysitting toddlers. Embracing help minimizes stress on you mentally and physically. And taking time off your feet will decrease the stress on the abdominal tissue.
Prioritize Preparation: A little preparation can go long way. The same way we prep for going to the hospital or prep for a marathon, you can prep for your c-section recovery. My sister is currently 37 weeks pregnant and, just in case, she ends up with a c-section, these are things I have for her for her recovery:
-a peri bottle for perineum care. Yes even through you delivered via c-section, you will still have bleeding vaginally. This is key to have when cleaning up after using the restroom.
-pads for the vaginal bleeding
-silicone scar pads: you can apply to the scar ONCE it is healed. Make sure you speak to your healthcare provider before using.
-ice packs and pain meds: for your c-section incision to reduce swelling and pain
- compression pants or undies. I’m a huge fan of Bao Bei Bloomers for the first few weeks postpartum compared to abdominal binders. You can use code empoweryourpelvis for a discount.
Control Your C-section Experience:
-Discuss concerns about your scar's appearance beforehand with your doctor. You can’t control what it will look like, but it help me ease nerves prior to surgery.
-Opt for a clear drape if you want to see the baby lifted up. I couldn’t not see much due to my big belly taking up my visual field. This also gives you the chance to chat it up with the staff in the room.
-Request to be the first to hold your baby or ask to have your partner do skin to skin for you while you are being sewn up.
Prioritize Pain Management:
Take your prescribed pain meds regularly. I tried to get off the meds with my first c-section because I was scared of getting addicted to them and I ended up causing myself way more pain and swelling than I needed too. Inadequate pain management can lead to increased reliance on opioids, prolonged recovery, and a higher risk of chronic pain and postpartum depression. So talk to your provider and develop a plan to keep you on the right healing path.
Walk To Get Your Ice In the Hospital: Once you can feel your legs and can safely stand and walk, make your self move in small distances. I did this by making myself walk to get my own ice in the hospital or prune juice to help with bowel movements. Walking can help with healing as long as it is in short distances in the beginning.
Master Proper Movement During Recovery: After my c-sections, every single movement hurt. Rolling in bed. Painful. Getting out of bed (remember you don’t have a core). Painful. Moving from sit to stand and stand to sit. Painful. I noticed with the pain, I started holding my breaath. When we hold our breath, it causes an increase pressure in the belly and the pelvic floor. It does not allow stability and support. So…when you feel pain (and practice this ahead of time), BLOW OUT to take the pressure off your pelvic floor and belly.
-Get out of bed: blow out as you log roll and use your arms to help get you to sitting up. This takes the tension off the scar if you just tried to sit up (difficult to do after a c-section with lack of core muscles).
-Getting out of a chair or off the bed: Scoot your butt forward on the chair or bed, think tits over toes and blow out as you stand up.
-Breastfeeding and bottle feeding: hold baby in a football hold and use pillows to take the pressure off the incision.
-Gentle movement: like short distance walking and small pelvic movements like the ones in your Body After Birth program, are so helpful and can be started day 1 after delivery.
Facing a C-section can be scary without knowing what to expect. I know, because that was me. Nervous Nelly. . By reading this, hopefully it eases your mind and gives you a little peace as you head towards your delivery. You've got this!!
New Self Pay Patients
Going Cash Based Pelvic Floor Physical Therapy
Empower Your Pelvis will be out of network with Blue Cross Blue Shield (BCBS) come November 1, 2023.
If you wish to cancel upcoming appointments with our group, please let us know as soon as possible. We have patients who would like to get in by the end of the year if possible.
We do have packages and self pay discounts available.
If you leave a positive review on Google, we will give you a $5 discount for a self pay visit. You can leave as many positive reviews as you would like for continued discounts.
Empower Your Pelvis has lots of online resources/ programs for pelvic floor issues:
Pelvic Posse Membership: Uploaded mobility, strength and core weekly, plus more: Try now for $10 this month
C-section Recovery: 4 Weeks of C-section Recovery Exercises and scar tissue work
Body After Birth: Perfect for NEW moms...can start as early as 2 WEEKS Postpartum. As a mom, you are already walking during this time, holding/ carrying baby and doing some household chores...this program is to help support you with some exercises that are safe to do during this time.
Pelvic Pain with Intercourse: This is a 4 weeks pre-recordedcourse to watch and you can share it with your partner as well. We have had clients who haven't been able to have sex, be successful after this course. And some who lacked or never had an orgasm, be successful in this area as well.
