January 2019 Newsletter
Blocked Milk Ducts: Prevention and Management
Milk ducts are tubes through which breast milk travels from the tissue where it is produced to your nipple where they end, allowing it to express from your breast. When the breast is filled with milk that is not relieved by breast feeding, the weight of the tissue can press on the milk duct and block the normal flow. Additional causes may include an overabundant milk supply or pressure on the breasts such as a tight bra. When the normal flow of milk is blocked, a plug can form, which causes pain and difficulty for breast feeding. If this isn’t treated quickly, it can lead to mastitis, decreased milk supply and breast feeding cessation.
Fortunately, there is much to be done to manage pain and discomfort resulting from a plugged milk duct. Your physical therapist can provide you with education and treatment to prevent a plugged duct from occurring, or manage pain and treatment if it does happen. However, if you have pain while breastfeeding, be sure to consult a lactation consultant and your MD.
Here are some helpful tips for managing a blockage at home:
If these techniques are not enough, your physical therapist may be able to help. Physical therapists can treat a blockage by using heat, massage and ultrasound. Ultrasound is a physical therapy modality that is painless and can help break up a blockage. It should help reduce pain and manage symptoms within 1-2 sessions.
Fortunately, there is much to be done to manage pain and discomfort resulting from a plugged milk duct. Your physical therapist can provide you with education and treatment to prevent a plugged duct from occurring, or manage pain and treatment if it does happen. However, if you have pain while breastfeeding, be sure to consult a lactation consultant and your MD.
Here are some helpful tips for managing a blockage at home:
- Don’t stop breastfeeding. Although it can be tempting to avoid nursing on a sore breast, it can increase the likelihood of a blocked duct. Keeping the milk moving is essential.
- Try to completely empty your breast milk each time you feed your baby. Use breast compression while your baby is feeding. If there is milk left afterwards, you can pump to further empty.
- Apply moist heat each nursing session for about 15 minutes to help loosen the plug. You can bend over while using moist heat to assist in drainage.
- Start each nursing session on the side of the blocked duct.
- Use self massage on the affected breast, starting on the outside of the breast and moving towards the nipple to help express milk.
- Cabbage! Studies have shown that cabbage leaves can relieve pain from swelling in the breast. First boil the cabbage, then let it cool and separate the leaves. Apply it to the affected area for about 20 minutes, 3-4x/day.
If these techniques are not enough, your physical therapist may be able to help. Physical therapists can treat a blockage by using heat, massage and ultrasound. Ultrasound is a physical therapy modality that is painless and can help break up a blockage. It should help reduce pain and manage symptoms within 1-2 sessions.
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For more information please email:
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Please visit www.sullivanphysicaltherapy.com/payments.html.
For more information please email:
Holly@sullivanphysicaltherapy.com
SPT Spotlight
Angela Dobinsky, Lead Physical Therapist
Angela Dobinsky received a Bachelor of Arts in Healthcare Administration and a Master of Science in Physical Therapy from Texas State University in San Marcos. She received her Doctorate in Physical Therapy from Shenandoah University in Winchester, VA. After graduating, she practiced outpatient orthopedic care in California and Texas. During this time, Angela developed an interest in women's and men's health conditions and has exclusively treated pelvic floor conditions since 2010.
Angela is the Lead Physical Therapist at Sullivan Physical Therapy. She is a recipient of the Certificate of Achievement in Pelvic Physical Therapy. Additionally, she serves as a mentor for the clinics Professional Mentor Program as well as a case report reviewer for Shenandoah University's Doctoral Physical Therapy Program.
Angela strives to create an environment in which her patients feel comfortable discussing diagnoses that are often sensitive in nature. She is committed to providing her patients with the best care possible in order to achieve their goals.
Angela lives in Austin with her husband and 2 sons and enjoys spending time with family and friends, traveling, reading, and being outdoors.
Angela is the Lead Physical Therapist at Sullivan Physical Therapy. She is a recipient of the Certificate of Achievement in Pelvic Physical Therapy. Additionally, she serves as a mentor for the clinics Professional Mentor Program as well as a case report reviewer for Shenandoah University's Doctoral Physical Therapy Program.
Angela strives to create an environment in which her patients feel comfortable discussing diagnoses that are often sensitive in nature. She is committed to providing her patients with the best care possible in order to achieve their goals.
Angela lives in Austin with her husband and 2 sons and enjoys spending time with family and friends, traveling, reading, and being outdoors.
Guest Writer
Let’s talk about [painful] sex.
Although Jill smiles and laughs with her girlfriends as they discuss their recent sexual adventures, she feels uneasy with the conversation. She wonders, “Am I the only one who thinks sex hurts?”
