Practice What You Preach

By the time we are parents, it may be tough for us to know what’s normal about our own bladder habits, let alone know how to impart proper potty training – lifelong bladder health! – to our children. Our recurring guest contributor, Jessica Keaney, MSPT, has shared the following post about this very topic…..

Practice What You Preach. . .To Your Children

White toilet bowl in a bathroom

As a women’s health and pelvic floor physical therapist, I stress the importance of healthy bladder habits to my patients — use the bathroom when you actually need to (addressing urinary urgency/frequency issues), don’t push or strain when you pee, actually sit on the toilet to urinate (NO hovering, lining the seat with toilet paper as necessary in public restrooms), wipe from front to back, progressively hydrate during the day (as opposed to downing those 3 glasses of water when you realize it’s been 6 hours and you’ve had nothing to drink), and avoid using the bathroom “just in case” simply because there may not be a bathroom accessible when you go out for a few hours.   Healthy bladder habits are just as important to pass along to our kids—these are lifelong habits that should be instilled from the potty training era, from the 6 year old doing the “potty dance” as to not interrupt play time, to the “I don’t need to go, Mom” of all ages before the long family car ride, and to the adolescent girl who squats and pushes when she pees because that’s what all her friends do when they use the bathroom. We stress healthy eating habits and hygiene in the childhood years. . .start adding health bladder habits to that list!!

 

Tackling the Trampoline: One PT’s take

I was recently turned on to the blog of Sara Sauder, a pelvic floor physical therapist in Austin, TX (Blog About Pelvic Pain). In her post, “God’s Honest Truth About Your Physical Therapist’s Education,” she talks about the passion and innate uniqueness of pelvic floor PTs, stating, “it’s just that we are wired to be drawn to things that most people aren’t. We love our jobs, we are really concerned about pelvic floor issues and we want to learn more.”

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I agree whole-heartedly, and proof-positive is the following post submitted by my colleague at Marathon Physical Therapy and Sports Medicine, Jessica Keaney, MSPT. She’s another one of those passionate types….and that’s the God’s Honest Truth.

~

I love having candid conversations with my girlfriends, particularly when I can clear up some common misconceptions regarding perinatal health and apply my PT clinical knowledge in a personal way. Over lunch recently, a girlfriend admitted experiencing urine leakage while at a trampoline park with her daughters; “I need to have that surgery where they sling your bladder back into place” she confided and then admitted the urine leakage had been an on-going issue that seemed to be getting worse.

Whoa—let’s back up!! There are times when corrective surgery such as pelvic organ prolapse repair is warranted but I’m a big proponent of trying conservative methods first, such as physical therapy and behavioral modifications. Sometimes in life we’re looking for that “quick fix” but there are many times when conservative methods can eradicate urine leakage without surgery–establishing a plan is the first step toward returning to those trampoline parks with your kids!!

A mother and her daughter jumping high having lots of fun

In my girlfriend’s case, I recommended she talk with her established OB/GYN or pursue a consult with a urogynecologist or pelvic floor physical therapist first to determine the underlying cause of her urine leakage. Diagnosing and understanding the actual cause of her urine leakage, implementing and following the recommended treatment, and then regrouping with her physician to discuss progress and other available treatment options is essential. In the event that surgery is actually necessary to address her urine leakage, she’s improved her overall pelvic health and changed some of the not-so-good behavioral habits that many of us fall into that will only optimize her surgical outcome if that is the ultimate end result treatment.

So the brain train of jumping into surgery may not always be the best way to jump back to those trampoline parks; pursuing a thorough medical evaluation and trying conservative measures first may prove to be a more effective way to jump back into pelvic health!

ShareMayFlowers 2014

“So are you doing Share MayFlowers, again this year?” asks our long-time nanny, at this point also a friend, honorary family member, and true lover of our children.

“You, bet,” I answer.

flowers_hands

Although it is not a movement that has hit its critical mass (yet….), it is one to which I remain committed and faithful. And when I have felt tired and vulnerable and stretched to the thinnest of thin, wondering if I should retire the flower, in steps a friend, a patient, a colleague, or family member encouraging Share MayFlowers—and me—to push onward.

A friend….who is volunteering to write and sow these MayFlower seeds in her adopted state of Georgia.

A patient…who is willing to share her story with all of our readers this year.

A colleague (& a friend of a colleague!)…who believes in the cause enough to write and share an impressive blog of her own for this cause, (PLEASE check it out! Thanks, Tracy!)

A family member…my 7-year-old daughter, who asked to take a flower to her teacher and to her reading buddy. She thinks the flowers are beautiful, knows I think they are special, and for her that is enough.

