Post Vasectomy Pain

Vasectomy is a common contraceptive technique that interrupts the pathway through which the sperm travels. Most people recover well with simple techniques such as short-term rest and ice packs. Others develop severe pain in the region of the scrotum and spermatic cord that can limit work, sitting, movement, sleep, sexual health and other activities. Post-vasectomy pain can be treated successfully with pelvic rehabilitation, yet this fact remains widely unknown.

There are different techniques used to interrupt the vas deferens, and regardless of the approach used, new onset pain may occur. To understand the common area of dysfunction, it is helpful to be familiar with the anatomy. The spermatic cord travels from the lower abdomen to the scrotal area. Through this cord you will find the vas deferens, a tube that extends from the epididymis all the way into the abdomen and behind the bladder where it can deliver sperm to the urethra. The vas deferens is typically cut or disrupted at a location that can be easily reached in an outpatient procedure, accessed via the scrotal tissues. 

The location where the cut or disruption is made can develop a sperm granuloma, which clinically may be palpable as a thick, hard nodule. Palpation to the area of the granuloma and nearby tissues can often reproduce the sharp, searing pain that is reported. Other symptoms may include a dull throbbing, nerve-like pain, or a hypersensitivity to touch or pressure on the tissues. In clinical experience, gentle palpation and mobilization of the painful area can not only decrease the size of the granuloma, but reduce the symptoms as well. This may only require a few visits and techniques instructed to continue with care at home. Because of the pain, nearby muscles may also become tense and sore. The sooner these concerns are addressed, the better. If you have questions about your recovery from vasectomy and and concerned about your symptoms, check in with a pelvic health therapist who can provide tools for healing.

Healing Anal Fissures with Pelvic Rehab

Anal fissures are unfortunately a common cause of rectal pain and bleeding. This pain or bleeding can significantly limit a person’s ability to sit, to empty the bowels comfortably, or to participate in work and leisure activities. The good news is that properly trained pelvic rehabilitation clinicians are able to help you heal this painful condition and learn how to manage flare-ups when they happen. 

A rectal fissure, or tear in the lining of the anal canal, is sometimes described like a paper cut. This small yet sensitive tear can first happen when someone passes a large or hardened bowel movement, so constipation is in general associated with fissures. Surgery or injury to the canal can also create a fissure, and once the tear takes place, re-injury to that tissue can happen. One theory on why some folks get fissures and others do not is that some people have a really tight anal canal and tight pelvic floor muscles. The anal canal has an external and an internal sphincter, with the external made up of skeletal muscle (muscle that you can contract and relax by thinking about it) and the internal sphincter is made up of smooth muscle (muscle tissue that your central nervous system operates). If either of these sphincters become too tight, the tension, pressure, and lack of blood flow may contribute to a fissure formation or make it difficult for an existing fissure to heal.

What can you do to help avoid or heal a fissure? Staying hydrated and eating a diet that promotes softer stools can help. Visiting a gastrointestinal or colorectal specialist to keep an eye on your healing is important as well. Some providers will prescribe a medicine that helps the smooth muscle in the anal canal relax. Beyond that, many fissures heal on their own with time, perhaps warm baths, and through keeping the bowels healthy. What if the fissure becomes chronic, or causes severe pain and bleeding? Bleeding that is outside of normal may have to be managed by a surgical approach, but much of the time it is the pain and difficulty passing stool that is problematic.

How does pelvic rehab address the issue of fissures? Interestingly, providing gentle manual therapy to the anal canal and pelvic muscles can be a huge help in speeding recovery and in reducing flare-ups. This manual therapy can involve placing a gloved, examining finger in the anal canal and applying gentle pressure to help the soft tissues relax and become less tender. A person can also learn to be more aware of any tendency to hold these muscles tight (fairly natural to tension these muscles if there is pain), and to relax when holding is noticed. If there is a healing scar from a fissure, this soft tissue can also be very gently worked on to help desensitize the pain and to improve blood flow and scar mobility. It can seem counterintuitive that this painful tissue can improve with pressure applied to it, but we see this condition frequently in the clinic, and fortunately the body is able to heal this tear and with healing, the pain and bleeding resolve. Deep breathing, learning how to empty the bowels properly with coordination between the abdominal wall and pelvic floor muscles, and having healthy nutrition and activity levels can also play a part in recovery. 

