By Melinda Fontaine

Back By Popular Demand: Here is the sequel to my 8 Pregnancy Tips. This is what a Pelvic PT/Mom wants you to know about labor and delivery. First off, you have little to no control over it. This can seem scary, so it is important to be flexible. I am a supporter of birth “plans”; I even made one myself. However, the term “Birth Plan” is a misnomer. Perhaps a more accurate name would be “Birth Ideas If Everything Goes The Way I Want And There Are No Surprises”. If anyone can be labeled as in command of this voyage, it would be Baby. Who better to control a birth than Baby?!  At any moment, Baby could decide that it is time to be born and will change the flow of hormones throughout the body and start the uterus contracting. Conversely, if Baby is having any trouble, your doctor or midwife may recommend a different course of action. As GI Joe would say, “Knowing is half the battle”, so here are some possibilities of what may occur during a birth and what choices you have.

 

What Happens

Toward the end of pregnancy, the baby moves lower into the pelvis which is usually what starts the effacement/thinning and dilation/opening of the cervix of the uterus. Stage 1 is when Mama starts to feel contractions and the cervix dilates to 10 cm. A typical rate of dilation is 1 cm per 2 hours. Stage 2 is when Mama feels the urge to push and delivers Baby. This stage lasts 1-2 hours on average for a first birth and an hour or less for subsequent births. Stage 3, the afterbirth, is when the placenta, amniotic sac, and umbilical cord are expelled within an hour of delivery. Baby suckling at the breast helps signal the uterus to expel them. Your midwife or doctor will check the placenta to make sure it is complete to avoid bleeds. Now that you know what happens, how do you prepare for it?

 

Store Up Energy

Having a baby is like running a marathon in many ways. Both require an immense amount of energy. If you can, get a lot of good sleep in the days before the main event. You will also need good nutrition for energy, so eat well prior to delivery. I ate the same breakfast protein packed breakfast before running my marathon and before delivering my son.

If you plan to deliver in a hospital, you will not be allowed to eat until after the baby is delivered. This is to keep you safe in case an emergency C-section is needed. Having a full stomach during a surgery increases risk for aspiration. If you want to eat something for energy while you are laboring, be sure to eat it early on, prior to admission to a hospital.

 

Get Things Rolling

So you’re ready to get this show on the road? You may find yourself ready for Baby to come, but labor is not beginning or progressing as you and your doctor or midwife would like.  An example would be if your water breaks, but there are no contractions, the pregnancy has continued too long, or you have been in the first stage of labor for a really long time.  There are different ways to induce labor. Prostaglandins are lipids that act like hormones. They are inserted vaginally near the cervix to help it thin and open in preparation for delivery, which may initiate uterine contractions. Pitocin is a synthetic form of oxytocin, the hormone that signals the uterus to contract. Pitocin is often administered intravenously in the hospital. It may also be used to help stop bleeding after delivery. Other fun ways to get your body to start producing oxytocin include nipple stimulation and orgasm. Midwives will sometimes use castor oil to get the uterus to start contracting (side note: it is also a very strong laxative, so be prepared). Lastly, a doctor or midwife might sweep the membranes that connect the amniotic sac to the uterus, or if your cervix is already dilated, they may rupture the membranes of the amniotic sac to progress labor. To avoid putting your baby at risk, do not attempt to induce labor unless you have your doctor’s or midwife’s seal of approval.

 

Delivery Options

You know how Baby got in there; now how will Baby get out?  The two options are through the vagina or through an abdominal incision known as a Cesarean section.  For a vaginal delivery, the bones and soft tissues of the pelvis stretch and open wide enough to pass Baby through. The uterus contracts to help push Baby down and out.  Mama bears down like having a bowel movement to further increase abdominal pressure and push Baby down and out.  Sometimes pushing is coached, meaning a healthcare professional instructs Mama when to push.  Stay tuned for Malinda Wright’s upcoming post about the ‘how to push controversy’!  Sometimes a doctor has to guide the baby through the birth canal using his or her fingers, a vacuum, or forceps. Episiotomies used to be routine in the 1980s. Now they are reserved for rare instances when the perineum is impeding the progression of the delivery.  C-sections may be performed in cases of maternal or fetal distress, large fetal head, small maternal pelvis, labor not progressing, Baby in an awkward position, placenta previa (placenta covering the cervix), etc. VBAC is a term that is increasingly popping up in conversations, and it means Vaginal Birth After Cesarean. Your doctor or midwife should discuss with you whether or not VBAC is a safe option for you.

