What's Missed at Our 6 Week Postpartum Check-Up (and How We Can Do Better for Our Moms)

Alexandra vividly remembers just how much she looked forward to that 6 week postpartum visit to her midwives office. Even though it was over a decade ago. 

She wanted to be reassured that her body was on track! She had already been to her pediatrician’s several times with her newborn and knew that her daughter's health was on track. She just couldn’t wait to hear HER body was. Did she  have diastasis recti (ab separation)? How was her perineum (she had experienced a 3rd degree tear at her daughter's birth)? How was her pelvic floor’s strength? Were the doubts she was feeling about being a new mom normal?

She had gotten rather used to seeing her midwives (she went weekly towards the end of pregnancy) that it felt like a bit of a much-needed homecoming.

She recalls that the visit lasted 10 minutes. She remember hearing she was cleared for exercise and sex. She was asked briefly about breastfeeding and given a quick postpartum depression screen and then asked about her contraception of choice. That was it.

There are so many things in between these topics that are of value to women, things that comprise our quality of life.

Becoming a mother is a sacred transition.

We need more.

While the American College of Obstetrician and Gynecologists (ACOG)’s recent update now recommends that postpartum care should be an ongoing process, rather than a single encounter and that all women have contact with their ob-gyns or other obstetric care providers within the first three weeks postpartum is a start, we need MORE.

How about better discharge instructions, better educational resources, and multiple follow-ups and check-ins? How about an actual hand-on assessment of our abdominals (checking for Diastasis recti and how we are breathing – this is crucial for stress management as a new parent) and how about actual instructions for performing kegels? Not just told to “do them!”

Even better, how about teaching women that leaking or pelvic pain is statistically common but not biologically normal. In many cases, doing kegels isn’t even appropriate for new moms. As a pelvic floor therapist, 80% of my postnatal clients definitely should NOT be doing kegels either because they are not recruiting the right muscles or because their muscles are actually too tense. Adding more tension to the picture is not going to make our pelvic floor stronger.

Here are my top 3 tips for moms (new or seasoned):

  • Spend a few moments a day connecting to your breath and pelvic floor. These are two key players in your inner core team. These are ‘quality of life’ muscles that will help you with all aspects of pelvic health. Check out my short pelvic floor meditation to get started.
  • Share the importance of perineal massage with mom friends who are expecting. I have written a ‘modern’ version of this massage that has helped so many of my clients connect to their pelvic floor and minimize tearing. Download the massage here.
  • Lastly, I wrote a 16 page booklet on how to care for your body within those first 6 weeks of life with your new baby. The booklet was inspired by discharge instructions I wished I received.

Mothers are the foundation of our families. They are the fortifiers and the bedrock. Let’s give them what they need to feel stronger from the inside out. Let’s mother the new mother so that we all can thrive for generations to come.

How To Really See If you Have Diastasis Recti (Ab Separation).

The importance of being an educated consumer of your own healthcare isn’t limited to your birth experience! Just as providers have different beliefs about the healthiest way to give birth, physical and occupational therapists may have differing opinions about the most effective way of addressing something like diastasis recti. I’m going to give you a crash course in the current research so that you know how to ask smart questions of your providers and get the help that you need.

First of all: what is diastasis recti? Your core is made up of the rectus abdominis (the abs), the linea alba (the dense band of mid-line tissue that vertically connects the abs), the internal and external obliques, and the transversus abdominis, which is the deepest core muscle layer. Diastasis recti (DR) occurs when the widening of the core muscles results in a relaxing of the linea alba – it’s no longer able to properly contract and connect all your core muscles. When there’s no integrity between these core muscles because of DR, the midline of your abs doesn’t hold tension when you gently lift your head and bring it towards your chest.

Now, everyone experiences DR to some degree in their third trimester of pregnancy because of the natural expansion of the belly. Most abdomens recover after birth, and the midline eventually closes and contracts. Some women, however, continue to experience DR in the postpartum period for as long as a year after birth. That’s where physical therapists and pelvic floor specialists come in!

Historically, rehab specialists have focused on crunches, sometimes with the belly splinted. The idea behind this approach is that the vertical gap in the middle of the abdomen will close over the course of a thousand crunches.

Thanks to advances like internal ultrasound imaging, we’re now able to actually study what happens internally and find the best, evidence-based practice. Recent research has proven what many suspected for decades: that from a functional standpoint, it’s not so much about bringing the gap back together as generating integrity and tension between the two sides of your abs. Although bringing the gap together may narrow that postpartum waistline, it’s a superficial move. A slim waist can make you feel confident, but having a functional core that saves you from urinary incontinence, pelvic organ prolapse, and lower back pain is even more of a confidence-booster!

When looking for a provider to help you rehabilitate your core, look for someone who recognizes the value of rehabilitating the deep core system in order to restore integrity: your pelvic floor, your transversus abdominis, your diaphragm, the multifidus muscles of your back. If someone wants to use crunches to focus on your obliques and rectus abdominis, which are superficial muscles, question that. You can choose to heal yourself from the inside out – and that’s the kind of healing that lasts.

