Dr. Mukta Chauhan PT, DPT, OCS, WCS

“What exercise can I do for my urinary leakage?” (Replace this with any pelvic condition— pain/prolapse/constipation/urinary urgency, ED)⁣
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And as a Pelvic Health Physical Therapist, I should know the answer… but this question stumps me every single time. ⁣
I have to ask a series of questions in response to get a little better idea about the state of the person’s pelvic floor.⁣
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So, I decided to make this post so that I could explain why we can’t determine what exercises— whether it is stretches/relaxation or strengthening— would be good for your individual case based on just your symptoms.⁣
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👉 Remember tense muscles are often weak… If they are in contracted position, doesn’t mean that they will be strong. An already tense muscle can not effectively contract to generate power.⁣
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👉 Remember a weak muscle can also be tense… we often find tension around a weak muscle as a subconscious protective guarding. ⁣
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👉 And finally remember that pelvic floor is not just one muscle! It’s a group of muscles and sometimes hypertonic and hypotonic muscles are found simultaneously. ⁣
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🤔 So doesn’t it make sense for you to first get assessed to learn what exactly is going on with your pelvic floor before you decide to do a certain kind of exercise off of the internet?⁣
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🧐If you don’t have access to a Pelvic Physio, get a virtual consult. Most of the times, we can figure out the state of your pelvic floor based on your history, posture and your movement.⁣
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Did doing an exercise or buying an equipment off the Internet backfired for you? ⁣
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𝗣𝗦: This post is not meant to create fear around movement and exercise. Just to create awareness and caution… and to encourage you to at least get an assessment from a professional.

March blogpost is here! And as Endometriosis Awareness Month comes to a close, let’s recognize that the advocacy mustn’t stop all year round 💪🏾💪🏾💪🏾.

And let’s not forget - the delay in diagnosing endometriosis is just one example of a broader issue: the systemic neglect and underestimation of women’s health concerns within medical practice and society at large.

Several factors contribute to this lag in women’s health… to read more about it, check the link to the blogpost in my stories🙂

Let’s talk about APD & how it actually affects the visceral perception of bloating. After understanding the mechanics of how both diaphragm & the ab muscles have a role to play in stimulating the abdominal visceral organs & digestion by affecting the mobility & motility of these organs, let’s further dig deeper & understand what exactly is happening in the body with bloating.⁣
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Bloating & distention are often used interchangeably, however, are not the same things. People who experience bloating clearly have a sense of pressure or a feeling of fullness & sometimes associated abdominal distension with it. However, people can experience distension without feeling uncomfortable sensation post meals. So it’s def not the same thing.⁣
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The abdominal muscles can also contract protectively in response to an increase in visceral sensation. Several of my patients often say that they have to tense the belly because without that bloating feels worse. However, the same tensing of the ab muscles can further make symptoms worse by adding the intrabdominal pressure on top of a system that is already feeling quite pressured.⁣
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In another scenario, diaphragm can stay in a contracted place and fails to return back to the chest cavity, pushing down on these abdominal organs. This could also increase intraabdominal pressure, which if accompanied with weak abs will cause distention. Because pressure needs to go somewhere. This pressure can go all the way down to your pelvic floor and can give you a constant urge to have a BM as well. It’s all about pressure management!⁣
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Very often the food we eat is blamed for our digestive issues, however, there are many mechanisms and systems that are involved in the digestion process and we should not forget that.⁣
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Working with a knowledgable & skilled dietitian is a great place to start, but physical therapists can also help with your bloating & digestion issues.⁣
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Some of my favorite dietitians who keep the musculoskeletal system in mind while working with their clients are .nutrition .ibs.dietitian⁣
Their practice revolves around reducing the fear around food & ditching the diet culture, which I love. Check them out!

March is here and it’s ‘𝗘𝗻𝗱𝗼𝗺𝗲𝘁𝗿𝗶𝗼𝘀𝗶𝘀 𝗔𝘄𝗮𝗿𝗲𝗻𝗲𝘀𝘀 𝗠𝗼𝗻𝘁𝗵’, but the advocacy and education mustn’t stop all year round!!

Here’s a post from last year that .happy.pelvis and I created together to start off the awareness month!

