Find Your Own Body…..How to Feel Your Own Pelvic Movement
 
Learning to feel our own discreet, hidden away pelvic floors is a thing!  We can do it from the outside with our clever hands and brains, breath and movement. It's our brilliant and amazing bodies finding how to move with ease, support our organs, breathe in many different ways, manage pressures inside our bodies and in daily life.  All of it!
 
It's super simple and here's how.  Start by standing up and reaching down with your long, middle finger to feel your very own anus from the outside; the "external anal sphincter" is her full name.  Studies show us that feeling with your mind's eye and with your finger is the best indication of the activation and release of your pelvic floor.  You can use both hands or just one hand (which is easier).  Hold your middle finger on your anus and let your index and fourth finger rest on either side of your anus.  They're helping you feel the action!

Now…the action:

1. Breathe into your belly, a long and full, tummy released, luxurious big breath and relax.  Feel what happens at your anus.
2. Do the same in-breath, stopping full of air.  Close and pull up your anus, holding it on while you breathe out.  Feel the anus close up and lift!  Then let it go (pretty talented, eh?).
3. Repeat #1, releasing everything (check your jaw, neck, buttocks and toes….release everything).
4. Do the same in-breath, stopping full of air.  Breathe out while "laying an egg" or bearing down gently (or big cheek out breath or shhhhhh or low groan).  Feel your anus open up and relax!  Let it go.
5. Repeat #1.

 
Would you like a different view/feel/idea?
Let your finger go a little north of your anus and rest on your tailbone or coccyx.  It's the tiny triangular bone at the base of your spine; it's an attachment point to your anus and other pelvic floor muscles.  See the tiny bone angulated forward on the picture?  It has a big role in pelvic muscle function!
 
Now….the action:

1. Repeat #1, the release breath.
2. Repeat #2, but feel your tailbone (coccyx) move further forward and upward toward your pubic bones.  You can thank your pubococcygeus muscle, a part of your pelvic muscle system.
3. Repeat #3 - 5.

 
Homework….ask yourself:

1. Do I need to activate my anus and pelvic muscles to strengthen them? Gain endurance?  Learn to use them better, more efficiently, more fluidly, during specific activities?
2. Do I need to learn to release my anus and pelvic muscles after I activate them, like when I lift or sneeze or get stressed or drive or ???
3. Are my anus and pelvic muscles always ON or frequently ON and don't know how to turn off?  I'm not always about to sneeze or lift or respond to stressors……it's OK to let go.

Full Circle Physiotherapy May 2022

Pelvic Pain conditions are so common.....1 in 10 Canadian women have endometriosis, 1 in 10 Canadian women have always experience painful sex (primary dyspareunia).....and that's just the tip of the pelvic pain iceberg.  There's painful urination, postpartum vestibulodynia, postmenopausal genitourinary syndrome, evacuation disorders of the bowel, proctalgia fugax......many, many more. 

But there is a commonality in many pelvic pain syndromes (with the HUGE proviso of "please see a pelvic physio, get diagnosed and proceed with a bespoke programme) that are summarized in this self care document. 
 
Self Care for Pelvic Pain Conditions                                                                       Mar 2022
 
Goal:  enjoy life's activities that stay as sub-threat (no grizzly at the door), non-nociceptive (always staying pain free), fun (laughter, silliness and joy) and fulfilling function (meaningful work, play, restorative activities).
 
Where we start:  You are normal.  You're not broken.  Everyone is different.  You are unique.
 
Where we're going:  You're in the drivers seat; you're in control.  The pain is happening to you (yes), but you can control the volume and choose your response (YES).  Pain is part of life (inevitable) but suffering is optional (you can change the story of the pain you've experienced).
 
How we do this:  We help you learn to calm your pain response.  Firstly, you calm the pain response down, then you build yourself up.
 