Another woman, Sarah, visits the gynecologist with every intention of identifying the cause of her painful intercourse. She has tried everything with her partner to ease the pain—more foreplay, extra lubricant, and even a different brand of condoms. Nothing has worked.
“I think you just need to relax and use more lubricant,” Sarah’s gynecologist says. “Based on your physical exam, you’re perfectly healthy.”
Sarah leaves the doctor’s office frustrated. She thinks, “I can’t be the only woman experiencing this.”
Painful intercourse is more common than you may think
According to the American College of Obstetricians and Gynecologists, nearly three out of four women have pain during intercourse at some time in their lives. For some women, the pain is temporary. But for others, such as Jill and Sarah, it’s is a long-term problem.
However, painful intercourse can be caused by multiple conditions. For women experiencing painful intercourse, the first step is to visit the doctor to rule out common causes, such as sexually transmitted infections and certain medications. If the pain isn’t a quick fix, symptoms could be caused by more complex conditions such as endometriosis—where the lining of the uterus, the endometrium, grows outside the uterus.
Other causes of painful intercourse include conditions of the pelvic floor—the area of muscles that support the pelvic organs, including the uterus, bladder, and rectum. Examples of pelvic floor-specific conditions are vaginismus and vulvodynia. Vaginismus is vaginal tightness that can cause discomfort, burning, pain, penetration problems, or complete inability to have intercourse. Chronic pain in tissues surrounding the opening of the vagina is known as vulvodynia.
Whether the pain is caused by gynecologic conditions or pelvic floor dysfunction, it may be treated with physical therapy. Amethyst Guerrero, a physical therapist at Sullivan Physical Therapy in Austin, has special training to treat these conditions.
Guerrero says much of painful intercourse can be explained by the vagina “bracing for impact.” Women who have experienced painful intercourse in the past may unintentionally tighten their vaginal muscles even more during sexual encounters. Thus, sex can become even more painful.
“If I were to punch someone in the stomach, they will try to brace for the impact,” Guerrero explains. “With that in mind, some of the muscle tightness and contraction that can occur [in the vagina] because of our response to pain is what I work on as a physical therapist. I try to get those muscles to relax.”
Specifically, Guerrero works internally and externally on the genitalia to teach women how to relax their pelvic floor muscles during touch and penetration. This muscle relaxation can help women feel more in control of their body’s response to intercourse. Women who engage in physical therapy may be able to have sex without pain or learn strategies to manage their pain.
How can physical therapy help avoid painful intercourse?
Physical therapy for painful intercourse involves multiple techniques, such as breathing exercises, tissue massage, and desensitization strategies. For vaginismus and vulvodynia patients who experience pain to the touch, one of Guerrero’s strategies is to desensitize the vagina and help the patient manage her pain.
“I might start by having the patient use their finger or a Q-tip and just place it at the opening [of the vagina],” Guerrero says. “This helps the patient’s brain process what’s happening … if it hurts, they can work through some breathing techniques to calm down.”
Guerrero says that treating painful intercourse may also involve seeing a sex therapist to help patients cope with their condition. Regularly visiting one’s doctor is also a good idea if certain prescriptions or additional care is needed.
Partners can also provide invaluable support. If the patient has a partner, sometimes Guerrero invites them to a physical therapy session to get a better understanding of their loved one’s condition.
Some patients with pelvic floor dysfunction are cured of their painful intercourse through physical therapy. However, patients with gynecological conditions, such as endometriosis, might not have the same results.
“As a physical therapist, I cannot change that you have a medical condition, but I can help change how your body responds to intercourse,” Guerrero says.
Overall, physical therapy for painful intercourse can be extremely beneficial. It can help women avoid or decrease pain during sex, and it is often life-changing, Guerrero says.
Don’t be afraid to speak out
If you’re experiencing painful sex long term, it’s never too early or late to seek treatment. Guerrero works with women of all ages, from about 17 to 70 years old. No matter the age, Guerrero says there is one common theme; many of them feel as though their concerns about their painful intercourse have not been heard.
“It’s unfortunate that we get to talk about our knee pain and back pain at the dinner table, but if you talk about your pain during sex at the dinner table that’s not appropriate,” says Guerrero.
While some women speak up, others may feel embarrassed or scared to share their experiences—even with their doctor. However, Guerrero wants these women to know that they are not alone and they should speak up to get the treatment they need.
“Probably 95 percent of patients who walk through my door had no idea that this therapy existed,” Guerrero says. “It’s so heartbreaking because I just want people to know that there’s help out there.”
