Category Archives: The Pelvic Chronicles

Your Vajayjay will thank you for this!

One of the questions I’m asked most often at Foundational Concepts is: “Do you have any recommendations on what I can do to get better?” The short answer to this is no. Tackling your pelvic health usually requires a multidisciplinary approach that is individualized to each patient. However, there are some fabulous general resources and treatment options that can get you started on the path to a healthier you. So I’ve decided to share some of our favorite pelvic health resources and products with you.

(A little disclaimer: Foundational Concepts is not affiliated with any of the following providers, resources, or products.  We just like them!!)

#1 Find Community

When faced with the many, many (did I say many?) questions of pelvic pain, it helps to know that you’re not alone. Finding a community of individuals who are also dealing with the same struggles that you are can greatly help reduce one of the contributors to pelvic pain/dysfunction; anxiety. Check out these groups to get started:

Happy Pelvis

Mom Support Groups: Baby Center and KC Metro Moms

Pelvic Pain Support Network

Endometriosis Groups

IC Network

Red Hot Mamas (Menopause Support Group)

Cancer Support Group: Gilda’s Club Kansas City


#2 Shop Wisely

DO NOT, I repeat, do not buy a product without first doing some research. Not every product on the internet will work to cure pelvic pain. Luckily, we’ve done some research for you, and compiled a list of our favorite products.


Spanx: firm compression to abdomen, perineum and thighs.  We like that it improves circulation, lymphatic flow and lifts and supports.


Squeem Binder: …firm compression, post-partum belly binder.


Desitin/ Witch Hazel Wipes/ A&D: …improvement in fissures and hemorrhoids

desitin  witch hazelA&D

Pelvic Floor Relaxation CD for Pelvic Pain: …30 minutes of guided pelvic floor muscle and whole body relaxation with breathing exercises, in two versions for men, and women.


Stop, Breathe and Think App: 10 different 5 minute meditations to stop what you are doing and focus on breathing for a few moments a day.

stop breathe think

Wondergel Cushion: …provides extreme comfort and support while eliminating pressure hot spots.

gel cushion

Pelvic Therapy Hot/Cold Pad:… targets the abdomen, hips, pubic bone, pelvic floor/crotch, tail bone and lower back simultaneously with natural hot/cold therapy.


Healthy Hoo Hoo…Eco friendly, and free of harsh chemicals feminine cleansing products

healthy hoo hoo

Organic Cotton Pads

Here are a few options:

Natra Care



Sckoon Cup

Diva Cup (not cotton but good product)

Prelief: …for bladder relief with acidic foods and beverages


Lubricants: organic, free of dyes, and sans chemicals. Here are a few options:

Coconut Oil: LOVE, LOVE, LOVE this and 99/100 of my female patients swear by it.  Also use it as lotion to your female area. Make sure it is 100% coconut oil. It is a multi-use oil…cook with it, use it for wrinkles, lotion, body scrubs, and lubrication. J Let it melt in the middle of your hand and put it to good use! (*IMPORTANT NOTE: Coconut oil breaks down condoms)


Sinclair Institute Organic Personal Lubricant

Slippery Stuff Personal Lubricant

slippery stuff

Honest Company Organic Nipple Balm…Helps relieve irritation & helps heal sensitive, sore or chapped nursing nipples.

nipple balm

GoCommandos:…all cotton patches stick securely in your pants and jeans, eliminating conventional underwear. Now worn by many women suffering from pelvic pain, vulvar and bladder conditions, and claiming their extreme soothing comfort.


#3: Explore all Treatment Options

We know that tackling your pelvic health can be a bit overwhelming, and you may not know where to start. In conjunction with physical therapy, many of our patients have found these treatments to be very effective in eliminating stress, reducing pain and improving their overall quality of life.


Below are our Acupuncturist recommendations for the Kansas City area.

Jenn Funk: (816) 745-1810

Stephanie Mall: Infertility Acupuncture

Mary Zhang: Herbal Acupuncturist


To promote a healthy balance of exercising, and not exacerbating patient’s symptoms, our therapists will often enlist the help of massage therapists, yoga, and Pilates instructors.

