Everyone experiences constipation, sometime! Maybe it was on vacation and you felt bloated and miserable; or when you were busy at work and had to rush to complete a task. In any event, you felt ‘awful’. Maybe you couldn’t zip your favorite jeans due to abdominal bloating, maybe you experienced lower abdominal discomfort or experienced a painful ‘movement’ once you went. There are many people who experience these symptoms and more on a daily basis. When someone finally gets the courage to see a specialist about this problem, they might be diagnosed with ‘pelvic floor dyssynergia’ or ‘muscle incoordination’.

Pelvic muscle dyssysnergia (incoordination) refers to the action that occurs in the pelvic floor musculature at the time of defecation. It can become a withholding pattern and in the case of vacation or a change in your work schedule, it can simply be tensing the muscle to avoid the bowel movement (due to inconvenience) rather than heeding the ‘call’. Over time, if this behavior is repeated, it becomes muscle memory; instead of relaxing the pelvic muscle to defecate, the patient tenses the muscle; thus the term dyssynergia or incoordination.

The function of the pelvic floor for bowel function is to provide closure of the anal canal to maintain continence. The muscle should signal the rectum and the colon when to defecate and should provide opening of the anal canal by total relaxation to allow for complete and effortless elimination. A dyssynergic pattern shuts the opening of the canal by tensing the muscle to prevent elimination. Thus an incoordination.

The research by Heymen, Scarlett, Ringman, Drossman et al entitled “Randomized, Controlled Trial Shows Biofeedback to Be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation” supports the value of biofeedback in the treatment of this withholding pattern associated with stool elimination. This study supports the benefit of biofeedback treatments using sensors to provide the feedback displayed on a computer screen for visualization. This study goes on to say, “We also have shown that the machines are necessary—instrumented biofeedback is an essential element of successful training; however, there is a shortage of practitioners who are trained to provide this form of biofeedback, and there are few clinics where biofeedback instruments are available and where this form of biofeedback can be obtained”.

Biofeedback provides visual and auditory feedback of muscle tension, It is a non-invasive technique that allows patients to adjust muscle function, strength, and behaviors to improve pelvic floor function. The small electrical signal (EMG) provides information about an unconscious process and is presented visually on a computer screen, giving the patient immediate knowledge of muscle function, enabling the patient to learn how to alter the physiological process through verbal and visual cues. This mechanism allows the patient to assess muscle resting tone, creating an environment that teaches how to downtrain a tense pelvic floor while providing the means to teach coordination of muscle function.

In short, biofeedback treatment/training using the proper instrumentation provides the precise information necessary to change behaviors associated with tensing the pelvic floor for defecation instead of the proper relaxation of the pelvic floor for release of stool from the anal canal.

Re-training the pelvic floor muscle is what Phoenix Physical Therapy is all about; treating patients with pelvic floor muscle dysfunction is the sole focus of our staff of highly skilled pelvic floor therapists. Whether treating patients for constipation, or bowel or urinary incontinence or pelvic pain, Phoenix is recognized and acclaimed locally, regionally, and even nationally for our compassionate and successful treatment of pelvic floor challenges for patients from young children to the elderly.

During May, all mothers were celebrated with a special day known as Mother’s Day.  How each and every family honors mother is different and special in their own unique way.  Women, as mothers, often celebrate the designated day with cookouts, brunches, dinners and just relaxation with (hopefully) breakfast in bed or a ‘bye’ on cleaning up the dinner dishes.  

Interesting, many women remarked that their celebrations included grandmother, greatgrands, aunts, children, neighbors and anyone else in need of a family support system for the day.  As women, we are collectively known as the ‘tend and be-friend’ gender versus the men who exhibit the ‘fight or flight’ behavior.  All of this jargon is based from research over years that indicates how the hormonal differences between men and women influence the relationship with others.

Women are, as many of us realize, the ones to care for others.  We are the nurturers, the caregivers, the ones to help spouses, parents, children and grandchildren.  As a collective and generalized ‘whole’ we take care of everyone else before we care for ourselves.  Sound familiar?

Women, as patients, are always in need of care, but will often put their needs aside to take care of others in the family, whether it is caring for a grandchild so the son or daughter can work, or driving a parent to an appointment, etc.  On average, women wait 6.5 years from the first symptom of bladder issues until they seek a diagnosis for their bladder control problem. (National Association for Incontinence, Facts and Statistics, www.nafc.org). When is the time to care for ourselves as women?  “Now”, would be my answer!!  