The metaphor of the flower serves well. With tending and the passing of seasons, a garden—and the flowers it contains—matures and reveals increasing beauty, depth and complexity over time. May this campaign do the same for women’s health. Maybe the biggest victory achieved with Share MayFlowers thus far, is that—as evidenced by the support of so many who believe in this cause—it is not my campaign. Since launching May 1, 2012, it has become our campaign. For that, I thank you, and I proudly wear my MayFlower.

Do you have yours?

We Can’t Stop. We Won’t Stop.

Today, a well-respected media outlet–the Wallstreet Journal–helped advance women’s health. It did.

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You see, there’s a mass of information swarming around new moms and moms to-be. Everyone’s talking about pregnancy, birthing techniques and breastfeeding. Strollers, carseats and cribs. Postpartum depression, baby care and returning to work. But there’s a critical piece missing.

By choosing to go ahead and run a piece called “Bigger Postpartum Challenges Than Just Baby Weight,” the Wallstreet Journal gave a mainstream nod to the fact that there are significant physical effects as a result of pregnancy and giving birth. Some of which get in the way of a good sex life–or any sex life, for that matter. Some of which are intensely painful, embarrassing or debilitating. So I thank them for running that and for allowing me to be a part of the piece. Because I’ve looked into the eyes of far too many women who are left blindsided when they learn their condition could have been easily treated–and often even prevented–if they received care postpartum. So check out the full article here, the pregnancy exercises slide show WSJ also published, and please pass along to every mother–no matter her age–and expecting mom you know. 

And. To the commenter who in response to the piece, wrote:

“What a crock!…Our mothers and grandmothers never complained about how having children affected their lives. In the 3rd world the women have it much tougher and yet aren’t complaining.”

I agree. No, they didn’t complain. They still don’t. But that’s the point. They deserve a system that educates and facilitates them through pregnancy and postpartum care–including their pelvic health. Seeing woman after woman after woman–mothers and grandmothers!–through treatment that restores their quality of life is proof that they want and very much need that. And yes, women in developing countries are faced with significantly more extreme challenges. But we all deserve the best maternal health possible. Don’t we, Jon? And I, for one, won’t stop until we’re there.

How to Get Your Sex Groove Back Postpartum

It’s pretty clear to anyone familiar with Share MayFlowers that we think new moms are an “at-risk” group when it comes to their pelvic health.  Lots is changing in their bodies, in their relationships, in their environment, and they are often left without the resources to negotiate all of these changes.  I addressed this today over at Isis Parenting’s blog in a post called “Let’s Talk About Trucks and Sex.” And tomorrow night I’ll be weighing in on a webinar hosted by Isis Parenting on postpartum sexual health, which will prove an excellent opportunity for moms connect with myself and my Isis gal pals, Chris and Nancy concerning precisely these types of issues and questions! If you’re a pelvic health provider, this is likely familiar info to you. But you also know as well as I do that it isn’t familiar across the board, so I very much appreciate your help passing along the info!  Registration can be completed in advance and the webinar will be archived and available to all registrants after the original airing.

Register Here

Get the Groove Back: Postpartum Sexual Health Webinar, Tuesday October 8, 8pm est 

sex

Cross Fit: Fit for Pregnant Women?

Hey-oohhhh, Share MayFlowers crew….it has been a while.

Mounds going on, lots to share, and we’ll start with the following posts.  First, a post from Emily Oster’s Facebook page (author of the recently-released pregnancy book, Expecting Better) regarding debate over a woman posting CrossFit pics of herself in her 3rd trimester.  Second, my “comment” to her post…which I admit was way too long for Facebook etiquette.  My bad.

~ jessica

Photo Credit: NYTimes.com Well Blog

Photo Credit: NYTimes.com Well Blog

Emily Oster On Facebook:

After approximately a million people shared this with me I have felt compelled to comment on the pregnant weight lifter (link is below in very unlikely event you have not seen).

 I should open by saying the first thing I thought when I saw the photo was that those are awesome socks. 

A lot of the discussion has revolved around the general topic of “exercise in pregnancy”. I think it’s first worth noting that we should separate the aerobic exercise issue from the lifting-heavy-things issue. I spent some time in my Slate blog (the post is here) on aerobic exercise. There, the concern is getting your blood pressure up too high. 

Perhaps the woman in the photo is also doing a lot of aerobic exercise, but weight lifting alone like this seems very unlikely to raise her heart rate to 90 percent of maximum, which is where it looks like blood flow to the baby might be compromised.

 This is actually separate, however, from the question of whether lifting heavy weights during pregnancy puts women at risk. Studies of this have mainly focused on women who do lifting for a job — which does introduce problems like that kind of women who have jobs involving heavy lifting tend to be different in other ways from women who do not — and they do seem to find some small negative impacts. 

A 2013 review (you can see the abstract here suggests that there may be some downsides, but they are small. 