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It’s incredible and heartening to see the rising awareness, with so many people sharing their personal stories and with doctors and public figures spreading awareness about this debilitating condition. But despite these concerted efforts and best intentions, the misinformation about endometriosis continues to spread.⁣
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🔹It is NOT enough to just talk about how painful this condition is!⁣
🔹It is NOT enough to just talk about how loooooong it takes to get diagnosed!⁣
🔹 It is NOT enough to just say that ‘period pain shouldn’t be ignored’!⁣
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We need to realize that making a minor error in the definition of the condition could change its meaning and treatment entirely for a person with endometriosis.⁣
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We must realize that incriminating a single disease process for a complex condition like ENDO will most likely limit a person’s treatment options.⁣
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We need to look at endo as a whole-body disease because it has been found on different organ systems, not just the reproductive system.⁣
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We need to recognize that we still do not completely understand this condition and there is a huge and pressing need for extensive research and to make treatment options easily accessible for everyone.⁣
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We also need to realize that educating the medical system gatekeepers— the PCPs, Pediatricians, and Gynecologists, would play a critical role to bridge the diagnosis and treatment gap for this debilitating condition.⁣
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Let’s do better together!⁣
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For this month’s newsletter, I thought - “Why not talk about something that I am personally dealing with?”

As you might know, I am currently pregnant & dealing with really bad acid reflux (GERD). Honestly, I had no idea how severely it can affect people’s quality of life until I experienced it myself. It’s a lot better now, for the most part, so I thought, why not share the strategies that worked for me with all of you?

Also, you might be wondering why a pelvic physio talking about GERD? Isn’t this something that GI doctors or dietitians should be concerned with? You would be surprised to know that acid reflux is one of the conditions I see in my practice. Many of my pregnant clients, people with hypermobility or EDS, people with constipation/IBS, etc., often have acid reflux as one of their symptoms, along with other gut-related or pelvic floor issues.

As most of you must be familiar with, acid reflux or GERD (gastroesophageal reflux disease) happens when the gastric contents regurgitate back into the food pipe. The gastroesophageal (GE) junction (where the food pipe enters the stomach) has a sphincter that usually checks any backflow of stomach contents. As we know, the stomach contents are highly acidic. This backflow, if continues for a long time, can erode the mucus membrane of the food pipe, creating inflammation in the area called esophagitis, and can be extremely painful.

The GE junction is controlled by:

The smooth muscular contraction of the lower esophageal sphincter (LES/internal sphincter)
And the crural portion of the diaphragm (external sphincter)
Of course, the diaphragm has a role here too!! It’s not one of the most special muscles in our bodies for no reason. ;)

In pregnancy, increased levels of the hormones estrogen & progesterone relax the smooth muscles of the LES, lowering the pressure. On the other hand, as the pregnancy progresses, the intrabdominal pressure also increases, which can further make reflux worse.

So if you are further interested in how GERD develops & what are some tips to prevent it, check out my latest blogpost.
For more reading and the full post, head on over to my blog. Link in bio & IG story.

xx,
Mukta

Incomplete defecation or a feeling of fullness is not always because of outlet obstruction caused by the pelvic floor dysfunction! We need to be more nuanced in our approach to helping our clients and do not let our biases get in the way. A comprehensive evaluation is always the first thing a client should undergo.

Thoughts on this?

**alismuscle

S*xuality counseling certification ✅

I am beyond excited to finally announce that I completed one of the best courses I have ever taken. And can not wait to see how it changes my practice.

I have been a Pelvic PT for a while now and had been thinking about adding the s*xuality counseling to my knowledge base... Isn’t PT all about ‘function’, anyway?

The goal is NEVER just ‘pain reduction’, but returning to function! So what is Pelvic Health PT without helping clients to reclaim their s*xuality!!

I enrolled for this course a little nervously as it required 3 months commitment and I was just embarking on my pregnancy journey. The timing may not have been the most perfect, but I am so glad I stuck with it. It took me a bit longer to complete, but I absolutely loved every aspect of the course. I learned so much in these last few months and can not wait to use this knowledge to help my clients.

Special thanks to UC and Heather ... you guys poured your heart into it and it shows! Thank you for creating this very thought provoking course!

*xualitycounseling *xeducati̇on

Hello friends,

The first newsletter of the year went out yesterday! Woohoo!
I am slowly getting back on track :)

January being the 🎗 month, I took the opportunity and wrote about and the importance of its timely screening.