If you, as a female caregiver/nurturer of others, don’t care for your own needs, who will do it for you?  If you leak urine when you sneeze, laugh, dance or otherwise are active, who can help you if you don’t help yourself?  How about at a baseball/softball game; do you need to head to the woods to pee?  Pregnancy, childbirth and menopause are major reasons of the increased prevalence of incontinence in women as compared to men. (WomensHealth.gov, Urinary Incontinence fact sheet, https://www.womenshealth.gov/publications/our-publications/fact-sheet/urinary-incontinence.html).  Who can help if you don’t accept you need help with this problem and seek intervention?  

So here we are; a group of professional women, willing to help you solve your problem so you can learn to help yourself!  What better way to learn to control this hidden muscle that is responsible for letting pee or poop out of your body.  Learn to control the muscle, learn to eliminate the problem and guess what?  Get control back in your life without drugs or surgery, just with you!!

At Phoenix PT we often hear, “I don’t have time”, or “I can’t do this as I have too many people to care for”.  These are NOT reasons to avoid treatment; we can help with those time jams.  After all, we are women too, with a great sense of how to help you deal with life’s uncertainty.  

Come see us.  Schedule an appointment.  Wouldn’t you love to attend your daughter’s wedding without a pad as protection in your underwear?  Wouldn’t you love to not worry about finding a restroom at your granddaughter’s softball game or track meet?  And wouldn’t you love to sit on the beach in the sun in your bathing suit and not worry about finding a restroom to pee all the time?

If you want to improve, we can help and Phoenix PT will also help you recognize the time in your schedule that you need to make this work.  Phoenix PT helps exclusively with pelvic floor muscle issues including pain, incontinence, infections, retention, constipation and many, many other embarrassing issues.  Call today and ask our personal staff if we can help.  A little information goes a long way to see if you can gain benefit from treatment, and we can then make that happen for you.

If you don’t care for yourself, who will care for you?  Learn to control this embarrassing issue now and enjoy your summer.  No surgery, no drugs, just you.  Call us today.

Phoenix Physical Therapy, PLC is pleased to announce the addition of Francesca Cannan Mihok, PT, DPT, LMT to our team of pelvic floor specialists.  Francesca, who joined the Phoenix PT staff in December 2014, earned her doctoral degree in physical therapy at the University of Vermont and is also a licensed massage therapist with certification from the Wellness Massage Center and Institute in St. Albans, Vermont.  In addition to specializing in physical therapy management of pelvic floor muscle dysfunction, Francesca has completed over 100 contact hours in Myofascial Release (MFR) with the renowned John Barnes at his clinic in Paoli, PA.

As a ‘non-traditional’ student at the University of Vermont, Francesca brings her knowledge and skills from two previous careers – Teaching English as a second language and horticultural customer service – to her practice as a physical therapist.  Francesca’s own experience as a patient at Phoenix Physical Therapy after the birth of her daughter, as well as her studies in Myofascial Release and Women’s Health contributed to her interest in pelvic floor muscle dysfunction.  These experiences inspired her to join the team at Phoenix Physical Therapy.

When not providing patient care, Francesca enjoys spending time with her daughter, hiking the Adirondack 46 (because she had to give up long distance marathon running due to knee issues), cooking from her Bon Appetit magazine, traveling to new places and spending time  with friends and family (she is one of 13!).  Francesca is a world traveler and has worked in Hawaii, France, Gabon (West Africa) and Madagascar.

The staff at Phoenix Physical Therapy is thrilled to add Francesca to our team of caring and highly trained specialists.  Her unique skills help to further round out our treatment options and skills as they relate to pelvic floor muscle dysfunction and disorders.

Have you recently sneezed, coughed, laughed or made a sudden or quick movement that resulted in an accidental leakage of urine or gas?  Has this leakage become more of an issue now that it is cough and flu season?  Have you started to exercise more as a New Year’s resolution and notice small leaks of urine throughout your workout or when you walk or jog at a brisk pace?  Our staff at Phoenix Physical Therapy wants you to know that this accidental leakage is NOT a normal part of aging and should not be chalked up to having children!  We want you to know that although this is a very common issue for women, it is a sign of a problem that can be easily treated at our office.  We specialize in helping women learn to manage these symptoms through simple, safe and effective exercises, tailored to the individual needs of the woman.  You should first mention this to your physician or health care provider.  Even though this problem is embarrassing and difficult to discuss, statistics show that it usually takes 6-7 years for a woman to express concern to her primary health care provider regarding this incontinence problem.  Wouldn’t it be nice for you to learn how to improve this issue before it turns into a larger problem that you have to deal with year after year?  This problem just doesn’t go away on its own despite wishful thinking!