 

Support The Perineum

The perineum is the tissue between the vagina and the anus.  It has to stretch a lot during vaginal delivery, and sometimes tears when it has to stretch too much too quickly. Perineal massage is often recommended for mothers considering vaginal birth to prepare the tissue to stretch.This massage can be done starting at 36 weeks of pregnancy and involves using thumbs or fingers to hold a prolonged stretch on the tissue.  This can also be assisted by devices such as

EpiNo or Materna.  A physical and occupational therapists can instruct you or your partner on how and when to perform perineal massage. During delivery, the doctor or midwife can apply counter pressure or heat to the tissues to encourage good stretching.

 

Manage Pain

The all too common image in the media of a woman screaming in pain during delivery is not necessary.  The process is painful, but there are ways to manage the pain.  There is no one right way to have a baby. Pick the pain management technique that is right for you and your baby.  Epidurals and other medical pain relievers are often very effective at reducing pain.  Hypnobirthing involves techniques to release the fear and tension associated with birth and to use one’s subconscious mind to thwart the feelings of pain. I chose hypnobirthing, and it worked unbelievably well – No really, my next three nurses all had to verify that the story they heard about my birth was true. A partner or doula can give massage and counterpressure to the pelvis and low back to relieve tension, and a warm shower or bath may also feel good.

 

Educate Yourself

You will be faced with certain decisions that you have to make for Baby, so think about them beforehand. Would you like to delay clamping the umbilical cord to allow Baby to get extra blood from the placenta? Would you like to bank Baby’s cord blood to store stem cells for your family or others? Would you like to do skin-to-skin, which is when Baby is placed on Mom’s bare belly as soon as possible after delivery? Routine baby care can be done while Baby is on Mom’s chest. Would you like your Baby to receive antibiotic eye ointment to kill possible bacteria that can cause blindness, a Vitamin K injection to prevent possible internal bleeding, and the Hepatitis Vaccine? Would you like to breastfeed? Will you offer Baby a pacifier, which has been linked to preventing sudden infant death syndrome (SIDS) and may interfere with breastfeeding. When would you like Baby to have the first bath, and who should be there? Who will be Baby’s pediatrician? If Baby is a boy, would you like him to be circumcised shortly after birth? The US is split on this decision about 50/50 right now.

 

Ask Questions

Six weeks after the birth of your beautiful baby, you will see your doctor or midwife. They will check you out and if everything is fine, they will give you the all clear to have sex and start exercising. Take this time to discuss your plan for birth control now that you are cleared for sex and have your doctor’s attention. If you notice anything uncomfortable when you do return to sex and exercise, call your doctor. They will often not follow up with you until your next PAP unless you bring it up. Common complaints are that sex is uncomfortable due to scar tissue or muscle spasm, that urine leaks out when you cough, laugh, or sneeze, and that there is a heavy feeling in the vagina. These may all be treated with physical and occupational therapy, so ask your doctor for a referral.  Another complaint after a C-section is meralgia paresthetica, which is a compression of the nerve that runs down the outside of your thigh and creates a feeling of tingling, numbness or pain in that area.

 

How PT Helps

Have you heard the myths about how it is “normal” for mothers to pee when they laugh, lose the tone in their abdomens, and have pain with sex? Well, the cat’s out of the bag now…though these are common, they are NOT normal. They are signs that something is off within the body.  Physical therapists help mothers with urinary and bowel problems such as incontinence, as well as prolapse, diastasis recti, and pain. Stephanie Prendergast is giving a lecture today at the Sexual Medicine Society of North America conference in Las Vegas on Physical and Occupational Therapy for Postpartum Sexual Wellness.  Check out her slides.