Regardless of how long a person has dealt with an anal fissure, pelvic rehabilitation can quickly make gains in discomfort and bleeding. Many providers have no idea that pelvic health can help heal fissures, and if you have any questions about your condition, feel free to reach out for answers. It’s important to work with a pelvic health provider that has specific training in colorectal health, and all providers at Flow have had this training. We work closely with medical providers to help a patient find the best pathway to recovery.

Tailbone Pain- Could It Be The Coccygeus?

Coccyx pain, when severe, can interfere with your entire day. Imagine not being able to sit down, ever. Where would you do your work? Is it reasonable to stand in all your meetings? Could you go out to dinner with your friends, or colleagues? Too many people are living their life with untreated tailbone pain, and fortunately, it’s one of the easiest conditions for us to treat in pelvic health. 

When we talk about the tailbone, we are referring to the part of the body that attaches to the sacrum, or the very tip of the lower spine. When your tailbone hurts, simple actions like going from sit to stand, sitting on the floor, engaging in sexual activities, or even having a bowel movement can be excruciating. The tailbone has attachments to the pelvic floor muscles, to several ligaments including the sacrospinous ligament, and to a muscle called the coccygeus. These soft tissues are frequently culprits in persistent coccyx pain. It’s easy to injure this part of the body through a fall such as on the stairs, on slippery surfaces, when participating in sporting activities, or even during during childbirth. Most patients will react to pressure on these soft tissues with a report that this is exactly where their tailbone pain is located. Even though the bone or joints might be the cause of the pain, clinical experience and research agrees that treating the soft tissues is often the most effective way to resolve tailbone pain. 

How do we treat this area? There are a variety of ways to get to these soft tissues, and the most efficient way seems to be when we work directly on them. This can be done by working near the gluteal muscles, or buttocks, and just to the sides of the tailbone. Internal pelvic muscle work is even more direct, and allows for a firm, gentle stretch to the soft tissues that are almost always involved when your tailbone hurts. “Internal” work means that the therapist places one gloved, well-lubricated finger inside the anal opening and into the canal so that this painful area can be treated. (The image below shows how a treatment can be directed to the coccygeus muscle through a canal.) While it might seem awkward initially, the pain relief that follows is well worth getting through the treatment according to our patients. 

Sitting is far too important of a daily task to suffer severe pain that limits sitting. It’s never too late to address tailbone pain, regardless of how old the injury is or how severe symptoms are. We hear too many stories of patients being told that the pain is coming from their low back or sacrum, or that there is “nothing that can be done.” Most patients have never had their tailbone properly assessed or touched to see from where the pain originates. More aggressive approaches such as removing the tailbone don’t guarantee the pain will be better. If you have questions, give us a call. Every therapist at Flow is trained in this specialty condition. 

Kids, Constipation and Bladder Leakage

Kids today are very constipated, and there are many thoughts about why. Kids in the US are in general less active, tend to eat more processed food, and drink less water. When older children and young adolescents attending school are asked about bathroom access, they describe some environments as feeling less than safe, not very clean, or complain that they are not allowed to go to the bathroom when needed. Kids who are constipated oftentimes have bladder leakage including night time bedwetting, so the first rule of care is to treat the constipation. (Interestingly, even kids who seem to have a bowel movement each day can be significantly constipated.) Aside from the reasons kids are constipated or are leaking, we must help address these issues in childhood so that they don’t grow up to be adults with significant bowel and bladder dysfunction. Most people don’t know that physical therapy can help address bowel and bladder dysfunction in kids and adolescents. While this is often not a quick fix, here are some of the ways that rehabilitation can offer support and a pathway to overcoming these challenging issues. 

Educate about how the body works

Bowel and bladder health are not usually explained to us growing up, and there is a lot of shame associated with our pelvic functions. Understanding how bowel and bladder function works is the first step in helping to overcome dysfunction. This is true no matter the age of our patients! We use books, stuffed models, pictures, and developmentally appropriate explanations of how bowel and bladder function works. 

