Boston Class

Spoiler alert: This blog is about woman's health, if you do not want to read about pee and women's anatomy then stop reading now. But if you want to learn a little, read on!

I traveled to Boston 2 Thursdays ago for a continuing education class sponsored by the American Physical Therapy Association's Section on Woman's Health. Pelvic Physical Therapy 1 is the first part of a 3 course series dealing with pelvic floor dysfunction. Here is a description of the course: 

This 3-day course provides physical therapists with practical knowledge and skill in the treatment of female urinary incontinence, with an introduction to the treatment of pelvic pain. Instruction in pelvic floor muscle function, anatomy, physiology and pelvic floor muscle dysfunction will provide the clinician with skills for immediate clinical application and build the base for future courses. This course is the first in a series of three courses designed to give the practicing clinician a comprehensive knowledge base in pelvic physical therapy treatment. Course content is evidence based, and will promote the use of the most reliable tests and validated outcomes measures. Instruction in vaginal examination of the pelvic floor is a key component of this course. Participants will perform and experience intra-vaginal EMG biofeedback, vaginal weights, and electrical stimulation.

The class consisted of several laboratories involving physical examinations internally and externally of the pelvic floor and surrounding structures. The first day, everyone was shy and initially reluctant but as the days past and we became more comfortable and at the end we were telling jokes and dropping trou with no problem.

They offered us the option of CAPP testing which after the 3 courses and a case study we will have a certification in pelvic floor physical therapy so I figured, why not. Everyday I had to wake up an hour early and take a lab practical and I have a take home written exam I have to complete and send in. The testing really was helpful to bring everything together and even though we were being tested, we were still discussing and actively learning. It was difficult sitting through 5 hours of non-stop lecturing but I really enjoyed the labs.

So what is the pelvic floor you might be asking. Well, I am really glad you asked, I would love to tell you.



The pelvic floor is the compound structure which closes off the pelvic outlet and is responsible for supporting the pelvic organs. The pelvic floor muscles (PFM) which consist of mainly the levator ani muscle group which consists of pubococcygeus, puborectalis and iliococcygeus. The PFM also consists of striated urogenital sphincter, external anal sphincter, ischiocavernosus, and bulbospongiosus. When the PFM contracts it causes the urethra (where urine exits), the vagina and anus to close. It is important for these muscles to be functioning properly for continence. It is equally as important for these muscles to relax for normal urination. If they are not fully relaxing you could be experiencing difficulty urinating, defecating and dysparunia which is painful intercourse.

I think women's health is fascinating. It is amazing what we tolerate as women that we should not (and I'm not just talking about our men). On average, a women with an issue involving woman's health and urinary incontinence will tolerate the problem for 5 years before seeking help. The average man when faced with an issue involving problems with the family jewels and urinary incontinence will wait 1 week to seek help. And no ladies, it is not normal to leak when you cough, sneeze, laugh or run EVEN if you have had children. I have heard so many women say, well, I had 3 children. It is still not normal. You should not tolerate it and there are many options for you. You should not tolerate stress incontinence (where you leak when the pressure in your abdomen increases; laugh, cough, sneeze) or urge incontinence (when you suddenly have to go and you have an accident because you can not reach a bathroom in time) or tolerate frequency issues. You should only urinate 5-7 times a day and you should be able to go 2-3 hours between voids. As you probably know, your bladder is designed to store urine. Your bladder is capable of storing 400-600 ml. Your bladder fills at a constant rate (slower at night, faster with bladder irritants, aka, fruit juice, alcohol, caffeine). Your first sensation to urinate occurs when your bladder is approximately half full (150-200ml). You don't have to go to the bathroom at this time. If it has only been 30 minutes since you went last, then you should do a Kegel (I know you have heard of these). Hold the Kegel for 10 seconds for 3 sets and this should inhibit your bladder and wait until it is time to go. This in turn will train your bladder to go when you want it to instead of your bladder controlling your life.

I really enjoyed the course and it felt good to learn again. I plan on registering for the Pelvic Floor 2 class during the next fiscal year. My company allows $1000/year for continuing education and this course fully exhausts that allotment but it is worth it. All you PT's out there that are maybe interested in women's health but are reluctant to take course, this course is worth your time and energy.  

Sorry if this was painful to read. It is my first physical therapy blog and I had a great time writing it. Hope someone learned something. 

Here are a couple photos from the weekend.

A view from the plane on the way to Boston. 

The sunset was incredible on the other side of the plane and I couldn't get close enough to get a shot.

A view of the gorgeous sunset from my sister's apartment in Brookline where I stayed even though she is living in Va now

Hope everyone is having a good week so far.