 

Postpartum Care

Baby is not the only one who needs tender loving care after a birth.  What about Mama? Abdominal binders worn during the first 6 weeks after delivery help the uterus to return to its pre-pregnancy size and approximate both sides of the rectus abdominus to reduce diastasis. Vaginal delivery or a significant amount of labor prior to a C-section will create swelling in the vagina.  Ice, witch hazel, and elevation help to reduce swelling. Every time someone asked me if I needed anything, I asked for a fresh ice pack.  Scar massage to vaginal or C-section scars will improve healing. Estrogen levels plummet after delivery, so new moms may note dryness, urinary incontinence, or painful penetration. Since the vagina is so sensitive to estrogen levels, a topical estrogen cream can be very useful. Breathing is affected in pregnancy when the baby is large enough that it limits the excursion of the diaphragm.  Good posture helps with breathing and prevents future injuries. Postpartum doulas help families learn about how to care for Baby and Mama and help with chores and errands to reduce the workload for the family.

 

At the end of the day (or days), your baby’s birth story is what it is: a miracle! The story of how this miracle occurs is special and unique. Be proud Mama!

Share your birth story or delivery tips in the comments section below!

All my best,

 

Melinda

 

Melinda is a native of Concord, California and is part of our Berkeley team. Melinda earned her bachelor’s degree in exercise biology from UC Davis and her doctorate in physical and occupational therapy from Simmons College in Boston. When she’s not at PHRC, you’ll find her either dashing around in her running shoes or cooking up delectable meals in her kitchen. She’s famous for her killer baked chimichangas and her inability to stick to a recipe.

It’s National Bladder Health Week and we want to dedicate this blog post to our favorite (and only) urine collecting organ! The bladder is a vessel that sits on the pelvic floor and its primary function is to collect and hold our urine. It is made out of a hollow muscle called the detrusor which stretches to allow urine to collect and contracts when it is time to urinate. Just like any other muscle in the body, it can become injured or dysfunctional when things go awry. So, in honor of National Bladder Health week, I want to highlight some of the most common bladder ailments that we encounter on a regular basis, as well as discuss how pelvic floor physical and occupational therapy can help.

 

Incontinence. An all too common issue that many of us deal with on a daily basis. Research has shown that anywhere from 8.5%-38% of the population experience urinary incontinence1 . However, incontinence tends to be more common among the female population; women experience urinary incontinence 75% more than men2  .

 

Stress urinary incontinence is the most common type of incontinence.  It is characterized by urine leaks that occur with an increase in intra-abdominal pressure, such as a sneeze, laugh, cough, or vigorous activity like running or jumping.  If the pelvic floor muscles are not able to contract strongly enough to resist this increase in pressure, then the result may be a leak.

How we can help:

It is important to make sure that the pelvic floor and pelvic girdle muscles have the proper strength, endurance, and control to ensure optimal muscle function. A pelvic floor physical and occupational therapists can work with you to prescribe a tailored program of strengthening exercises (beyond the ubiquitous kegel) and neuromuscular re-education of both the pelvic floor/girdle and core musculature to train these muscles how to contract appropriately and eliminate incontinence.  Biofeedback is one of the many tools that a physical and occupational therapists may choose to employ to enhance a treatment program.

*As we have discussed in previous blog posts, not every person with incontinence needs to be doing pelvic floor up training/strengthening. So, check with a qualified physical and occupational therapists to determine the appropriate treatment plan for you. This post is a great example of someone who is experiencing stress incontinence, but would not be appropriate for a strengthening program.