We recommend the following practitioners in the Kansas City area

Lee Anne Jester, Pilates instructor at Lee Anne Pilates, LLC  (Lee Anne gives amazing individual feedback on how you are moving and what you need to be using)

Molly Root, Massage Therapist at Sage Center for Yoga and Healing Arts

Alex Jackson: Holistic Health Practitioner

Cathy Trenton: Massage Therapist (816) 694-4666

Pelvic Pain Physicians/ Sex Therapists/ Psychologists

At Foundational Concepts, we get it. Pelvic floor dysfunctions can destroy an individual’s relationships, as well as their mental, and emotional health. It is essential to overcome these types of obstacles. Check out our provider/ therapist recommendations below for the Kansas City area.

Center for Pelvic Pain and Sexual Health : All of the practitioners at this site ar–e AMAZING!!

Erin N. Donnelly, Psy.D.,M.Ed.: Clinical Psychology Fellow, Sexuality Educator & Therapist

Rhonda Johnson, PhD: Clinical Psychologist, Sexuality Educator & Therapist

Turner Professional Group: Relationship therapy

Hopefully, the above list will help encourage you to improve your pelvic health. Let us know if you have any other great products or resources you use!

–Amanda Fisher, DPT

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 or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates.

Why do I leak with exercise?

I decided to re-visit a topic that we have talked about before, primarily because I seem to have had several people ask me recently, “Why do I leak when I work out?”  Followed by “It is normal after babies isn’t it?”  Let me begin by saying that leaking urine during exercise is common, roughly 1 in 3 women experience it.  However, it is not normal, it is a sign that there is a breakdown in the core system.  Just like knee or hip pain would indicate a weakness in the system, so does incontinence.  Yet we don’t always seek help for incontinence either because we are embarrassed or we assume it is just part of motherhood.  As a physical therapist I see women everyday who leak urine with exercise.  It is important to recognize this as a symptom of muscle imbalance and educate women to seek help so they can reach their exercise goals and prevent further problems from arising in the future.

It is very important to have an evaluation by a pelvic specialist in physical therapy to determine why the leaking is happening.  Leaking urine does not always mean you need to do more “Kegels”.  Often the issue may be muscles that are too tight, do not properly coordinate with the abdominal wall, and diaphragm muscles.  There may be hip muscle weakness that causes an imbalance in the system and when restored, the pelvic floor can function more optimally.  Even if your Gynecologist or urologist say you don’t need physical therapy, you need to seek help from one. Be your own advocate!  Many states allow direct access, meaning you can see a PT without a physician referral.  The other important part to evaluation by a pelvic PT is that they actually put their finger inside your vagina to assess what the muscles are doing.  If they only use biofeedback (surface electromyography) they are not getting a true picture of the muscle function.

Core stability is important in order to perform simple daily activities, but especially important in exercise.  This requires muscular strength, awareness and coordination with the deep abdominal muscles, respiratory muscles and the spinal stability muscles along with the pelvic floor.  It is important to work with a pelvic PT to determine what is wrong with your core system.  If weakness is the problem, we can train the muscles to generate a strong contraction with appropriate relaxation.  It is just as important to be able to relax as to contract.  The idea of just doing Kegels all day long is quite wrong and poor advice.  Constant tension is not the goal, in any muscle.  The relationship with the respiratory, spine and abdominal muscles is of utmost importance.  One great way to begin to retrain the system is with coordination of breathing:


Lay on your back, with knees bent and feet flat.  Inhale and allow the belly to rise, and relax the pelvic floor, feel heaviness in the pelvis.  As you exhale, open your mouth to allow a “haaaaa” sound and feel your deep abdominals and pelvic floor lift gently. Work on this daily, until the sense of contract vs. relax is easy to feel in the pelvic floor.  When you can feel this, move onto sitting, standing or with other activities like squats.  With squatting, inhale as you squat down, and exhale on the upward motion, contracting the pelvic floor and abdominal muscles.  When lifting baby, inhale and squat then exhale and contract while picking up baby.  This can be applied to all exercises and functional tasks. Best advice would be to stop the activity that is causing leaking for now, and focus on retraining this system to function properly, eventually working up to the activity that is the problem.  You have to take the time to build a solid foundation before you progress to higher level activities.