Want to check to see if you have diastasis recti? Have a look at my booklet about caring for your postpartum body. You can also check out this helpful page from Diane Lee, one of the physical therapists who spearheaded the recent diastasis research. I had the honor to learn directly from Diane Lee.



Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. J Orthop Sports Phys Ther. 2016;46(7):580-589.

How To Heal Your Birth Scar

Our midwives and our ob/gyns take magnificent care of us while we are pregnant. And then we have our babies and *poof*, there are no weekly or even monthly appointments to check-in on progress anymore. No dedicated time to answer questions about our own bodies or even babies development. 

It can be a challenging transition for the best of us. As a pelvic floor therapist (and a mom!) I've thought long and hard about how we can make this transition easier on moms. How can we provide education to help answer the myriad of questions about a moms changing body?

I've created two free educational guides that I hope midwives, ob/gyns, nurses, and doulas can give women to help fill the gap of conversation and hands on care we receive postnatally. 

My two guides, "Caring For Your Back, Core, and Pelvic Floor: Your First Few Weeks Postpartum" and now "Heal Your C-section and Perineum Scar: Self Care Tips" is my attempt to bridge the gap between delivering our baby and helping expedite recovery and proper use of our bodies I order to connect to our deep core. 

I've always been perplexed about why the assessment for women post c-section stops at "it healed well; it looks good."  What about the way it feels? What about the emotional experience of how I had my baby? The low abs (where the incision occurs) goes directly through our true core (transversus abdominus) and right above our bladder and uterus. This is a part of of our body that must be able to move. Adhesions (sticky fascia that forms beneath a scar) can affect our ability to correctly use our low abs. It can also stick to the bladder and uterus (two organs that must be able to move to function well). 

After knee or hip surgery, it's standard practice to recommend rehab (which includes scar mobility). Why is this not standard for a mom who's had a c-section?

I want to change that. My latest guide "Heal Your C-section and Perineum Scar: Self Care Tips" will help start this conversation and give moms a tangible tool to help heal themselves. What we do in early days on recovery can have profound impact on our experience in our bodies for our lifetime. 

Rehearse for Birth

Have you thought about the ideal way to birth a baby? Yes, this could mean whether you want scented candles or your favorite soundtrack playing in the background. But I mean even bigger picture -- such as the universal desire for a delivery that is kind to our bodies and a robust recovery. YES! So how do we do that?

Let's begin by talking about how we actually get the baby out. Did you know that the healthiest way to birth a baby is not by using the core to push the baby out? That's the job of our powerful uterus. It knows how to contract to coax the baby out.  And baby helps too! Did you know that baby actually pushes his/her way out as well?

The job of the core and pelvic floor is to yield, open and relax to allow the baby through. This requires opening, relaxing, and letting go. That's the opposite of tightening, gripping and kegeling. The absolute opposite. 

The pelvic floor opens or relaxes for these other daily activities:

  • Peeing
  • Bowel movements
  • Penetration with intercourse. 

The pelvic floor muscles tighten, contract or kegel for the following daily activities:

  • orgasm (a rhythmic tightening and releasing)
  • continence (keeping urine and bowel movements in)
  • supporting our internal organs. 

When preparing for your birth, whether you participate in a birth class, take yoga or are an avid spin class attendee, remember that tension and tightening our pelvic floors is not what helps our babies out. 

Instead, focus on opening and relaxing your pelvic floor (perhaps next time you use the bathroom -- ask yourself how do I pee? Do I contract or squeeze out my pee or do I let it go? ) Just as many people contract or squeeze to pee (which actually discourages complete elimination), many people tighten or close their pelvic floors in birth.  So I suggest practicing with daily activities as a form of rehearsal for your pelvic floor for the big day. 

Yes, birth is a one time event, but it's implications on the body (and mind!) are enormous. 

Mental rehearsal can be so helpful. Yes, our bodies know how to birth our babies but we all know that practicing for an athletic event is always a good idea. 

Why is Estrogen, Testosterone & Progesterone Important During Pregnancy?

We hear so much about hormones during pregnancy - when I was suddenly hot natured instead of my usual cold self, my best friend said, "it's hormones." When I ate an entire chocolate cake (true story), my mom said, "it's your hormones."  What the heck? What are these mysterious hormones and what else are they doing to my body during pregnancy? Here's an overview of 3 big ones: Estrogen, Testosterone, and Progesterone.


Let’s talk about estrogen. Not just what you learned in high school biology, but how it affects your day-to-day life after you’ve had a baby.

Right after you give birth, the levels of estrogen and progesterone in your body dramatically drop. This is good news if you’re breastfeeding, as that drop allows a hormone called prolactin to be released, and it maintains your milk production. If you continue to breastfeed, your levels of prolactin will stay elevated and prevent you from ovulating. No ovulation means: low estrogen.

So, what does estrogen actually do for us? So what if it’s low? Well besides playing a significant role in the menstrual cycle, estrogen promotes blood flow and lubrication to the vagina/vulva, and it keeps vaginal tissue elastic and supple. If I didn’t have your attention before, I’m guessing I do now!

