Author Archives: Admin

When Your Poo Pusher Doesn’t Push Poo

“My Poo Pusher Doesn’t Push Poo.”  That is the best description of constipation a patient has ever given me.  Exactly right.  So, what happened and how do you fix it?

Let’s start with a more complete, scientific definition than my patient’s description above.  Constipation is defined as pooping less than 3 times per week, straining with pooping, feeling like the colon isn’t empty, or having to using other techniques (finger, enema) to be able to poop. There are many reasons to be constipated, but here we are going to focus on pelvic floor dysfunction.  So, besides not eating your leafy greens, what cause constipation?  When looking at constipation from a pelvic floor perspective, some of the most common causes include not enough fiber, lack of exercise, medications (many can cause constipation), ignoring the urge to go poop, travel or just getting off routine, pregnancy, irritable bowel syndrome, and aging.  In these situations the root of the problem is the inability to relax the pelvic floor muscles in order to poop.  The rectum is a complex organ that has the amazing ability to sense whether you need to pass gas, liquid, or solid.  Based on that sampling response, your pelvic floor is able to relax enough to pass the gas or tighten up enough to stop the liquid stool.  This is at the level of the internal anal sphincter, which is involuntary.  This means that you are not able to control this muscle—kind of like your heart.  The internal anal sphincter relaxes when you sit down to poop but stays tightened until it is time to go.

The external anal sphincter (EAS) is the layer of muscle that you are able to control.  You are able to tighten this muscle to close off your rectum to prevent the passage of gas at inappropriate times.  But it also must be able to relax when it is time to have a bowel movement.  If the muscles are unable to relax, it becomes difficult and sometimes painful to poop.  When this occurs, your body tightens up more against the pain, which adds to the hurt.  All of a sudden, a vicious cycle has started and it is important to find a way to stop the madness!

Toileting techniques can play an important role in easing constipation.  When you are standing, the anus and rectum are at an 80-100 degree angle to each other, making it hard to have an accident in standing since there is a kink in the tube.  When you sit down and lean forward with your hands on your knees, the angle of the rectum to the anus increases closer to 170 degrees, making the tube straighter and thus, easier to poop.

Pelvic floor therapists can be very helpful in the treatment of constipation.  We can help break the cycle!  To treat constipation, pelvic floor therapists begin by examining the patient’s ability to relax the pelvic floor muscles and looking for connective tissue issues. We also talk about toileting habits, food, and exercise.

Pelvic floor therapists spend a lot of time teaching is proper pooping technique.  Again, if the pelvic floor muscles are not able to relax, you are trying to poop through a closed tube.  Working on relaxing the appropriate muscles through biofeedback, manual therapy, and exercises is the first important step.  Taking the ability to relax the muscles laying down and then into sitting and then into the bathroom are big steps and there can be a big learning curve.  It is hard to break bad habits even when the habits are painful.  That’s where working on the proper techniques comes into play—posture, breathing, relaxing the pelvic floor.

Pelvic floor physical therapists play an important role in helping to treat constipation and help prevent it from coming back by teaching you how to relax the pelvic floor muscles instead of fighting against the poop and how to use techniques to improve your success!


–Jennifer Cumming, PT, MSPT, CLT


This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.


Why Fee for Service PT is best for the client too!

Check out this link. It is an excellent piece on Fee for Service model specifically for Physical Therapy and why it is actually more cost effective and promotes higher quality of care for our clients!


Listen Up Ladies!


With posting the Cross Fit info recently, I had a few friends mention they read up on it.  They also said “I really did not realize what you do” and followed it with ” I mean I leak sometimes too when I jump or run”.    GIRLS!!!!!  I can help you with that, was my emphatic reply.  I have realized that despite me talking about what I do, even some of my good friends thought it would need to be severe leakage to need therapy, or maybe just thought a little was no big deal?  These are young women, mid to late 30’s who have multiple children, are very active and athletic.  And yes, while our lovely children are clearly to blame for the leaks, we do not have to sit back and deal with it. Do not just assume it comes with being a mother and certainly stop being a martyr and take care of you!  If you leak at all with exercise, laughing, coughing sneezing or strong urges to go YOU HAVE PELVIC FLOOR  DYSFUNCTION, and I can help you make it better.  Now, let’s talk about how…