Share this with friends, family, sisters and mothers.  There is never one answer to “why do I leak with exercise”  every person is individual and needs an individual program specific to their body.  We know that 1 in 3 of you reading this is experiencing this symptom.  Take the time to have your body evaluated by a women’s health physical therapist to develop an appropriate, individualized exercise plan for your body.  This will allow you to reach your fitness goals, and keep a healthy, strong body that you can be proud of.

–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 or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates.

Vulvo-vaginal hygeine

Just sharing a great post from Every wonder really how you should clean your vajayjay?  Or if the things mom told you were dead wrong (or, maybe she was right?) ?  This is a great blog on just that!  Enjoy.

–Sarah Dominguez, MSPT, CLT

“Don’t Worry, Be Happy….Because Research Says So!”


Happiness is everywhere. It’s heard on the radio, it’s seen on billboards, it’s expressed as a smile or a good laugh, and it’s supported in the research. As I approach the end of my time as a physical therapy student at Foundational Concepts,  I reflect on how happiness and positivity can be such a powerful component to each patient’s plan of care. Additionally, research supports that a positive outlook can lead to positive outcomes.  By making small, positive habits a part of a daily routine, those habits could become second nature and could play a large role in relieving chronic pelvic pain.

Chronic pelvic pain, or continuous or episodic pain in the lower abdomen or pelvis for at least 6 months, is a common occurrence for many patients at Foundational Concepts.2 If left untreated, this chronic pain has the capability to compromise quality of life, function, and increase the likelihood of psychological impairments.2 Negative thoughts about pain can proceed pain-related fear, and further play into functional disability.5 In order to target pelvic pain, a multidisciplinary approach that includes physical therapy interventions, and emphasizes an improvement in day-to-day pain management and function, should be utilized.

Chronic pain is more than just a feeling of agony, it is a sensory and emotional experience that is related to how the brain organizes input and stimuli.1,4 Treating chronic pelvic pain should embody a mind-body approach to target more than the muscles and tissues affected but also to retrain how the brain perceives pain.4 Thoughts are considered to be nerve impulses, and research finds that negative thinking can exaggerate perceived pain states.4 However, the thoughts that the nervous system develops about threats and pain can be changed over time.4 Neurons in the brain can become less sensitive and stop misinterpreting a non-threatening stimulus as painful.4 Physical therapy encompasses the “mind-body” approach through manual skills, neuromuscular therapeutic interventions supported by research, and with the development of a unique plan of care to each patient.  Practice, persistence, and patience in conjunction with physical therapy, can restore function in a way that does not just mask the pain, but targets the pain.positivity

Negative beliefs and persistent stress, particularly without positive thoughts, lowers resistance, weakens the immune system, and increases the risk of health problems.4 Researchers believe that successful results can come from visualizing not only the movement, but also visualizing a positive outcome as well as imagining a movement performed perfectly.6 If your goal is to run a half-marathon or even to sit for an hour without pain, research considers that even visualizing success through positive thoughts can be beneficial to reducing pain.  Affirmations and positive thinking can potentially help one to better learn how to control thoughts regarding pain and how to handle stress and conflict to be better managed.4  Furthermore, pain was found to be reduced, as seen on imaging by use of positive pictures, sweet tastes, and expectations.4 

There are a variety of ways to make positive thinking a part of your everyday lifestyle. One technique may suit you better, but here are a few places to start:

1. R-E-L-A-X: Research shows that people who mediate better stimulate the region of the brain that is important for attention and regulating emotions.4  In addition, meditation can also decrease anxiety and improve self-confidence.4  Deep breathing, a good tool for EVERYONE (see blog post September 6, 2014) is believed to calm down a hypersensitive nervous system, which exacerbates pain states.4 (Stuck on how to mediate? Refer to our Resources tab for a recorded step-by-step meditation piece.)