Investigate current strategies

With non-invasive tools such as surface emg biofeedback and observation of pelvic muscle coordination, we can help a person understand if they are tightening when the body needs to be gently bearing down to empty the bowels, or relax to empty the bladder. These evaluation tools often provide an “aha” moment for patients, parents and caregivers as they can see in real time what is going on with the muscle use patterns. 

Teach home program

Home program activities need to be useful and simple in order to be incorporated into an already busy day. We love to teach kids and adolescents what they can do on their own, and provide parents and caregivers with the tools they need to assist with activities such as belly massage, stretching, breathing, and toileting habit re-training. It’s surprising how many people have dietary sensitivities or habits that influence the bowels and bladder, or how changing up a scheduled toileting time can improve symptoms. 

Improve the body’s ability to have and listen to urges

Many of us have heard of the kids who are “too busy” to stop and use the toilet. Another piece of this puzzle is that the body can actually stop providing good urges and sensations that are recognized and then managed. With bowel and bladder retraining, we look for these urges (and the ability to “tune in” to these urges) to improve. Education for teachers, caregivers, parents, and the patient are also a part of the process.

Coordinate care with medical providers

Bowel “clean outs” and imaging studies, bladder function testing can be an important part of managing pelvic health, and this requires positive working relationships with medical providers. Physical therapists are accustomed to sending reports, making phone calls, or sending messages to providers to coordinate care. Kids with more intensive medical histories may require even more frequent coordination and follow-up. Therapists who work in pediatric pelvic health have completed specialized training to best understand when a visit to the medical provider is needed. 

Bring some peace of mind to families

Bowel “holding” or bladder leakage can appear to be something that a child is using to manipulate parents and caregivers. While sometimes this is true, most often, it is only a small part of the story. If a person learns how to support their own system well (stay hydrated, avoid drinking right before bed, learn to “listen” to body urges) then any level of success can feel like a reprieve. Families are incredibly frustrated by these issues, which can further the tension in the family system around bathroom habits. 

At Flow Rehab, we enjoy the process of teaching how the body works and how to optimize its function. Every clinician at Flow has specialized training in pelvic floor function and dysfunction. Pelvic health needs to be a part of every person’s health, and the sooner we can address these issues, the better! Let us support you in our goal of having fewer adults who report bowel and bladder dysfunction “ever since they can remember.” Pelvic health is good health!

Benefits of Yoga

Yoga is an activity that it seems everyone is either doing, has tried, or thinks maybe they should try. There are classes at gyms, formal yoga studios, hospitals, corporate offices, and even in the park when the weather is nice. There is a type of yoga for every person’s goals and hopefully a studio or teacher within a reasonable distance. Yoga has varied aspects: yoga can refer to a physical practice, a mindfulness or meditation practice, a spiritual practice, and a breathing practice. Yoga can mean a way of making choices throughout the day in order to strive towards more kindness and compassion.

What are the benefits that keep students coming back to their practice, or that entice newcomers onto those sticky mats? While yoga is not generally cardio-intensive like running, biking or swimming, yoga can improve strength, increase flexibility, and improve coordination. And while getting the heart rate up through cardiovascular exercise is important, yoga has been described as improving the efficiency of cardiovascular system functions. Yoga has also been used to support the management of anxiety, depression, and insomnia. Many cancer survivors have found the practice to support not only their physical bodies, but also their emotional and spiritual experiences, leading to an improved sense of community and peacefulness. Combined with other forms of treatment, yoga can be very useful for managing chronic pain conditions.

The yoga practice has often been a tool to manage stress.

How nice is it to get on your mat, and for the duration of class to only be responsible for tuning in to how your body feels? Another gift of yoga is developing body awareness: what’s difficult, where do you feel tight or more flexible, and what’s actually happening with my 5th toe when I try to balance on one leg? Yoga can offer us the opportunity to learn about the body we inhabit and as we learn, we may be offered more choices about how we move and care for our bodies. A down dog may feel very different after a lovely Hawaiian vacation versus during a particularly stressful week at work. That’s so interesting because while it’s the same posture, maybe even within the same month, we can find each moment to offer a different experience.