 

**Pregnancy is a factor that creates many changes in a woman’s body, including  increased intra abdominal pressure, increasing weight of the fetus, and hormonal changes.  All of these changes put stress on the pelvic floor and increase the risk for incontinence. Over half of pregnant women have reported varying degrees of stress urinary incontinence. If you are experiencing any bladder symptoms, check with your OBGYN and a physical and occupational therapists to determine the best course of action.

 

Urge urinary incontinence occurs when we feel a strong urge to urinate and are unable to delay the urge long enough to get to a toilet in time. Such a strong urge to urinate can be created by tight tissues near the bladder or other various triggers.  One example of a common trigger is when we get our key in the door, it has even been named it ‘key in the door syndrome’!

How we can help:

There is often both a behavioral and musculoskeletal issue happening for people dealing with this symptom. Tight pelvic floor muscles can irritate the urinary tract which can cause urinary urge that is disproportionate to the amount of urine that is actually in the bladder. Working with a PT to normalize the pelvic floor tone and make behavior modifications can be a huge factor in overcoming this issue.

 

Prolapse. The bladder is supported in the bony pelvis by connective tissue and the pelvic floor muscles.  When one or both of these structures are unable to support the bladder, it becomes hypermobile, allowing itself to fall backwards, into the vaginal wall.  When this happens, the angle where the urethra meets the bladder changes, and it becomes more difficult for the pelvic muscles to compress the urethra to stop the flow of urine.  When this occurs, a person may be asymptomatic or may experience symptoms ranging from a heaviness in the pelvis to urinary incontinence.  

How we can help:

A physical and occupational therapists can give instruction on a pelvic floor/pelvic girdle muscle strengthening/neuromuscular re-education program to increase support for the bladder, as well as how to use these muscles appropriately to avoid excess pressure on the pelvic floor and reduce symptoms.  A person may also need to use a pessary or have surgery to correct for the degree of pelvic organ prolapse. Check out this blog post for more information.

 

Urgency/Frequency. Urgency is the sudden need to urinate that (as mentioned above) may cause urine to leak on the way to the bathroom.  Frequency occurs when we are feeling the urge to urinate more than what is considered the norm. Normal is about 6-8 times per day or once every 2 to 5 hours. We want to strive for not waking up in the middle of the night to urinate; however, during pregnancy or menopause, one time in the middle of the night is considered “normal”. (Similar to urge urinary incontinence, urgency and frequency are often a combination of both pelvic floor muscle overactivity and behavioral factors).

 

How can we help:

The urge drill is one technique to retrain the bladder to reduce urgency, frequency, and urge urinary incontinence. When you feel a sudden, urgent need to go to the bathroom, do not run to the toilet. Rushing will activate your fight or flight system and increase the urge. To help control the urge, first stop and be still, as this quiets your nervous system.  Then try doing 5 quick pelvic floor contractions or pelvic floor drops (relaxations). This sends a signal to your bladder to stop trying to get the urine out.  When the urge is under control, slowly and purposefully walk to the bathroom to empty your bladder. Timed voiding schedules may also be necessary for those experiencing urgency and frequency.

 

Pain. Bladder pain (aka painful bladder syndrome (PBS) or interstitial cystitis (IC)) is a condition that can be caused by various mechanisms that presents with a range of symptoms. Different treatment plans will be successful for different people, however a very common finding in people with bladder pain is a tightening of the muscles and connective tissue in the surrounding area. Painful organs can cause painful muscles and tissues in the surrounding areas which then restrict blood flow and oxygen to that area. This further irritates the tissues and nerves causing further bladder discomfort (a perpetual cycle). Stay tuned for an upcoming post dedicated to PBS/IC.

 

How we can help:

A skilled pelvic floor physical and occupational therapists can help to decrease the tone of the involved muscles and tissues allowing improved mobility, blood and oxygen flow, and aid in the healing process. Here is a link for more information on PBS/IC support.

 

**This blog is intended to give a brief overview of some of the physical and occupational therapy treatment options for musculoskeletal factors contributing to bladder dysfunction. If any of these issues are affecting you, there is hope! Let’s seize the moment of National Bladder Health Week to get on the path of recovery! Contact your physician or physical and occupational therapists today to determine the right treatment plan for you!