Self Compassion takes three roads:

• common humanity (shared challenges, shared suffering) 
• kindness (no self blame or self criticizing or guilt)  
• reduce your identification with a pelvic pain condition (not "my" endometriosis or "my" vulvodynia)

 
Control your thoughts:

• mindfulness (bringing attention to the current moment without judgement + with acceptance, not thinking about the future with anxiety or drifting back and ruminating on the past, focusing on what doesn't hurt and what's going well, focusing on your breath)
• mindful walk in nature (nature bathing) at a wander, puttery speed, notice the birds, sun, wind, smells
• meditation - 10 - 20 mins., a daily commitment + training, use Jon Kabat-Zinn (Mindfulness Based Stress Reduction) and/or Dr. P Neumann pelvic-specific downtraining MP3s)
• prayer time (focused, quiet, calming)

                        **Key is consistent practice**
                        **Specifically effective in reducing pelvic pain as the pelvic floor muscles + jaw muscles are the first and most active muscles to respond to anxiety or stress or fear or pain (or all)**
 
3 Good Things Practice:  write down the 3 good things that happened today (Keep it simple:  You woke up safe and warm in your bed, You had coffee, You can take time to write 3 things down) within 3 minutes
 
Movement:  Balance out your movement and rest, leaning towards shorter more frequent rests and consistent, happy, gentle, calm movement through your day

• lymphatic pump - natural detoxification of your body, immune supporter
• constipation relief - moving your body moves your bowels
• regain trust in your body - it is capable, strong and carries you through your day
• get out of your head and into your body

Food You Eat/Nutrition: evidence based food choices to reduce inflammation and influence pelvic pain, All evidence points to a healthy, whole food, organic, plant based diet ("Real food, Mostly plants, Not too much").

• Nosy Neighbour Syndrome - your digestive organs + pelvic muscles share one communicationpathway to spinal cord, so when one system is unhappy, they gossip, getting nosy neighbour syndrome.  When your bowel is happy, the neighbours chill out and quiet down.
• Elimination diet - remove dairy x 3 weeks then add it back in for a week, then remove gluten x 3 weeks, then add it back in.  What happens with your symptoms with gradual re-introduction of foods?  Check yourself for bloating? Constipation? Loose stool? Happy belly?
• Low FODMaP - trial for those with Endo and/or IBS, even better if you add yoga (equally helpful to dietary changes), check Kate Scarlata online for North American food choices.  Follow simple diet for    2 - 6 weeks, then add in one category at a time, noting what your body likes/dislikes.
• Autoimmune Pelvic Syndromes/Diseases: Leaky Gut Syndrome, IBS (Gut-Brain syndrome, not gut on its own, so work on trigger foods but also work on calm + quieting), SIBO, Coeliac, BPS, Endometriosis, Fibromyalgia - all these may flare up musculoskeletal pain + also create a hypertonic (tight, short, weak, ineffective) pelvic floor, so both your whole body and pelvic floor may need attention
• Deficiencies in Vit B, C, D, Iron, Magnesium, Zinc may increase PF dysfunction - take good Multi-Vitamin daily
• Vitamin D - 1000 - 2000 ID daily as it can reduce overactive pelvic floor muscles + help with fecal incontinence + lift mood, heart health, reduce pain perception, protective for ovarian/breast/colon cancer (esp. in post menopausal women)

 
Self medication with opiods, alcohol, cannabis - have a look at your short term use and long term goals….do they match up happily?  Are there other options that are non-medicative, non-addicting, narcotic-free?
 
Yoga:  classes at The Yoga Room with Barb Minichiello, Gail Thompson or Stephanie Derraugh and/or online with Shelly Prosko, Part A for quieting, Part B for activating on Vimeo (clientdiscount10 for 10% discount)
            **Twice weekly for one hour over 6 weeks is effective in reducing pelvic pain on long-term studies**
            **Three poses specifically help: Legs up the wall, reclining bound angle (fish), Savasana (corpse)**
 
Sleep: good, consistent sleep reduces your pain perception and improves your pain resilience, ask for sleep hygiene handout/help.
 