Your pelvic floor has many functions beyond accomodating childbirth and sexual intercourse.  It provides stability to the pelvis and lumbar spine by working with the abdominal and deep spinal muscles.  It controls abdominal pressures through coordination with the diaphragm.  It helps with pelvic circulation and lymphatic flow. And it controls bladder and bowel function.  When any piece of this amazing machine is weak, the entire system can become dysfunctional.  Pelvic PT’s are trained to examine these functions and structures involved and determine where your problem lies. We can then develop a program specific to your problem to address the cause.

Your bladder function is affected greatly by any weakness or tightness in the pelvic floor, abdominal or deep spinal muscles.  The bladder and pelvic floor muscles communicate to one another. As the bladder fills and stretches, a signal is sent to the brain that it needs to be emptied. The pelvic floor muscles contract to signal the bladder to relax, they have things under control.  If your pelvic floor are weak, or too tight they cannot provide a good line of communication to the bladder, and it panics, and you leak.  This is called urge incontinence.  If you have weak pelvic floor and/or weak abdominal muscles and you cough or sneeze this creates an increase in abdominal pressure.  The pressure is too great for the pelvic floor muscles and you leak.  Strengthening these muscles, the pelvic floor, abdominal and deep spinal muscles, is essential to stopping the leaking.  It is also essential that you learn to coordinate them together, and use the diaphragm too so that abdominal pressure is well controlled.  A pelvic PT is specially trained to do just that!

Habits can be an important piece to the puzzle too.  Do you drink a lot of bladder irritants?  Examples would be Coffee (caffeine), Sodas (carbonation, artificial sweetener), citrus and tomato products and Alcohol.  Cutting back or eliminating some of these can be very helpful.  How frequently are you going to the bathroom?  If you are going too frequently you are training your bladder it cannot wait. You should go to the bathroom every 2-3 hours during the day, and young women (under 65) should not get up at night to void.  Are you pushing or straining to empty or start the flow?  You should never do this.  It creates significant problems for the pelvic muscles, and can actually create or worsen prolapse. You should be able to relax and pee without any effort on your part.  Do you go “just in case”?  Well, don’t;  this too can train your bladder it needs to be emptied more frequently than it does. The big deal is you do this and when the bladder gets even just a quarter full it flips out, sending crazy signals to your body to empty it.  Your pelvic floor is weak and oops, you are leaking again.  A pelvic PT can teach you strategies and tips to retrain your bladder to make this better.

So…if you are experiencing even just a little leakage with exercise OR any activity, seek help! It’s out there.  Surgery or medications are not the only option.  In fact conservative treatment by a pelvic physical therapist is one of the best options with a very high success rate (check out this article).  A pelvic PT can help you to know if you are in fact engaging the pelvic floor correctly, and teach you how to coordinate them with your abdominal and spinal muscles. We can help you with strengthening for your sport, or exercise regimen so that you don’t perform the exercise incorrectly and cause leakage.  You can perform high level exercise without leaking and I can help you do that.   We examine so much more than just those pelvic floor muscles. We look at everything from head to toe to determine where the dysfunction lies. We consider bowel function and bladder function. We take into consideration surgical history, childbirth history and your level of stress and emotional concerns.

Why am I so passionate about this?  I hate to see women suffer with, or ignore symptoms that are a huge impact to quality of life when there are answers. I hate to see women seek out surgery when they don’t need it.  I hate to see women limit their activity level for something that can be fixed.  I recently received a call from a patient who was scheduled for bladder sling surgery in the near future.  She was unsure if coming to see me was worth it or not, as she was going to have surgery soon.  She decided to give it a try. I spent one hour with her at her evaluation, educating her on everything I just shared above, but based on her individual findings.  We met on a Friday.  On Monday morning I opened my email to read this:

“You may recall I’ve been having 2-3 accidents per day for about 6 months now.  Since employing the trick you gave to me on Friday, I haven’t had even 1 tiny leak.  I am so grateful, Sarah.  Thank you.”

