Five Bullet Friday: Women’s Health January 31, 2020

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Happy Friday!

Today’s Five Bullet Friday:

1. Is it Time We Started Treating Endometriosis as if it Were Cancer?

2. The First Road-map for Ovarian Aging

3. How do you Explain to Someone How Muscle Imbalances Can Lead to Acute, Unexpected Pain?

4. Exercise has the Same Effect on the Brain as Coffee

5. Patient HANDOUT: All About Pessaries

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

1. Is it Time to Treat Endometriosis as if it were Cancer? 
In an article published in the Journal of Obstetrics and Gynaecology Canada just this week, authors Matthew Leonardo and colleagues proposed that we need to have a shift in our mindset when it comes to the field of endometriosis.
Leonardo and colleagues discussed how since the establishment of gynaecological oncology as a sub specialty, outcomes for patients with ovarian cancer has very much improved, likely by the care managed by multidisciplinary teams in specialized units. Leonardo advocates that we now do something similar in the field of endometriosis. He advocates that we recognize complex benign gynaecology (that would include endometriosis) as a subspecialty.
By recognizing this subspecialty and managing care of women with endometriosis by a multidisciplinary team of dedicated and specialized health professionals, Leonardo and team expect there will be improved outcomes, including improved quality of life, for people living with endometriosis.
 
Ref: Mathew Leonardi, Alan Lam, Mauricio S. Abrão, Neil P. Johnson, George Condous, Ignored Because It Is Benign – It Is Time to Treat Endometriosis as if It Were Cancer, Journal of Obstetrics and Gynaecology Canada, 2020, https://doi.org/10.1016/j.jogc.2019.12.014
2. The First Road-map for Ovarian Aging
Read an exciting new summary of research just published today on the discovery of how non-human primate ovaries age, with implications for human fertility:
“Infertility likely stems from age-related decline of the ovaries, but the molecular mechanisms that lead to this decline have been unclear. Now, scientists have discovered, in unprecedented detail, how ovaries age in non-human primates. The findings reveal several genes that could be used as biomarkers and point to therapeutic targets for diagnosing and treating female infertility and age-associated ovarian diseases, such as ovarian cancer, in humans.”
Read more of this exciting new research at the reference below!
 
Ref: Si Wang, Yuxuan Zheng, Jingyi Li, Yang Yu, Weiqi Zhang, Moshi Song, Zunpeng Liu, Zheying Min, Huifang Hu, Ying Jing, Xiaojuan He, Liang Sun, Lifang Ma, Concepcion Rodriguez Esteban, Piu Chan, Jie Qiao, Qi Zhou, Juan Carlos Izpisua Belmonte, Jing Qu, Fuchou Tang, Guang-Hui Liu. Single-Cell Transcriptomic Atlas of Primate Ovarian Aging. Cell, 2020; DOI: 10.1016/j.cell.2020.01.009
 
3. How do you Explain to Someone How Muscle Imbalances Can Lead to Acute, Unexpected Pain?
As a physiotherapist I oftentimes will see people who have a new onset pain that is related to a loner standing imbalance somewhere in their body. This can sometimes be difficult for people to understand: if they’ve had an imbalance for some time, why is it that all of a sudden there is pain without an appreciable event/injury that happened?
This is where I love to use the analogy of “the lazy man on the assembly line”.
Check out one of my articles here for the full analogy and how you can explain it to your patients!
4. Exercise has the Same Effect on the Brain as Coffee
A new study which was published in Nature Scientific Reports determined that just 20 minutes of exercises is as good as a coffee for your working memory.
In this study, researchers investigated the difference between caffeine and exercise when it came to working memory. What they found was the results were quite similar, but that overall exercise was better because not only were improvements in working memory similar after doing 20 minutes of exercise as compared to consuming a serving of caffeine, but exercise didn’t lead to the side effects of caffeine, or caffeine withdrawal.
Authors also note that if people are ever experiencing caffeine withdrawal, simply taking a brief, brisk walk will help reduce symptoms!
So, instead of (or maybe in addition to!) reaching for that cup of coffee in the morning, ensuring you get 20 minutes of exercise first thing can make a big difference in your memory and overall health!
Ref: Morava, A., Fagan, M.J. & Prapavessis, H. Effects of Caffeine and Acute Aerobic Exercise on Working Memory and Caffeine Withdrawal. Sci Rep 9, 19644 (2019). https://doi.org/10.1038/s41598-019-56251-y
5. Patient HANDOUT: All About Pessaries
 
Find a quick, concise and useful handout talking about what pessaries are and their role in the handout attached to this email!