Skin Support: 

• wash with water only or gentle soap,
• a twice daily vaginal moisturizer (Menopause Chicks Vaginal Moisturizer at Pure Pharmacy (online),
• sexual lubricant choices (Uberlube Silicon or Yes),
• cotton undies or undies with a cotton, breathable crotch piece,
• pads for periods or menstrual cup?,
• pads for bladder leakage or retrain bladder?,
• medication for lichens sclerosis short term or long term?
• Chronic yeast infection medication and systemic yeast treatment?

 
Do a monthly vulvar and vaginal assessment with a hand mirror (ask for the handout) of your skin condition, your movement with breath, bearing down and closing/lifting.
 
**Property of Full Circle Physiotherapy, not to be reproduced without permission**
 
Joanne Gailius, BSR, PT/OT
Physiotherapist       Full Circle Physiotherapy
C2 - 1204 NW Blvd.     Creston, BC     Ph  250-254-3494   Fax  1-855-655-5281   jgphysio@shaw.ca

How to Fully and Completely Empty Your Bladder
or
How to Void Well (pee, tinkle, wee, widdle, micturate, go to the loo……)
 
First, what is normal, healthy voiding for an adult woman or man?
Think about each of these statements and ask yourself, "Does this describe me?"

• You void 6 - 8 times in 24 hours.
• During the day, you void every 3 - 4 hours.
• If you're over 60, that may include once at night.
• If you're over 80, that may include twice at night.
• You always have enough time to get there, never needing to rush.
• When your bladder calls, you get a cue to void, but can put it off for 15 - 30 minutes if you need to.
• When you sit down, you release immediately and easily.
• It takes 12 - 20 seconds from start to finish.
• In your mind's eye, it looks like a bell curve, starting slowly, building into a waterfall, ending slowly.
• Once you're done, you're done….no double voiding or leaking afterward (even when you stand up).
• You can enter your home, walk by the loo or wash your hands without suddenly needing to void.
• You don't need to wear pads, even when you're going for a long walk or jumping.
• If you've had a baby recently, you have full bladder control at 6 - 8 weeks.
• If you've had surgery lately (women), you have full bladder control within 2 weeks.
• If you've had prostate surgery (men), you have full bladder control at 2 - 6 weeks post removal of your catheter.
• You NEVER leak.
• Even if you cough, sneeze, laugh, snort, sing, run, jump on a trampoline, have sex, you NEVER leak.
• Even if you walk on a cold tile floor in bare feet, get chilled or come inside from the cold, you NEVER leak.
• Even if you delay peeing for 30 - 60 minutes, you NEVER leak.
• Even if you drink a lot of water, you NEVER leak.
• Even if you drink coffee, tea, beer or wine, you NEVER leak.
• Yup, you never leak.

 
Now…..when you arrive at the toilet, there are some tricks to keep in mind.
 

• Make time for this important task….no phone, no multitasking, no busy mind.  You're here to pee.
• Sit comfortably, your thighs level or your knees slightly higher than your hips, seated well, knees open.  Use support under your feet (don't make pointy ballet feet) if you need to (a low step or yoga blocks).
• Breathe into your belly with a long, relaxing, deep breath, feeling your vagina and anus open and widen or your scrotum and anus descend.
• If you start to void, enjoy the feeling and notice the bell curve.  How talented are you!
• If you have a "shy bladder" or "hesitancy", just stay calm, breathe into your belly, massage your tummy and don't let anxiety or a sense of "gotta go!" take over.  You're here for one reason, so enjoy the quietude and trust that you're learning to let go with ease.  Each time you take time helps!
• If you feel totally empty, wipe front to back or pat gently until dry and off you go.