As women, our bodies go through tremendous changes across our lifespan. The drop-in estrogen that we experience after childbirth mimics the drop-in estrogen brought on by menopause. So in learning how to best take care of yourself after giving birth – how to care for your skin when it’s more fragile, how to moisturize the sensitive tissue of your vulva – you are getting ahead of the curve and learning how to care for yourself down the line. It’s a blueprint for the future.

I emphasize the importance of using moisturizer on the vulva (something pure like coconut oil or Vitamin E) and silicon or water-based lube during sex with every one of my female clients, but especially with new moms, perimenopausal, and menopausal women. Our skin is extra grateful to have a little buffer during those periods in life. This is important from a pelvic floor therapist’s perspective because if you’re experiencing pain during sex due to dryness, your muscles will be more prone to clench up. Comfortable skin opens us up to deeper relaxation – which, incidentally, leads to better orgasms.

A quick note about what you’re putting on your skin: choose wisely! The tissue of your vulva and vagina is the most sensitive tissue of your body – and it’s incredibly absorbent. It’s so important that we all choose vaginal products that are free from unnatural chemicals and mystery ingredients (which can lead to yeast infections and UTIs to boot).

Here are some of the lubricants that I most often recommend to my clients:

1.  Water-Based: (Safe with condoems; important that it’s PH balanced due to osmolarity) Pjur

2. Silicon-Based: Sliquid Silver


I’m going to dive right in here and let you in on a little secret. Let’s talk about your libido and your body’s sexual response. When you’re aroused, your tissues plump up and your clitoris and nipples become more sensitive. This in turn increases your partner’s pull towards you, as these bodily changes signal that you’re ready for action. Guess which hormone is behind these amazing changes in your body and your libido levels? Testosterone.

Say what?! We hear about estrogen and the ways in which that hormone affects us at various stages of life, so it’s about time we shed some light on the helpful role of testosterone for women. In fact, testosterone actually plays a key role in our body’s ability to produce estrogen. “The concept that one is male and one is female is completely incorrect,” says Dr. Irwin Goldstein, who has researched sexual function since the late ‘70s. Pretty amazing, right? We have testosterone to thank for one of the most vibrant parts of our physical experience.

As a pelvic floor therapist, I got interested in the role of testosterone in women’s health when I began to encounter clients who either over- or under-produce the hormone. You see, whereas estrogen affects the mucous membrane, testosterone works on tissues and muscles beneath the surface. This means that it may be a part of the puzzle when it comes to physical therapy and healing in the pelvic area.

Why am I telling you this? Because knowledge is empowering; it helps us to take ownership of our bodies and our experiences. Plus, who doesn’t need a healthy dose of wonder about the intricacies of our feminine biology! So next time you see a group of men trying to outdo each other at the gym, you can smile to yourself and know that you are – happily – in the testosterone club.

[Not sure if incorporating this paragraph would kill the mood, as it were - ha ha!]

I’m always a proponent of empowering women to know more about their bodies. But I’m particularly intent on getting this information out there because of how many women take a daily medication that significantly decreases testosterone levels: the pill. (This is why oral contraceptives are so effective in reducing acne!) Menopause also reduces our testosterone production, causing it to drop to half of its peak level.

For the geeks, here's more resources:







Meet a helpful hormone who doesn’t get a lot of press: progesterone. “That has something to do with periods, right?” Yes – and so much more!

Progesterone, which is made in our ovaries and adrenal glands, prepares the uterus’ lining for a baby each month. Essentially, it preps the guest room in your body for a visitor. If you do happen to have a little someone set up camp, progesterone then steps into the important role of suppressing further ovulation and cheering on milk-producing glands.

This gives you a hint as to why progesterone is also helpful for women who don’t want to have children: artificial progesterone (aka progestin) in birth control pills prevents the body from ovulating.

As recently as January of 2017, exciting new research has shown a link between progesterone and repeated miscarriage. Remember the effect the hormone has on your uterine lining each month? By giving women additional progesterone, it seems we may be able to create an internal environment that’s better able to hold and nourish an embryo in the first eight weeks of pregnancy (before the mother’s blood takes over the job of feeding). If you’ve had two or more miscarriages in your first trimester of pregnancy, talk to your doctor about progesterone and how it might help.


For the geeks, here's more resources:



The Female Body, Aroused.

Promoting healthy sexual functioning is a big part of my practice, as the pelvic floor muscles play a key role in our sexual experience. There are so many changes that occur in your body as it prepares for sex – and not all of them are obvious! If you’re interested in a little adult sex ed, read on.

Before we go further, let’s clarify something. Colloquially, we say vagina – but we’re actually referring to the vulva. The vulva is the external sex organ, and that includes the labia minora and majora, the clitoris, and the vaginal opening. The vagina is the muscular canal leading from the vulva to the cervix (the “neck” at the base of the uterus). Side note: it’s interesting to consider the implications of the language we use to describe female anatomy in America– we fail to name the part that typically provides the most pleasure to women!

So what happens to the vagina and vulva when the female body becomes aroused?  Blood-flow to the genital area increases, warming the skin and leading to swelling of the clitoris, labia minora, and vagina. What many don’t realize is that the clitoris’ full structure is much more expansive than what you see externally. Just like a penis, the full structure of the clitoris gets erect when a woman is aroused. And the coolest part? This little organ’s only function is pleasure. 

