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The Washington Post Promotes Pelvic Floor Physical Therapy

The Washington Post Article Includes Pelvic Floor Physical Therapy
You know you have successfully convinced your friends about the importance of your profession when not one, but several friends email you the latest major shout out to your profession- an excellent article in the Washington Post about the benefits of pelvic floor physical therapy (link to article).  On December 22, 2015, Tara Bahrampour published her article, “The hidden medical epidemic few women have been willing to talk about, until now” which mainly addresses pelvic organ prolapse, descent of the pelvic floor organs.  The article also discusses urinary and fecal incontinence.

I’ll recap some of the facts and statistics from the article that I most appreciated:

  • The age of onset of pelvic floor dysfunction is 56 years old for the average American female
  • 10% of women who experience pelvic floor dysfunction eventually undergo surgical intervention
  • Pelvic floor muscles tear in approximately 10-15% of vaginal deliveries, thereby interfering with their ability to support the pelvic floor organs
  • As with many medical related matters, genetics plays a significant role in the development of prolapse, and the condition tends to run in families
  • Approximately 200,000 of the 320,000 annual pelvic floor corrective surgeries are prolapse related
  • Invest stock in Depends rather than Always, because more pads are sold for incontinence than for menstruation in the USA. (Even better- tell others about the benefits of pelvic floor physical therapy.  No offense to incontinence products, but I look forward to the day when the success of my field will make them obsolete.)
  • In France, postpartum women are routinely referred for ten sessions of physical therapy after vaginal deliveries

 

While clearly there were many excellent points raised in the article, I will express my disappointment over one issue.  In my humble opinion, pelvic floor physical therapy was only briefly touched upon as an effective intervention.  Further elaboration about what to expect during the process and what physical therapists actually teach would have been helpful.  There was too much emphasis on pessaries and surgery, and not enough discussion about Kegels, biofeedback, and endurance training.  Therefore, I will take the liberty to do so right now.  (That comes with the poetic license of writing a blogJ).

Pelvic floor muscle contractions are colloquially referred to as Kegels, and these are the subtle yet powerful exercises that pelvic floor physical therapists teach to appropriate patients who are undergoing a strengthening, or uptraining, program.  Biofeedback is a tool utilized by some therapists to help patients create a mind-body connection.  Oftentimes, women arrive at physical therapy without prior knowledge of the very existence of their pelvic floor muscles.  It is therefore understandable that these women do not know how to properly contract these obscure and small muscles.  Biofeedback provides visual cuing to patients, which makes it an especially helpful device when teaching visual learners.  A patient is able to see on a computer screen or handheld biofeedback device the amount of electricity being generated by the muscles, represented by a bar or line, at rest, during contractions, and after contractions.  Furthermore, the treating therapist can challenge the patient to squeeze the pelvic floor muscles and to hold the contraction for as long as they can.  This allows the therapist to assess the patient’s muscle endurance, and it helps them set appropriate endurance goals.  Often times, patients experience an “Aha moment” while using the biofeedback (“Oh! That’s what it looks like when I’m contracting the muscles properly?  Ok cool, I get it now”), and there is nothing more rewarding for a teacher than watching the integration and understanding of knowledge unfold before their very eyes.

According to Bahrampour, “Pelvic floor physical therapy can help reduce the tension on the ligaments by strengthening the surrounding area, but the service can be hard to find.”  If you are reading this blog, then you are one step ahead of the game, for you have already found a clinician who can help you or your loved ones.  If you are geographically too far to benefit directly from the amazing services offered at Revitalize Physical Therapy, then it would be our pleasure to help direct you to someone closer who can help.  Please contact us with any questions you may have- it is our pleasure to assist you along your healing journey.

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Bothersome Bile

Common Symptom of Cholestasis of Pregnancy: Itchy Palms of Hands and Feet
 

Many of us are familiar with gestational diabetes, a form of temporary diabetes that occurs during pregnancy, but very few of us have probably ever heard of cholestasis of pregnancy.  I am not ashamed to admit that I myself had not heard of the concept until last week, when a patient brought it to my attention as part of her medical history, despite my specialization and continuing education classes.  Therefore, I did what any health care provider would do.  I decided to research it and discuss it in my latest blog in order to educate and enlighten you!

Cholestasis of pregnancy (aka obstetric cholestasis and intrahepatic cholestasis of pregnancy) is an uncomfortable phenomenon characterized by severe itching, most often on both palms of the hands and soles of the feet.  It involves impaired flow of liver bile, a dark fluid involved with lipid digestion in the small intestine.  Itchiness may occur on other parts of the body as well.  Itching is often worst at night, and it often interrupts one’s ability to sleep.  Other less common symptoms of cholestasis include jaundice (yellowing of the skin and whites of the eyes), loss of appetite, and nausea.

The exact cause of cholestasis of pregnancy is unclear, yet researchers believe there is a strong genetic factor that contributes to its development due to the commonly observed familial pattern of the disease.  Furthermore, certain pregnancy hormones which circulate in greater concentrations, especially during the third trimester, may contribute to its development.  It is believed that pregnancy hormones decrease the flow rate of bile from the liver, and the buildup of bile in the liver causes bile acids to seep into the bloodstream.  Once the acids have entered the circulatory system, they can be transported anywhere in the body, including the hands and feet, where they often tend to accumulate and create itchiness.

Risk factors for developing cholestasis of pregnancy include a family history of the condition, a previous history of liver disease, and a twin pregnancy.  A previous personal history of cholestasis of pregnancy is also highly correlated with development of the condition in subsequent pregnancies.  In fact, approximately 50-66% of women will experience a recurrence of cholestasis of pregnancy.  While onset of cholestasis of pregnancy often occurs during the third trimester and worsens prior to one’s due date, it may develop earlier in the pregnancy as well.  It can be diagnosed via blood sample tests which measure liver function and blood bile levels.

Treatment of cholestasis of pregnancy is aimed at alleviating maternal discomfort and prevention of complications.  Ursodiol (Urso or Actigall) are medications commonly prescribed to decrease the amount of bile in the bloodstream and to relieve itching.  Antihistamines are contraindicated and may be harmful to the fetus.  Lukewarm water baths are also recommended to decrease itchiness.  Doctors often recommend early induced delivery at approximately the 37th week of pregnancy due to the fact that it may have harmful effects on the fetus.  Cholestasis of pregnancy is associated with preterm birth and meconium contamination of amniotic fluid, which may lead to fetal breathing complications.  Once the baby has been delivered, the intense itchiness resolves within several days.

If you or someone you know are pregnant and can relate to these symptoms, please discuss them with your general practitioner or obstetrician.  Accurate diagnosis can lead to proper treatment, which will help both you and your fetus.  For other pregnancy changes and challenges, Revitalize Physical Therapy can help with your musculoskeletal related pregnancy needs.  Please contact us with any questions you may have about how our services can help you.