 

• If you're a fellow, you're typically a shaker or stripper or may be a talented bilingual guy.  If you feel fully emptied, do your thing, then off you go.
• If you're not sure that you're empty you have a few options:

• Rock and roll - As you breathe into your belly, rock your pelvis forward, letting your belly bulge and hips open up, then let your pelvis rock backward as you breathe out.  Notice if there's a little "whoosh" part way.  This might mean that you have a prolapsed bladder that had kinked at the bladder neck during voiding.  It needed to tip it up again to fully release all the urine.  Repeat 3x.
• Breathe in deeply, fully, tension-free in your belly, buttocks, hips, with big puffy cheeks then let the air out slowly (keeping big puffy cheeks).  This helps keep your sphincters and pelvic floor open sufficiently to stop early closure, like during a urinary tract infection when you have those pesky urethral spasms.  Repeat 3x.
• Do a few gentle (25 - 50%) pelvic floor contractions (only your pelvic floor, not your hips and buttocks), holding for 3 seconds, releasing for 5 seconds and repeating 3x.  This can "milk" the urethra, helping that sneaky little bubble of urine hiding out in your urethra.  It will drop down when you come to standing if you don't empty fully, so help it go now!
• Enjoy practicing any or all of these until you're sure you're empty, then wipe and/or shake/strip and off you go.
• Don’t Bear Down or "push out" the urine.  You can be instrumental in creating your very own prolapsed bladder if you make this a habit.  And STOP yourself from using this technique to start the flow to begin with.  It's just not helpful.

Other Rules:

• No "just in case" voiding (check your excuses with the "normal, healthy" list).
• If you know where ALL the publicly accessible toilets in the town of Creston and neighbouring communities, you're busted.  3 - 4 hours between voids with no leaking is usually substantial enough.
• Pads are costly and your tender vulvar skin doesn't like them.  Learn to control your bladder and its function rather than relying on pads.  If you use pads, find the ones for urine, not for period flow.
• Medication can help, but learning to retrain your amazing brain to your skilled voiding reflex is way more effective in the long run, less costly and less likely to need upgrading/changing over time.
• Prolapses can mask urinary incontinence.  Learn full urinary control while learning to lift your prolapse (pelvic physio + hypopressive training is a well researched and effective blend).  If you're going to have a hysterectomy and/or prolapse lifting surgery, learn urinary control first.  It will ease your post-op recovery and you'll impress yourself.
• If you've had a perineal tear of Grades 3 - 4 in order to deliver your baby, relearning bladder control is a more difficult job.  Seek help.
• If you've had a surgical delivery of your baby (caesarian section), you may have scar tissue that's impacting your bladder function.  Seek help.
• If you have pain when your bladder fills in the area of your lower pelvis, urgency to pee and pee too often, all of which are relieved immediately upon voiding, you may have Painful Bladder Syndrome.  Seek help.
• If you're heading down the road of prostate hypertrophy (enlargement, stiffening of the prostate) and/or prostate cancer treatment (surgery/radiation) find a pelvic physio trained in men's pelvic function. You will learn to use your pelvic floor muscles and external urethral sphincter so that, when they become the gatekeepers of your urine flow (now that your internal urethral sphincter and prostate are reduced in function or removed surgically), they know what to do and how to do it!  This reduces the number of days that you're wearing pads and brings you dry days/nights/sport/fun sooner.  Research has shown us that learning prior to surgery/radiation brings much quicker and better results.

 
 
Joanne Gailius, BSR, PT/OT                                                   
Physiotherapist       Full Circle Physiotherapy
C2 - 1204 NW Blvd.     Creston, BC     Ph  250-254-3494   Fax  1-855-655-5281   jgphysio@shaw.ca  Mar 2020

Topic of the week at Full Circle.......post menopausal women in their 60s, 70s and 80s
working hard, busy harvesting in this agricultural valley and frustrated! 
In pain! 
Pushing too hard! 
Not coping, not sleeping, not restoring.

This blog is a loving reminder that after our bodies are no longer supported by estrogen, we aren't as physically strong as we once were BUT even moreso, our endurance will have waned somewhat. 

There are some habits that will bring us joy in doing those meaningful work, rest and play. 

Here are my suggestions:

1.  Jot down your list in pencil, then prioritize.  What 3 job actually need doing today?  Which ones could wait until tomorrow or tomorrow's tomorrow?

2.  Know when you have the most physical, emotional and relational energy.  Match the job to the time with some cleverness.