Here’s another thing you might not know about your body: as you become aroused, your uterus elevates and grows in size. As this happens, the top of the vaginal canal actually expands, creating room for a full-sized penis. Wow! Breast size also increases slightly, and the muscle that surrounds the vaginal opening becomes tighter. Bodies are pretty amazing, right?

Female lubrication also prepares us for penetrative sex with a partner, but that lubrication builds over time as we become more aroused. It isn’t instantaneous. Life changes that affect our hormone levels (such as breastfeeding and menopause) also have an impact on the natural lubrication process. With all my female clients, I emphasize the importance of using lubrication to protect the delicate skin of the vulva. Topical discomfort or pain during sex naturally provokes a tensing of the muscles, which can cause deeper pain for those who have overactive pelvic floor muscles – that is, many of us!

There are a few different theories about the process of the female sexual response. Some say it’s linear, some say it’s circular, and some say it’s neither. See for yourself what the various response models are and which best describes your own body. And whatever it may be, take a moment to appreciate all the nuances of the female body!

So, what's the take away from this fascinating female anatomy lesson?

  • Breastfeeding mom, not getting much sleep? Take it slow and use healthy lube to provide the moisture your body isn't producing much of these days.
  • Explore non-penetrative sex to increase arousal and allow the uterus to elevate to make room for your partner.
  • Take advantage of the morning hours when you may be more well-rested.
  • Good communication with your partner (sharing this article, anyone!) to help them better understand the physiological changes that impact arousal.

To read more, check these pages out:

Good Sex
Female Sexual Response
Female Body

Meet Your Bladder

There are a number of basic body functions that we do in life without much reflection: we breathe, we sleep, we pee. Let’s talk about that last one. How much do you really know about how your bladder works?

Your bladder is actually pretty awesome. This grapefruit-sized organ can expand significantly as you hydrate throughout the day, functioning as a little storage vessel so that we can delay urination. Just as we have a sphincter muscle in the rear, the base of your bladder has a sphincter muscle as well. It’s relaxing this muscle that allows us to pee.

Now, this is something to think about when you’re hovering above a toilet seat. Fully voiding your bladder is important for the health of your urinary tract, as emptying your bladder flushes out bacteria that might hang around and cause a UTI. In my practice, I recommend that clients sit and consciously relax their muscles while voiding through diaphragmatic breathing, which encourages our pelvic floor muscles to relax. (Ask me if you need help with diaphragm breathing!)

If frequent UTIs are a problem for you, hydrate, hydrate, hydrate! Not drinking enough water will cause your urine to be more concentrated, and this irritates the lining of the bladder. You might also try a supplement called D-Mannose, which is a natural sugar that absorbs very slowly into the body (and therefore doesn’t have any adverse side effects, even for diabetics). D-Mannose attaches to E-Coli bacteria, the most common cause of UTIs, and allows them to stick to each other instead of to the lining of your bladder. Our bodies are pretty amazing, huh?

To Read More, check out these sites:


2017 and Self Care...

It’s January again – that time of year when we all get a fresh start and the gym is totally crowded. But how about some self-care resolutions that you can incorporate into your life without taking time away from your busy schedule? Here are four resolutions that will change your pelvic floor’s life for the better:

1. We all know that babies’ sensitive skin needs the protection of moisturizer from time to time. So does yours! Grab something pure like coconut oil or Vitamin E, apply it to your labia before bed a few times a week, and let that sensitive tissue get some beauty rest. (Don’t forget to use moisturizer before sex, too! I have a great resource guide for why you would pick 1 of the 3 main types of lubricant -- email me and I'll send it to you!)

2. Incorporate one stretch into your routine. Yes, I would love to see you incorporating even more, but this is a place to start. Hip openers can release tension in the pelvis and in deep muscles that may contribute to pelvic pain, which can be especially helpful for those of you who sit all day. Rodney Yee demonstrates three different stretches in this three minute video. Incorporate these stretches into your routine: baby’s tummy time can be mom’s hip-opening time!

3. Commit to drinking more water and eating more fiber. Finding a water bottle that you love and make it easy! Hydration helps keep your skin healthy, your muscles mobile, and your urinary tract happy. (Less water = concentrated pee, which can be irritating for your system.) So where does the fiber come in? Getting 25-27 grams of fiber per day will help you pass bowel movements more regularly and more easily, which is critical for your pelvic floor. You can even track your fiber intake through the app My Fitness Pal. And this leads us to…

4. Poop better. You can start by propping your legs up. Sound strange? Well, imagine how we were designed to live in nature. Squatting actually allows the angle at the base of your rectum to open up, leading to more complete elimination that doesn’t require straining. Using books, a stool, or a squatty potty will help you do this. We’re raised in a culture in which “girls don’t fart” or “women don’t poop,” which may lead us to do our business quickly instead of, say, luxuriating on the porcelain throne. But the best thing you can do for your pelvic floor is to let those muscles fully relax instead of straining to have a bowel movement. So treat yourself! Grab a book, your iPad, a crossword, and take your time!

But Emotion Does Control Intensity: Let's Apply This to Pelvic Pain!