Five Bullet Friday: Women’s Health January 26, 2020

NB** Sorry friends – I emailed this out on Friday but forgot to post it here… enjoy!

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Happy Friday!

Today’s Five Bullet Friday:

1. Are Women Getting Incorrect Treatment When it Comes to Their Heart?

2. Why Can’t We Talk About Periods?

3. Patient HANDOUT: Common Food & Drink That Can Worsen Incontinence

4. Our Biological Clock Plays a Crucial Role in Healing from Surgery

5. Teens with Obesity & PCOS Have More ‘Unhealthy’ Bacteria

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

1. Are Women Getting Incorrect Treatment When it Comes to Their Heart?
A paper published recently in Nature Medicine showed that many cardio-metabolic disorders, such as diabetes, heart disease, and stroke, are alarmingly difficulty to successfully treat in women.
Author, Professor Eva Gerdts believes health services are not considering the biological differences between men and women when treating heart disease. She explains “men and women have different biologies, and this results in different types of the same heart diseases. It is about time to recognize these differences.”
According to their study, authors of this paper found that women are more at risk of receiving the wrong treatment because health service professionals fail to spot symptoms or risk factors that are unique to women.
What were these risk factors and symptoms the authors were talking about, exactly?
Obesity was one – as women and men store fat differently and the mechanisms behind this process being different in women creates an increased risk of type 2 diabetes and heart disease. After obesity, the authors spoke of the benefits of estrogen women have in impeding metabolic syndrome, but how this changes during menopause when estrogen decreases. Researchers also talked about the different lifestyle risks women experience, all of which can be read at the reference below.
Prof. Gerdts hopes that her research will incite action among the medical community and lead to future research to discover the best way to treat heart disease in women.
 
Ref: Gerdts, E., Regitz-Zagrosek, V. Sex differences in cardiometabolic disorders. Nat Med 25, 1657–1666 (2019). https://doi.org/10.1038/s41591-019-0643-8
2. Why Can’t We Talk About Periods?
Dr. Jen Gunter, OB/GYN, Pain Medicine, and author of ‘The Vagina Bible’ recently gave a TED talk on menstruation. Dr. Gunter is doing amazing things to empower women and teach everyone about their bodies. I love to share this information with clients and patients, and highly recommend her talk!
Check it out, here!
“It shouldn’t be an act of feminism to know how your body works,” says gynecologist and author Jen Gunter. In this revelatory talk, she explains how menstrual shame silences and represses — and leads to the spread of harmful misinformation and the mismanagement of pain. Declaring the era of the menstrual taboos over, she delivers a clear, much-needed lesson on the once-mysterious mechanics of the uterus.
3. Patient HANDOUT: Common Food and Drink that Can Worsen Incontinence
This is a handout that I use A LOT in the clinic. Check out some common food and drink that could irritate the bladder and lead to worsening symptoms of incontinence, urge, and/or frequency.
Shoot me an email if you’d like a copy of this handout! cassie@tayloredtraining.ca
4. Our Biological Clock Plays a Crucial Role in Healing from Surgery
A recent study from McGill University found that timing of medication – based on our circadian clock – dictates their effectiveness when healing from a surgery.
Researchers found that taking anti-inflammatories in the morning or at noon were effective in promoting post-operative healing and recovery, but that they were much less effective if taken at night. In fact, research shows that if the anti-inflammatories were taken in the afternoon or at night, they actually severely DETER healing and bone repair following surgery.
The reason for this finding – that anti-inflammatories can both promote healing post op (if taken in the morning or noon) or hinder healing post-op (if taken in the afternoon or evening) is based on our circadian clock genes that are involved in healing.
Inflammation, following surgery, is crucial to healing since part of the process involves both destroying any bacteria that may be in the area, and signaling to attract the cells that will rebuild the tissues. But the process is not a constant.
“There are periods of inflammation that are actually very destructive, and there are periods that are constructive and important for healing,” said Faleh Tamimi. “So many pharmaceutical companies have been trying to develop drugs that will inhibit the destructive processes during inflammation but not interfere with the helpful ones.”
He adds, “The idea that I came up with in the shower one morning is that we could perhaps use the circadian variations in inflammation to our advantage. The destructive component of the circadian rhythm as it relates to bone healing occurs during the day, when cells known as osteoclasts break down bones. The constructive cells, known as osteoblasts that rebuild bones are active at night. By limiting the use of anti-inflammatories to the mornings and giving analgesics at night for the pain, I thought we might get better results in terms of bone healing than if anti-inflammatories are given throughout the day.”
For more details, see the reference below.
Side Note: as a therapist this research is fascinating to me and I believe it will have huge implications in the use of both anti-inflammatories and ice in the future in terms of optimizing the healing stages post injury!
Ref: H. Al-Waeli, B. Nicolau, L. Stone, L. Abu Nada, Q. Gao, MN. Abdallah, E. Abdulkader, M. Suzuki, A. Mansour, A. Al Subaie, F. Tamimi. Chronotherapy of Non-Steroidal Anti-Inflammatory Drugs May Enhance Postoperative Recovery. Scientific Reports, 2020; 10 (1) DOI: 10.1038/s41598-019-57215-y
5. Teens with Obesity and PCOS Have More ‘Unhealthy’ Bacteria
New Research published in the Journal of Clinical Endocrinology & Metabolism suggests that the microbiome may play a role in polycystic ovary syndrome (PCOS).
PCOS affects 6-18 percent of women of reproductive age and is characterized by elevated testosterone levels in the blood that cause acne, excess hair growth and irregular periods. Teens with PCOS often also struggle with obesity and have higher risk for type 2 diabetes, infertility and depression.
Researchers discovered that “in adolescents with PCOS and obesity, the bacterial profile (microbiome) from stool has more “unhealthy” bacteria compared to teens without PCOS. The unhealthy bacteria related to higher testosterone concentrations and markers of metabolic complications.”
This information can be useful in the future as a new path to treatment – looking at the gut microbiome. Future research is still needed.
 