3.  Stay ahead of your endurance dips.  Plan a wise, intentional, constructive 15 minute rest mid or late morning and repeat that in the afternoon.  Don't wait until you're at the over and out stage!  You'll know that you're    becoming brilliant at this when you feel pretty lively in the early evening and have the energy to enjoy some fresh activities when the sun is going down.

4.  Support your sleep.  Get boringly attentive to the same time, the same place, the same room, fresh air, warm bed, comfortable sleeping duds, no tech in the room (use a non-cellphone alarm)......think of when you were desperately trying to get your babes to bed and treat yourself with the same brilliant sleep support.

5.  If you enjoy a daily glass of wine, have it at lunch rather than dinner or evening.  Wine can create a pancreas-induced awakening in the wee hours. 

6.  Awaken with energy......you'll know that you're doing all of the above well when you awaken with energy, not ache and pain and dread.

7.  Go for a walk.  Those big muscles that move you through space (your gluts) are made for the job.  Enjoy a walk daily.  Breathe in deeply and stand tall at each telephone pole that you pass, letting your arms swing with each step.  Enjoy the freedom of movement, the place that we get to live and the beauty of the onset of autumn.

8.  Make time for something that you truly enjoy.  Knitting?  Reading?  T'ai Chi?  A phonecall with someone that you miss?  An email or an old fashioned letter?

9.  Most Importantly - Know your priorities, moderate your expectations and have respect for your age and stage.  You're one of the lucky ones who is here with all the wisdom that the years have brought.  Some self-compassion and self-care (not just self-soothing.....a pedicure and manicure are wonderful, but self care is the practice of employing daily habits that provide you with optimum health and joy) go a long way. 

Take care of yourself.

As the days are shortening, the evenings are having a sense of chill and we're harvesting tomatoes and peppers.....we begin to see the glimmers of summer's end.  "Unprecedented" describes the summer of 2020 in every way.  It's been a summer of constant change, resiliency developed, losses noted and a deeper sense of home for so many of us.  No traveling?  You've stayed home, found your place, your town, your city.  Not visiting restaurants?  You've cooked at home more, enjoyed takeout, eating in the park, shared meals with family more often.  Not going to the gym, pool or ice rink?  You've walked, biked or just rested.  Or???

Interesting times.  This is a short blog, a simple nudge to check in and take care of yourself.  Check in with the human in the mirror.  Notice how you're feeling, how you're thinking, how your body is responding to today and all it has brought to you.  You don't have to begin to journal or meditate.   Checking in with your one and only home, the body you inhabit is a gift to yourself.

Our body "keeps the score", noticing all the experiences, interactions, life habits that we experience every day.  Are you holding tension in your shoulders?  neck?  pelvic floor?  hips?  feet?  What would it feel like to let that go?  Maybe tighten up your tight area more....more..........more.  Then release!  Is that different?  Is your posture restfully letting gravity pass through you when you're standing up?  Or are you a "bum tucker", "chin poker" or "sloucher"?  Begin at your sit bones (in standing).....rock them back and forth with your breath, then let them release just when they're pointing straight to the ground.  Feel them!  They're an amazing pair of dense, thick, strong bone that is the centre of your pelvic floor and your sitting destination in the chair.  Hold that.  Then lift your sternum (breast bone) up to the sky.  You'll feel your braband lift off your front ribs, your mid spine activate right where your bra does up, your shoulders rock back and settle and feel an urge to take a brilliant, nutritious deep breath!  Hold that.  Finally, tuck in your chin towards the back of your head, not tipping forward, simply making a wee double chin.  You might feel an urge to clear your throat or swallow.  Hold that.  Now notice how that feels.  Look forward.  Feel tall and strong.  Really Strong!!!  Gravity is passing directly through you, through the curves of your spine that provide you with spring-like responses to movement, through your strong, dense cortical bone and your balance will be dynamic and spunky.