And, of course, there are upsides to being in good shape for labor, recovery, etc. 

http://well.blogs.nytimes.com/2013/09/24/pregnant-weight-lifter-stirs-debate/?_r=0

My Response to her Post:

Hi Emily-  I have to admit my first thought was, “Her right lower extremity is externally rotated more than the left,” followed by “Wow, my cleavage never looked that good, “ followed by, “Man, she is strong!”  However, my first thought when looking at the thoughts of other’s on Ms. Ellison’s CrossFitting decisions was, “Why is there no concern for mama’s body in this debate?”  The concerns cited by others appear predominantly focused on the fetus, with the studies cited similarly focused (pre-term delivery, low birth weight), save for the additional factoring-in of preeclampsia.  I see a situation like this, count on evolutionary biology to protect the fetus through all manner of otherwise unfavorable circumstances, but count on only the mother’s coordination of her deep stability system – the deep abdominals, pelvic floor muscles, and respiratory diaphragm – to keep her uterus inside her body for the long run.  And lots of things – related to life in general, exercise, and pregnancy and childbirth – have the potential to muck that up.  A just-published review of the literature reports “some evidence linking strenuous physical activity with pelvic organ prolapse but this is neither consistent nor adequately powered to reach any firm conclusions,” but goes on to state that there is “a marked paucity of literature relevant to the research question (that) makes it difficult to draw firm conclusions.”  A previously published report in 2009, discusses the role of obstetric and non-obstetric factors in development of pelvic organ prolapse.  It suggests that heavy lifting is a factor and says conclusively that parity is a factor (leaving me to wonder what does risk look like when both are combined…?).  Beyond all this, CrossFit has recently come under scrutiny for accepting “exercise-induced urine leakage”, aka “stress urinary incontinence”, as proof-positive of the workhorse ethic espoused by many (after the release of this CrossFit video), but colleagues of mine have reason to believe that many CrossFitters actually want information on how to integrate pelvic floor training into global strength and conditioning.  Great news, since both stress urinary incontinence and pelvic organ prolapse share risk factors.  So time will tell (because it hopefully will lead to more research) the degree to which exercise involving impact and/or heavy lifting in life and during pregnancy brings risk to the mother in the short and long term, and how much any risk might be mitigated with good technique and integrative pelvic floor training.  For now, I am quite impressed with Ms. Ellison’s obvious capabilities, think her baby will be just fine, and hope she is exhaling and engaging her deep stability system with every heavy rep.

“All In” For Pelvic Health

jess 3Writer’s block.  I am learning that it can happen even to those of us who feel we have endless thoughts to share.  Those thoughts run around my head like bumper cars on the ocean – swirling and churning and running into each other, and it all leaves me wondering sometimes, “What am I doing?”

Will Share MayFlowers become a game-changer of a campaign, breaking down barriers that keep people from accessing care and feeling like they deserve that care in the first place?  Can it really be the pelvic and maternal health pink ribbon equivalent that I have always thought possible?  Will it make a difference?  These doubts and ponderings hit me hard over the last 48 hours, so I borrowed a bit of advice from ‘The Princess Bride”: “Go back to the beginning.”

I re-read my own essay about why I wanted to launch this whole crazy journey in the first place.  And it helped.  The beginning reminded me of why I’m in the middle now and of where I hope that we find ourselves.

Happy MayFlowers.  I’m still all in.

Jessica

May is a month of new beginnings and blooming flowers. A day and a week are already set aside in May to honor mothers and to promote women’s health, respectively. Good stuff, to be sure. But not enough. We want the whole month. Let’s elevate conversation and action with regard to female pelvic and perinatal health all month long!

I am a woman. And I love being a woman. I love girly things, like miniskirts and painted nails. I love the challenge that childbearing and breastfeeding brought to my body and spirit. I love my “women’s intuition,” well known as a phrase only because it actually does exist. I love being part of a deep sisterhood that is without words; that lets me look in the eyes of a woman in the Democratic Republic of Congo, hold hands with her, share a smile and know that we share a connection as women that doesn’t need me to speak Swahili or her to speak English (or ask for help from our male interpreter!).

Women are beautiful and complex and strong, and profoundly amazing. I am fortunate enough to be surrounded by many people who share that sentiment and strong enough not to be brought down by those who don’t. Women can be sensual, tough as nails, tender and resilient all at the same time. And yet woman, upon woman, upon woman embodies resiliency to a fault by putting the needs of others before her own—to the detriment of her own health. Despite pelvic pain that renders sex un-enjoyable for her she is “tough as nails” and continues for the sake of her partner “because it’s not fair to him to not have sex, so I just bite my lip, suck it up, and get through it.” Ponder what something like this, or ongoing urine leakage, does to a woman’s connectedness to her inherent sensuality. So what is Share MayFlowers?  Hang with me…I promise I’ll bring it around.