What are you wanting to learn more of in the Pelvic Posse emails?
REPLY to this email and let me know!!
-With wellness in your pelvis!
-XX-Amanda Fisher
Everyone Poops 💩
Everyone Poops 💩
Favorite Pooping Recipe from a pelvic floor physical therapists by Amanda Fisher, a pelvic floor physical therapist in Kansas City.
I had the privilege of working with the amazing Amy Slater in the summer of 2021 to help me figure out how to regulate my hormones.
One of the number one things she had mentioned to me with helping to regulate my hormones, was having regular bowel movements. Each time you poop, you are pooping out excess hormones, like estrogen.
The longer poop (toxins) stay in our system (decrease in bowel movements), the higher levels we can have.
Made sense to me, so for someone who was used to going every other to every 2 days or so, I was determined to change this for my health.
First, I started trying to get 10,000 steps minimum a day. I aimed to walk in the morning and night. (I ended up getting a dog at this time to help me with this 😆)
Second, I started eating Chia Seed Pudding every morning for breakfast. Here is what it consisted of:
1 cup of dairy free milk (I use Milkademia milk)
2 scoops of chocolate collagen protein (I’m a huge fan of CB Supplements. Use code EYP or empoweryourpelvis for a discount).
Then I add 3 tablespoons of chia seeds
2 Tablespoons of pumpkin seeds
1 Tablespoon of Ground Flax seeds
1/2 cup of berries
I, personally, like mine more like a cereal consistency vs overnight oats…so I eat mine within 30 minutes of making it in the morning.
Third thing to help my hormones and bowel movements, I started eating PRIOR to drinking caffeine. This was HUGE with helping my blood glucose. Great for me with my history of PCOS and family history of diabetes.
Please let me know what you think of this recipe and let me know how often you are walking and having bowel movements!! If you are wanting more help with bowel movements or decreasing fecal smearing, check out our online program, Em-POO-er Your Pelvis.
Top 3 Mistakes with Lifting
Top 3 Mistakes with Lifting
A blog post written by Dr. Alyssa at Empower Your Pelvis-a pelvic floor physical therapy clinic in Kansas City.
Ribs stacked over the pelvis
Whether you are a weight lifter, a person who frequently does yardwork, or a new mom with a baby, we are all lifting to some capacity each day. We all stand up from chairs, lift our groceries/bags of mulch/babies and transfer them to various surfaces. Therefore, we all are lifting each day! It is important for our bone health and overall mobility to be able to do these things regularly but there are some common things I see go wrong when watching patients move in the clinic.
Overarching
The first is breath holding. When we go to stand or pick up something heavy, oftentimes we hold our breath and grunt as we do it. This pushes pressure down into our abdomen and pelvic floor as we move which can cause bladder leakage or pelvic heaviness. Instead, exhale as you move to lift pressure up from the pelvic floor. For example, as you stand from a chair - exhale. If you pick up a box or a kid from the ground - exhale. When you lift plates overhead to the cabinet - exhale. This is the easiest way to incorporate good patterns and health for our pelvic floor!
The second thing I see happen is that we tend to shove our pelvis in front of our hips and arch our back when we stand up from a chair or from lifting something off the ground. This can contribute to back tightness, bladder leakage, and pelvic heaviness. My tip for correcting this is to think about stacking your ribs over your pelvis when you stand up from a lift.
The third thing is that we tend to tuck our pelvis under and round our back as we lift something from the floor. This places most of the work on our back and doesn’t allow our glutes to do the work for us. Instead, when you bend to pick something up off the floor, think about hinging your hips back as if shutting the car door with your butt. This can be a hard thing to master for some, so I suggest practicing with a dowel or broom at your back first to get the movement down. This keeps our spine neutral and makes our glutes work!
If you have any questions or want to know more, send us an email at info@empoweryourpelvis.com or check out our YouTube channel HERE.
How to Avoid Prolapse
Don’t let your bladder fall out!
“3 Tips to avoid prolapse!
was written by Dr. Marin Cole, DPT, a Physical Therapist at Empower Your Pelvis in Kansas City
Pelvic organ prolapse is when your bladder or uterus start bulging into the vaginal area and create symptoms of pressure or heaviness. Patients who have prolapse often report these symptoms but some do also complain of vaginal or pelvic pain and bladder or bowel symptoms such as urgency, incomplete emptying, or incontinence. Oftentimes our patients with prolapse have been referred to us by a urogynecologist or OBGYN who recommend starting with pelvic floor physical therapy instead of surgery or medication. I want to share with you three tips that we always emphasize with patients who are experiencing a pelvic organ prolapse.