This is why I am passionate. This is why I LOVE my job. This is why you, yes YOU!  Should not let this go.  Get in to see me, or a pelvic PT near you.

Sarah Dominguez, PT, MSPT, CLT


This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.


CrossFit and Leaking

This is a blog post by another Pelvic PT, Tracy Sher that I just had to share. She is absolutely right on in her discussion of this CrossFit video.

Check out the video and Tracy’s comments at this link:

In Celebration of Cancer Survivor’s Day–A Personal Story of Prostate Cancer.

pic with dadIn celebration of all cancer survivors on this Cancer Survivor’s Day, I would like to honor my dad, John Hanson. This year he celebrates 6 years cancer-free after being diagnosed with prostate cancer in 2006. I spoke with my dad recently about his experience with prostate cancer and recovery and asked if he would share his story.

My dad lives in south-central Nebraska where he farms. When my dad was 57, shortly after my oldest kiddo was born (and his first grandchild), Dad decided to go in for a physical. He had some blood work done which showed that his PSA (prostate specific antigen) was high. He was referred from his primary physician to an urologist in the closest town that has one, about an hour away. There, he had a biopsy of his prostate done which confirmed that he did, in fact, have prostate cancer. On the Gleason scale, he was given a score of 7, which is an intermediate grade. According to Jim Kovarik, PA-C, a physician assistant in the Urology Department at the University of Kansas Hospital, prostate cancer is rated on the Gleason Scale from 6-10. Grade 6 would indicate a low grade, slow growing cancer. The grade 7 that my dad was diagnosed with is an intermediate grade that requires some form of treatment. Grades 8-10 are higher grades with more risk and tend to be more aggressive, typically requiring more than one treatment option.

According to Kovarik, the 10-12 year outcomes for low to intermediate grade prostate cancer following either radiation or surgery are similar. The difference tends to come 15-20 years after treatment. At that point, patients who underwent surgical intervention have lower PSA recurrence rates than those who underwent radiation. The other down side with radiation is that if the cancer does recur, usually surgery is not a secondary treatment option.  Typically, the next recommended treatment option is androgen deprivation. The side effects of this type of hormone therapy can be uncomfortable with side-effects similar to women’s menopause with hot flashes, breast tenderness, and weight gain. The hormone therapy is effective for an average of 8-10 years.

The urologist gave my dad several treatment options. The first was to wait and see what happened. The second was to have the prostate removed. Third was to have radioactive seeds implanted. He did not feel comfortable waiting and seeing. He has a family history of prostate cancer and his uncle died from advanced prostate cancer. The urologist discouraged him from having radioactive seeds implanted as there are fewer treatment options if the cancer recurred. Thus, he opted for the prostate removal surgery. He was told they would do the nerve sparing surgery and that he should be able to have an erection after the surgery. The hospital where he was treated did not yet have the robotic option, which is surgery where the surgeon is assisted with robotics. According to Kovarik, the benefits of the robotic surgery over traditional surgery are less blood loss and a shorter hospital stay. There is no consistent statistical advantage of the robotic surgery in terms of cancer recurrence, urinary incontinence, or erectile dysfunction.

My dad underwent the surgery with the retropubic approach, leaving a small incision just above his pubic bone. The surgery was a success, the cancer was encapsulated and completely contained in the prostate gland, and he was declared cancer free! The afternoon after the surgery, the nurses made sure he was up and walking and he was sent home with some pain pills. He told me that he took just a pill or two, and didn’t need any after that.prostate image

Before the surgery, dad was proactive and talked to me and the PT at his local community hospital. We both encouraged him to do pelvic floor activation exercises (commonly known as Kegel’s). I have also taught him how to activate his core stabilizing muscles for improved pelvic floor support. Being in south-central Nebraska, there are no formal support groups. However, dad knew quite a few men who had undergone prostate surgery, and they have formed their own informal support group. When I told him about, the prostate support group, he was excited and is planning to bring that information to his urologist. He stated that one of the best things he discovered from his experience with cancer is how many other men have had the same diagnosis and the bond he has formed with them.