I love women that are strong. One example is the recently departed and deeply missed Lyn Lusi, who together with her husband Jo Lusi, a Congolese orthopedic surgeon, founded Heal Africa in Goma, DR Congo. She committed her adult life to her family and the development of an amazing place that is more than just a hospital. It is hope and help and stability for people in DR Congo, where war and insecurity and violence have been a way of life for far too long. For women in particular, it meets unique and sometimes devastating needs for physical, social, emotional and spiritual healing.

In an entirely different way, strong is also Brittany Howard of the band Alabama Shakes, whose authentic and visceral stage presence positively killed it at the Paradise Rock Club in Boston last month. I don’t have many conventional hobbies, but good music—particularly good live music—is a part of what keeps me in balance (or some semblance of it!) with life as a mother, healthcare provider, wife, etc. Given my love affair with both women and music, seeing Brittany own her rock star status was monumental. Don’t just take my word for it. My 61-year-old mother went as my last minute date to the show and raved about how captivating and empowering it was to see a strong woman bringing everything she has and “rocking out” (Mom’s words!). I can’t sing OR play guitar, but when I grow up I still want to be Brittany—or Susan Tedeschi, another female inspiration, true to her passions of motherhood, marriage and downright BRINGING IT with her soulful vocals and guitar, all while in a fabulous dress!

So Share MayFlowers is for women who are strong and who are looking for strength, for women who are inspirational and looking for inspiration, women who can rock out and those who still want to be rock stars when they grow up! Because despite the advances in women’s health in our country (kudos to pink ribbons!) and TV and radio segments about painful sex on WBUR and pelvic organ prolapse on Dr. Oz (on which I have to completely agree with my colleague, Julie Wiebe, PT) too many people still squirm at the mention of female genitalia and too many women wait too many years before seeking care for pelvic health issues such as urinary incontinence and pelvic pain. There is no reason for us not to move toward open, engaging and meaningful discussions about female pelvic and perinatal health (perinatal = preconception, pregnancy, childbirth, postpartum). We may need to first collectively learn how to have these conversations—yes Virginia, you do have muscles down there. And it’s not un-ladylike to talk about them or want to know how they work! Share MayFlowers is here to help us all find our voices and to be a platform for advocacy, education, and connecting the general public, the media, and healthcare providers to each other and to the many organizations that have tirelessly been working in one meaningful way after another to promote issues related to female pelvic and perinatal health.

It takes a lot of self-assurance for a celebrity to admit to having urinary incontinence and be willing to be the face for protective garments. Why should it end there? Can we get a celebrity to talk about perineal trauma during childbirth? Or dealing with painful sex? Or how they had urinary incontinence and sought treatment to eliminate the leakage, not just a palliative measure to keep their clothes dry? Or instead, can we give all the credit and praise afforded to celebrities in our country to the “everyday” women who are pursuing this level of openness and striving for better care for themselves? These are the women who inspired me to add this new adventure to my already teeming aspirations and schedule. The women who come into our clinics wondering where this information was when they had their injury/symptoms/baby—wondering what can be done to change things for their friends, their daughters, for every other woman. Wondering why they spent months or years (decades) thinking it was their fault, that it was a normal consequence of aging or childbirth, or that there was nothing to help them.

Why do we feel so passionately that female pelvic and perinatal health—yes the “down there” kind of health—deserves at least a month of focused attention annually? Consider these statistics:

  • Nearly 80% of women in the US have at least one pregnancy resulting in childbirth in their lifetime.
  • Pregnancy/childbirth is the single greatest factor in lifetime risk of developing urinary incontinence, and developing urinary incontinence for the first time while pregnant is the single greatest predictor in ongoing postpartum urinary incontinence.  (For the record, ANY amount of urine leakage counts with any activity—from a trickle to a few drops to a gush!)
  • Urinary incontinence affects 13 million Americans, 85% of whom are women and it is estimated that 50% of women will have urinary incontinence at some point in their lifetime.
  • Chronic pelvic pain disproportionately affects women 4:1 with research indicating that its prevalence is on par with that of chronic lower back pain and asthma.

I’m not just a hammer wearing my nail-goggles. These are real statistics. And real statistics come from real people—women just like you and the people you love. Please consider them as you take in my explanation of why this cause is so significant for all of us.

Lastly, consider why women are expected to travel through the natural, wondrous, but monumentally physical experience of pregnancy and childbirth without really getting guidance on how to get their bodies put back together and on the right track postpartum. And yet someone sprains an ankle and often without question heads straight for physical therapy. I’m just sayin’…

So are you ready to start wearing and sharing some flowers?