1.Exhale on exertion: When you do a movement that requires muscle exertion, ie. going from sitting to standing, picking something up, bending over, getting out of bed, etc, make sure to EXHALE as you do the movement. Clinically speaking most people tend to hold their breath when they do these actions which actually puts more pressure on the pelvic organs and pelvic floor muscles. This is something I like to say is “easy to do, hard to remember!” Start practicing this now, it’ll get easier with time!
2. Yoga Poses: These are my three favorite yoga poses to show patients and they all are effective in decreasing pelvic pressure. These are especially helpful after a long day of being on your feet or if you are starting to feel that vaginal pressure/heaviness. They are all great but I recommend my patients choose the one that they feel is most helpful or if one is more practical for their lifestyle than the others. Try to hold for 3-5 minutes at least 1-2x per day.
3. Glute/Hip strengthening: Obviously there are endless amounts of exercises I could recommend for glute or hip strengthening, but the idea here is that having hip strength and stability will help to support the pelvic floor muscles. The exercise that is recommended will depend on your starting strength, any other musculoskeletal impairments, and severity of your prolapse. A bridge is a great place to start!
Top 5 Reasons Why Childbirth Prep Is Needed
Top 5 Reasons Why Childbirth Prep Is Needed
“Top 5 Reasons Why Childbirth Prep Is Needed” was written by Dr. Michaela Lupo. Dr. Lupo is a
Physical Therapist at Empower Your Pelvis, based in south Kansas City.
Happy Baby Stretch to relax pelvic floor muscles
What is Childbirth Prep?
Childbirth prep is the work done before baby is born. As a pelvic floor physical therapist (PT),
preparing for the event that is labor and childbirth is a no brainer. However, this isn’t always a
common thought.
There are plenty of reasons that preparing for childbirth can help the birthing person and her
partner in the delivery room.
Top 5 Reasons to Childbirth Prep
Here are my top 5 reasons why childbirth prep is needed, according to a pelvic floor PT.
1) Labor and childbirth is a marathon.
Labor and childbirth is hard work both mentally and physically.
Like a marathon, it is not something that you can just power through without a little preparation
of the mind and body. This can be overwhelming without support.
There are apps that help with mindfulness, and there are certain exercises and stretches that
can help prepare your body for the event.
A childbirth prep course can provide many avenues for preparation and give you a community to
hold you accountable.
2) Expectation of childbirth does not equal reality.
At some point during your pregnancy, you might hear people asking about your birth plan. This
is something you can bring to the birth that helps all the people in the room be on the same
page about what you would like to happen in an ideal scenario.
Butterfly stretch to target inner thighs and pelvic floor muscles.
These things include your choice of medications (if any), who cuts the cord, if the baby comes
directly to your chest, if you will nurse, etc.
It is helpful to know more about what happens during the labor and delivery process, both with
you and your baby’s body to help you make these decisions. These plans help at the moment
as you may not have the capacity to reinforce what you would like to happen.
However, it is equally as important that you mentally prepare for the unexpected. There are
many things that happen between both mom and baby during the labor and delivery process
that can change plans in order to keep you both safe.
Taking a childbirth prep course can help you and your partner mentally prepare for the
unexpected and learn more about what your options are if things take an unexpected turn.
3) You can reduce your chances of tearing.
You can reduce your chances of tearing by prepping your tissue with perineal massage and
exercise. Evidence shows that seeing a physical therapist for “prehab” prior to a surgical
procedure can improve outcomes.
Essentially, you are preparing muscles by making them stronger, bringing blood flow to the
area, and improving the brain-muscle connection that is needed for a good muscular contraction
Child’s Pose Stretch with knees apart to relax pelvic floor.
before any changes happen to the tissue.
You can think of childbirth prep the same way. Whether you have a vaginal delivery or
cesarean; whether it is planned or unplanned, tissue prep can do wonders on the postpartum
healing process.
Just as we said above, labor and childbirth are a marathon, so stretching and strengthening
muscles in and around the pelvic floor can help with positions and pushing during delivery.
