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Heather and her staff blog about all things pelvic health related

Including male, female, pediatric, transgender and nonbinary chronic pelvic pain, urinary dysfunction such as incontinence, prostatitis, sexual dysfunction, pregnancy, back pain, upcoming events and more.

Coping with Restless Leg Syndrome | Image Courtesy of Yuris Alhumaydy via Unsplash
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Restless legs syndrome (or RLS)

Restless legs syndrome (or RLS) is a condition where there are uncontrollable urges to move limbs (mostly in the legs, but sometimes in the arms) that follows a circadian pattern, namely evenings/overnight when resting.

The urges usually come with unpleasant sensations such as tingling, burning, itching, or otherwise painful. Usually, it can be alleviated by movement, but as you can imagine, it can be debilitating and impair sleep, and thus quality of life. It is common to experience mood swings, anxiety and depression. It is estimated that about 3.9-14.3% of the general population suffer from RLS. It is the most common movement disorder in pregnant women. There is either primary (idiopathic) RLS, or secondary (acquired) RLS due to pregnancy, renal pathologies and are also associated with diabetes, hypertension and other metabolic conditions. The two most common risk factors for RLS are iron deficiency and kidney disease. 

Read more: What is Restless Leg...

Interstitial Cystitis | IC & Symptoms | Image Courtesy of Marek Piwnicki via Unsplash
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Interstitial cystitis (IC) also known as bladder pain syndrome or painful bladder syndrome, is a debilitating condition that significantly affects the quality of life of patients living with it.

Symptoms of IC include: 

  • An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder >6 weeks in duration6,7,9 
  • Increased pain with specific foods or drinks and/or worsened with bladder filling and/or improved with urination9.
  • Urinary urgency (Seen in 84% of IC patients)6.
  • Urinary frequency (>10x/day) (Seen in 92% of IC patients)6.

Read more: What is IC and What Are The...

treatments for lower urinary tract symptoms
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Causes & Treatments for Lower Urinary Tract Symptoms

Men may experience different types of lower urinary tract symptoms (LUTS)

Men may experience different types of lower urinary tract symptoms (LUTS) and are often divided into different categories: storage symptoms (urinary urgency, frequency, nighttime peeing, incontinence), voiding symptoms (painful urination, incomplete emptying, dribbling, poor urinary stream), and/or post voiding symptoms (post-void dribbling, pain after urination, etc.).

Living with these symptoms can be debilitating and significantly decrease quality of life. Between 70-90% of older men over 80 experience some version of LUTS. LUTS are often associated with bladder outlet/obstruction issues due to enlarged prostate. However, this is not always the case and can arise from other bladder or urethra disorders including overactive bladder syndrome, painful bladder syndrome, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and other.

Read more: Men and LUTS | Causes &...

Grip Strength & Incontinence | Image Licensed by Securecat under Creative Commons BY-SA 2.0
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November is Bladder Health Awareness Month.

At Fusion Wellness & Physical Therapy, we take pride in understanding and applying how your whole body affects your pelvic health. In this article, we explore how urinary incontinence and other bladder issues are correlated with grip strength.

A study conducted at the Jeju National University measured grip strength in patients and found statistically significant differences in patients with incontinence, overactive bladder and nocturia4. They found these patients had a weaker grip strength (less than 18kg) using a hand dynamometer. 

Types & Frequency of Incontinence

In the United States, 51% of women live with urinary incontinence1. Urinary incontinence is the involuntary loss of urine which can be mild (a few drops) to a complete inability to control the bladder. There can be different triggers that may

Read more: Grip Strength and Urinary...

Urinary Incontinence and Low Back Pain | Image Courtesy of Toa Heftiba via Unsplash
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It has long been recognized in the Pelvic Physical Therapy World that there is a connection between urinary incontinence and low back pain.

Clinically, we often see patients that come in with both symptoms. How common is urinary incontinence among people also affected by low back pain? What comes first, the urinary incontinence or the back pain? What causes this?