Dad stated that he isn’t having any leaking at this time, but that sometimes he feels like he can’t quite hold it as long as he would like. The biggest residual effect, for him and many, many other men, is the sexual dysfunction that goes with the prostate surgery. Each man’s experience varies and can range from complete erectile dysfunction to the inability to have as strong of an erection as before the surgery.  Peyromaure_Management of SUI after radical prostatectomy

So, I asked my dad, what would you have liked to have known before the surgery? He told me how important he felt it was to do the Kegel’s leading up and immediately following the surgery to prevent the leaking that many men he has talked to have experienced. He also said that walking was an excellent pain relief for him—that sitting and standing in place seemed to increase his discomfort. And most importantly, he wished he had known how common the sexual dysfunction is among men after this surgery.

Men with a Gleason Score of 6, 5 year survival rates are near 100%, a score of 7 are 96% and a score of 8-10 are 90% assuming definitive treatment was provided.

Currently, the American Urological Association (AUA) Prostate Cancer Guidelines recommend men ages 55-69 discuss potential benefits of prostate cancer screening with their provider and make an informed decision whether to proceed with screening.  Currently, there is insufficient data to make a definitive recommendation regarding the benefit of prostate cancer screening in men 40-54 years old or over age 70.  However, this is a conversation that these men should have with their provider taking into account their age, family history, other medical conditions, and personal wishes.

Congratulations to all cancer survivors out there! We celebrate with you this day! And a special thank you to my dad for sharing your story.

Pelvic Floor Specialist, Our Role in Sexual Health

Having worked as a pelvic floor specialist in Kansas City for the last 7 years, I have helped a lot of patients who experience sexual dysfunction.  This “hush” topic may scare off a lot of people, and quite frankly it took me awhile to be comfortable discussing with clients their concerns about sex, intimacy, decreased desire, different positions and general questions about sexual health.  As a pelvic floor specialist, clients are referred to us through their doctor, chiropractor, psychologist, or are self-referred after many frustrating years of dysfunction without any help. Pelvic floor physical therapy examines the structures involved in healthy intercourse and addresses the problems found through exercise, manual therapy, neuro-muscular retraining using surface EMG (electromyography) and A LOT of patient education. There are many symptoms that fall under the umbrella of sexual dysfunction. I would like to talk about the ones that we most often see and are very capable of helping through pelvic floor physical therapy.

Both men and women can experience a general lack of sexual interest and the numbers probably won’t surprise you that 32% of women aged 18-59 complain of lack of interest while just 15% of men the same age experience this concern. Lauman, EO, et al. JAMA. 1999;281-537-544   Arousal Disorder can be due to medical factors that create poor circulation, poor lymphatic flow, hormone imbalance, tissue restrictions or muscle weakness or spasm.  They can also be greatly influenced by psychological factors.  A pelvic floor specialist is trained to take a very thorough history and recognize that this type of disorder needs to be treated in a multi-disciplinary approach alongside a doctor, psychologist and/or psychiatrist and possible other alternative therapy providers.  Physical Therapy for Sexual Arousal Disorder will examine the muscles of the pelvis for strength and endurance and evaluate tissue elasticity for possible restrictions or circulatory restrictions, and design a treatment plan using exercise, and manual therapy to restore normal function to these structures.

In their study on sexual dysfunction in the United States, Lauman, et al. found the prevalence of orgasmic dysfunction to be 28% of women aged 18-59 and just 8% of men of the same age. It is clear these concerns affect women more frequently than men, yet sales of Viagra are staggering while women are still waiting for the magic pill to cure our sexual ailments.  I digress…  At any rate, in order to have a good orgasm, you have to have strong, healthy pelvic floor muscles and a clear head.  Huh?  You heard me, the more anxiety and worrisome thoughts that are rolling around up there during sex, the harder it is to achieve orgasm.  No surprise then that conflict in a relationship is highly correlated with poor orgasm or none at all (Lauman et al.) Once again, a good pelvic floor specialist knows we can’t fix the relationship, but should have a list of practitioners who can help in this regard. We can work on getting the muscles and tissues of the pelvis strong and healthy.  Without  muscle and tissue health, the pelvis becomes congested due to poor blood flow, or poor lymphatic flow, or both.  This leads to poor performance, no orgasm and anxiety about it all, creating a spiral downward to dysfunction.  Stopping that snowball effect is the first step toward improving sexual health.  In my experience as a pelvic floor specialist treating orgasmic dysfunction, clients are most improved by integrating therapy with a certified sex therapist or psychologist who has experience with this.