Likewise, prepping your tissue down there for the exit of the baby can help minimize the risk of
tearing. This is called perineal massage, and it is something a pelvic floor PT, childbirth prep
course, midwife or doula can acquaint you with.
4) Childbirth prep helps your partner too.
Most partners want to be there for their significant others, but they just don’t know what to do
with their hands!
With a little bit of childbirth prep, partners are more mentally and physically prepared, too. They
are more aware of what actually happens in the labor and delivery room, and how to help!
5) You don’t know what you don’t know
A good childbirth prep course introduces you to what happens to mom and baby during labor
Dr. Michaela with Empower Your Pelvis
and delivery as well as what to expect in the hospitals and birthing centers.
Many new moms do not know that they have choices in the birthing process, and a birth prep
course can help prepare you to ask the right questions, and give you a voice to opt out of things
that might be standard, but not something that you want for you or your little one(s).
Childbirth Prep Resource
As a shameless plug, my colleague Dr. Erica is doing an online birth prep course starting
September 19, 2022. If you are unsure of where to access childbirth prep support in your area,
this would be a great option!
Sign up for weekly live zoom calls, 4 weeks of exercise to prep for labor, 24/7 chat access with
Dr. Erica, expert interviews about breastfeeding, mental health, c-sections and vaginal delivery
Postpartum Intimacy: What to Expect?
Postpartum S.E.X.
By: Dr. Erica Magruder
It’s… different. You’ve just birthed a baby, and your body feels like it’s still not your own.
I remember feeling exhausted, overwhelmed, AND if I was really lucky also leaking milk from my boobs.
There were definitely moments the boobs were off limits; my bra stayed on, because who knew when the milk makers were going into action.
To say the least, there are barriers. But, you can find ways to work around the barriers.
Happy Baby Stretch
Here’s what I talk about with my patients who are having trouble returning sex postpartum:
Find Other Ways to Create Intimacy
Do you know your love language? How about your partner’s love language?
Does your partner know YOUR love language?
We can build intimacy with our partners in many different ways.
Some people need physical touch. Make out with your partner. Get frisky in other ways outside of penetrative intercourse. Cuddle. Take some time to find touch that feels good to you.
Butterfly Stretch
Conversation can be huge for building intimacy. Conversation can also be exhausting or draining. So pick your topics. Or maybe just pick what topics are off limits. I would suggest: kids, finances, chores, and family drama. Make these conversations fulfilling and enjoyable.
Can somebody give me a shout out for DATE NIGHT!?! This is not impossible. It may feel this way, but get creative folks. Have an afternoon date, or a date at home while your baby is napping. Use your community; let someone babysit if you have this available to you. It will be so worth it.
Schedule Time for Intimacy
I know this sounds like a real downer, but better to have scheduled intimacy than no intimacy at all!
And for the love, refer to the above section… this does not just mean the grand finale. Find what helps you and your partner feel closer to each other, and get it scheduled.
Let me help you out a bit:
-During nap time
-After bedtime
-During play time on the floor
-While you have visitors (leave them with the baby and go have a coffee, play a game, chat it up)
Child’s Pose Stretch
-You won’t just “have time.” You need to make time. Schedule time.
Prep Your Body for the Main Event
Take some time to chill, wind down. If you have no idea where to start, here are some exercises to get you on the right track.
Breath Work
Use your breath to connect to your pelvic floor. Work through diaphragmatic breathing to move your pelvic floor muscles and help them prepare for lengthening.
Stretching
There are many easy and effective stretches to open your pelvis. You can pair these stretches with your breathing to really encourage your pelvic floor muscles to relax and prepare for intimacy.
These are some of my favorite: Extended Child’s Pose, Reclined Butterfly, and Happy Baby
Pelvic Wand
A pelvic wand is a fantastic tool to directly lengthen your pelvic floor muscles. Your pelvic floor physical therapist can help direct the best use based on your pelvic floor muscles.
Tell Your Partner What You Need
To do this, you first have to figure out what you need.
Your partner does not know. They do not know you don’t feel sexy. They do not know you’re worried about leaking milk. They do not know you’re having pain with sex. They do not know (but should know) you’re exhausted. They do not know you’re worried about baby waking up, or needing to eat.
It could be you need to ask for some help with your baby or things around the house. You may need to “set the mood”-- dim the lights, clean up your room, shower, put on something that makes you feel good.
It’s not easy to figure out what you need, or what’s “missing.” But, you can do it.
