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.

Building a Recovery Routine | Kasia Gondek's Road to the Boston Marathon
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A very important component of any running program, ranging from a 5 km (3.1 miles) race to an ultra-marathon (anything more than a marathon which is 26.2 miles), is adequate recovery.

Many people neglect this portion of their training because it doesn’t involve getting sweaty or doing high intensity intervals or weights. However, building in a solid recovery routine is crucial to helping your body bounce back after training as quickly as possible. A good recovery routine also helps prevent injury, decreased immune system function, and muscle mass loss. A recovery routine encompasses a cool-down activity, nutrition, and exercises like hatha-based yoga, foam rolling, and/or stretching the major muscle groups used during your workout. Although not discussed here, getting good quality sleep is critical to recovery as well!

My Post-run Recovery Routine:

Read more: Road to Boston Marathon Part...

Image credit: Kasia Gondek - Selfie taken on one of my 18-mile long runs leading up to Boston Marathon, sporting my Boston Marathon running hat from the last time I did the race in 2014!
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10 Strength, Conditioning, and Balance Exercises for Marathon Runners

Leading up to the Boston Marathon, I have been incorporating these 10 key exercises into my weekly routine (3x/week) to keep my body strong and balanced. Check out videos of these exercises here (link to instagram post). These exercises target the key muscle groups used by runners. These are for educational purposes, not meant to treat medical conditions nor supplement medical advice. 

Mat-based Strength and Conditioning for Boston

Read more: Road to Boston Marathon Part...

exercises for marathon runners
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Road to Boston Marathon Part 1

A Tribute to the First Female Runners

On April 18, 2022 I am excited and grateful to be able to run the historic and prestigious Boston Marathon! As a physical therapist at Fusion Wellness /Femina Physical Therapy and avid long-distance runner for over 20 years, I’m excited to share my training journey with you leading up to the race. This race holds a special place in the hearts of long-distance runners because you must run a qualifying race with a qualifying time. Females ages 18-34 must run 3 hours 30 minutes or better, and males ages 18-34 must run 3 hours flat or better.

Read more: Kasia's Road to The Boston...

Osteoporosis | Image Credit: "Dlx3 deletion in osteoblast progenitors induce increased trabecular bone formation " by National Institutes of Health (NIH) is licensed under CC BY-NC 2.0
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May is Osteoporosis Awareness Month.

Did you know that Physical Therapists are an essential member of your interdisciplinary care team?

With life expectancy increasing it is becoming more evident that bone health and fall prevention are key to a good quality of life. Osteoporosis is defined as a decrease in bone mass or a change in the structure of the bone causing the bone to be more fragile.1 If the bone is weak there is a higher chance of a fracture (bone break). The most common areas of fractures are the hip, spine, forearm, and humerus (upper arm bone). Osteoporosis causes more than 8.9 million fractures annually worldwide, affecting predominantly postmenopausal women.  The probability of women, at menopause, of having an osteoporotic fracture exceeds that of breast cancer and the likelihood of a fracture is approximately 40%.2

Bone mineral density is measured through a scan called a Dual-Energy X-ray Absorptiometry (DEXA). It can be used to measure the bone mineral density of the whole skeleton as well as specific sites. Approximately 21% of women aged 50–84 years are classified as having osteoporosis.2 

Risk factors for osteoporosis are:

  • Sex--Women are more likely to develop osteoporosis
  • Age--risk increases with age
  • Race--Caucasian and Asian descent have a higher chance
  • Family History--having a parent or sibling with osteoporosis
  • Body frame--smaller frames have a higher chance as they have less bone to draw from as they age
  • Lowered sex hormones ie. postmenopausal women with decreased estrogen
  • Increased thyroid hormones can increase risk
  • Low calcium intake 
  • Long term use of corticosteroids 
  • Certain medical conditions have a higher chance of developing osteoporosis 
    • Celiac disease
    • Inflammatory bowel disease
    • Kidney or liver disease
    • Cancer
    • Multiple myeloma
    • Rheumatoid arthritis

Read more: Osteoporosis Awareness...

Gender-Affirming Surgery | Image Courtesy of Olga Guryanova via Unsplash
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Over 1 million people in the United States self-identify as transgender, and according to the 2019 Plastic Surgery Statistics by the American Society of Plastic Surgeons, around 11,000 gender confirmation surgeries were performed annually in the U.S. Gender-affirming (also referred to as sex-affirming or gender-confirming) surgery encompasses various elective plastic surgery procedures that result in physical characteristics typically associated with being male or female. While not the case for all people who identify as transgender, some people experience distress that their sex assigned at birth does not match their gender identity (termed gender dysphoria). These procedures are just one means to help someone feel congruence between their gender identity and physical traits associated with a particular sex. It is important to note that just because a person identifies as trans-gender or non-binary does not mean that they feel gender dysphoria, nor does it imply that they need or want medical procedures or surgeries to look more feminine or masculine.

Types of Gender-Affirming Surgeries: 

Gender-affirming surgeries can involve the face, chest, or genitalia, and are listed in the table here: 

Read more: Gender-Affirming Surgeries:...

Male Dysorgasmia: When Sex Hurts | Image Courtesy of Unsplash contributor Road Trips with Raj
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Male Dysorgasmia is on the Rise

In our practice, we see many males who come in describing recent or long-term pain with orgasm or after orgasm (called dysorgasmia). It is not uncommon for a patient to come in feeling discouraged or hopeless due to their pain or sexual dysfunction. Sometimes their medical providers may have prescribed pain medication or antibiotics, or others simply don’t have a solution. But there is hope and we are here to help!

This blog covers some of the main medical or post-surgical conditions that can contribute to male dysorgasmia, followed by the benefits of pelvic floor rehabilitation or pelvic floor physical therapy to improve pain and sexual functioning. 

Read more: Male Dysorgasmia: When Sex...

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 and urinary incontinence
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Is There Really a Relationship Between Grip Strength and Urinary Incontinence?

Read on to find out1

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. 

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...

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

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