Ref: Beza Jobira, Daniel N Frank, Laura Pyle, Lori J Silveira, Megan M Kelsey, Yesenia Garcia-Reyes, Charles E Robertson, Diana Ir, Kristen J Nadeau, Melanie Cree-Green. Obese adolescents with PCOS have altered biodiversity and relative abundance in gastrointestinal microbiota. The Journal of Clinical Endocrinology & Metabolism, 2020; DOI: 10.1210/clinem/dgz263

Five Bullet Friday: Women’s Health January 17, 2019

Happy Friday!

Today’s Five Bullet Friday:

1. A Clarification of Use of Mesh in Gynecological Surgeries from the President of the AAGL

2. NEW Guidelines for Recurrent UTIs, 2019

3. Heavy Menstrual Bleeding Common in Teens and Requires Multidisciplinary Care

4. Weight & Major Psychiatric Disorders Genetically Linked

5. Improve Sleep by Losing Fat from Your Tongue?

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

  1. A Clarification of Use of Mesh in Gynecological Surgeries from the President of the AAGL

President of the American Association of Gynecologic Laparoscopists (AAGL) recently commented on the announcement from the US FDA which recalled transvaginal mesh used for the treatment of pelvic organ prolapsed (POP).

Dr. Fidela Paraiso explained that there is an important distinction that many people aren’t realizing: the FDA recalled surgical mesh for some – but not all – procedures related to pelvic floor disorders, which some media sources are not disclosing that subtlety.

Dr Fidela Paraiso furthers that the mesh itself is not defective and that the recall only applies to repairing of POP. It has not, however, been recalled when the mesh is inserted through an abdominal incision for POP repair, nor mesh used in midurethral sling procedures for the treatment of stress urinary incontinence.

For more details on the difference between the use of mesh for POP repairs and for the treatment of stress urinary incontinence, please see Dr. Fidela Paraiso’s full explanation in the reference below.

Ref: Click here for Link

2. New Guidelines for Recurrent UTIs – 2019

Uncomplicated urinary tract infection is one of the most common indications for antimicrobial exposure in otherwise healthy women. We are obviously concerned with overuse of antibiotics as it has led to drug-resistant organisms in the past 20 years. Because of this, new guidelines were created and published in the Journal of Urology in 2019 to help guide treatment of recurrent UTIs.