And, maybe the most important thing to remember about sex postpartum is there is no universal right time to have sex after baby. Everyone has their own timeline. 6 weeks is your doctor saying, your body is physically “safe” to have intercourse. Not “you have to start having sex at 6 weeks” or “it’s time, make it happen”. This is simply when you’re “cleared”. If you’re excited or ready to go, do it! If you’re hesitant, nervous, exhausted, or just not ready, use this guide to ease back in.
Postpartum sex can, and should be great! It should be just as wonderful as before you birthed a baby!
If you have any questions or want to chat about your personal postpartum experience with returning to sex, please reach out to our clinic!
Here are some of my favorite products to help you on your postpartum returning to sex journey:
Lubrication:
Slippery Stuff
Good Clean Love
Coconu: Use Code: EYP for a discount
Pelvic Wand by Intimate Rose
Use ERICA22 for $5 off a checkout
Come as You Are. By: Emily Nagoski
Empower Your Fertility
Improve Your Fertility
How physical therapy can optimize your chances of trying to conceive
By: Dr. Heather Evans, DPT
These are my twins, Hannah and Gavin, as embryos. To reach this point took us four years, four IVF cycles, two reproductive endocrinologists (in two different states), and an egg donor. Our TTC (trying to conceive) journey was long, hard, and stressful. It was also nine years ago, before more was known about how physical therapy can actually improve your chances of becoming pregnant.
Physical therapy? Squats and lunges? Not quite. Let me share with you a little bit on how a trained physical therapist can boost your chances of success.
1. Tissue mobility: The tissues around your uterus, tubes, and ovaries need movement! Many times, we have restrictions from connective tissue or scarring that can block tubes and restrict the movement our organs need. A PT can help mobilize this tissue and teach you how to work on this at home.
2. Blood/lymphatic flow: A PT can use manual therapy and exercise techniques to improve the flow of blood and lymph around the pelvis/reproductive organs.
3. Stress management: Stress affects hormones and hormones affect fertility along with other body systems. A trained PT can teach you techniques to combat this stress hormone release by using breathing techniques, mindfulness, and stretching.
4. Education on inflammation, dietary factors, environmental agents, and more: In our clinic, we work with many women who have conditions that are affected by inflammation – endometriosis, PCOS, Hashimoto’s, and more. Inflammation can be both positively or negatively affected by things you do or do not consume as well as by environmental toxins, sleep, and stress.
Interested in learning more on how physical therapy can optimize your journey while trying to conceive? Join my 5-day Empower Your Fertility challenge which will be held online (live or recordings) October 17-21st. This course is appropriate for anyone anywhere along their TTC journey from just starting out or preparing for a future IVF cycle.
I’ve been there, ladies, and I know how hard it is. I look forward to helping you out in any way that I can!
4 Best Exercises For The Pelvic Floor
4 Best Exercises For The Pelvic Floor
Alright these are my go -to favorite exercises for the pelvic floor…whether you are pregnant 🤰 , postpartum, dealing with bladder leakage or pelvic pain/ low back pain etc.
I’m obsessed with these and think we should be doing them daily!
Try them out and let me know what you think.
-XOXO Dr. Amanda
PREHAB
“PREHAB”
Treating patients during their pregnancy has always been a passion of mine. I came from a clinic that was an orthopedic outpatient physical therapy clinic and anytime a patient came in that was pregnant was put on my schedule. Even if they had a toe injury. All of the therapists were scared to touch anyone who was pregnant. But I had not had a ton of exposure to working with patients during their pregnancy at that point in my career. I had already done my foundational courses for pelvic health but even in those specialized courses, there wasn’t a lot of emphasis on the pregnant patient. Most of the emphasis was on postpartum rehab or elderly patients with bladder, bowel, or a pain dysfunction. Then as I began to work with more patients that were pregnant, I realized that these are just like any pelvic health patient that I had seen before. They had similar bladder, bowel, pain, movement dysfunctions as well.
I can’t tell you how many times that I’ve seen patients who are postpartum, whether they were two weeks postpartum or two years postpartum, telling me, “Well I had these issues during my pregnancy but I just thought I had to wait until after I had the baby to come in to see you”. I wanted to change that. Which is why we talk to so many women about “prehab” before the baby is here. Pregnancy is such a vulnerable time for a woman’s body and it is also the most amazing time. The reason I say vulnerable is because your body is changing on a daily basis during pregnancy out of your control.