For women, pain with sexual intercourse is seen in roughly 21% of us from age 18-59, according to Lauman et al. Another study by Glatt et al. found 60% of women surveyed experienced pain with intercourse at some time in their lives.  Men can also experience pain with intercourse, although the rates are much less.  There are many reasons pain can occur during sex. These can stem from situations where a women has been abused either sexually or physically, even verbally. Women often find after childbirth they may have pain due to tissue restrictions or scarring.  Often it is due to postures or habits of holding tension in the muscles of the pelvis. There are a number of disorders that can cause pain with intercourse, some relating to the tissue sensitivity in the vulvo-vaginal area. Often men and women may have pain with intercourse after cancer treatment.   As specialty physical therapists, we will help identify the causes of your pain, evaluate the musculoskeletal structures of the spine, hips, pelvis and abdominal wall and determine a plan of care to help you reduce pain and regain pelvic health.  Sex should not be painful. You are not imagining it. There are many people who also have symptoms like yours. I have treated them successfully for the past 11 years.

Pelvic health is so important in maintaining interest in sex, desire and arousal, good orgasm and  happy healthy intimacy.  I realize it isn’t easy to discuss with anyone.  Why is this so important?  Why all the fuss? The benefits of sex are tremendous!  It can reduce stress, and who doesn’t need a little help there?  It can enhance mood and improve self-esteem.  It helps maintain regular blood flow through the pelvic arteries, which can help tissue health and prevent thinning. Sex can also improve pelvic floor muscle health as well. And guess what!?  Having sex twice per week adds two years to your life expectancy.  And wait (ladies you may want to keep this to yourselves) but gentlemen you will be happy to learn that sex daily could add 8 years to your life! (Berman/Berman, For Women Only pg 194)

–Sarah Dominguez, PT, MSPT, CLT


This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.

Men have pelvic pain, too!

I was telling a friend about pelvic floor physical therapy and I happened to mention that I treat men.  She was surprised and asked “You treat men, too?”  “Yes”, I answered.  “Men have pelvic pain, too.”

Male pelvic pain is hard to talk about and many men don’t.  The symptoms can be very similar to the pelvic pain that women experience–pain with sitting, standing, walking, going to the bathroom.  This pain can be with in the hip, buttock, inner thigh, and low back.  That’s easy to talk about.  It’s the pain in the penis, scrotum, and testicles that can become difficult for some men to talk about with anyone.  Some men will have pain with a full bladder or with emptying their bladder, sometimes with an erection or ejaculation, or a bowel movement.  Often times they might have a difficult time starting the stream of urine, take a long time to empty their bladder, or not be able to empty at all.  Often, all the different pains will get grouped into a chronic prostatitis diagnosis.

Pelvic pain can result from many different factors.  One of the most common causes is muscle tightness in the pelvic floor muscles, inner thighs, lower abdomen, diaphragm, and lower back.  If the muscles are unable to relax and lengthen, the tissues that surround the muscles can also carry increased tension in them.  These tissues can include nerves, connective tissues, and joints.  If a nerve has increased pressure on it, particularly the Pudendal Nerve , the pelvic floor muscle tightness can radiate to the penis, scrotum, and testicles.  This is sometimes referred to as Pudendal neuralgia.

Many times, men will come to our clinic and ask two questions.  Am I the only ones with this type of pain and is there anything to make it better.  The answer to the first question is “You are not alone.”  And the answer to the second question is a resounding “YES!”  Pelvic floor physical therapy can make a world of difference with the pelvic pain you are experiencing.  When I do an evaluation for male pelvic pain, I am looking at how the muscles of the hip, low back, and abdomen move with the surrounding joints.  I also check the muscles of the pelvic floor to see if they are able to relax and if there is any specific point of pain.  Treatments include stretching exercises, increasing muscle and soft tissue mobility, core strengthening, and relaxation strategies.