Also, shared some tips to make the pelvic exam more tolerable, so at least one barrier to timely screening and care is taken care of.

Sharing the link in my bio as well as stories so you can sign up for it and read it.
When did you get your last 🤨
I went for it last year ✅

Do sign up for the newsletter if you don’t want to miss it in the future 🙂

When was your last ? Mine was 2 years ago :)

That was one long, unplanned break.. but so necessary!😇

Those of you who reached out asking if I was doing okay, thanks so much for noticing my absence 🙏! And those of you who may not have noticed, but stuck around nonetheless despite zero content, thanks to you as well 🤗! I feel really grateful to have this community, but at the same time find it really awkward to “announce my return” here. So I’ll just THANK YOU for patiently waiting for me while I took care of a few life-things.💗

Starting end of September, I decided to go into a little hibernation to prepare my body for a successful embryo transfer. Our one and only embryo … so the stakes were really high (I want to share more on this later).

Thankfully, the excruciating wait resulted in a positive pregnancy test! However, the cycle of fear and anxiety was just starting (or perhaps taking a newer shape). It took me a long time to feel the joy of what is about to come, and I still find myself stuck in fear mode every now and then (I’m sure many people can relate).

But.. the first trimester fun symptoms of nausea, exhaustion, splitting headaches and acid reflux helped in believing my pregnancy, a little more, every day✅!! I also learnt that first-trimester exhaustion is no joke. It completely derailed my grand plans to stay active and strong throughout my pregnancy. I am in my second trimester now, but things haven’t changed a whole lot, yet. Some energy is slowly returning though, so I intend to make the most out of it… including a gentle IG re-entry.

This pretty much sums up last 4 months for me.

Keep reading below 👇

I have a confession— I am a hoverer!! 🫣🫣Yes, I know I am always preaching here, and in my office, to my patients to NEVER hover over toilets. But let’s be real, who wants to sit on urine-splashed toilets even after wiping??😰⁣
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It’s just so gross! And let me be clear, my fear is not about catching some infection. Unless our immunity is down the toilet (pun.. well, intended), I don’t think we are so fragile as to catch an infection just like that. 🤔 There is no hard evidence behind people catching infection from toilet seats. 🧐⁣
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But… it… is… just… sooooo… gross!!⁣
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Now, I have mastered a technique of hovering, so that it doesn’t affect my pelvic floor (most of the time), but this post is not about that. 😏And of course, I hover maybe twice in a week.⁣
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Yes I know, I could start carrying disinfecting wipes with me, but it just doesn’t do the trick for me. Once my brain registers a toilet seat as gross, I can’t sit on it.🤢⁣
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My recent travel to the Nordic countries made me realize that the best solution to not hover over the toilet is if we all 𝘤𝘰𝘭𝘭𝘦𝘤𝘵𝘪𝘷𝘦𝘭𝘺 decide to NEVER hover.⁣
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I don’t think during my 2.5 weeks of travel to Denmark, Sweden and Iceland, I encountered a sprayed toilet even once. I didn’t have to think twice to sit down.😌⁣
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So I think this madness of hovering can only be stopped if we all collectively decide to 𝘚𝘐𝘛 𝘋𝘖𝘞𝘕. (including men, yes, guys you CAN sit down to p*e, especially if it’s a shared bathroom).⁣
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PS: I am back in NY, and have been really trying to practise this.⁣
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⚠️ Please keep in mind that the pelvic floor needs to relax in order to allow the urinary sphincter to fully open in order to empty the bladder completely. When we are hovering (neither sitting nor standing) over the toilet, it tenses the pelvic floor and the bladder is unable to empty out fully. You may also feel that you have to strain in order to empty out bladder. If you make this a habit, it can cause your pelvic floor to become overactive, and, over time, you can develop pelvic floor dysfunction. If you already are dealing with some form of pelvic floor dysfunction, hovering can exacerbate your symptoms. ⁣

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What is the connection between your feet and your pelvic floor? Why do I often tell my patients to take good care of their feet in order to keep their pelvic floors happy? And by “care”, I don’t just mean weekly spas and pedicures (though those are great as well!) but actually making sure that your feet are getting the nourishment they need from the strengthening and flexibility exercises.