 

Finally, check out this blog post for ideas on how to locate a pelvic floor specialist in your area!

 

 

 

References:

1Ashton-Miller JA, Howard D, and DeLancey JOL. The functional anatomy of the female pelvic floor stress continence control system. Scand J Urol Nephrol Suppl 2001;207:1-7.

2Pages IH, Jahr S, Schaufele MK, et al. Comparative analysis of biofeedback and physical and occupational therapy for treatment of urinary stress incontinence in women. Am J Phys Med Rehabil 2001;80:494-502.

3Price N, Dawood R, and Jackson SR. Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas 2010;67:309-315.

By Gabriella Chavarin

 

As you may have noticed, IPPS is a pretty big deal around here. Every year, our PHRC physical and occupational therapistss attend the International Pelvic Pain Society’s annual scientific conference. Additionally, Stephanie Prendergast has been on the IPPS Board of Directors since 2003, and was the first physical and occupational therapists to serve as president in 2013.  Since our staff commits so much of their time to continued education, and as the field of pelvic pain advances, we wanted to recap what our clinicians took away from this year’s IPPS conference.

First, some background information…

 

The meeting is broken down into four sections. The first day is a “Basics” course, intended for the general medical professional who is interested in pelvic pain, but not regularly treating it. The topics span how the general gynecologist, urologist, psychologist, primary care physician, and pain management specialist can identify pelvic pain syndromes and direct the patient towards a solution.

Following the basics course, the next two days consist of the “Scientific” session, where the latest management strategies are presented for medical professionals who regularly manage people with pelvic pain and want to learn about the latest medical advances. It is during this time that our clinicians are able to attend lectures ranging from various topics and areas of expertise.

On the final day, IPPS hosts a post-conference course. The topic this year was a panel, their topic titled  “Talking about sexual health and function with your patients: a healthcare professional’s guide”. The expert speaker panel consisted of Hollis Herman, DPT, OCS, WCS BCB-PMD, CSC, IF, PRPC Alexandra Milspaw, PhD, LPC, and Tracy Sher, MPT, CSCS. The speakers did an excellent job helping providers increase their competency discussing sexual challenges with their patients.

Alright, now on to our clinician’s summaries:

 

Liz Akinicilar- Rummer, MSPT, PHRC Waltham:

Liz gave a lecture at the basic’s course titled “Evaluation and treatment of musculoskeletal causes of pelvic pain”. Click here to view her presentation.

 

Shayna Reid, PHRC Los Angeles:

The basics day at IPPS provided a comprehensive review of the many factors, physiological, psychological and musculoskeletal, that are components of pelvic pain. I enjoyed the flow of the sessions and found that they built nicely upon each other. Starting the day with a reminder of how pain messages are transmitted in the body, then bringing in the psychology behind pain and next seeing specific diagnoses and musculoskeletal treatment provided a good foundation for understanding and treating pelvic pain. What I learned at the basics day at IPPS will translate into patient education on the science behind pain.

 

Stephanie Prendergast, MPT PHRC Los Angeles:

Stephanie lectured with Drs. Conway and Jordan on Interdisciplinary Management Pudendal Neuralgia. Click here to view her presentation.

 

From Malinda Wright, DPT, PHRC Los Gatos:

Alexandra Milspaw, PhD, M.Ed., LPC gave a wonderful lecture Saturday morning titled Training the Brain to Heal Painful Habits. Alexandra started her presentation off with an imagery to demonstrate the power of the brain. She had us close our eyes and imagine ourselves driving. How does the body feel as an aggressive car speeds by? Now, imagine in the speeding car is a father rushing his child off to the hospital due to a severe asthma attack. How does the body respond to that knowledge? Alexandra stated, “Not only can we change our brains just by thinking differently, but when are truly focused and single-minded, the brain does not know the difference between the internal world of the mind and what we experience in the external environment. Our thoughts can become our experience.”