Pain Really Is All in Your Head and Emotion Controls Intensity” is the title of a new book by David Linden, professor of neuroscience at Johns Hopkins University. This title has created some controversy.  This phrase “it’s all in your head” has been used historically in an attempt to explain (or possibly dismiss) explainable symptoms.  For example, you've been through a battery of specialists and tests that yield no explanation for your condition. However, Linden’s book, despite its title, really does give credence to this explainable pain. Perhaps a more fitting title could have been, “Pain Really Is All in Your Head and It’s Real. But Emotion Does Control Intensity.”

Chronic pain has gotten even more press recently with the movie Cake with Jennifer Aniston.

The reason I am talking about this topic as pelvic floor therapist is because a lot of my clients experience pelvic pain. And they have been to specialist after specialist and none of the tests have provided any clarify as to WHY they are experiencing pain “down there.” It’s not a UTI, it’s not bladder stones, and it’s not IBS. We hear a long list of what it ISN’T. Then what IS it?

By the time I finally see my clients, the answer to this question is what they so badly want to know. They are exhausted from the feeling of not being understood and not getting the clarity of a diagnosis for what they are experiencing. Could it all be in their head?

The role of emotion, as Linden’s book states, comes strongly into play here.

‘"The brain can say turn up the volume on this pain information that's coming in.' Or it can say, 'let's turn down the volume on that and pay less attention to it.

The brain also determines the emotion we attach to each painful experience. One system determines the pain's location, intensity and characteristics: stabbing, aching, burning, etc”

"And then," Linden says, "there is a completely separate system for the emotional aspect of pain — the part that makes us say, “This is terrible."

Linden says positive emotions like feeling calm and safe can minimize pain. However, negative emotions tend to have the opposite effect.

This is powerful! The descriptive category that we place our understanding of pain can ultimately determine our experience of it.

Share this with laboring women everywhere! Share this with anyone experiencing “explainable, undiagnosable” pain.

The emotion we use to process our experience does have its influence over us. This is empowering; there’s an aspect to the “unexplainable” that we can control!

Product Junkie: A Review of the “Travel John” Disposable Urinal

Genius. I love this idea. It’s a disposable urinal (for men AND women!) that enables you to urinate anywhere. The plastic collar makes it unisex. There is a gel inside the container that absorbs the urine, making it spill proof and odorless. Sort of like cat litter. All kidding aside, this really is awesome.

Campers, distance drivers, and tailer gaiters all have voiced their love of the product. In the pelvic health world, this product has brought comfort to those who prefer not to sit on public toilet seats. It also brings people reassurance who aren’t sure where they may find their next restroom (sound familiar New Yorkers?)

5 (actually good) Caffeine-Free Options

As a pelvic floor therapist, I spend time talking about the importance of being hydrated. Water influences not only elimination (both urination and defecation) but also helps other vital body functions such as transportation of nutrients in the body. We are composed of approximately 70 percent of water and nearly every aspect of our body's function calls for it.

As a mom of two kids under age 3, I love my fair share of coffee. However, when I find myself grabbing java excessively, I notice I drink less hydrating beverages throughout the day. Coffee seems to be my go-to beverage for the majority of the morning, and then becomes my excuse for that need for an “afternoon pick-me-up.” Pretty soon, I notice that I hardly drank any water and its dinner time. Think I have any time to drink any water at that “magical hour” for toddlers?!

One of the biggest problems for people (such as myself) who drink high volumes of coffee is that we eventually replace water as the daily form of hydration, as I’ve described above. And coffee is a diuretic. So excessive amounts of coffee can actually negatively influence the water balance in the body. 

I’ve compiled a list of my favorite caffeine alternatives below. Especially in the winter, having a warm beverage is soothing so I’ve tried to focus on warm drinks. An added plus is that a warm beverage in the morning can help elicit your gastro-colic reflex, which basically means it encourages you to poop in the morning, as our bodies naturally want to do.

Drink up! Here’s my list: 

  1. Warm lemon water

I know, I know, this is not anything like coffee. But There are so many studies that tout the benefits of lemon water. It’s high in vitamin C, postassium and aids digestion. Read more here.

      2. Teeccino Herbal Coffee, Mediterranean Java, Caffeine-Free

This tasty beverage is sweetened from dates and figs. It’s rich in inulin, a soluble fiber in chicory root that helps improve digestion and elimination plus increases the absorption of calcium and minerals.

      3. Peppermint Tea

One of my personal favorite caffeine replacements. It has no caffeine but peppermint tea has an invigorating energy to it that is perhaps more subtle, but very soothing.

Peppermint tea is a powerful digestive aid, especially for bloating and stomach gas.

     4. Chicory Root Coffee

This is an herbal coffee substitute that tastes like real coffee with no caffeine. Brews like coffee, drinks like coffee, without the edge and side effects of caffeine. It has roasted barley, chicory root, and rye.

     5. Cashew Milk

Soak 1 handful of raw cashew nuts overnight (or for a few hours) and rinse them carefully. Infuse about a mug of boiling water with your milk (dairy, almond, soy). Blend your cashews, your milk of choice and a pinch of cinnamon.