Yoga can help a practitioner gain focus.

Mindfulness is en vogue right now, and for good reason. Mindfulness is inherent to the yoga practice. “Be here now, feel what you feel at the present moment, tune in.” As much as yoga is mindfulness, mindfulness is in fact yoga, which means you can practice yoga anywhere, at any time. For example, you can participate in the practice of yoga when you take care of yourself when sick or injured simply by choosing how you place your body mindfully, how you interact thoughtfully with others, and by noticing how you feel as you heal. Mindfulness often lowers a person’s sense of irritability and reactivity to the daily stressors such as traffic. Mindfulness often leads to a sense of well-being, and being aware of your wellness can also reveal when you might benefit from further support such as from a health professional, a counselor or a friend.

Making rest a priority is a healthy habit.

Our society is great at supporting productivity, striving towards goals, and living a full but sometimes overbooked life. What we often need help in making space for is rest. Doing nothing is really important, and an active or restorative yoga practice may help us rest more fully. Some folks like to have a practice on their own at home. Other times having a structured class environment is more successful because students can know that from 8am-9am its yoga time, the phone is put away, and the teacher guides the class, allowing the student to follow along. Scientifically, yoga helps us balance our nervous system and can lead to increased ease and relaxation, getting out of our “go-go-go” state. With increased relaxation, our bodies may experience decreased blood pressure, decreased release of stress hormones, and healthier gut function too!

If yoga sounds like it would be an interesting addition to your week, consider trying out different styles and teachers to find the best match for you. Sometimes the way the studio feels, or what kind of philosophy the teacher utilizes to frame the class can fit students differently. For example, you might prefer a quiet, private studio or a bright, upbeat environment. There is a practice for everyone, and that may or may not include the physical practice. If you are more interested in the mindfulness or meditative practices, finding a meditation workshop or meditation teacher is a good way to get started. Ask questions of teachers and studios to find the right practice for you, which might change or develop over time. To check out a yoga class at Flow, check out our scheduled (and growing) class list at http://flowrehab.com/yoga.

New Year’s Reconstitution

The New Year, beyond the darkest day of the calendar, and when the days gradually increase in light, is a powerful time to reflect upon the 12 months that have past, and look ahead with renewal for the coming year. New Year’s Resolutions can be challenging, and if we don’t meet our goals, it’s easy to be hard on ourselves for not following through on sometimes unrealistic tasks. What if this year we tried a variation on the theme and focused on a different word: reconstitution? The word reconstitution has definitions including “building something up again” or to “restore to a prior condition”, to add water, or even to shift something into a different form. At Flow, we’d like to offer some thoughts and ideas for our 2019.

Instead of focusing on losing weight, emphasize gaining muscle.

Increasing strength has a wide range of benefits including being better able to power ourselves out of chairs, off the floor, up the stairs or up a mountain. Strength training is becoming known for being one of the best ways to lose excess weight when needed, and to build confidence in daily movement. Some folks like to find small ways to fit strengthening maneuvers into daily life, and others like to move heavy things other than their body weight such as sleds, bike wheels, weights, or tires. Working with a rehab professional or strength trainer for a period of time may be the best way to gain expert advice for developing positive habits over time. 

Pick one body area that limits your activity, and seek help for that issue.

There are so many wonderful ways to access health, and many philosophies and methods. If you have been told by a provider or by one group of providers that you have to “learn to live with it”, maybe it’s time to try a different approach. Ask your friends what worked for them, look up that one treatment that’s always intrigued you, find a local pain management class at a hospital, or maybe a nearby meditation class. If cost limits access to non-covered care, look for local colleges and training schools that may have student-run (and instructor-supervised) clinics, or free classes at local places of worship, community centers, or other gathering places. If you can overcome or improve one issue in your body, you may be able to move more, sleep better, and gain confidence that you are capable of healing. 

If something isn’t working, can you try something different?

Maybe you’ve had poor sleep, or you keep trying to get back into running, or your usual daily routine isn’t creating your desired health. Consider adding in a nap, getting into a pool instead of onto the track, or changing up any aspect of health. A goal of returning to the things you love or achieving a desired health goal is terrific, and sometimes we need a different perspective when trying to accomplish such goals. If what you’ve been doing isn’t working, could you shift that focus for a short time, aim for a part of that goal, or talk to a friend or professional to see how you might approach the problem differently? It can be hard to see a new path towards something we’ve always expected our body to be able to do, or to see outside of our habits. 