Note: recurrent UTIs are defined as two culture-proven UTIs in a 6-month period, or three culture proven events in 1 year. The following guideline is heavily focused on treating not only symptoms, not only cultures, but rather the important combination of symptoms combined with positive cultures. This new guideline is an important step in helping physicians reduce the “collateral damage” or over-prescription of antibiotics to slow the rate of development of antimicrobial resistance.

2019_UTI_Guidelines

Ref: Anger, Jennifer & Lee, Una & Ackerman, Roger & Chou, & Chughtai, Bilal & Clemens, J. & Hickling, Duane & Kapoor, Anil & Kenton, Kimberly & Kaufman, Melissa & Rondanina, Mary & Stapleton, Ann & Stothers, Lynn & Chai, Toby. (2019). Recurrent Uncomplicated Urinary Tract Infections In Women: Aua/Cua/Sufu Guideline. Journal of Urology. 202. 10.1097/JU.0000000000000296.

3. Heavy Menstrual Bleeding Common in Teens and Requires Multidisciplinary Care

The reported prevalence of heavy menstrual bleeding in adolescents ranges from 34% to 37%, authors Dr. Borzutzky and Dr. Jaffray note in their recent paper.

This can lead to anemia, fatigue, and hemodynamic instability which may result in ED visits, hospital stays, the need for transfusion and oral or intravenous therapies to stop blood loss.

Authors say it is important to distinguish the etiology of this in adolescent girls to guide treatment, which can include hemostatic medications, hormonal agents, or a combination of both. They also note that historically the evaluation of heavy menstrual bleeding has been predominately the role of a primary care clinician or gynecologist, but given that a high prevalence of female individuals (specifically adolescents) with heavy menstrual bleeding have underlying bleeding disorders, hematologists should also have a prominent role.

Ref: Borzutzky C, Jaffray J. Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents. JAMA Pediatr. Published online December 30, 2019. doi:10.1001/jamapediatrics.2019.5040

4. Weight & Major Psychiatric Disorders Genetically Linked

New research shows that there appears to be a robust genetic link between body weight and major psychiatric disorders, an international research team has concluded.

Using data from more than a 500,000 individuals with major depression, bipolar disorder, and schizophrenia, the investigators showed extensive genetic overlap between body mass index (BMI) and psychiatric disorders. Interesting, they found that although the genetic risk variants for major depression and bipolar disorder were primary associated with increased weight, the majority of genetic variants for schizophrenia were related to reduced weight.

Authors found this quite interesting, because essentially this meant that if people had a susceptibility for increased BMI they were also likely to suffer from depression or bipolar disorder, but for schizophrenia it was the opposite: if they were at risk of schizophrenia, they were less likely to be obese. They conclude that increased body weight in schizophrenia seems to be directed mainly by diet, lifestyle, and side effects of mediation, but that it is a completely different picture with bipolar disorder and depression.

Authors further conclude that, “aligned with epidemiological findings, [their] results underscore the importance of considering both metabolic and psychiatric factors when trying to understand and treat mental illness effectively.” They are hopeful that this could lead to more prediction tools and better treatment choices for individuals with severe mental disorders.

Ref: Bahrami S, Steen NE, Shadrin A, et al. Shared Genetic Loci Between Body Mass Index and Major Psychiatric Disorders: A Genome-wide Association Study. JAMA Psychiatry. Published online January 08, 2020. doi:10.1001/jamapsychiatry.2019.4188

5. Improve Sleep by Losing Fat from Your Tongue?

A new study published in the American Journal of Respiratory and Critical Care Medicine just this month discovered that reducing the amount of fat in your tongue improves sleep apnea.

Previous research has shown that obesity is a key risk factor for sleep apnea, and that those who are obese who suffer from the condition tend to have considerably larger tongues with a higher percentage of tongue fat than obese people who do not suffer from sleep apnea.

So, how do you trim down your tongue fat? It comes down to overall body fat loss, the study found. “This study shows reducing excess fat in general can reduce tongue size. [And] the more tongue fat you lost, the more your apnea improved”.

This leads authors to believe that tongue fat is a potential new therapeutic target for improving sleep apnea, and they suggest future studies explore whether certain diets are better than others in reducing tongue fat, and whether cold therapies might be applied to reducing tongue fat.