There is a big difference in postpartum recovery outcomes between the patients that I saw during their pregnancies and the patients who did not seek out a pelvic floor PT during their pregnancy. I do not have a research article on this but I am speaking from clinical experience and treating thousands of women who are/have been pregnant. For example, I would have to see a patient anywhere from 4 to 12 times postpartum if I’ve never seen them during their pregnancy. However, when I have seen them during their pregnancy, I would say that 4 to 12 average goes down to about 2 to 6. The reason for this is they’ve already understood the basics about their pelvic health, have an individualized plan care, and they have prepared their body to potentially dodge some of those unwanted postpartum symptoms.
In a perfect world, all providers (doctors, chiros, doulas, etc.) who see a patient during their prenatal period would teach them about pelvic floor rehab. We should all be working as a team for the patient and baby. In my opinion, I look at a woman’s prenatal journey in regards to a pelvic floor PT and a midwife/OBGYN like I do a principal and a math teacher at a school. Think of the pelvic floor PT as the math teacher and think of the midwife/OBGYN as the principal. Yes, the principal is the boss of the math teacher and is in charge of the day to day well being of the school. But the principal would not be able to just jump into the math teacher’s class and teach the subject seamlessly. This is the same thing as the midwife/OBGYN are like the “principal” of the patient during their pregnancy and the pelvic floor PT is the specialist when it comes to the musculoskeletal system. They both have to work together to help the patient achieve the best pre and postnatal outcomes.
Back to the “prehab” thing. Many of us realize that delivering a baby is a pretty big deal. It changes your life in so many ways and especially your body. Physical therapists are in charge of getting your body ready for the big event a.k.a. childbirth. Seeing a pelvic floor PT during your pregnancy is so important because they are going to talk to you about bladder health, bowel health, safe exercise progression, posture, positioning, breath work, and more. Since your body is changing so rapidly during those nine months, it’s important to be continually assessed so that you know that you are doing the right things to protect both your body and baby.
My hope is that for anyone who is reading this will understand the importance of pelvic floor PT during pregnancy. I want this to become the “norm” because I have seen the benefits with my own eyes time and time again.
Peeing Your Pants Is Not Normal Part 2
PEEING YOUR PANTS IS NOT NORMAL PART TWO:
Stress urinary incontinence means that your body will experience loss of urine when there is an increase in pressure in your abdomen. So if you leak urine when you laugh or run or jump or cough we need to work on your pressure management as it relates to your pelvic floor muscles as well as the strength of your muscles!
Urge urinary incontinence means that you aren’t able to “hold it” long enough to get to a bathroom before you experience urinary leakage. We need to educate you on urge deferment techniques to retrain your bladder and make sure your pelvic floor muscles have good mobility!
The majority of what we see in the clinic are types 1 through 4 but physical therapy can help with any of the 5. The moral of the story is that while up to 40% of the population experiences some form of urinary incontinence, so many people don’t seek treatment because they don’t know it’s not normal.
So let’s start with educating ourselves, our friends, and our family that these symptoms are COMMON but NOT NORMAL.
Peeing your pants is not normal! Part 1
Peeing your pants is not normal!
By: Marin Cole
PART ONE:
Let me ask you this, did you have a baby recently, or even 20 years ago, and think to yourself, well I had a baby so now I just leak when I sneeze, it’s totally fine because it happens to all of my friends?
I can’t tell you how many times I have heard patients say this, or at least something similar to this. And let me clarify, not everyone who experiences loss of urine has had a baby; this can happen to men or women, bladder dysfunction doesn’t discriminate. Well I’ll let you in on a secret, urine loss is COMMON but NOT NORMAL. This is one of the first things a pelvic floor physical therapist will tell you during an evaluation; the symptoms you are experiencing are not uncommon, but just because of your pregnancy history, past surgeries, or even your age or gender, this does not mean these symptoms are “normal,” and there is something you can do about it!
I want to ask you several questions to see if you’re experiencing any of the 5 types of urinary incontinence.
Stress urinary incontinence: Do you cough or sneeze and notice a little or even a lot of urine loss without your control? Did you try jump roping again at the gym for the first time in a while and notice urine leaking with every jump? Did you try going for a jog and noticed the faster you ran the more urine you lost?
