APP-solutely Amazing

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Admittedly, I am not the most technologically savvy individual. As my web-designer, my friends who work at Google (who patiently field my many questions), and basically anyone who has ever met me already knows, I know enough to outsource most tasks that involve a plug and an outlet (#noshame). I kid you not when I share that one of the highlights of my week thus far was independently figuring out (okay, fine, with a little help from the internet) how to import photographs from my phone onto my laptop. I believe my grandmother has already been doing that for years.

That being said, I appreciate when others who are fluent in devices, computers, and programming create tools which enhance my life and the lives of my patients. I have recently been introduced to several mobile apps which are extremely beneficial for patients with pelvic floor dysfunction, and I would like to highlight three of those apps in today’s blog.

Pelvic Track

Pelvic Track is an incredible and comprehensive app developed by Dr. Evelyn Hecht. The app allows patients to keep track of exercises, enter information into bladder and bowel diaries, monitor symptoms, and set reminders for themselves (ex. “relax your pelvic floor” at set times throughout the day). The app provides helpful pictures and explanations of the exercises as well as self-help techniques. I encourage pelvic floor therapists to introduce their patients to Pelvic Track, especially ones who love having their homework consolidated in one easy to use application.

Seconds Pro Interval Timer

For patients who get bored of counting the seconds remaining to their monotonous endurance Kegel contraction, Seconds Pro Interval Timer is the perfect app. Instead of counting oneself, this interval training timer app will do all the work for patients while they enjoy music, watch Netflix, or daydream. The patient can customize both the squeeze/hold time as well as the rest time, and they can modify both factors as they get stronger and can holder for longer periods of time. Patients can also monitor heart rate and calories burned during the workout.


Biofeedback is a modality employed by pelvic floor physical therapists to teach proper muscle recruitment, relaxation, isolation, and discrimination patterns. It is a technique in which a typically unconscious physiological process is presented to the patient (and therapist) as visual or auditory signals. Many patients who appreciate biofeedback and the positive educational experience it offers have expressed that they wished there was an equivalent home version. Thanks to developers in Europe, there is now. The Perifit is a kegel exerciser with sensors that connects through Bluetooth to one’s smartphone. The user opens the app and can perform pelvic floor exercises with feedback from the sensor appearing on their phone. The company claims, “This is about as fun as you can get training your pelvic floor muscles,” and my own patients have confirmed that assertion. In fact, one postpartum mother told me that she would recommend this innovative technology to all postpartum clients, because the Perifit provided extra motivation and allowed for greater ease in tracking progress.

So there you have my top three pelvic floor apps! I am excited to see how future technological advances will converge with and benefit pelvic health and wellness. It is an ever-unfolding story that possesses abundant potential.

Planting a Seed

While it may not be self-evident, NOT all bacteria are created equal. Like good cop-bad cop, there are good bacteria and bad bacteria. In fact, this discussion has recently become relevant to a different conversation, namely, the pros and cons of vaginal delivery vs. cesarean section (c-section) delivery. Vaginal delivery introduces the newborn to vaginal fluids which help develop a healthy newborn microbiome (the collection of microscopic organisms which live on and in us).

These microorganisms exist on the skin, in the mouth and saliva, in the eyes, and in the gastrointestinal (GI) tract. It is believed that many of these organisms, especially ones in the GI tract, contribute to healthy gut flora and function. In other words, exposure to the mother’s vaginal fluid, bacteria and all, helps develop a healthy newborn microbiome. Furthermore, it helps develop the neonatal immune system, prevents growth of negative bacteria, and produces certain vitamins.

Babies delivered via c-section are deprived of the maternal vaginal fluid along with its corresponding health benefits. Furthermore, c-section delivery is often accompanied by antibiotic usage which may also interfere with healthy infant microbiome development.  In fact, it has been hypothesized that the recent rise in childhood asthma, immune diseases, and obesity may be associated with the increased rate of c-section, which nowadays is approximately one in three births nationally.

This has led researchers to explore the field of vaginal seeding, the artificial introduction of maternal vaginal fluid to the infant’s mouth, nose, or skin. This exposes the baby to the same bacteria he or she would have encountered through a vaginal delivery. This progressive and creative solution is still in its initial stages, and the American College of Obstetricians and Gynecologists (ACOG) is recommending, “Ladies, don’t try this at home.” In fact, they only recommend undergoing the process as part of an IRB approved clinical trial. The reason for this is because they still lack adequate research to support this procedure routinely. It is still unclear if the benefits outweigh the risk of exposing the infant to pathogens or other dangerous maternal bacteria.

However, it won’t be long before we have more data, and clinical trials are well underway. In fact, microbiologist Dr. Maria Gloria Dominguez-Bello’s pilot study compared the microbiomes of infants born vaginally with those of infants who were delivered via c-section followed by vaginal seeding. Dominguez-Bello found that the microbiomes of both groups appeared very similar after one week. This is promising, and longer-term studies with larger sample sizes will determine if vaginal seeding will become par for the course within the c-section community.

To learn more about this fascinating research, I encourage you to listen to Dr. Aviva Romm’s interview of Dr. Dominguez-Bello. Dr. Romm is a physician, a midwife, and an herbalist with over thirty five years of experience. She has an amazing website replete with valuable information, including her blog and podcasts. This is the link to her website, and this is the link to her interview. I hope you find this information as exciting as I do!


Dominguez-Bello MG, De Jesus-Laboy KM, Shen N, Cox LM, Amir A, Gonzalez A, et al. Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer. Nat Med 2016;22:250–3.