There is no perfect posture.  Each of us is built differently, has had different experiences in life and does different things with our body each day.  But you can enjoy ease in your body by taking time to check in and find ease-filled, gravity-enhanced, respiration-supported posture and movement through your day.

When you notice that life feels heavy, that losses feel cumulative and "life as it was" feels distant, find your strong posture, your gravity defying self.  Breathe fully.  Balance well,  Stand and walk with ease.

The second chapter on men's pelvic stories is a more specific look at how men (and those who love them) can work through pelvic challenges, focusing on prostate cancer, surgery and treatment.  The first chapter talked about the pelvic problems that a man may face.  The good news is that with pelvic physiotherapy and a solid commitment to follow through with the work at home both before and after surgery and treatment, complete resolution of both leakage and impotence is possible.  Each man will have varying severity and duration of these physical side effects and they can lead to a much reduced quality of life.  You can rewrite your story with help.

The protocol that is described here leans heavily on the brilliant work of Jo Milios in Australia, a pelvic physio devoted to men's pelvic health and aided by over 3000 men who have had radical prostatectomies.  Men who followed this protocol had much less leakage, much reduced duration of leakage and a much improved quality of life throughout their recovery time.  Even more convincing is the statistic that 1 in 6 men had no leakage whatsoever!

For 4 - 6 weeks prior to surgery and resuming immediately after surgery, men are taught the following protocol:  six times daily, in a standing position, two exercises are performed.  The first is 10 fast twitch (or speed 'ems) maximal (full on!) contractions and releases.  These are followed by 10 slow twitch (endurance building or hold 'ems) contractions, holding each for 10 seconds with a 10 second relaxation time between each contraction.  It's important to find "the right muscles".  Try this:  squeeze the front passage as if you're stopping the flow of urine, then lift your testes and retract the penis.  Doing these exercises in standing is important as this is the position in which most men leak.  With your pelvic physio, you'll learn awareness of which muscles activate correctly, then how to release fully and more!  The importance of "pre-hab" or beginning training prior to surgery can't be reinforced enough.  The time between biopsy/diagnosis and surgery is a time to begin learning about your pelvic function, strengthening and releasing.  Bladder control (voiding with control and fully 6 - 8 x daily or learning to do so) and a happy bowel really make a difference as you head into the choppy waters of surgery and treatment.  Jo's research has shown that men respond very well to the improved physical control of their waterworks and sexual function with this help, but additionally they are emotionally and relationally so much stronger!  Her goal is to improve the quality of life for all undergoing prostate cancer diagnosis, surgery and treatment.

Let's get specific....one appointment for assessment/training is sufficient to help you begin.  Palpation can be done externally in most cases.  Your important three muscles that control your urine, the trio that you need to learn to turn on and off and strengthen are called the external urethral sphincter + bulbocavernosus + puborectalis.  Sometimes that pesky external anal sphincter gets dominant and you need to learn to teach it to quiet down.  Once you've found these muscles, you'll move onto working in synergies, becoming powerful (for coughing and sneezing), strong (for sit to stand and lifting), having endurance (for standing and walking), improving the quality of contraction/lifting of the pelvic floor as well as improving release/relaxation in order to support the next contraction.

The toughest bit?  Fatigue.  Standing upright will fatigue the system and that fatigue may worsen as the day progresses, causing leakage to occur.  Many men will have overactive muscles that need to learn to release and NOT exercise at first (called pelvic downtraining), some men will vary

When I write about women's health, oncology (cancer related) and pelvic physio, it's a logical to assume that it's only women that we pelvic physios assess, treat and talk about.  This is the first in a series of articles that will introduce you to the challenges that men face in their pelvic region, despite "being absolutely mortified to be discussing their private parts" (to quote Dr. Jo Milios, our lead teacher, a brilliant physio who had set up a non-profit organization in 2012 in Australia called PROST! Exercise for Prostate Cancer Inc.).  Her passion is to educate all of us so that the everyday man on the street has better health outcomes and a much longer life.