Reconstitute your life.

Do you need to drink more water? What a great way to hydrate your tissues, keep your nervous system happy, and make your bowel or bladder’s job easier (concentrated urine tends to make the bladder irritable.) When we are hydrated, we may be more likely to replace sugary or higher calorie beverages with water, and to not mistake thirst for hunger. Find a great water glass or mug, or even a water bottle that is both practical (easy to clean, has a built-in straw) and cheerful (think of stickers on Nalgene bottles, water bottles in your favorite team colors or great patterns) and try to keep that habit going. Beyond being hydrated, are there activities or hobbies you enjoy that have “dried up” in your life? Adding back in satisfying activities such as crafting, outdoor activities, projects, or reading, can make the activities that we feel we “have to” do all the more easy to accomplish because we also choose to do fulfilling things. Keep in mind that to build back in activities, you may have to schedule it so it can happen.

Be more gentle with yourself.

Being more gentle with ourselves doesn’t have to mean treating ourselves all the time, or giving in to the voices that keep us from endeavors that improve our health. But it might mean talking to yourself in the way you talk to a friend, and finding a way to be a cheerleader in your own life. Give yourself a pep talk instead of a scolding. Find ways to negotiate with those voices: “so I didn’t make it to the gym, but I can find an online video to do some exercises at home” or at the minimum not letting negative self-talk be the norm. Do talk to your body. Say nice things like “thanks body for allowing me to take that walk by the lake today” or “come on body, I know if we do these stretches, you’ll feel better in the morning.” When you “fall off” that wagon you hoped would keep on rolling, just climb back on and remember why you set your goals in the first place. Many of us have learned to say negative things to ourselves subconsciously, and it takes some practice to shift those words.

We look forward to connecting more with our community this year, and reconstituting some of our own habits and goals at Flow. We hope you reach out to learn more about how you can improve your health and function, and take good care of your body for this new year we get to experience. 

When Sex Hurts

One of the more common issues we hear about on a daily basis in the clinic is difficulty with sexual health and function. Sexuality is a broad concept, and sexual health relies upon many factors. When considering pain with sexual activities, it’s crucial to know that most issues can be healed and sexual function restored. Below are some common pain issues related to sexual health we treat in pelvic rehabilitation:

Pain with arousal

 The mere physiologic function of having increased blood flow into erectile tissues (we’re talking about any gender here) can cause increased discomfort. Perhaps the muscles, nerves or tissues (including the vessels) are sensitive to any change in filling and pressure. Thinking about sex or feeling attraction can trigger such blood flow. This means that even a kind word whispered into a loved one’s ear or a gentle touch, even the thought of intimate acts can be painful. To emphasize this point, the pelvic area can become painful even before a person is ever touched. 

Pain with orgasm or ejaculation

With pelvic dysfunction, achieving orgasm can be difficult due to muscle tension, changes in blood flow or physiology, or even due to fear and worry about performance or pain. Orgasm is often associated with ejaculation, and either often involve some really intense muscle contractions. If the muscles involved are painful, or if the nervous system is too sensitive, what should be pleasurable is excruciating. The rhythmic contractions that often characterize orgasm or ejaculation (remember that ejaculation is not for men only) can cause severe cramping, making it challenging for the person to want to engage in sexual activities, or to even avoid achieving climax. 

Pain with positions limiting comfort

 A couple’s usual positions for engaging in sexual activities (or even new positions) may cause activation of tender areas in the thigh, cause a cramp in the hip, or lead to aching in the back or pelvis. A severe case of sacral pain can make any prolonged position challenging to tolerate, and can feel worse with any added motion or weight. General orthopedic issues like arthritis, a joint replacement, a torn hip labrum, or tailbone pain can get in the way of lovemaking or sexual health.