5 New Years Resolutions for Your Privates

A time for renewal. New Years. 2015. You've just opened the first page of a promising new book. You have a bucket list of things you'd like to accomplish this year. This time you're gonna commit, right? Right!

I'm gonna make it simple for you. 5 things. 5 simple things you can start on Thursday, January 1 to be kinder to your pelvis.

1. Use moisturizer for your private parts. Yes, your vay-jay is sensitive. Just like the skin on your face which you moisturize daily, you should be moisturizing your vagina a few times a week. Something pure like coconut oil or vit E. Put it on before bed, pull up your underwear and wake up refreshed. Also, don't forget to use moisturizer before sex. These tissues need TLC.

2. Prop your legs up when you poop. Use something like old phone books, a trash can on it's side or even the squatty potty. Basically, you need to re-create the angle (squatting) that makes defecation easier on your body. Sound fascinating? Read more at A Proper Way to Poop?! Tell Me More!.

3. One Stretch. Of course I would love to see you do more than one stretch. But if I had to be a realist and provide one essential stretch for those of us who sit all day, try a hip opener. I love hip openers because they help release tension in the pelvis and the deep muscles that can contribute to pelvic pain. Watch Rodney Yee's 3 minute video... he demonstrates 3 different ones.

4. Fiber and water. Get 25-35 grams of fiber a day. Drink at least 50% of your body weight in ounces. And make it all water. The right amount of fiber helps your poop have the right consistency, which means less strain on the pelvic floor as it leaves your body. Water has a similar role in aiding elimination and also helps to hydrate the delicate tissues of your privates.

5. Sleep. Who doesn't desire more rest? Here's a suggestion you may not have tried: a meditation app. I've recently discovered headspace - an app that guides you through 10 minutes of meditation a day. This app doesn't over complicate it. There is no requirements to sit cross-legged on the floor. The idea is to give you more 'headspace' through unwinding. And the founder lived as a monk for 10 years and has a dashing British accent. Bonus: sleep helps heal the whole body, and of course the pelvic floor reaps the benefits, too. If you're constipated, experience pelvic pain or have trouble getting all of your urine out, taking time out to relax and unwind the muscular tightness will help.

Cheers to 2015!


Elongation of the Pelvic Floor? Why Would I Want It?

Range of Motion. We hear the term tossed around at our local gyms and therapy offices. But how does it relate to the pelvic floor?

Just like any other muscle in the body, the pelvic floor must be able to move through flexion (pulling up and in or "Kegeling") and extension (opening and elongating). These two ranges of motion give us healthy movement and optimum function. We need to be able to flex our pelvic floor so that we can stop gas or to not pee or have a bowel movement. We need to be able to extend our pelvic floor muscles so that we can completely eliminate our pee and poop and birth a baby. Fulling appreciating intercourse is the ultimate example of being able to participate in both flexion and extension.

I often hear "am I pulling up or pushing out?" from my clients. It may be hard to figure out which way you are moving the first few times you try. A pelvic floor therapist can help you discriminate this movement.

For those stuck in flexion, you may:

  • Find intercourse uncomfortable
  • Feel like you haven't completely eliminated after your bowel movement
  • Feel like you pee frequently or incompletely

For those of you stuck in extension, you may:

  • Not be able to control the passing of gas
  • Not be able to control the passing of pee or poop
  • Intercourse may not have the same sensation it used to
  • Tampons may feel like they "don't fit'

What can we do about improving our ability to participate in full range of motion? A pelvic floor therapist has many tricks of the trade to address this. However, I find visual imagery helpful as a way to help enhance the pelvic floor's mobility.

For the flexion junkies (you need extension. Here's a way to picture it):

  • Imagine a cold pat of butter striking a hot frying pan. Picture how the edges soften and spread out as it melts. 

For the extension-oholics (you need flexion. Here's a way to picture it)

  • Imagine fluid being pulling up through a straw.

It's vital for comfortable movement to have all our muscles being able to participate in their full range of motion. I just happen to think that having it apply to the pelvic floor is a little more fascinating than just your bicep :)






Product Junkie: A Review of Dear Kates Underwear

The idea is brilliant -- beautiful, comfortable underwear that has built-in protection against leaks. Over the years, I have had several of my clients try Dear Kates and then rave about them. So of course, I had to do my own research!

I read about the founder, Julie Sygiel, and even had the opportunity to meet her since she is based in NYC. I was dazzled by her background: a chemical engineer who is the creator behind this lovely concept. As many of you know, pelvic floor rehab is also my second career; my first career was in communications & writing.  I am often asked how I got into therapy from a liberal arts background so I loved meeting a successful female entrepreneur who appeared to have reinvented herself as well.

I watched the youtube video on the Dear Kate website. I loved that not only the inner layer is wicking but that the outer layer is water repellent. This means no stains on your clothes! There are many colors and styles to select from, and she has even developed a yoga pants line with built-in protection. Amazing.

As an occupational therapist, I love the idea that adaptive equipment, or supportive measures can be used while we are working hard through the rehab process. Evidence shows that pelvic floor rehab can take 7 weeks (of daily work) for our hard work to pay off. Why not be more comfortable along the process? These underwear may replace (or complement) the pads you may be wearing to help with your incontinence.