Ref: Stephen H. Wang, Brendan T Keenan, Andrew Wiemken, Yinyin Zang, Bethany Staley, David B. Sarwer, Drew A. Torigian, Noel Williams, Allan I Pack, Richard J Schwab. Effect of Weight Loss on Upper Airway Anatomy and the Apnea Hypopnea Index: The Importance of Tongue FatAmerican Journal of Respiratory and Critical Care Medicine, 2020; DOI: 10.1164/rccm.201903-0692OC

Five Bullet Friday: Women’s Health January 10, 2019

Happy Friday!

Today’s Five Bullet Friday:

1. Fragmented Sleep May Trigger Migraine 2 Days Later

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

5. Women’s Health RESEARCH Opportunities Local and Online

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

  1. Fragmented Sleep May Trigger Migraine 2 Days Later

A fascinating new study published in Neurology found that people whose sleep is fragmented during the night are at a higher risk of experiencing a migraine episode not the next day, but the day after that.

Authors Dr. Bertishch knew that sleep and migraines have been linked for a long time, both anecdotally and by scientific research, and wanted to look a bit deeper in to their relationship.

What they found that was sleeping for 6.5 hours or under each night, as well as having poor quality sleep, did not correlate with migraine episodes the next day or day following. However, having a fragmented sleep was linked with a 39% higher risk of migraine on the day after the fragmented sleep.

Further research is needed at this time to better understand this low sleep efficiency and migraine correlation going forward.

Ref: Suzanne M. Bertisch, Wenyuan Li, Catherine Buettner, Elizabeth Mostofsky, Michael Rueschman, Emily R. Kaplan, Jacqueline Fung, Shaelah Huntington, Tess Murphy, Courtney Stead, Rami Burstein, Susan Redline, Murray A. Mittleman. Neurology Dec 2019, 10.1212/WNL.0000000000008740; DOI: 10.1212/WNL.0000000000008740

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

Low back pain is the leading cause of disability worldwide, and is often associated with costly, ineffective and sometimes harmful care, yet unhelpful patient beliefs about low back pain remain pervasive. This great, free to- the -public resource printed in the British Journal of Sports Medicine outlines 10 facts about our back and back health that everyone should know, especially those who are struggling with back pain.

Find this helpful info graphic along with the rest of the article at the reference below, or see attached to this email.

bjsports-2019-101611-F1.large

Ref: O’Sullivan PB, Caneiro J, O’Sullivan K, et al Back to basics: 10 facts every person should know about back pain British Journal of Sports Medicine Published Online First: 31 December 2019. doi: 10.1136/bjsports-2019-101611

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal:

Transvaginal synthetic mesh and mesh sling placement for the treatment of stress urinary incontinence and pelvic organ prolapse can yielded adverse outcomes, including pelvic pain and dyspareunia. Pelvic floor physical therapy (and medications and injections as necessary) in compliant patients experience significant improvement of their symptoms, and pelvic pain-focused interventions are a worthwhile recommendation in women with refractory pelvic pain after vaginal mesh or mesh sling removal.

Ref: Abraham, Annie & Scott, Kelly & Christie, Alana & Morita-Nagai, Patricia & Chhabra, Avneesh & Zimmern, Philippe. (2019). Outcomes Following Multidisciplinary Management of Women With Residual Pelvic Pain and Dyspareunia Following Synthetic Vaginal Mesh and/or Mesh Sling Removal. Journal of Womenʼs Health Physical Therapy. 1. 10.1097/JWH.0000000000000140.

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

This is an older video, but one that I love to share because it is so well done. The Fuzz Speech, but Dr. Gil Hedley, is a fantastic explanation of our fascia, how important movement is, and what can happen to our bodies if we are consistently sedentary. Most patients very much love this video and learn a lot from it. I do say most, however, as Gil does show a cadaver at some point.. so your more squeamish patients may not enjoy the recommendation!

Check out this 5 minute video, here.

5. Women’s Health RESEARCH Opportunities – Local in Kingston, ON and Online

Some amazing and important research is happening right now at Queen’s University in Kingston, Ontario looking at a number of topics including:

  • Psychoscial and Treatment Factors Associated with Persistent Genital Arousal Disorder
  • Biopsychosocial Investigation of Persistent Genital Arousal Disorders in Women
  • Sexual Wellbeing of Women Using SSRIs
  • Sexual Wellbeing of Women Experiencing Depression Symptoms
  • Sexuality and Breast Cancer
  • Sexuality and Menopause

Some studies are available to online participants, while others are in lab. For more details for you or your patients, visit here.