Pain limiting penetration

This is a really common problem. When the goal of the sexual activity is penetration of a canal, the opening or canal may be so tight, so tense, or so painful that the muscles and soft tissues do not allow for penetration. This can lead to frustration within relationships, more pain, avoidance of activity (or even avoidance of all sexual relationships) and may lead to harm if the person who has pain ignores the body’s tension. In the clinic it is not so unusual to meet a couple who has been trying to consummate a marriage for a very long time. 

Pain following sexual activity

Even when sexual activity is tolerated, some people describe increased pain or cramping, aching, even burning for several days and sometimes 1-2 weeks after engaging in sexual activities. It’s no wonder that a person might give up on engaging in sexual health activities when these types of pain are present.  

Pain limiting sexual health is very isolating, and not only within the relationship. Many of the people who come to the clinic describing limitations in sexual health think they are the only one to experience such challenges. When hearing that we in pelvic health work with people every day who have similar issues, this information can feel reassuring and hopeful. Some typical conditions that pelvic rehab specialists work with include sexual health following surgeries, in relation to cancer care, as part of healing pelvic pain, and for postpartum recovery. In all ages of life, from adolescent to adult, to older ages, all deserve to experience healthy and pleasurable sexual activities. This may include masturbation, or sex with a partner or partners, and the rehabilitation process may require a multidisciplinary approach. Knowledge from sex therapists or relationship counselors may be needed to bring about a return to healthy sexual activities.

Although pain with sexual activities is common in cases of pelvic dysfunction, other issues can be going on. Sometimes lack of healthy blood flow, difficulty keeping blood flow into the erectile tissues, or difficulty getting the increased flow out of the pelvis afterwards is difficult. Some folks have low arousal, have issues related to hormones, and some have neurologic conditions that affect sexual health. As part of a team approach, pelvic rehabilitation is essential in helping people recover. If you have questions about the care that could be included in your recovery, find a local pelvic health therapist, and find out more about how to optimize your sexual health.

14 Ways to Love Your Pelvis!

 

Your pelvis does so much for you, and much of the time, asks for very little in return. How can you give your pelvis and pelvic floor muscles a little more appreciation and attention? Read along to see a few of the many ways that you can love your pelvic floor.

1. Give your pelvic muscles a squeeze!

When you contract your pelvic floor muscles (the ones that help you hold back gas or stop the flow of urine) you can protect against the forces created by a blasto sneeze or a strong cough. Think of this as good body mechanics for the pelvis! Similarly, if you are lifting something heavy, giving the pelvic floor muscles a gentle squeeze can help counteract the pressures from the strain of lifting.

2. Stop holding in your gut!

Did you know that when many people tighten their abdominal wall, other muscles like the pelvic floor can tighten too? Sucking in your gut unnaturally and for long periods can create too much tension and create soreness in your muscles from all of that clenching. This situation can make it difficult for the pelvic floor muscles to contract when you really need them, or rest and recover.

3. Go for a walk!

You don’t have to do high-intensity workouts to have many of the benefits of exercise. Moving your body by going for a walk gets your limbs, trunk and pelvis moving, your heart pumping, and keeps your pelvic floor active. Just about any exercise that you participate in will get your pelvic floor going, especially total body exercises like swimming, hiking, playing soccer or tennis.

4. Don’t push when you pee!

Emptying your bladder should not require much effort from you. When you pee, your pelvic floor muscles are supposed to relax, and the muscles surrounding your bladder are the ones doing the squeezing. If you are pushing to pee, there might be too much tension in your pelvic floor or you might be in too much of a hurry! Slow down a little, breathe, and let it flow. 

5. Don’t strain when you poo! 

Let your pelvic floor muscles relax when you have a bowel movement too. Just like when you empty your bladder, the lengthening and relaxing of the pelvic muscles helps the body empty during a bowel movement. A little effort with a bowel movement is ok, but straining for long periods of time or with outrageous efforts can harm your pelvic floor muscles. 

6. Sit down on the toilet!

If you are hovering over the toilet, your pelvic floor muscles will not relax. See #4 and #5 for why this is important. If you *hate* public bathrooms, pack some travel size toilet seat covers in your car or purse, and use them if it helps you sit down. If you are accustomed to squatting or find that your legs dangle when sitting on a toilet, try using a small foot stool. Your pelvic floor will thank you. 