Let’s look at a few interesting facts about why you need to take special care of your feet, especially if you are someone with a pelvic floor dysfunction:
1. GPS coordinates of the foot and our ge****ls are right next to each other on the ‘Somato-sensory Homunculus’. For the uninitiated, Somato-sensory Homunculus is the part of the brain that receives sensory information from different parts of the body, with the feet and ge****ls sitting right next to each other on it. So, it’s hardly surprising that these two regions talk to each other. It’s like accidentally receiving mail that belongs to your neighbor - the issues in the feet can be felt on the pelvic floor, and vice-versa. I often find overactivity in the pelvic floors of people with chronic ankle instability (multiple ankle sprains).

If you want to keep reading, check out the blogpost I wrote to explain this in detail. (Link in bio).

And stay tuned for some exercises to build strong feet!

Come join me and Becky to learn about Hypopressive exercises and how they can be used to improve overall pelvic health or if you have ever wondered about their mechanism, safety and application.

Becky Keller is a PT with over 23 years of experience and she is a LPF (Low pressure fitness) certified master coach and teaches Hypopressive system to other professionals in the US and internationally.

Join our instagram LIVE tomorrow at 9 am EST and bring your questions.

If you can’t attend this LIVE, it will be posted to both Becky and my IG page.

Let me first say that I am not an expert in hypopressive exercise (HE), but it’s gaining popularity in the US & I can see how in certain cases it can be super useful.⁣
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So to define HE for those who are hearing this term for the very first time… HE is a form of exercise that’s believed to improve Pelvic Floor (PF) strength.⁣
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In HE, a person: ⁣
1. Exhales completely to their expiratory reserve volume & then holds their breath (apnea)⁣
2. Then expands their rib cage, which essentially increases the volume in the thoracic cavity⁣
3. Draws in the abdominal wall up & in (towards the expanded rib cage) while maintaining the breath holding⁣
4. This position is maintained for about 10 s & is repeated in different positions such as standing, 4 point kneeling, sitting & supine with different upper & lower limb positions.⁣
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So essentially with HE, we are trying to create a negative intra- abdominal pressure (IAP)/ vacuum that would lift the PF up. However, studies are not that robust & do not show any ‘better results’ with HE over traditional PF training.⁣
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I think it can be effective for people with prolapse, stress incontinence, or for people who want to learn to manage their IAP. ⁣
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The biggest takeaway from these exercises for me is the ‘ability to expand the rib cage’. We know that if you dont have good mobility in your rib cage, you are going to struggle with managing your IAP. So in my eyes, a baseline mobility of ribcage should be the starting point for HE.⁣
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Also, since we know how sucking in the belly (increases IAP) may have an opposite effect on the PF (increases the pressure on it), you may have to be very careful in learning how to create that scooping motion of Abs by REALLY expanding the rib cage. Otherwise that pressure might go towards the PF instead of going upward & can either cause PF dysfunction or strain the pelvic connective tissue.⁣
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Also, because it is an indirect method of activating the PF, I am not sure how effective it is in the long run to actually improve the strength of the PF. However, one study did show really good results with HE with PF activation of 74.4-86.5% which is pretty good, I would say.⁣ (long term effects ?).⁣
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Read👇

Benign does NOT mean that Fibroids won’t cause any issues and won’t need any treatment. Many women continue to live with them without seeking care, which significantly affects their quality of life. Limited understanding/education about normal menstruation, shame/taboo can prevent them from reporting their symptoms to their healthcare providers, delaying the diagnosis and timely care.

Bladder and bowel-related symptoms can also be seen along with heavy and painful periods as the fibroids can put direct pressure on the pelvic organs and affect their normal functioning or cause pelvic floor dysfunction, which, in turn, can affect the functioning of the pelvic organs as well.

Different women may have different experiences with fibroids. Some women may develop only tiny fibroids that go completely unnoticed and may not even require treatment, while others may experience severe symptoms and should be offered different treatment options, including pelvic physical therapy.

Please follow for further information on fibroids.