Cognitive behavioral therapy (CBT) and mindfulness therapy are treatments aimed at retraining the brain. Alexandra defines CBT as,  “Changing the thoughts we entertain throughout the day via behavioural interventions.” It is altering our thought patterns and beliefs. Mindfulness is, “The skill of training the brain to be aware of our experience in the present moment.”It is being aware of the cognitive response within the moment. Both therapies are helpful in treating pelvic pain, however Alexandra states there is a greater effect and a decreased rate of relapse when the two therapies are used together.

In her presentation, Alexandra stated chronic stress, pain, and trauma can actually change the brain’s physiology. It can decrease the size of the hippocampus, contribute towards a hypervigilant amygdala, and create a thinning of the cerebral cortex. These changes can create memory loss, exacerbate the flight-or-fight mode, and create slower processing. Neurotherapy interventions, such as CBT and mindfulness based therapy, can help resolve these changes by creating new neural pathways. This is done through habit modification. Alexandra defines a habit as, “An unusual way of behaving; something that a person does in a regular and repeated way. Habits are behavioral, emotional, or cognitive.” Some habits are helpful and some are painful. Examples of painful habits given by Alexandra are: negative self-talk, i.e. “I have a bad back.” “I can’t handle this.”; future based language, i.e. “My body will heal when…”; and guarded movements or lack of movement that is fear-based. Changing a painful habit includes being mindful to the cue/trigger for that habit. Triggers of a habit may include environment, social reinforcement, smells, sounds, and lights. Once the trigger has been identified, an intervention is needed. Alexandra stated, “It takes a habit to alter a habit.” Having the willpower to change a habit is not enough. She reported we need to have a reward system. Rewards influence our emotions and outcomes via neurotransmitters and neuropeptides. Neurotransmitters influence our emotions and neuropeptides influence our hormones, for example endorphins. Endorphins help to inhibit the transmission of pain signals and they help us to feel good. Alexandra stated the emotional state we are in can shift our outcome. The Prefrontal Cortex in the brain is also involved in the formation of new habits. Creating vision boards, reviewing one’s successes, and creating a daily to-do list are examples given by Alexandra to help access the Prefrontal Cortex and create a new habit. She reported it takes approximately 21 days to grow neural nets to change a habit. Practicing mindful awareness leads to cognitive and behavioral interventions, which leads to developing new habits.

I now have a better understanding of the importance of CBT and Mindfulness therapy, especially with treating pelvic pain. Her lecture has inspired me to research more into this field and to refer appropriate patients when necessary.

 

From Allison Romero, DPT, PHRC Berkeley:

Summary of Function Nutrition for Chronic Pelvic Pain: Evidence- Based Treatments for Success by Jessica Drummond, MPT, CCN, CHC Founder, The Integrative Pelvic Health Institute

I was lucky enough to get to hear Jessica Drummond the Founder and CEO of the Integrative Women’s Health Institute Fall 2015 talk about functional nutrition. She brought up some great tips for managing some issues that could be contributing to persistent pelvic pain.

-She laid out evidence to support increasing dietary omega-3 fatty acids, reducing sugar, and including supplements such as lycopene and zinc.

-If the gut is a problem including fermented foods, such as sauerkraut can actually be beneficial. I also wanted to include that there is some research suggesting that eating pistachios (who doesn’t love pistachios?) can improve good bacteria in the gut. Some probiotic strains may be helpful-however this is something that should be discussed with a dietician/physician before starting.

This was a great topic to bring light to at IPPS this year and already I have been able to make some suggestions to patients that have helped to improve their symptoms!