7. If it hurts, get help. 

If your pelvic floor muscles hurt when you try to tighten them, sit, have sex, when you are toiling, or during any other activity, talk to a healthcare provider. Getting a referral to a pelvic rehabilitation provider may be the first step in easing your pain. Although these issues may seem tough to talk about, rest assured that others area dealing with these same issues, and that you deserve to have any concerns heard.

8. Check things out “down there.” 

How are you going to know what your genital area is supposed to look like if you’ve never checked it out? Use a mirror and see what your tissues look like. See what your pelvic floor muscles do during a contraction and relaxation! If you have questions, ask a healthcare provider for more information about what you see and what is normal for you.

9. Stop calling it “down there.” 

One of the healthiest things we can do for ourselves and for our loved ones is to stop calling our body parts cutesy, strange names or avoiding using the anatomy terms out of embarrassed or because that’s what we were raised believing it should be called. Your pelvic floor muscles, vagina, or testicles are amazing parts of your body with really cool jobs, and deserve to be properly recognized. 

10. Wear clothes that feel good. 

If you aren’t comfortable or can’t move well because of the clothes you are wearing, or if you simply don’t like how you feel, try changing things up! Some folks like boxers, some like briefs, maybe it’s thong versus granny panties. Do jeans feel restrictive or skirts feel best? Wear what feels comfortable, and choose fabrics that allow your body to feel good. 

11. Drink plenty of water. 

Your body feels best when you are properly hydrated and when you are eliminating with ease. If you are dehydrated, your bladder can get irritated, or bowel movements can be painful to your pelvic floor. Keep some fresh water nearby and keep reaching for it! 

12. Have more sex.

Healthy sex keeps the pelvic floor muscles active, in addition to other terrific benefits to the body and soul. Whether you are having sex with others or solo, sexual activity can be a great part of a pelvic health regimen. If you would like to learn more about your sexuality, finding a sex therapist or counselor can be of great benefit.

13. Buy some new underwear.

You read that right- some new underwear. While they may not directly impact your pelvic floor muscles, when you put on some well-fitting underwear that still retracts after being stretched, life feels a little bit better. Choose some in your favorite color, or that make you smile when you pull them on- remember Underoos and the power of the underclothes?

14. Find a pelvic health expert who lives nearby.

This last one is really important. When you feel confident that you are doing the right stretches, performing your Kegels correctly, or have a qualified person to help ease your aches, you’ve got a lifeline to some really intimate and valuable care. Even if you don’t need pelvic rehab today, keep in mind that at any age you or a loved one may benefit from expert care. 

What Keeps You Moving During Pregnancy?

Across any group of people, beliefs about physical activity and exercise habits vary greatly. During a pregnancy, many hope to be as healthy as possible, and may even choose to start a new exercise program. For those who already have an exercise habit, it’s common to want to continue with usual activity as able. Because every pregnancy is different from the next, and because the goal of a pregnancy is both a healthy mother and fetus, a person’s desire to be physically active may not match what is possible or best. For example, conditions related to nausea and vomiting, blood pressure issues, a cervix that softens too early, or health challenges in the mother or fetus can mean that rather than exercise, bed rest or light activity only is recommended.

So what keeps women motivated? When their body gets heavier, when swelling and joint aches increase, what is it that helps a person keep moving? A recent research article (reference below) identified attitudes and perceived barriers for being active during pregnancy. The authors found that being tired, a lack of time, and discomfort related to pregnancy were barriers to physical activity during pregnancy. Discomfort included a range of symptoms from nausea to pain, or even a sense of "awkwardness" from body changes. The factors that aided in more movement included a belief in the value of improving health for both mother and fetus, goals of decreasing stress, increasing fitness levels, have social support and having access to pregnancy-specific programs. 

“Social support was the most frequently cited interpersonal enabler of physical activity, particularly partner support and family/friend’s support.”

When pregnancy is complicated, a medical provider may tend to provide vague recommendations to err on the side of caution, and provide general information about modes of exercise such as “swim but don’t jog.” If more detailed information is desired, working with a person trained in pregnancy-related fitness and wellness may be needed. It’s always critical to follow a medical provider’s advice, yet unless that medical provider is with you when exercising, it’s unlikely you will have detailed guidelines on how hard to exercise or how to modify the activity in real time.