Let’s normalize talking about ✊🏽✊🏽✊🏽

Let's talk !⁣
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I recently shared my thoughts with on this important topic (link in bio).⁣
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It is incredible that vaginismus, a pretty debilitating, soul-crushing condition, is getting all the attention it truly deserves & people are finally coming out of the shadows to seek care for it. But a concerning question is: what if it is being overly diagnosed, even misdiagnosed, in the absence of a deep understanding of the various factors that could cause vulvo-va**nal pain?⁣
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As shown above, there could be so many different reasons behind someone’s pelvic pain (and it’s not even a comprehensive list). This is not to overwhelm you, but to help you understand the complex and diverse nature of vulvo-va**nal pain. ⁣
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Vaginismus is typically understood as an involuntary contraction of the pelvic floor muscles when someone attempts to insert anything (a tampon, a finger, a p€nis) in the vag ina. These muscles may not be tense at rest otherwise. ⁣
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People can experience symptoms like sharp, burning pain, feeling of hitting a wall, increased anxiety associated with pelvic/speculum exam or insertion.⁣
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However, these similar symptoms can be seen in other vulvo-va**nal conditions as well.⁣
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Vaginismus’s close cousin is pelvic floor dysfunction (PFD), and they get confused with each other all the time. In PFD, the muscles may be tense even at rest, which could be due to either an underlying pathology such as infection, inflammation, hormonal conditions, nerve related issues or because of habitual clenching/tensing of butt/abs/jaw muscles, weakness in core muscles etc.⁣
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In the absence of above mentioned reasons, the treatment of Vaginismus includes understanding your anatomy to feel comfortable with your body, gradual desensitization to insertion, & reducing the fear/anxiety around insertion with the help of various modalities.⁣
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Both vaginismus & PFD could also develop secondarily to the conditions mentioned above as a protective guarding, and will need proper assessment and treatment of those underlying causes first (or concurrently).⁣
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Contd. 👇

Took us a long time, but soooo glad to finally see this being talked about ‘openly’ in the South Asian community.

As I shared with Trina Paul in the Juggernaut piece above, all too often, the "taboo" causes too much silent suffering. We need to put aside all stigma/shame and see pelvic health as HEALTH! Getting a timely response care for pelvic pain is really crucial and there are many of us working in this space who can help!

Repost

🩺 When Ananya,* a 35-year-old , first tried to insert a tampon at age 14, she nearly blacked out because of how painful it was. Ananya* — whose name we have anonymized due to the sensitivity of the topic — didn’t tell her friends or her parents about it. Years later, when she tried to have penetrative s*x with her college boyfriend, the issue reared its head again. Having s*x was painful and impossible. It would take nearly 15 more years, many doctors’ visits, and multiple failed relationships before she would receive the correct diagnosis and treatment.

Ananya’s* story is similar to that of many who struggle with conditions such as vaginismus, which causes the involuntary tightening of the pelvic floor muscles, and vulvodynia, or chronic v***ar pain. S*x can feel like razor blades cutting you, a knife stabbing you, or burning. Some women also experience pain without insertion — wearing tight pants or sitting can trigger discomfort. Many don’t seek help or, when they do, are misdiagnosed, dismissed, gaslit, or told to drink a glass of wine.

Taboos surrounding s*xual health can make measuring the prevalence of these conditions difficult, especially for South Asians. Female s*xual dysfunction affects between 12% and 24% of women. To make matters more complicated, a recent analysis found that studies underrepresented women of color.

Read the full story by Trina Paul at the link in bio, then click this image 🔗

Is tailbone really a vestigial structure in human body as we are taught in high school, or was it the middle school 🤔. Can’t remember it’s been too long! 😄

Coccyx is supercool and serve some really important functions in the body. It can’t simply be removed if it’s causing too much trouble (except in rare circumstances)!

Tailbone is often missed during the examination for low back pain, pelvic pain, re**al pain, pain with
S ex, constipation, pelvic floor dysfunction etc.

One small study showed that close to 85% of the participating women experienced tailbone pain after child birth.

Women are 5 times more likely to develop tailbone pain than men.

Tailbone could be a referral point for some gastrointestinal and urogential conditions. A thorough exam is a must!

Most people may not require an X-ray for the assessment of their pain, as it may improve with conservative treatment/physical therapy. However, if fracture or dislocation is suspected, a coned down lateral view is the best for X-ray.
A comparison of seated and standing X-rays is extremely beneficial to make sure nothing is missed.