In a recent systematic review, a positive association of 83% was found between urinary incontinence and low back pain or pelvic girdle pain. Pelvic girdle pain is defined as the area below the low back and below the abdomen (gluteal region in the back and pubic bone in the front). The strength of this correlation depends on many factors such as type of urinary incontinence, pain severity, and length of pain.

The relationship between urinary incontinence and low back pain is seen equally in both men and women and can be applied to all folks. Low levels of low back pain were mostly associated with both, stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). Whereas high levels of low back pain were associated more with urge urinary incontinence. Based on one study by Stockil et al., SUI was seen more often with sudden onset pains than with chronic pain. Unfortunately, their sample of patients was limited, consisting mostly of young women who have never given birth. To measure the correlation more accurately, studies involving a broader population will need to be conducted.

Read more: The Link Between Urinary...

Post-Radical Prostatectomy Incontinence & Erectile Dysfunction | Image Courtesy of Attila Szantner via Flickr
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The Frequency of Post-Radical Prostatectomy Incontinence

November is Movember -- Men’s Health Awareness Month. This article focuses on male urinary incontinence and erectile dysfunction following a radical prostatectomy, two diagnoses that incorporate pelvic floor physical therapy as part of the care team.

The incidence rate of post-radical prostatectomy incontinence can range from 2.5–90% depending on the definition for urinary continence. While some studies define continence by using 0-1 incontinence pads per day, others define it as 0 incontinence pads used per day, for a full week.  On average, after robotic-assisted radical prostatectomy, rates of incontinence at a 12-month follow-up are 20.2% (where incontinence is defined as 0-1 pad per day)1.  

What causes Post-Radical Prostatectomy Incontinence?

Continence is controlled by the connective tissue, pudendal nerves, and muscles of the pelvic floor. The main muscles in charge of maintaining continence are the urethral sphincters (internal and external), puborectalis (of the levator ani muscle group), and suspensory ligaments. After radical prostatectomy, a portion of the internal urethral sphincter muscles, as well as the suspensory ligaments, are removed. This means that continence relies more heavily on the external urethral sphincter and other pelvic floor muscles to compensate for the loss of sphincter muscle mass and the prostate, which also aids in maintaining continence. It is also possible for the pudendal nerve fibers which innervate the urethral sphincters to be damaged during surgery or from cancer, which may impact their functionality1


Possible Types of Urinary Incontinence after Radical Prostatectomy

Post-radical prostatectomy incontinence is broken into three types of urinary incontinence:

Read more: How Pelvic Floor Therapy Can...

Urinary Chronic Pelvic Pain and Resilience | Photo courtesy of Mark Adriane via Unsplash
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 A Recent Pilot Study Looked at the Connection Between Urinary Chronic Pelvic Pain and Resilience

A recent pilot study looked at how resilience affects patients with urinary chronic pelvic pain (UCPP) conditions and chronic overlapping pain conditions (COPCs).

Resilience can be defined as the “capacity to adapt successfully to disturbances that threaten a patient's viability, function or development.” (Southwick et al., 2014)

Resilience is now an important aspect in the treatment of pain, as it can increase psychosocial well‐being and the quality of life in patients living with chronic pain. (Casale et al., 2019)

Read more: Urinary Chronic Pelvic Pain...

Safe Sex During Covid
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Are You Wondering About Safe Sex During Covid?

Whether you're asking for a friend or for yourself it's an important question these days.

Practicing social distancing and wearing a mask can make it quite difficult to have intimate relationships. Through the last year and half, we have learned more about COVID-19 and each and every day new data helps us better understand this virus and how to practice safe sex during COVID.

How is the virus transmitted?

The virus spreads through infected saliva, mucus, or respiratory particles entering the eyes, nose, or mouth. This means it can be transmitted through kissing and close contact. Studies have also detected the virus in feces and in sperm in those infected (Diangeng et al., 2020). It is unknown at this point if the virus can be spread through sperm or feces.  Educating yourself can be the key to safe sex during COVID.  

Read more: Sexual Health Awareness...