Many of our patients are initially unaware of why these accidental leaks of urine or gas occur.  In every male and female, there is a small muscle at the bottom of our pelvis that helps to support the bladder, urethra and colon.  This muscle is called the pelvic floor muscle.  Piercing this muscle are “tubes” that run from the bladder and colon to the outside of the body.  Although this muscle is not readily visible, it is entirely under our control.  This means we have the ability to contract and relax this muscle to control any form of accidental leakage.  Because we cannot readily see this muscle it is often difficult to know how to make our muscle function in a timely or appropriate fashion.  When there is an increase in abdominal pressure such as with a cough or sneeze, this increases pressure on the bladder and colon which then requires our pelvic floor muscle to hold the urethra and/or colon closed to ensure that urine or gas (or other) stays inside where it belongs!  If the muscle is unable to function correctly, perhaps due to weakness, it becomes difficult to keep closure when this increase in pressure from the abdomen occurs.  This is called stress incontinence.  Common activities that can result in leakage include, but are not limited to, sneezing, coughing, laughing, lifting heavy objects, running and bending.

If you experience such leakage, rest assured!  Our staff is skilled in teaching you how to use your pelvic floor muscles.   If you learn how to use your pelvic floor muscle and you practice timing your muscle contraction prior to and during the activities that create your leaks, you will learn to retain your muscle to respond the way it was intended.  In essence, you are learning to retrain your muscle.  This is called the “Knack Maneuver” and is named because you have the knack to get the hang of it! It is all about precision timing of the contraction!  It may take weeks of proper practice to see a difference, but our staff will help and encourage you with tips and suggestions to make your practice successful.

Incontinence is treatable!  You shouldn’t have to resort to use of pads to protect yourself from accidental leakage.  Waiting years to treat this problem only adds to prolonging your incontinence and pelvic floor muscle dysfunction.  Call us today!  Nonna, Francesca, Meg or I are here to help you overcome this embarrassing problem.  Our office manager, Linda, is ready to take your call.

As the holiday season fast approaches and winter is upon us, it is often difficult to find time to take care of ourselves. At Phoenix Physical Therapy, we often hear how tough it is for women to find even a few minutes to manage their health, stress and daily lives. Women of all ages are caregivers by nature and caring for others is top priority. But what about those nagging health issues that many women face? It is easy to ignore incontinence, constipation, urinary urgency and frequency. It is easy to think, ‘maybe it will go away on its own’ or ‘maybe I will be better tomorrow’. Unfortunately, it never gets better on its own….only increasing in severity if left alone.

At Phoenix Physical Therapy, we specialize in treating pelvic floor issues related to muscle dysfunction. Urinary incontinence, fecal incontinence, constipation, pelvic organ prolapse, urinary urgency and frequency and nocturia (frequent trips to the toilet at night) are but a few of the female issues we deal with on a day to day basis.

Our staff is great at helping busy women find a few minutes to care for themselves. We focus on each individual’s needs, priorities and health concerns related to pelvic floor muscle dysfunction. Treatments in our office are tailor made for each woman; no two patients are alike! We are proud of our treatment success and our ability to listen, help and empower women to take charge of their bodies!

If you are a woman who has difficulty taking a few minutes to care for yourself, if scheduling an appointment to manage your incontinence seems just too overwhelming, we are here to help! Call our office, discuss your needs with our helpful and caring staff and schedule that appointment. The hardest part is picking up the phone or sending that email to us. Make 2015 the year to carve out a few minutes for your own health! If pelvic floor issues are a concern to you, you will be pleased you contacted our office and scheduled that appointment. Incontinence is not a normal part of aging and can be corrected with simple strategies and modifications in routine. We are here to help!

Learning to control the embarrassing symptoms of incontinence gives you more freedom, more confidence and empowerment. Take care of your symptoms…call us today and schedule a time to take care of yourself in 2015!