2. Exercise: Research supports that exercise can lower a response to stress and improve one’s mood.

-For cardiovascular exercise, the American College of Sports Medicine ACSM), suggests up to 30 minutes a day for 5 times a week, of exercise of moderate intensity (walking, biking, swimming, etc.).4

-Yoga is another great form of exercise that targets body perception, deep breathing, and awareness of one’s mental and physical state.4 Yoga has been shown to increase the amount of positive thoughts and emotions and could potentially reverse the effects of negative thoughts through a physiological effect.4

-Pilates has been found to provide pain relief by increasing flexibility, mobility, and strength. Literature supports that pilates-based exercises provide a significant benefit to reducing pain.3

happy3. Take note: Document your day in a positive way! A journal (or even just a blank piece of notebook paper) can act as a place for all of your positive thoughts and actions throughout your day. With the holidays approaching, a journal makes the perfect gift for a friend or loved one, and mostly for you. Take time from your day to see all that there is to be thankful for and document those positive actions that you should take responsibility for. If you made someone’s day by holding the door or by calling a loved one, take note. You may come across a day where writer’s block takes over or where you need a different approach to your journal. If so, write down at least 1 thing that was good about the day. If it snowed, if it was sunny, or if you got the promotion you had wanted, anything that was good. Write down 3 random acts of kindness: 1 to a stranger, 1 to a loved one, and 1 to yourself. Embrace each day by starting and ending it with a positive thoughts or statement.

The small, positive thoughts can become everlasting habits into your day that can better target your pain. Try with just a few positive thoughts to start and see where your mind can take you.

— Lindsay Sureck, SPT




1.  Bowering K, O’Connell N, Tabor A, et al. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. J Pain. 2013 Jan;14(1):3-13.

2. Chao M, Abercrombie P, Nakagawa S, et al. Prevalence and use of complementary health approaches among women with chronic pelvic pain in a prospective cohort study. Pain Med. 2014 Oct 3.

3. Sullivan A, Scheman J, Venesy D, Davin S. The role of exercise and types of exercise in the rehabilitation of chronic pain: specific or nonspecific benefits. Current Pain Headache Rep. 2012 Apr;16(2):153-161.

4. Vandyken A, Hilton S. The puzzle of pelvic pain: a rehabilitation framework for balancing tissue dysfunction and central sensitization II: a review of treatment considerations. J Womens Health Phys Therap. 2012 Jan;36(1):44-51.

5. Vlaeyen J, Linton S. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr;85(3):317-332.         

6. Warner L, McNeill ME. Mental imagery and its potential for physical therapy. Phys Ther. 1988 Apr;68(4):516-521. 


When chronic prostatitis doesn’t involve the prostate

I have many men who come to clinic with a long history of pelvic, testicular, penile, scrotal, and/or lower abdominal pain. They have been through the wringer when it comes to failed treatments.  Many rounds of antibiotics, every bladder and prostate test and scan you can think of, and multiple doctors—many who have thrown up their hands in defeat.   Almost all of them come in with the longstanding diagnosis of chronic prostatitis.  When a new male patient comes in to clinic with this history, I take a different approach.  What if the prostate isn’t involved?  What if it is more a problem of pelvic floor tension and pain?

male side viewThe prostate gland sits below the bladder and above the pelvic floor.  It acts as a secondary urethral sphincter, helping to stop the flow of urine and giving the bladder support.  Often, men with chronic pelvic pain also have urinary symptoms—slow urine stream, pain or relief of pain with urination, or hesitancy.  Thus, it makes sense that they often seek the medical advice of urologists.

But, again I ask, what if the prostate is not the problem?  Right below the prostate are the pelvic floor muscles.  This group of muscles supports the prostate and the bladder.  They also have a role in urinary function.  With increased muscle tightness, the urethra is not able to completely open, creating the same urinary symptoms.  Tight pelvic floor muscles also correspond with the pain symptoms these men experience.  Pain with sitting, standing, walking, sports, playing with their kids, and having a bowel movement.

Looking at the male pelvic floor muscles, you can see the correlation of this pain and the urinary male caudal viewsymptoms.  From the penis to the sit bones, a triangle of muscles is formed called the urogenital triangle.  The transverse perineal muscles form a strut from sit bone to sit bone.  These muscles are stretched when you sit, stand, walk, etc.  The other sides of the triangle are formed by the Ischiocavernosus muscles.  These muscles line the inside of the pubic bones and support the penis, particularly with an erection.