I truly enjoy the challenge of working with men who have pelvic pain.  So many times, once we are able to pinpoint where the pain is coming from and figure out some stretching and stress management strategies, the embarrassment related to not knowing the cause of the pelvic pain is lifted.  So, yes, pelvic floor physical therapy is for men, too!

–Jennifer Cumming, PT, MSPT, CLT


This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.


Getting back after baby

I love working with clients post-partum! 6 weeks or 6 months or 6 years, there is always so much to teach, so much progress to be made, and so many women who look at you with eyes welling up in gratitude for the words you’ve just said, “This can get better.”  To expect that after delivery women should accept things like urinary incontinence, pain with intercourse or pelvic exams, and saggy weak abdominals as if there is no hope for these ever returning to any kind of normal, is disheartening.  There are so many providers who will see you at your 6 week check up and if you even dare complain of urine leakage or pain with sex, look you sternly in the face and say “give it time” or “you did just deliver a baby”.   As if we should just sit back, shut up and live with it!  Well, girls, I am here to tell you, beg you, please don’t just live with it!  You don’t have to.  I am going to share some insights into those problems and how physical therapy can heal your labor and delivery battle wounds.

Let’s begin with the trauma of giving birth.  Give yourself some serious points here, as this process is truly amazing, but at the same time horrifying for those poor tissues and muscles within the pelvis.  Their ability to stretch is on level with some super-human abilities, if only the recovery were as easy.  We can compare delivery to a whip-lash injury in a car accident. Those pelvic muscles are stretched to their max in a short amount of time, often with tearing of the fascia and connective tissue and/or nerve tissue aggravation. Or we have the reverse, where a woman is asked to push for 2-3 hours, which is darn near the time it takes to run a marathon!  We expect that people after whiplash or after running a marathon will have full recovery and return to their normal activities, so why not after baby?  Well, for years women were just accustomed to the problems that bearing children left them. Thank heaven for modern progress and for pelvic PT’s everywhere!   We are working hard to get the information out, educate people and providers so that  we can live happy healthy lives, laugh with our friends without leaking, and enjoy sex with our spouses!

What exactly do Pelvic Physical Therapists do to help you?  We start with a very thorough musculoskeletal evaluation. We can rule out lumbar spine, sacroiliac joint, pubic symphysis joint, hip joint and the abdominal wall as a source of the problem.  We will examine your abdominal, pelvic floor and spinal musculature to determine weakness, poor coordination, muscle imbalance, and dysfunction. These joints, connective tissues and muscles must all work together, in a coordinated manner, or symptoms such as urinary incontinence, urinary retention,  constipation, coccydynia (tailbone pain), pain with sex, or vaginal or pelvic pain with other activities  will appear.  The trouble with “just giving it time” is, it won’t generally work itself out on it’s own. You will heed the advice of the media or other fitness guru who will work your abs, gluteals, hamstrings, quads until they are so sore you cant get out of a chair, but you wont see the pelvic symptoms resolve. This is because strengthening these big, global muscle groups will only mask or worsen your problem. You have to get to the source of the problem and PT’s, namely pelvic PT’s, are the only specialists who truly know how to examine the many muscles that make up the pelvic girdle, while also examining the spine, SI joint and  hips and put it all together to develop an individualized program to help you reach your goals.  Physicians don’t do it, trainers, yoga instructors or pilates instructors can’t do it.   Pelvic Physical Therapists will take the time to find the source of your problem, devise a treatment plan that will work for you and spend countless hours educating you so that you can continue to maintain a healthy pelvis after you are no longer seeing us.

So girls, please hear what I am saying!  I love to treat this, I have seen it time and time again, even years after the last baby.  You can stop hurting and enjoy sex again. You can sneeze, cough, and laugh hysterically and not leak. You can return to activities and exercise you love and see your abdominal wall get stronger.  I can help you do it!  Our clinic was founded for this purpose!  Foundational Concepts  focuses primarily on pelvic dysfunction, and we want to help you feel better. So, stop reading all the self help exercise stuff, put Dr. Oz on pause and come in to see us and see what we can do to help! It is worth your time, money and effort. Believe me you will thank me for it!