 

From Melinda Fontaine, DPT, PHRC Berkeley:

Richard E. Harris, PhD of The University of Michigan spoke on The Impact of Acupressure on Cancer Symptom Cluster: Molecular Mechanisms of Management. Patients with cancer and patients with chronic pelvic pain have a similar cluster of symptoms which include fatigue, disturbed sleep, depression, anxiety, altered cognition, and pain. Of these symptoms, fatigue is the most bothersome according to patients. Increased glutamate and creatine in the insula of the brain facilitate higher levels of fatigue by opening calcium channels and participating in the citric acid cycle and ATP production respectively. Glutamate can also enter the system through one’s diet in the form of monosodium glutamate, or MSG. Patients with pelvic pain or endometriosis were found to have higher levels of insular glutamate.  Self-administered acupressure decreases insular glutamate and creatine and improve symptoms. Acupressure was well-tolerated, brief (15-20 minutes), low cost, easy to learn, low risk for side effects, and can be performed as frequently as needed. This makes acupressure a feasible and effective treatment option for patients with chronic pelvic pain and fatigue or cancer related fatigue.” My take home message was that patients can learn to do acupressure techniques on themselves to relieve chronic pelvic pain and fatigue.

 

On Friday and Saturday, expert roundtable lunch discussions covered 20 topics. Stephanie and Irwin Goldstein, MD led a table on Persistent Genitall Arousal Disorder.

On Saturday morning, Casie Danenhauer, DPT led a course teaching medical professionals how to integrate yoga into their clinical practice. 

 

  “My most accomplished moment of IPPS 2015 was getting a room full 40 physicians, PTs, and other allied health professionals to “OM” with me.  The best part was that I supported it with research!  A couple weekends ago I had the great pleasure of sharing my yoga practice and yoga for pelvic pain class with a group of very special practitioners at the IPPS meeting.  I was excited (and a little nervous) to see the room fill with early birds unrolling their yoga mats at 6:15am on a Saturday morning!  After sharing a little bit about my background (pelvic floor PT/ orthopedic PT background/ 6 years of yoga teaching experience) I set forth on sharing my intention for the class: First, I wanted to share and teach the physical postures and specific verbal/tactile cues that I have found to be most beneficial for pain management and which facilitate the most relaxation of a hypertonic pelvic floor.  See my yoga blog for examples of these poses.  Second, I aimed to share breathing techniques (including “OMing”) that have been shown to facilitate parasympathetic activation and calming of the nervous system.  Third, I wanted take the class through a guided meditation specifically targeting the pelvic floor.

Based on the excellent feedback after class, I’m happy to say that my intentions were fulfilled and there is now a group of dedicated practitioners who walked back into their clinics on Monday with some new “yoga tools” to share with their patients!

 

From Rachel, PHRC San Francisco:

Dr. Jane Leserman discussed the impact of abuse/trauma on gastrointestinal(GI)and chronic pelvic pain. Individuals with a history of abuse or trauma are more likely to develop GI dysfunction or pelvic pain. Many individuals develop both a GI condition and pelvic pain as Leserman reported that 35% of people with IBS have pelvic pain and vice versa. Leserman explained that people with a history of abuse were shown via functional MRI to have altered brain activation in areas that are involved in pain sensitivity and pain processing. These patients also demonstrated decreased activation in areas of the brain associated with pain inhibition and down regulation of emotional arousal. This date may explain why patients with a history of trauma are prone to pain syndromes. Although, many patients have pelvic pain or GI dysfunction without a history of sexual abuse or trauma, Dr. Leserman’s lecture brings up the point that pain syndromes involve more than just the area the pain is located and the importance of looking at the brains impact on a patient’s presentation.

All in all, IPPS was very informative. Next year, the conference will be in Chicago, October 13 -16, 2016. Additonally in 2017, IPPS is hosting the Third World Congress on Abdominal and Pelvic Pain in Washington, DC, October 12 -15. We hope to see you there!

 

Be Well,

Gabriella

 

Gabriella originally hails from Monterey, California and attended San Francisco State College where she majored in International Relations. With four years of experience, Gabriella ensures the wheels go round at PHRC as the Senior Administrator, and Social Media Strategist. When she doesn’t have her nose in a book, Gabby enjoys writing, community outreach,  and a good run with her office dog Neziah.