Deeper in the pelvis, are the layers of muscles called the levator ani muscles.  These muscles act as support for the low back, hips, sacrum and tailbone, and abdominal organs. If these muscles have trigger points or areas of tightness, they can produce many of the painful symptoms these men experience.  When I palpate these muscles during an evaluation, many times my client will tell me, “That is my pain!”.


pelvic girdle

So why am I suggesting that the prostate may not always be involved?  Because often it is not!  The National Institutes of Health groups prostatitis into 4 groups.  Type I and II are pelvic pain with bacterial infections and IV is prostate inflammation without symptoms.  Type III or chronic prostatitis accounts for 90% of all men with chronic pelvic pain.  That’s right—90%!!  Type III is defined as “chronic pelvic pain symptoms and possibly voiding symptoms in the absence of UTI”. (   That means no infection, no bacteria, and most likely, no prostate involvement.   The European Urological Association has recently changed their terminology to Painful Prostate Syndrome.  I still don’t love this term, but at least they’re taking the infection off the table!  Maybe looking at it as a pain syndrome instead of an infection, we can decrease the time it takes for these men to receive appropriate treatment.

So what can physical therapy do for “Chronic Prostatitis?”  Well, it turns out quite a lot.  In a recent study by Dr. Colleen FitzGerald (, men had a 57% improvement with physical therapy with a focus on myofascial mobility compared to a massage.  This  shows a significant improvement and is even a significantly more effective treatment then medications (


So, let’s take the prostate out of the corner!  If you have been experiencing pelvic related pain and have not been able to find a cause or a definitive diagnosis, find a trained pelvic floor physical therapist and rule in or out the pelvic floor muscles.  We can make a huge difference in helping with your treatment.

– 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 or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates.

Hysterectomy for Chronic Pelvic pain? 7 questions to ask first!

Great post by Dr. Jen Gunter.  Enjoy!

Just Breathe

My mother used to always say “Take a Deep Breath” when I was angry at my sister, or upset about something as a child.   I never realized how very valuable that advice was until much later.  I teach breathing techniques to my patients every day.  We go over and over it everytime they come in.  I get into a rut with it and doubt it’s importance and then I do a little reading and google searching and am reminded of the amazing, beautiful importance of the diaphragm and its amazing ability to impact so many of our bodies functions.  It truly is at the heart of “holisitc” healing.  So these days when my children push my buttons, or I have had enough of traffic, or my phone seems to buzz constantly, I take that deep abdominal breath and think of my mother.  Then I remember all the things that are benefitted by that simple action.  I wanted to share all the reasons it is important to exercise the diaphragm muscle and just breathe.

First, lets review the normal mechanics of breathing.  The diaphragm muscle sits at the top of the abdominal cavity, separating the chest cavity from the abdominal cavity.  Upon inhale, it contracts pulling air into the lungs.  At the same time, the muscles between the ribs, the intercostal muscles  contract expanding the rib cage.  As we exhale, the diaphragm muscle relaxes and air moves out of the lungs.  The intercostal muscles relax and the rib cage gets smaller.

breathingThe pelvic floor muscles are a very important piece in this system as well, functioning alongside the diaphragm for breathing.  During inhale they relax and descend down. With exhale, they recoil back up, mirroring the movement of the diaphragm. This piston-like movement provides massage and movement to the abdominal and pelvic organs, helps to pump blood and lymphatic fluid through the trunk, it helps to aid in pelvic floor muscle healthy function and keeps a balance through the trunk musculature.

Taking even 5 minutes every day to practice abdominal breathing is beneficial to us as humans!  The more you do the longer the carry-over becomes greater and greater.  Abdominal breathing teaches self-soothing to allow for better stress management, less anxiety and better sleep.  It is calming to our bodies in a world of stimulation from phones, tablets, computers, and TV.  Abdominal breathing turns down our sympathetic nervous system. Wait! it sounds too technical but keep reading…The sympathetic nervous system is responsible for “fight or flight”, meaning if you walk up on a bear in the woods this system is what tells you to RUN! Of course like all things in nature, there has to be a balance, and the sympathetics’s partner is the parasympathetic system. We need a good balance between the two. When one is overstimulated (ahem, put down your cell phone for a minute and focus here!), we tend to live in that mode of heightened awareness.  This increases heart rate, blood pressure and decreases blood flow away from our organs to divert it to where it needs to be to get away from that bear.  Helpful when we really need to get away, but not helpful in our daily lives when really all we need to do is calm down.