–Sarah Dominguez, PT, MSPT, CLT


This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.




Why do I pee my pants when I laugh?

Oh the embarrassment!  Having a good laugh with the kids and all of a sudden you have a little accident, or worse yet, a big accident.  Do I need to wear a pad?  Will it happen again?  Why did this happen at all?

There can be several reasons that leaking, or urinary incontinence, can occur.  The most common reason is muscle weakness. This includes muscle weakness of the pelvic floor muscles that form the bottom of the pelvis and help to support the bladder and other organs.  But just as importantly, it can be weakness of the abdominal, or core, muscles and poor coordination of the abdominal and pelvic floor muscles with activity.  Imagine the area from your pelvic floor to your diaphragm is a pop can–the tops, sides, and bottom all maintain a constant pressure until you pop the top and have a swig.  Now imagine that your pop can has a hole in it–all of a sudden you have pop all over the place!  Ideally, your core–the pop can–has a solid pelvic floor, abdominal wall, and diaphragm.  However, if you have had a baby, abdominal surgery, prostate surgery, a hysterectomy, carry your weight in the tummy, or are a smoker, all of a sudden you may have a hole in your pop can.  All of a sudden, you may pee your pants when you have a good laugh!

Often, when someone goes to their physician or nurse practitioner about leaking, they are asked if they are doing their Kegels.  The question is–how do you know if you are doing your Kegels correctly??  At our clinic, we use biofeedback so that you can see on a computer screen how your muscles are engaging–or not engaging–then your brain is telling them to fire.  Oftentimes after baby or surgery, our pelvic floor muscles and abdominal muscles have difficulty getting back in sync.  The biofeedback is an easy, non-invasive way to help them find their rhythm again with exercises, lifting, and laughing.

Pelvic floor physical therapy for urinary incontinence can help prevent the leaking!   Excellent pelvic floor PT focuses on not only the pelvic floor, but making sure that the entire system is working together to prevent leaking.  Are you activating your pelvic floor when you cough, sneeze, or laugh?  Are you holding your breath when you lift something heavy?  Are your abdominal and hip muscles strong enough to play a supporting role to the pelvic floor muscles when you go from sit to stand or climb the stairs at work?

So, before you consider buying pads or having a more invasive treatment for urinary incontinence, consider pelvic floor physical therapy at Foundational Concepts.  Many times, with a little help for pelvic floor and abdominal muscle strengthening and improved coordination of the core muscles, we can make a big difference in eliminating the embarrassment of having an accident while just having a good laugh!

–Jennifer Cumming, PT, MSPT, CLT


This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.

What is pelvic dysfunction?

What is Pelvic Dysfunction?  It encompasses many different disorders and symptoms. What we as physical therapists are trained to treat are the pelvic floor muscles, the structure of the pelvic girdle (bones, joints and ligaments) as well as the connective tissue and musculature of the abdominal wall. Weakness of the structures in the pelvic girdle may cause urinary or fecal incontinence, back pain or sacroiliac joint and hip pain.  On the flip side, if those muscles and structures are unable to relax properly, they may cause a variety of symptoms and disorders from pelvic pain to constipation to back or hip pain. During pregnancy the pelvic girdle is truly challenged and then under great stress during labor, which can also cause a variety of symptoms.  As Physical Therapists trained in evaluating and treating the pelvic girdle, we can get to the bottom of what is causing your symptoms and restore balance to these structures.

There are many of us who experience symptoms of pelvic dysfunction, and many more who do not seek help. These can greatly impact a person’s quality of life. We are here to help.  We have seen how greatly our treatments improve patients lives, it is why we so enjoy this work and are excited to bring to Kansas City this specialty practice in a warm, comfortable environment. Don’t wait another day or suffer any longer, we see people everyday with similar problems, you are not alone!

–Sarah Dominguez, PT, MSPT, CLT

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.