Urinary Incontinence Cameron Smith
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Overview: Urinary Incontinence

About 13 million people in the United States experience some type of incontinence, or unwanted leakage of urine. More than 50% of women over 20 years old reported experiencing urinary incontinence at some point in their lives. Moderate to severe urinary incontinence is prevalent in 17% of women aged 20 years or older, but more commonly occurs in 38% of women aged 60 years or older.

Types of Urinary Incontinence

Stress Urinary Incontinence

Stress urinary incontinence is when leakage occurs during stress-induced activities such as exercises, coughs, and sneezes.

Urge Urinary Incontinence

Urge urinary incontinence is leakage associated with urgency, and can make it difficult to hold the bladder without leaking. This can arise from poor bladder habits or overactive bladder syndrome (OAB). About 16% of the United States population are diagnosed with overactive bladder syndrome, which causes intense sudden urgency and frequency to urinate. This can cause depression, social and work disability for many adults.

For urge urinary incontinence alone, the estimated national costs in 2007 included 1.5 billion dollars in direct nonmedical costs (for example, incontinence pads). Depending on the type of incontinence and their comfort level, some people avoid certain activities or perform more “just-in-case” peeing to avoid leakage. There are also many products people use to help them continue those activities but in a more hygienic way.

Treatments for Urinary Incontinence

Standard nonsurgical, non-pharmaceutical treatments for incontinence may include:

  • pelvic floor training
  • behavioral training
  • vaginal cones/bladder supports

There are also pharmaceutical treatments available that help improve urinary retention or affect pelvic nerves or muscles that may be the underlying cause for urinary incontinence. Along with incontinence products and/or medication to help you continue to do the things you love, it is best to have a specialized pelvic floor physical therapist by your side to help understand your bladder physiology and thus improve incontinence or prevent worsening of symptoms. This way, we can help you decrease incontinence, reduce reliance on such products, or reduce the absorbency needed so you can get back to doing the things that you love in a leak-free manner!

Read more: Urinary Incontinence |...

Sexual Function After Cancer | Unsplash
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This article introduces common unwanted side effects that affect sexual function after cancer and discusses strategies to counteract these symptoms. 

Sexuality can be a big part of who we are as individuals.

Sexual functioning can be defined as “specific physical, physiological, neurological and emotional behaviors expressed by an individual response” (Wood, 1984).

Certain cancers can unfortunately affect our sexual health, including cervical, ovarian, bladder, kidney, colorectal and breast cancer to name a few.

Some cancer treatments can cause unwanted side effects that affect our sexual health such as decreased sexual arousal or desire, vaginal stenosis (narrowing of the vaginal canal), dyspareunia (painful sexual intercourse), and bladder/bowel dysfunction. Issues with sexual function after cancer can affect our relationships with ourselves and with our partners, and reduce quality of life. Hopefully a physical therapist is part of your team to help guide you during this challenging time and minimize these aforementioned side effects. Otherwise, ask for a pelvic floor physical therapist to join your team during your recovery!

Read more: Sexual Function After Cancer

Tarlov Cyst - Unsplash neONBRAND
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This article will go over what a Tarlov cyst is, what symptoms can arise from having a Tarlov cyst, how it is diagnosed, and common conservative and surgical treatments. 


What is a Tarlov Cyst?

Tarlov cysts are sacral perineural cysts that consist of cerebrospinal fluid (CSF) close to the dorsal root ganglion on our sacral spine (the triangle shaped bone that connects to our tailbone). Tarlov cysts are often incidental findings on MRI’s, meaning most people with no symptoms may have Tarlov cyst(s). Paulsen, et al, looked at 500 MRIs of the lumbosacral spine and found an incidental rate of 4.6%; of which 20% were symptomatic. Approximately 1% of the cysts are large enough to cause compression, thus requiring prompt treatment.

Read more: All About: Tarlov Cyst

mens pelvic pain
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Highlight on Mens Pelvic Pain

June is Men's Health Month

Pelvic health is not only tied to females; males also experience pain in their pelvis including their bladder and rectum, but may also extend to their testicles, penis, prostate, etc. Common mens pelvic pain diagnoses include (but not limited to):

Read more: Highlight: Mens Pelvic Pain

**This information is for educational purposes only and is not intended to replace the advice of your doctor.

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