The underwear (TMI: I'm wearing them now!) truly are incredibly comfortable and breathable. And capable of holding up to 1 tbsp of fluid. These underwear personify femininity, redefined as functional!





Reduce the Strain of the Sag

“Brilliantly lit from stem to stern, she looked like a sagging birthday cake”

The inspiration for this blog is a quote by Walter Lord. I thought that it captured the concepts of aging beauty well. We grow into our 30's, 40's and beyond perhaps still brilliant and beautiful but the basics aging facts remain the same: our faces, bellies and breasts start to sag.  What can be less easy to see is that our internal organs sag, too. And as us mothers know, the bladder and uterus are especially vulnerable after the strain of childbirth. 

There is a booming business to slow down the aging process -- creams, tinctures, tonics, diets, vitamins, you name it...the list grows by the second -- all in the pursuit to not sag.

When internal organs sag (loosely put, prolapse), incontinence can occur. Incontinence is a battle won by gravity and the weakness of muscular/supportive structures.

A recent patient of mine who has fecal incontinence told me she had such a challenge in finding the right doctor who could identify her problem and provide a solution.  A solution she was willing to accept. She finally found pelvic floor therapy (shameless advertising: she found the Functional Pelvis)! 

Here was an option for her she could accept: conservative, non-invasive treatment. Yes, she had to do the work -- and the work (exercises/behavioral management) had to be done daily. But she was not interested in a magic tonic to fix her. She wanted to own the work, she wanted to feel empowered by her follow-through and the results that ensued.

She learned postural exercises that helped her alignment and body carriage. She learned in a concrete way how the foods and beverages she was consuming affected her elimination. And she learned how to recruit her core muscles (of which the pelvic floor is a part of) in order to reduce the strain of the sag. Her pelvic organs (and perhaps face, belly, and breasts) did still sag. But she learned how direct choices she made (diet, posture, body positioning) influenced the sag. And that she could do something to influence it for better or worse.

Life happens. Sag happens. But you can learn ways to reduce the strain and empower yourself. You can be brilliantly lit from stem to stern, and still find ways to be a functional and strong (and lovely) sagging birthday cake.  

Pelvic Floor Disorders "Break Free" Events Hosted Nationally in November

In honor of Bladder Week, the Pelvic Floor Disorder (PFD) Alliance is presenting, "Break Free From PFDs." Local Events will be held in locations across the county to further educate women. The pelvic health topics that will be discussed include: prolapse, incontinence, and other pelvic floor disorders. The events can give women the knowledge and confidence they need to evaluate their own pelvic health and address pelvic health issues with their physicians.

There are events scheduled nationally. Please visit the PFD Website to see if there is any event occurring in your neighborhood. 

Locally, here in NYC, Mt Sinai is hosting the event on November 13 at 4 pm. Address is the  Kilingenstein Pavilion at 1176 5th Ave, 9th Floor. 

How Breathing Can Help Strengthen Your Core

How is breathing important for core strength? The diaphragm (which plays an important role in breathing) is part of the deep core muscles that help us stabilize and regulate pressure in our body. The deep core muscles work together synergistically to provide a foundation from which we can move fluidly. This includes the pelvic floor. Yes, the pelvic floor is a part of our core! And most importantly, we can use our breath to activate our deep core stabilizing muscles, thereby protecting our pelvic floor.

Exhaling to Feel the Core

Try something for me. Put your hands on your belly, a few inches away from your belly button and a bit lower than the belly button.  Keep your fingers firmly in this spot.  Take an inhale, and then exhale and "SHHH" loudly as if you are telling someone in a crowded library to be quiet.

Do you feel a depression of the muscles, especially at the end of the exhale? This exhale will elicit core tightness and a lifting of the pelvic floor muscles. Once you can learn to activate and engage these lower abdominal muscles, you can use them throughout your day to help stabilize and support your body. I often tell my clients to tighten these core muscles before they stand up from a sitting position. This simple act of engaging these supportive muscles as we transfer out of our chairs can not only support our lower back back but help to reduce pressure on our pelvic floor. 



I've Had A Baby, Now Sex Hurts

A patient of mine, Ms. L, had a baby 6 months ago. Her doctor had given her the "OK" to have intercourse with her husband again several months prior. However, they have not been able to do so. She reported pain when they attempted intercourse and she could not figure out why. She wondered if sex was always going to feel this way.

Intercourse is supposed to be a pleasurable experience. However, when sex becomes painful it can seem impossible that it will ever feel good again. There are several potential causes of pain with intercourse, and often a women’s health therapist can offer help to return you to pain-free enjoyable sex! 

There are several reasons why sex could hurt after having a baby. Let's examine them further.

Episiotomy and/or abdominal incisions that may cause scars

  • Scars that bind down can make tissues less flexible and painful
  • Women may feel as if tissue is tearing with insertion into vagina
  • Having a bowel movement can even feel painful

Vulvodynia or Vestibulodynia 

This is an irritation of the tissues of the perineum. The cause of pain is from the muscles surrounding the vagina and rectum may become painful as a result of this irritation.

Vaginismus, Levator Ani Syndrome

This is tightening or a spasm of the muscles around the vagina and/or rectum.