Pelvic physiotherapy for men addresses loss of function in the pelvic region including prostate cancer pre-hab (prior to surgery and other treatments) and rehab, pelvic floor muscle dysfunction, urinary incontinence, painful urination, recurrent bladder infections, urinary frequency, bowel dysfunction, erectile dysfunction, chronic pelvic pain syndrome and Peyronie's Disease (a crooked or bent penis).

Let's begin with the prostate.  The prostate gland is a walnut sized donut shaped gland found right under the bladder and wrapped around the urethra (urine tube).  Its job is to produce most of the fluid that makes up semen.  The prostate can become inflamed (prostatitis, acute or nonbacterial) or enlarged (benign prostatic hyperplasia).  Enlargement of the prostate doesn't mean it's cancerous and is usually noticed after age 40 during a regular doctor's visit.  Prostate cancer is the most common cancer in North America and accounts for 11% of all cancer diagnoses in BC men; 1 in 9 males is expected to develop prostate cancer in their lifetime with 89% of them being over the age of 60 when they are diagnosed.  There are some well known correlations (not causes) that may raise a man's risk of developing prostate cancer, including aging, family history, high levels of testosterone, being overweight, not exercising regularly and a poor diet.  Large studies have shown that there is no correlation between having a vasectomy and prostate cancer.  Yet again, Grandma's sage advice to exercise regularly, eat real good and maintain a healthy weight (for all cancers!) are actions that you can take to reduce your risk of developing prostate cancer.  Your doctor (GP or urologist) or nurse practitioner may do a DRE (digital rectal examination) to palpate your prostate or you may have a PSA (blood test) to measure how much of a specific antigen is in your system.  If you notice changes in your urination (stuttering flow, slow stream, painful, frequent, dribbling/double voiding, feeling the urge to bear down to start or finish, urge or loss of control, increased night time voiding or blood in your urine and/or painful ejaculation), please tell your doctor.  Even though it's difficult or embarrassing to open up these conversations, your healthcare professional will want to know, will have had these conversations before and will make you comfortable sharing your story.  Tell them!

We pelvic physios become involved with men going through prostate surgery because most men (99%) will experience incontinence and erectile dysfunction.  One of the prostate's secondary jobs it to support the bladder and to give neurological support of continence through the autonomic (involuntary) nervous system.  The Cavernosal Nerves, responsible for erections, are wrapped around the prostate and they're usually damaged or removed in the process of the surgery.  Each man will have varying degrees or severity and/or duration of physical side-effects of the surgery but please know that each man will generally improve over time.  With pelvic pre-hab and rehab, complete resolution of both continence and sexual function is possible.  It's all about restoring wonderful function and quality of life while reducing anxiety and depression, penile fibrosis and shrinkage and stopping the development of Peyronie's disease.

Most importantly, men and partners who love men, talk with your doc if your experiencing pelvic dysfunction.  In part 2 of this series, I'll share Dr. Milios' well researched brilliance after seeing >3000 men with radical prostatectomies, showing that, by using her protocol, men had less leakage (in amount and duration) with 1 in 6 men having no incontinence at all!

Each week as I prepare to teach the Yoga for People with Cancer class, I seek some inspirational words.  I'd decided that we'd visit and revisit Tree pose in all its iterations, from lying to long sitting to static tree to moving tree to a pre-savasana resting tree, each time finding a new kind of balance.  This poem, written by Ilan Shamir, really struck a chord with me and so here's playful blog to share with you.  As we transition into spring, let's celebrate the catkins on the hazelnuts, the swelling buds on the maples and our own roots and growth!

Advice from a Tree

Dear Friend
Stand Tall and Proud
Sink your roots deeply into the Earth
Reflect the light of your true nature
Think long term
Go out on a limb
Remember your place among all living beings
Embrace with joy the changing seasons
For each yields its own abundance
The Energy and Birth of Spring
The Growth and Contentment of Summer
The Wisdom to let go like leaves in the Fall
The Rest and Quiet renewal of Winter.