Urge urinary incontinence: Do you know where every bathroom is and have to plan your days around when and where you can use the bathroom? Do you feel a sudden urge to urinate and then all of a sudden you have involuntary loss of urine?
Mixed urinary incontinence: Are you experiencing a little bit of both of the above symptoms?
Overflow urinary incontinence: Do you feel like you aren’t able to fully empty your bladder? After you go to the bathroom do you notice a little bit of dribbling?
Functional urinary incontinence: Do you have an impairment, that you may or may not be aware of, that prevents you from making it to the toilet, causing you to leak urine?
If you answered “YES” to any of these questions, and you thought “this happens to everybody,” well you aren’t alone, and pelvic floor PT can help!
How can we help you ask? Let me tell you… TO BE CONTINUED….
Prostatectomy and Your Pelvic Floor
Prostatectomy and Your Pelvic Floor
When people think of the pelvic floor, they often think of women, specifically ones who have recently had a baby. While we certainly work with a lot of women, it is very important to remember that men have pelvic floors, too!
Men can experience many of the same symptoms that women do including urinary leakage (often after prostatectomy), pelvic pain, pelvic floor muscle tension, and constipation. Seeing a pelvic health specialist can be vital to getting men on their way in treating these diagnoses.
When men are diagnosed with prostate cancer, one of the possible treatment options is prostatectomy (removal of the prostate). The prostate sits below the bladder and the urethra (the tube that the urine travels through from the bladder to exit the body) runs THROUGH the prostate. During prostatectomy, the urethra (and sometimes the bladder neck) may need to be surgically repaired. Whether or not the nerves can be spared is determined by each man’s specific cancer.
Initially after the surgery, urinary incontinence is present in almost all men. Over time, this should improve however with many men, it either does not improve or it does not improve enough. This is when the pelvic floor becomes important since strength, endurance, and proper activation of these muscles with daily activities becomes crucial.
A pelvic floor physical therapist can help instruct men in necessary exercises as well as proper use of the pelvic floor throughout the day. These exercises can be started before a prostatectomy or afterward, whenever a man learns about this information. If you or a loved one is about to have a prostatectomy or has already had one and is experienced urinary incontinence, see a trained pelvic floor physical therapist. If you do not have one near your home or if you would prefer to address these issues on your own, Empower Your Pelvis now offers a program on our website that provides further information and walks you through the rehabilitation process. Check it out at: https://www.empoweryourpelvis.com/new-products/prostatectomy-incontinence-and-the-pelvic-floor
Bladder Myths and Misconceptions
Bladder Myths and Misconceptions
When we evaluate a patient on their first day, we ask a lot of questions about bladder habits. For example, how often do you go during the day, how often at night, what is your stream like, what is your fluid intake like, and more. Based on many years of responses to these questions, I thought I’d go over a few things I hear most often that we want you to avoid. There are many myths and misconceptions out there in regards to bladder health, and you might be doing something in order to try to HELP yourself, but in reality, it might be causing harm. Check out these four common misconceptions…
1) Pushing when you pee
SO many patients tell us they push to urinate. They either push the whole time or they push at the end to try to get additional urine out. Please stop doing this today! In order to have proper urination, you need to RELAX the pelvic floor muscles so that the muscle attached to the bladder can contract and the urine can flow out without any restriction. Appropriate emptying can be achieved with muscle relaxation, and pushing is NOT required. If you feel like you are not emptying fully, try the following strategies instead. Sit and relax on the toilet, wipe, stand up, then sit and relax again (we call this double voiding). Another option is to sit and urinate, then rock your hips side to side on the toilet to release any further urine. No pushing allowed!
2) Holding your urine too long
Holding your urine for five or six hours is too long! If you are adequately hydrating, you should be urinating every 2-3 hours during your waking hours. If you find you frequently get involved in projects and lose track of time, set yourself a timer (watch, phone, kitchen timer) for 2-3 hours, and if that timer goes off, STOP and go the bathroom. This is also a great trick to use for kids and teens who struggle with bladder leakage.
3) Going too often (and going just in case)
We also see patients who do the opposite – going all the time “just in case.” This can lead to your bladder getting used to emptying at the first urge which can increase bladder urgency and frequency. You should not have to urinate at the very first, slight bladder urge. Our bladders are designed to give us multiple urges before we really need to stop and go. As mentioned above, with good hydration, it’s normal to urinate every 2-3 hours (more if you just consumed a bladder irritant, such as coffee). Exceptions include getting ready to exercise, right before a pelvic exam, or right before a long car ride!