If body aches and pain are limiting your participation in physical activity, during or after pregnancy, find a rehabilitation provider who is trained to optimize your comfort and movement so you can stay as active as possible. The more active you are during pregnancy, the easier the transition may be from early postpartum recovery to increased physical activity.

10 Things to Know About Testicular Pain

1. Developing testicular pain might be an emergency, especially if you’ve never had it before. Go to your medical provider, walk-in clinic, or emergency room if the pain is severe. One of the potential culprits of new onset testicle pain is testicular torsion, in which the cord that travels from your lower abdomen to the scrotum is twisted. This twist, or torsion, can cut off blood supply to your testicle and that is why quick intervention is needed. Oftentimes, a simple procedure such as an ultrasound is all that is needed to find out if this is the cause.

2. Even if not an emergency, testicular pain could be an infection or a mass, so making sure that all is well can ease your mind and help keep you healthy. It is also helpful to ease your mind so that you don’t worry too much about your symptoms. Some men find that worrying increases their testicular pain, and it is possible to create testicular pain by constantly squeezing your testicles to see if there is a lump! Doing self-exams is important, but you want to avoid over-doing the checking, and always apply a gentle pressure as the testicles are sensitive structures. 

3. Getting a blow or kick to your groin is not an uncommon way to feel temporary pain in the testicles. Once the initial injury has calmed down, if pain persists, follow-up with a medical provider to make sure everything is healthy, and you will likely be advised to use conservative strategies such as a cold pack, rest, and maybe lightly compressive shorts to give a lift and support to your scrotum. 

4. Sometimes the nervous system gets a bit overactive and can tell the smooth muscles around the testicles and scrotum to pull up, and up, and up. So much so that the testicle can even retract into the lower abdomen. Although it’s not always the case, for some men this can be very painful. Learning to identify the triggers for this such as cold, stress, low back pain and then identifying strategies to avoid or alleviate this issue can be accomplished in pelvic rehabilitation.

5. Because the testicles are supplied by nerves that branch off of your spine at the level of the low back, even a bout of low back pain may be related to developing pain in the scrotal area. Don’t be surprised if your therapist wants to examine your thoracic and lumbar spine, your abdomen, pelvis, or another nearby region. Many men who sit for really long periods of time every day have symptom improvement when they include more movement and less sitting into their day.

6. While having a vasectomy often involves a simple recovery with short-term discomfort only, sometimes pain develops after this procedure. In some men, a small granuloma forms at the surgery site, or a nerve that travels along with the vas deferens gets irritated. Rehabilitation providers have a lot of techniques and tools to help you recover from this discomfort. 

7. A great way to develop new testicular pain is to start doing 300 sit-ups a day, especially if you haven’t been exercising AT ALL. I lost count of the number of men I’ve examined who decided, for some unreasonable reason, to start off a new exercise regimen with 200, 300, or maybe even 500 sit-ups per day, every day. That amount of effort on the abdominal wall can really annoy structures such as the nerves that travel from your low back to the scrotal area. Remember this when you start planning, give your body a chance to gradually adjust and remember to stretch related areas like the hip flexors. 

8. Some authors and healers have found a relationship between testicular pain and being worried about such things as your job, your marriage or relationships, and other important topics related to your emotional well-being. Fortunately, some men find relief from their pain when they are able to share with a mental health provider any worries or fears, anger that may be carried in the body. 

9. No matter where your pain is, strategies such as deep breathing, focusing on what you can do to help yourself (and them doing them), visualization, gentle movement such as walking, or even a hot bath can be helpful. Just knowing that there are providers who are trained to help recover from testicular pain can ease symptoms by providing some hope and relief. 

10. Most importantly, physical therapists and other pelvic health providers are trained to treat testicular pain, and much of the time, this treatment is simple and effective. Before you let anyone convince you to have a painful testicle removed (which might not even fix the pain!), be sure to find a pelvic health provider to sort out how your body may be influenced by all the amazing structures involved.