 

The Blessing & Curse of Slow Change Over Time

“The chains of habit are too light to be felt until they are too heavy to be broken”

– Samuel Johnson

Today we are going to talk about two sides of the same coin: change. More specifically, how insidious seemingly small actions or symptoms can build over time to the point where we wonder what and where things went wrong. Yet on the flip-side how we expect everything to revert back to its previous state in the matter of days or weeks.

As you read through this article there is one concept I want to really sink in and that is that the habits and changes that happen slowly and consistently over a long period of time are the ones that stick. These are the changes that we don’t see coming until one day we can no longer deny them.

This is a truly important and empowering concept because it means we have a whole lot more control over our own health than we may think. And the sooner we can understand this, the sooner we can come face-to-face with our own habits, then the sooner we can recognize how they may be influencing our life and make long-lasting, positive change.

Insidious Change Over Time

I am a pelvic health physiotherapist so I will speak often about issues women face when it comes to the pelvic health, but the concepts I’m speaking about today can be true for other aspects of behavioural change.

I’m so fortunate to work with and be able to help incredible, strong, powerful women who come to me for help with a variety of health issues ranging from minor to quite debilitating. In my years of working with these amazing clients one reoccurring story keeps coming up that sounds something like this:

“I don’t remember when it started. There was no one event or one memory I have of leaking/pain/discomfort. But somehow along the way it has become my normal. It has become something I now deal with everyday.”

OR

“If I think back I can remember small incidents of leaking/pain years ago. But I just brushed it off. And then yesterday I completely emptied my bladder unexpectedly while I was at work and I could not stop it. It was so embarrassing and it was the last straw. I’ve waited long enough for help, enough is enough.”

OR

“I skipped going to the gym when I was slammed with work while on deadline for a big project and somehow never got back in to my old habit again. That was seven years ago.”

These statements (or similar versions) may sound familiar to you. The truth is we’ve all likely said something to ourselves along these lines. I think it is almost some sort of invincible fallacy – we simply don’t appreciate how much things will effect us. If we experience something negative (leaking when coughing, pain during sex, or a tweak in your knee) or make a choice to skip something positive (going to the gym, going to sleep at a reasonable hour) we try to logically justify why it happened or why it wouldn’t matter for us, because we’re different! We say things like:

“Oh, my bladder must have been REALLY full just then, and wow, that was one STRONG cough. Anyone would have leaked a bit with that one!”

OR

“I know I shouldn’t really strain hard to lift up this box or really push to have this bowel movement, but I’m in a hurry and it won’t make a difference if I do it just this one time, right?”

OR

“I’m beat. I’m going to skip the gym just this one time. Don’t they say that sleep is more important, anyway?”

It’s logical. It makes sense to us. And it really will be just this one time (or so we tell ourselves). But then after we brush off that one time (that first episode of leaking, that first episode of pain, the first time we go against what we know we should do) then the second time seems easier to justify too. Then the third.

See where I’m going with this?

It’s insidious.

We either do it entirely unintentionally (whether it be because we don’t notice or we don’t think it matters), or we do it intentionally but ignorantly – not realizing just how much of an effect over time these choices can have on our health and wellness habits.

This is the curse of small, slow change over time because we simply don’t recognize how important each individual decision, or each individual warning sign our body is telling us, is. And when we finally realize, when we finally take an objective look at what we are experiencing, what our body is telling us, or how we are feeling, when we finally are ready to do something about it, to improve our health, our habits, that is when we need to take a hard look at the flip-side of the coin.

Positive, Long-Term Change Takes Time Too

Have you ever dropped a behaviour after only a few weeks (or days) because it just wasn’t leading to the results you wanted as quickly as you expected?

I think the truth is we all have. But remember, you didn’t lose your shoulder mobility in a week so it is going to take longer than a week to get it back. You took 9 months to grow your beautiful baby girl so it is going to take longer than 6 weeks to look like your pre-pregnancy self.

The magic pill doesn’t exist. That vibrating chair you sit on for 30 minutes that claims to make your muscles contract to the equivalent of “11,000 Kegels” isn’t going to cure your incontinence. That crazy restrictive diet you’re going on isn’t going to be sustainable. Going so hard at the gym you injure yourself and can’t continue is only going to set you back.