4) Decreasing water to avoid leakage
This is one of the most common ones I hear. If someone comes in with incontinence, often they are limiting their water intake to decrease the leakage. I see the thought process, but here is the reality – if you limit your water intake, your urine can become more concentrated (you know this is happening if your urine is a darker yellow in the toilet). More concentrated urine can actually irritate the bladder and increase leakage! Aim to drink half your body weight in ounces of water (so a 200 pound person would consume 100 ounces of water).
PAIN WITH SEX… BUT I HAVEN’T HAD A BABY
PAIN WITH SEX… BUT I HAVEN’T HAD A BABY
Have you had pain with sex?
Have you had an injury to your pelvis or tailbone?
Do you have pain with orgasm?
Are you not sure if you’ve ever had an orgasm?
Has sex always been painful?
Do you have PCOS or endometriosis?
Did sex suddenly become painful?
You are not alone.
I’ve seen countless patients with pelvic floor dysfunction (pain with sex, leaking urine, pelvic organ prolapse) who have never had children.
Having a baby is not the only qualifier for pelvic floor dysfunction. Sometimes the dysfunction can be related to a specific event: falling on your tailbone, an injury to your pelvis, or other trauma to the pelvic floor. Sometimes the “cause” is unknown. Either way you can be helped. And you should be helped.
Oftentimes these muscles have decided to guard the pelvic region. Our bodies are so smart. And they do what they need to do to allow us to continue on with life.
So, what can we do about it?
We can gently retrain the pelvic floor muscles. We can teach them how to move; how to relax and contract. You can connect to your pelvic floor muscles. You can learn how to feel when they are holding tension and when they are relaxed.
Then the cherry on top: build strength. Build strength in your glutes. Build strength in your core. Build strength to allow you to do what you want to do without pain.
You can workout without having pelvic pain afterwards.
You can go to work all day without having cramping afterwards.
You can have sex without pain!
If you have further questions about this please feel free to reach out to us at the clinic: info@empoweryourpelvis.com
Dr. Erica Magruder
The First Trimester
The first trimester
By: Marin Cole
Usually we don’t see too many pregnant mamas during their first trimester because, well, they usually aren’t experiencing too many symptoms that would bring them to Physical Therapy. That being said, let's talk about a few things that we see people later on that may be stemming from issues that begin during the first trimester!
Leaking urine. This is something that we see so many moms for during pregnancy and especially postpartum. There are a number of reasons why women start to lose control of their bladder during pregnancy, including greater pressure on the bladder from a growing uterus and growing baby, change in posture, frequent vomiting, and having greater urinary urgency and not being able to make it to the bathroom. Urinary urgency is a sign early on in pregnancy because of increased blood flow to the pelvis, while this is actually very common and quite normal, it is something worth discussing. When we start feeling urinary urgency and we start going “just in case” we actually start to retrain our bladder, hence 10 years later and you’re still peeing every 30 minutes. So while urinating more frequently during pregnancy is completely normal, do not let your bladder take over your life, and if you think it is starting to, see a pelvic floor physical therapist! The other causes of incontinence that I mentioned have more to do with pressure control, this is a huge issue in pregnancy and something we spend a lot of time addressing with our pregnant mamas. The way we stand and move can increase pressure on the muscles that are responsible for controlling our urine flow, and if you’re lucky enough to feel that constant pressure on your bladder, it is that much more important to have good mobility and control of your pelvic floor muscles! And the dreadful morning sickness… if you spent the first 10 weeks of your pregnancy running back and forth from the bathroom, your pelvic floor likely took a toll and addressing that earlier in pregnancy will help you later!
Is it just me or did that “round ligament pain” start earlier than you were expecting? The reason we start to feel pulling in the front of our abdomen so early is because our uterus starts growing even during those early months! Learning how to move our bodies in bed and getting up from the couch will help to support our growing bellies. The two most important concepts to start working on even at the start of pregnancy is breath work and learning how to engage your core! This is something that a pelvic floor physical therapist can help you with early on in pregnancy and then teach you how to progress or modify exercises throughout your pregnancy.
Moral of the story, pregnancy is an amazing experience that women go through, but it is also something that changes you physically from the very start. We as physical therapists want you to have the tools that you’ll need over the next 9 months to stay pain free, active, confident, and safe as your little one grows!