  • Often times it can feel like penetration is not even possible. It is often described as your partner is hitting a “closed door."
  • Vaginismus can vary from mild discomfort with intercourse to the man being unable to enter because of pain and spasm.
  • Suggested reading on vaginismus:  "Woman’s Experience of Sex" by Sheila Kitzinger. Ms. Kitzinger is a nurse/midwife and the mother of five daughters. Another good book is "A Woman’s Guide to Overcoming Sexual Fear and Pain" by Goodwin and Agroni.

How Can a Women's Pelvic Health Therapist Help?

We are specially trained therapists that can conservatively rehab the muscles of your pelvic floor. We educate you on ways to relax the pelvic floor muscles, regaining their full ability to move through a healthy range of motion again. We will also help you strengthen your core muscles to take some of the burden off of the pelvic floor. We will also examine proper body mechanics in caring for baby (lifting them up, changing them, etc) so as to not exacerbate the pain and weakness. In France, woman are referred to pelvic floor therapy automatically after having a baby -- how brilliant! As Claire Lundberg so eloquently shares, “Two months after our daughter was born, I summoned the courage to teach my vagina some new tricks.”

Why not teach your vagina some new tricks -- contact your pelvic floor therapist today!

What is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the normal support of the vagina is lost, resulting in dropping of the bladder, urethra, cervix and/or rectum. It may be considered a type of hernia in which the pelvic organs descend or shift within the pelvis, and can then protrude outside the vagina. 

It is difficult to gauge exactly how many women are affected by this condition, because many of them do not ever seek medical treatment. Latest research shows that an estimated 3.3 million woman in the US have pelvic organ prolapse. It is estimated that nearly 50% of all women between the ages of 50 and 79 have some form of prolapse. By age 80, more than 1 in every 10 women will have undergone surgery for prolapse.

What Causes This?

Pelvic support comes from pelvic floor muscles and connective tissue and ligaments. When pelvic floor muscles are weakened, the connective tissue and ligaments have to provide the majority of the support. This can lead to further weakness and ultimately allowing pelvic organs to drop and press into the vaginal wall. Other risk factors include:

  • Pelvic Floor Injury: Vaginal delivery, Surgery, Pelvic radiation, back/pelvic fractures, Hysterectomy
  • Chronic Straining with Bowel Movements
  • Smoking
  • Chronic Coughing
  • Repetitive Heavy Lifting
  • Obesity

Pregnancy & Prolapse

Changes in connective tissue during pregnancy, pressure and weight of the uterus on the pelvic floor, weight gain of the mother, trauma to the pelvic floor during vaginal delivery, abdominal straining during labor and ensuing nerve damage all promote prolapse.


The first symptoms are often subtle, such as an inability to keep a tampon inside the vagina, some incontinence, or discomfort during intercourse. 

Signs of worsening symptoms include:

  • A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements 
  • Feeling of incomplete emptying during bowel movements 
  • Difficulty starting to urinate 
  • Urinary frequency

The Four Main Types of Prolapse

  • Cyctocele: The wall between the bladder and vagina weakens. The bladder falls down in to the vaginal cavity.

  • Uterine Prolapse: The uterine wall slides down into the vagina.

  • Rectocele: Part of the rectal wall may protrude into the vagina

  • Enterocele: Small bowel herniates into the vaginal wall. Usually occurs in women who have had a hysterectomy.

Conservative Treatment Options

Pelvic health rehab, a conservative treatment option, can be a first option for pelvic organ prolapse. Pelvic health rehab is most effective in early stages of pelvic organ prolapse. 

Treatment interventions may include:

  • Muscle re-education and strengthening
  • Functional activities of daily living alternatives
  • Bowel and bladder training
  • Postural education
  • Soft tissue mobilization
  • Biofeedback

For more information on preventing pelvic organ prolapse visit the Voice for Pelvic Floor Disorders web site.


Product Junkie: A Review of The Squatty Potty

After writing the "Proper Way to Poop" blog entry, I was asked about simple ways to elevate the legs to mimic squatting. I often mention putting a trash can on its side, using a stool,  or even a stack of old phone books as a way to get the legs elevated into a good squat position when pooping. These items are all pretty narrow though.

Why does a stool being too narrow matter?

We don't just want the legs up in a squat-like position to open the anorectal angle, we want the legs relaxed out to the sides  - the floppier the better! This is because the hips need to also be relaxed in order for the pelvic floor muscles to relax. Letting the legs fall out to the sides helps accomplish this. All of the accessory muscles that attach into the pelvic floor can either create tension or enhance relaxation. So let's set ourselves up for success by relaxing the best we can.

A product that can help facilitate these concepts is the Squatty Potty. It has a smart design for the following reasons:

  1. It has a horse-shoe shape enabling the legs to fall out to the sides, helping the hips to relax (it's not narrow like a standard stool)
  2. It comes in two heights (7" and 9") to fit both standard and elevated toilet heights
  3. It can be discretely placed underneath the toilet and out of the way due to its shape.

So get your legs elevated, hips relaxed and let that pelvic floor elongate for a full evacuation of your bowels. Happy pooping!