Abdominal breathing favors the parasympathetic nervous system. It brings increased oxygenation to our blood stream, it slows heart rate and decreases blood pressure.  It turns the sympathetic nervous system down a notch, putting that bear into hibernation mode. This allows for decreased stress, decreased anxiety and improved cognition and brain function.  This improves blood flow to vital organs, keeping systems mo ving happily. It relaxes muscle groups, reducing pain and inflammation. In a world where we are going every minute it would greatly benefit everyone to take just 5 minutes daily and JUST BREATHE.

Here is how to do it:

Find a comfortable position, the one shown below should work for most people.  Do this at a time of day when you can follow it with a calm activity or are ready for sleep, as this is designed to soothe you and put you in a sedated state.  Place one hand on your belly and one on your chest.  Inhale through your nostrils, allow your abdomen to expand and blow up like  a balloon.20140904_093026

Exhale, and the abdomen falls down.  Repeat this for 5 to 10 minutes, feeling and allowing your entire body to relax.

Try working this into your day, every day and see and feel the benefit!

— Sarah Dominguez, PT, CLT

Urine leakage in the female athlete


I continue to be blown away by the number of young female athletes who are leaking urine during their sports activities.  I have heard that many women who leak think it is normal.  I also hear women say that it is normal for them to leak urine because that’s what women do. It is never normal to leak urine especially in a young woman who has not had children.  Urine leakage is a symptom that occurs when there are musculoskeletal dysfunctions within the pelvic girdle.  pelvic girdle

I would consider urinary leakage or incontinence to be a sports injury.  No, it may not be a sprained ankle or a torn ACL, but having urinary incontinence is a sign that there is something wrong with the stability system within the spine and pelvic girdle.  When a female athlete has knee pain, a coach, guardian or physician would suggest she see a physical therapist.  This is prescribed to help rehab her knee back to good health, because knee pain prevents an athlete from performing her best.  But what about a female athlete with urinary leakage?  Leaking urine can be embarrassing, frustrating and can greatly limit the athletes’ performance, therefore it is an important issue in the lives of these women.

The International Continence Society states stress urinary incontinence is the “complaint of involuntary leakage on effort or exertion or with sneezing or coughing”.  Some studies over the years have reported a prevalence of incontinence, up to 69% in the general population.  This occurs, due to the muscles and support structures in the pelvis being unable to withstand the pressure that is created in the abdomen with activities; such as coughing, sneezing or changing positions, like moving from sit to stand. You can read more about this on a previous blog, “Why do I pee my pants when I laugh”.

Recent research is showing a rise in incontinence in the young and athletic female population.  Having a teenager with urinary incontinence, just doesn’t seem right.  While it is more common for women who have had children to experience urinary incontinence, younger female athletes are also experiencing urine leakage with their sport. Young women who haven’t had children shouldn’t experience incontinence, right?  Well, no they shouldn’t but they do.

Risk factors for stress incontinence include: increased age, pregnancy and vaginal delivery, being a female, strenuous work, and exercise. A 2011 study that looked at urinary incontinence in female athletes found that a whopping 41% of elite female athletes experience urinary incontinence with their sport, and 95% of them would not dare discuss this issue. (Jacome et al)  Another study from 2006 found 29% of athletes studied had incontinence versus just 9% of their non-athlete counterparts. (Caylet et al.) Not all female athletes have incontinence, but there are sports which have a higher prevalence of incontinence in females; usually due to increased ground reaction forces through the body from landing after jumping or weight shifting movements. For example, one study found 0% female golfers had incontinence, while 67% of female gymnasts had leaking with their activity.  Leakage is reported both during competitions as well as practices for female athletes.

Research suggests female athletes have a stronger pelvic floor than the general population. So if they have higher pelvic floor strength, then why are female athletes leaking?  One theory suggests the added impact of repetitive stress on the muscles, ligaments and connective tissue can cause stretch weakness or overuse to these structures, causing them to become weak or fatigued and less able to control the increase in pressure which then makes them more likely to leak.