Watch out for those seatbelt buckles in cabs or cars, I’ve seen a couple of cases of tailbone pain caused by them. 🧐

What caused your tailbone pain?

The obturator internus (OI) muscle is Michelle’s arch nemesis & one of her most difficult muscles to release. Could this muscle be a contributor to your bladder pain, too?⁣
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The obturator internus (OI) is a deep triangular shaped muscle of the hip joints which is part of the sidewall of the pelvis. Just like with other muscles in your pelvis, it can become overactive/tense which then reduces the blood flow to the muscles & the nerves within the area creating a lot of irritating symptoms.⁣
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Due to the proximity of the OI muscles to the pelvic anatomy, the OI can cause irritating bladder symptoms. Research has found that as the bladder fills, it can further irritate already sensitized nerves around the overactive muscle, which the brain can interpret as a sense of urgency or other symptoms.⁣
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Speaking of nerves, the pudendal nerve is a close neighbour of the obturator muscle & has the ability to become irritated with the OI muscle! The pudendal nerve supplies muscle coordination/control & sensation to the re**al, perineal, and clitor1s/pen1s. ⁣
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Unfortunately because of this, OI muscle dysfunction can cause other symptoms such as urinary burning, itching sensations, buzzing/tingling, shooting pains into the groin, abdomen & surrounding areas.⁣
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What can you do about it?⁣
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✔️Get evaluated by a trained pelvic floor PT: they will treat and teach you how to release the OI & fascia in the surrounding area on your own using tools such as Intimate Rose Pelvic Wand.⁣
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✔️OI stretch: In standing, bring your left knee up on a table or high chair, keeping your back leg straight. Lean forward until you feel a stretch in glute. Hold for 30 seconds, repeat 2x/daily.⁣
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✔️Deep hip stabilization: Gradual training of the muscle starting with lying in a 90/90 position with feet flat on a wall & a yoga block between the knees-- try to move your foot out while keeping the yoga block in place.10 reps to start with.⁣
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✔️ Botox & ultrasound guided injections are some other interventions to help with an overactive OI when physical release doesn’t resolve/ease the issue for you. Discuss with your doctor.⁣
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Let us know what ❓you have 👇⁣


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DYK that last week we celebrated both National V***a & National Va**na Days? But why two different days to celebrate something that means the same thing? 🤔⁣
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But, is it?!⁣
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Do you also confuse the va**na with the v***a, l***a, or perineum… and that mostly happens because everything down there is labeled as the va**na? ⁣
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But this seemingly harmless confusion can backfire when people find themselves not being able to describe their symptoms correctly when they see their Gyn, urologist, &/or their pelvic PT.⁣
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DYK that it’s not all VA**NA down there?⁣
⁣👉 Do you know what are different parts of your ge****ls called? ⁣
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⁣Female genitalia is a complex collection of various structures that includes:⁣
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1. V***A: the external genitalia, including the outer & inner lip. The outer lip is the hairy fold of the skin. The inner lip usually doesn’t have any hair on it. The v***a includes everything from the Cl****is, the Vestibule, Bartholin, & Skene glands (produce lubrication) & the opening of the Va**na (yes, 𝘫𝘶𝘴𝘵 the opening— called the Introitus).⁣
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2. VESTIBULE: the innermost part of the V***a that surrounds the Urethral opening at the top & the Va**nal opening at the bottom. It also contains both the Skene & the Bartholin glands.⁣
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3. VA**NA: It is a fibromuscular tube that connects the Introitus to the Cervix (most of it is internal).⁣
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4. CL****IS: is the pleasure house of our body & hosts more than 10000 nerve endings, & is located at the top of the v***a. However, we still can only locate a teeny tiny part of the cl****is externally. Most of it is located internally.⁣
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5. URETHRAL opening: lies at the top part of the Vestibule, & no, people with v***a DO NOT p*e through their va**na.⁣
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6. PERINEUM: The space between the lower end of the Introitus & the upper end of the Anus.⁣
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⁣I cannot emphasize enough how important it is to know our bodies down there & NOTICE any unusual redness, heavy discharge, dryness, bumps, unusual white patches, or the fusion of the l***a.⁣
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If you’re curious to read about this in detail, check out the blogpost I wrote (in my stories 👆)⁣
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⁣ ***anotva**na ***apower **na