The truth is the magic pill to success really isn’t all that sexy. It’s doing things that are good for your body day in and day out. Making positive choices and working with a coach (like a pelvic health physiotherapist, an orthopaedic physiotherapist, or a fitness and nutrition coach depending on your goals) who can guide you, progress you, and support you as you consistently work towards your goals.

I’m not saying this is easy. It most certainly is not. You may go through periods where you think it isn’t working, where you think that nothing is changing and that all of your hard work has been in vain. But then, one day (just like we talked about earlier), you will realize just how far you’ve come and wonder when exactly it all happened. But this time you won’t be sad and frustrated, but proud and empowered.

Remember the power of small change over time. How negative habits can creep in without us realizing, or how the positive ones can overcome. “The chains of habit are too light to be felt until they are too heavy to be broken.”

The Sex Coach You Didn’t Know You Needed.

We all talk about it. Think about. Dream about it.

What am I talking about?

I’m talking about sex of course.

I think it’s fair to say most of us would be more than okay with a little extra fun and passion in the bedroom. Which brings me to my question for you: are you getting the most out of your sex life, or could it be even more pleasurable?

I want to introduce you to the person out there who can help make your sex life even better. The sex coach you didn’t know you needed. The person who can help make sex with your partner more comfortable, more pleasurable and more intense. The person who has all the resources you need to take your sex life to the next level.

As a Pelvic Health Physical Therapist I can help you have the best sex of your life and I want to tell you how.

1. I teach the best sex positions for you and your partner based on your physicality.

Early in my career one of my favorite moments as a physical therapist happened when one of my clients (who had just had hip surgery) contacted me to find out what positions she could enjoy and which she should avoid while having sex with her partner that evening. Her surgeon informed her as to what day to day activities to be careful of, but never once mentioned sex. Moreover they didn’t have that close of a relationship, so she wasn’t about to ask!

Sex is what we physical therapists like to refer to as an activity of daily living. Sex is an activity everyone should be able enjoy as much as possible, regardless of circumstance, physical limitations or injuries.

While this may be a more extreme example, the truth is we all sometimes have some aches or pains that can make sex sound a little less appealing as it may lead to discomfort during or after the fact. Some of us may also experience pelvic floor dysfunctions such as prolapse or incontinence that can lead to feeling awkward or unsure between the sheets, or just plain less into it.

This is where I come in.

As a pelvic health physical therapist, I know all the tricks. If sex leads to a sore back in the week following foreplay we can show you the best positions. In some cases, it is as simple as using your hands and not your elbows to support yourself while in the throws of passion. For example, if you’re someone who feels discomfort or pain in your back when you sit too long, one of the best sex positions for you is on all fours resting on your hands. Adopting this same position but resting on your elbows? This is actually one of the worst positions for you, along with – believe it or not – the missionary position. In contrast, if you’re someone that doesn’t enjoy lying on your stomach because of discomfort, the missionary position with your knees and hips bent up one of the better positions for you.

Together with my patients who experience discomfort during sex, we find the best sex position so you don’t have to worry about anything other than enjoying yourself.

2. You shouldn’t have pain or discomfort with penetrative sex.

Want a crazy stat? Nearly 1 in 10 women experience pain with penetrative sex (known as dyspareunia) with a quarter of these women experiencing this pain often. Women between the ages of 16-24 are the second largest group of women to experience this type of pain. Though some women assume it is because they partner is “too big” the truth is that that is rarely, if ever the case.

There are a number of reasons that penetrative sex might hurt you, but a common one comes down to the muscles of the pelvic floor being overactive, tight, or in spasm. The muscles of the pelvic floor, like all muscles, are meant to contract and relax throughout the day. For a lot of women who have pain with sex, those muscles cannot fully relax and instead are in a constant state of contraction. This leads to difficulty and pain for these muscles during penetration. This also leads to a more complex psychological pain cycle where after penetration has been painful our brain recalls this feeling and then resists it in the future because of the painful memory.

The good news is there is so much we can do to both relax overactive pelvic floor muscles and change this pain cycle! Our goal is not only to make your sex life pain-free, but to also make it as enjoyable as possible!

3. You can experience more intense and longer lasting orgasms (yes it IS possible).

I love my job. How many other health professionals can say that their female clients come to them so happy (sometimes with tears of joy) because their orgasms are getting more pleasurable and intense because of the right treatment, coaching and advice?