So, as I said before, a female athlete with knee pain would see a physical therapist for rehabilitation of the knee.  A female athlete experiencing urinary incontinence, with sport or daily activities, should do the same. It is stated in the literature that conservative treatment, namely pelvic muscle training should be the first line of treatment for stress urinary incontinence (Bo et al).  There is something wrong with her stability system, therefore, she should rehab it. It is important to bring this issue up in order to reduce the stigma associated with it, and get these athletes help.  Improving the function within the pelvic girdle can not only cure incontinence, it can greatly improve sport performance as well.  There are physical therapists who are specifically trained in pelvic floor rehabilitation, which is the kind of therapy a female athlete with urinary incontinence needs.  These physical therapists know how to diagnose impairments and improve the coordination of “the core” to ensure continence.

At Foundational Concepts, specialty physical therapy is what we pride ourselves in.  We treat pelvic floor dysfunction, prenatal/ postpartum pain and especially urinary incontinence in female athletes.  If you would like to learn more about pelvic floor physical therapy you can visit our website at or call us at 816-569-2802.

Please share this with the female athletes you know and the people that care for and work with them. Let’s encourage them to speak up and hopefully we can contribute to decreasing the rate of urinary incontinence in female athletes.

Amanda Fisher, PT, DPT 

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 or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates.

Hospital based outpatient PT more expensive than Private clinic

be informed in your healthcare choices!

Why is the tailbone (coccyx) so important?

Often during my conversations with patients, they will mention an old tailbone injury from a fall, an accident, or a challenging birth of a child.  Many times, the injury is blown off with an “It was just my tailbone.”  Oh, the little attention the tailbone gets!  How is this little bone so often involved with pelvic pain, urinary incontinence, constipation, and pelvic organ prolapse?  Let’s take a closer look at this little bone that gets so little respect.

The lack of coccyx support has far reaching consequences, beyond the pelvic floor.  Let’s start with the pelvic floor and expand outward.  The coccyx (tailbone) is the very end of the spine, attaching to the bottom of the sacrum, and is the anchor for the many of the muscles in the pelvic floor.  It is the attachment site for the levator ani muscles which are the muscles that form the bottom of the pelvic bowl connecting the pubic rami to the sacrum.  These muscles act as a support system for the sacrum, pelvis, rectum, bladder, and in women, the uterus.   When the tailbone has been injured, the angle of attachment for the levator ani muscles changes, causing tightness and spasm in some muscles and weakness in others.  This can contribute to hip and back pain with sitting, walking, lifting, bending and squatting. 

pelvic diaphragm

With decreased muscular support for the sacrum, external support must be provided to decrease the hypermobility and pain.  In many cases, this can be provided by a sacral support belt to stabilize the sacral iliac joints and to prevent sacral torsions and innominate rotations.  However, even with this external support, some people will continue to have a decrease in balance and proprioception due to the internal decrease of core, hip, and pelvic floor stability and strength.  This can lead to an increased risk of falls and injury with everyday activities.

SI belt

The coccyx and levator ani muscles also play an important role for lymphatic and blood flow to the trunk.  Changes in lymphatic and blood flow occur due to decreased or changed pelvic floor muscle activity.  In conjunction with the thoracic diaphragm, the pelvic floor muscles act as a pump for the lymphatic system, issuing fluid to the thoracic duct, the main drain for the lymphatic system.  A backup of fluid often occurs when there is poor coordination of the diaphragm and the pelvic floor muscles.  This will appear as abdominal swelling, bloating, or pelvic heaviness.  A pelvic floor physical therapist who also has a strong understanding of the lymph system can work to coordinate both diaphragm activation and relaxation patterns and to pelvic congestion management.

abdominal contents

With the changes in the pelvic floor muscles, patients will also have decreased support of the pelvic organs.  The weakness of the pelvic floor and core muscles lead to pelvic organ prolapse of the bladder, rectum and/or uterus.  Pelvic organ prolapse can contribute to urinary leaking, constipation, and pelvic heaviness.  If the prolapse is not advanced, often muscle strengthening and pelvic floor PT is successful in reducing the symptoms. 

The coccyx truly is our anchor and is not to be overlooked or taken for granted.  Pelvic floor physical therapy can make a world of difference when dealing with issues of the coccyx.  A hand’s on approach to treatment can assist in the decreased pain and improved strength of the muscles surrounding the tailbone. 

–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.