Feel the wind and the sun
And delight in their presence
Look up at the moon that shines down upon you
And the mystery of the stars at night
Seek nourishment from the good things in life
Simple pleasures
Earth, fresh air, light
Be content with your natural beauty
Drink plenty of water
Let your limbs sway and dance in the breezes
Be flexible
Remember your roots
Enjoy the view!

Menopause.  Hot Flashes.  Uncomfortable, disturbing, nauseating, fuzzy brain, disturbed sleep....hot flashes are listed as one of the most negative aspects of our peri to post menopausal years.  We begin to feel like Goldilocks, desperately seeking a "not too hot, not too cold, just right" kind of world.

75% of women have hot flashes during their menopausal transition.  Moderate to severe hot flashes typically last 7 to 10 years on average and less frequent or severe (either end of the spectrum) can last even longer.  Let's talk about how you can influence the frequency and intensity of hot flashes, sleep and feel better!

We enjoy a breadth of temperatures in our lives before surgical (full hysterectomy), chemical (induced by medication) or natural menopause....we can be too warm or too cold and simply put on or remove a layer of clothing and stay comfortable.  This is due to our clever hypothalamus, the part of our brain noticing and controlling thermoregulation.  When it sense that we're becoming too warm or cold, it send signals to our organs, muscles and hormonal systems.  They collectively respond to bring our internal core temperature back to normal.  With menopause, the range of acceptable fore body temperature is drastically narrowed.  We become more sensitive to external temperatures so much that we experience a sense of panicking with crisis messages zipping around, causing blood vessel dilation, sweating, wakefulness, peeling off of clothing/blankets....the list is long!

Why now?  There are a number of theories including declining estrogen theory, elevated noradrenergic activation (stress) theory, east vs. west (consumption of phytoestrogens) theory, stress-coping theory, perception of menopause theory and thyroid dysfunction masquerading as menopause symptom theory.  Estrogen does 400 jobs in our premenopausal body each and every day.  We have declining estrogen with menopause, reducing support to our hypothalamus, making our threshold to heating much more sensitive.  Simply adding estrogen sounds logical, but isn't an answer for women who are sensitive to estrogen (a history of estrogen related cancers), nor for those who are estrogen dominant (actually have low progesterone in relation to their estrogen).  This is a condition that is more common in recent decades due to chronically high stress hormones that creates chronically low progesterone in relation to our declining estrogen.  It's all in the balance.

We need stress hormones in our lives in order to wake up each morning, but again, not too much stress. With our reducing estrogen, we handle stress less well after menopause due to altering of our neurotransmitter activity.  Rather than thinking that we've become wimpy, we now know that our stress response is more sensitive through menopause due to physiological changes!  Those of us who dread menopause or fear aging, those who are stressed by daily life (financially, physically, relationally, emotionally), those who have suffered trauma and those who smoke and/or are obese are likely to experience more frequent, intense and long lasting hot flashes.

Triggers for hot flashes include caffeine, dehydration, alcohol, smoking, sugar, hot foods (spicy and temperature), stressful situations, stressful thoughts, sleeping in a hot/unventilated room, wearing too many clothes/blankets, focusing on/worrying about hot flashes/aging and not prioritizing restoration time (like quietude, meditation, prayer or nature walks).  Hmmmm......notice any patterns for you?

Begin by keeping a hot flash diary for a week.  When do they come?  How severe are they?  How long do they last?  Which of the triggers can you align with your hot flashes?  Each woman is unique and it's up to you to sort yourself out.  Be your own personal sleuth.

Some general guidelines are:  Address one personal trigger per week from your list, beginning with your toughest personal challenge.  Stop and congratulate yourself, knowing that the balance of the list will be easier.  Learn and practice calm breathing by doing the following:  breathe in for a count of four and out for a count of four.  Keep going for 5 minutes, building up to 10 minutes, repeating 2 - 4x/day.  Lose 5 pounds; repeat if needed.  Begin a gratitude journal, noting 3 items each day that you're grateful for.  Controlling your controllables is your first step!  You'll sleep better, fell better and enjoy life more.