Yes – you heard that right. Part of my job includes helping women have more powerful orgasms. I’m confident that I’m correct in assuming that most women would be “ok” with experiencing more powerful orgasms. Research shows that working with a professional coupled with a pelvic floor exercise plan, improves the support function of the pelvic floor, increases blood flow, and stimulates the awareness (or proprioception) of our pelvic floor. Better functioning, stronger, pelvic floor muscles, contribute to increased sexual desire, performance, and both achievement and intensity of orgasm.

Plus, the improved proprioception and awareness of our pelvic does more than just improve our physical experience during sex. It also, quite simply makes us feel sexier. Trust me, when you feel your pelvic floor muscles functioning better and feeling sexy, you are more likely to experience mind blowing sex compared to if you’re feeling less confident in your pelvic floor.

4. I have all of the best resources and want to share them with you.

There is one more way I can help you spice up your sex life. I know where all of the coolest resources are regarding sex.

Strange but true fact: I am on a first name basis with the adult stores in town, know some amazing therapists (who can also play a huge role in improving your sex life), and I can guide you on additional strategies to up your sex game even more.

As an example, have you heard of OMGyes yet? This is an game-changing resource I direct many of my clients to. An easy, self-directed platform that teaches you how to find even more pleasure in your life – whether you are going solo or with a partner.

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My mission as a pelvic health physiotherapist is to help people alleviate their pain and feel amazing so they could experience the best in life. And yes, that includes helping you have a great sex life solo or with your partner!

Should you exercise during pregnancy? Yes!

Pregnancy is an incredibly exciting time of life, but it can also be a time where you feel unsure about all of the things you should and should not do. A lot of women who have always been active wonder if they can continue to train the way they have previously, while others who have been more sedentary feel they cannot start anything new as their changing body isn’t yet used to it.

It’s time to clear some things up for you!!

Unless you have a high-risk pregnancy exercise is not only a good idea, it is actually so incredibly important for both your health and the health of your baby!!

Due to all of the misconceptions out there on exercising during and after pregnancy, an Expert Committee from the IOC was formed to specifically look at exercise and pregnancy in both recreational and elite athletes. Their recommendations are as follows:

In absences of maternal or fetal contraindications, exercise prescription in pregnancy includes the same principles and elements used for the non-pregnant population.

BUT it is important or remember and work with someone who understands the changes associated with pregnancy, which the IOC committee list as “significant anatomical, hormonal, metabolic, cardiovascular and pulmonary changes/adaptions.”

What does this mean?

That pregnant women should continue to incorporate exercise (or start to exercise)! In fact, the article continues on to state that there is very strong evidence that strength training both in general and of the pelvic floor muscles during this time can both prevent and treat urinary incontinence during pregnancy and after birth. It is also associated with a shorter first stage of labour.

Are there any signs you should slow down?

The IOC Committee explains that women without contraindications should exercise regularly during pregnancy while being regularly assessed. They indicate the following signs to indicate it may be time to stop exercising:

  • Vaginal bleeding
  • Regular painful contractions
  • Amniotic fluid leakage
  • Dyspnoea (shortness of breath) prior to exertion
  • Dizziness/syncope (fainting)
  • Headache
  • Chest pain
  • Muscle weakness
  • Calf pain or swelling

What about Post-Partum?

The birth of your child is a wonderful moment, but it also can very much impact Mom’s musculoskeletal system, with delivery being likened to an acute sports injury. Therefore, deciding when and how to return to exercise can sometimes be more complex and multifactorial. This is why it is important to seek the help of a pelvic health physiotherapist who can guide you based on your needs and your rehabilitation goals.

The IOC committee encourage exercise in the post-partum period should start gradually with a pelvic floor muscle first focus.

Key Take-Aways:

– Exercise before, during and after pregnancy is so important for both the health of you but also for your baby

– In the absence of high-risk pregnancies, exercise is safe and beneficial as long as the anatomical and physiological changes that mom undergoes are considered

– Monitor your body during exercise and be followed/assessed regularly by a skilled coach or practitioner who is experienced in working with pre and post-natal clients.

– Begin exercise post-partum slowly and under the guidance of a professional who can help you take a pelvic floor first approach to strength training

Find this awesome research article, here.

And to find out more about exercise during pregnancy, follow the amazing @coach_vanessagiguere on instagram (she is the one above in the photo, rocking the prowler while in her third trimester!)