If you experience painful intercourse long term, talk with your doctor about treatment options. Physical therapy may help.
Callie Rainosek is a graduate student in the Science & Technology Journalism program at Texas A&M University. Her special interests include women’s health and sexual health education. Callie can be reached at callierainosek@yahoo.com.
Although Jill smiles and laughs with her girlfriends as they discuss their recent sexual adventures, she feels uneasy with the conversation. She wonders, “Am I the only one who thinks sex hurts?”
Another woman, Sarah, visits the gynecologist with every intention of identifying the cause of her painful intercourse. She has tried everything with her partner to ease the pain—more foreplay, extra lubricant, and even a different brand of condoms. Nothing has worked.
“I think you just need to relax and use more lubricant,” Sarah’s gynecologist says. “Based on your physical exam, you’re perfectly healthy.”
Sarah leaves the doctor’s office frustrated. She thinks, “I can’t be the only woman experiencing this.”
Painful intercourse is more common than you may think
According to the American College of Obstetricians and Gynecologists, nearly three out of four women have pain during intercourse at some time in their lives. For some women, the pain is temporary. But for others, such as Jill and Sarah, it’s is a long-term problem.
However, painful intercourse can be caused by multiple conditions. For women experiencing painful intercourse, the first step is to visit the doctor to rule out common causes, such as sexually transmitted infections and certain medications. If the pain isn’t a quick fix, symptoms could be caused by more complex conditions such as endometriosis—where the lining of the uterus, the endometrium, grows outside the uterus.
Other causes of painful intercourse include conditions of the pelvic floor—the area of muscles that support the pelvic organs, including the uterus, bladder, and rectum. Examples of pelvic floor-specific conditions are vaginismus and vulvodynia. Vaginismus is vaginal tightness that can cause discomfort, burning, pain, penetration problems, or complete inability to have intercourse. Chronic pain in tissues surrounding the opening of the vagina is known as vulvodynia.
Whether the pain is caused by gynecologic conditions or pelvic floor dysfunction, it may be treated with physical therapy. Amethyst Guerrero, a physical therapist at Sullivan Physical Therapy in Austin, has special training to treat these conditions.
Guerrero says much of painful intercourse can be explained by the vagina “bracing for impact.” Women who have experienced painful intercourse in the past may unintentionally tighten their vaginal muscles even more during sexual encounters. Thus, sex can become even more painful.
“If I were to punch someone in the stomach, they will try to brace for the impact,” Guerrero explains. “With that in mind, some of the muscle tightness and contraction that can occur [in the vagina] because of our response to pain is what I work on as a physical therapist. I try to get those muscles to relax.”
Specifically, Guerrero works internally and externally on the genitalia to teach women how to relax their pelvic floor muscles during touch and penetration. This muscle relaxation can help women feel more in control of their body’s response to intercourse. Women who engage in physical therapy may be able to have sex without pain or learn strategies to manage their pain.
How can physical therapy help avoid painful intercourse?
Physical therapy for painful intercourse involves multiple techniques, such as breathing exercises, tissue massage, and desensitization strategies. For vaginismus and vulvodynia patients who experience pain to the touch, one of Guerrero’s strategies is to desensitize the vagina and help the patient manage her pain.
“I might start by having the patient use their finger or a Q-tip and just place it at the opening [of the vagina],” Guerrero says. “This helps the patient’s brain process what’s happening … if it hurts, they can work through some breathing techniques to calm down.”
Guerrero says that treating painful intercourse may also involve seeing a sex therapist to help patients cope with their condition. Regularly visiting one’s doctor is also a good idea if certain prescriptions or additional care is needed.
Partners can also provide invaluable support. If the patient has a partner, sometimes Guerrero invites them to a physical therapy session to get a better understanding of their loved one’s condition.
Some patients with pelvic floor dysfunction are cured of their painful intercourse through physical therapy. However, patients with gynecological conditions, such as endometriosis, might not have the same results.
“As a physical therapist, I cannot change that you have a medical condition, but I can help change how your body responds to intercourse,” Guerrero says.
Overall, physical therapy for painful intercourse can be extremely beneficial. It can help women avoid or decrease pain during sex, and it is often life-changing, Guerrero says.
Don’t be afraid to speak out
If you’re experiencing painful sex long term, it’s never too early or late to seek treatment. Guerrero works with women of all ages, from about 17 to 70 years old. No matter the age, Guerrero says there is one common theme; many of them feel as though their concerns about their painful intercourse have not been heard.
“It’s unfortunate that we get to talk about our knee pain and back pain at the dinner table, but if you talk about your pain during sex at the dinner table that’s not appropriate,” says Guerrero.
While some women speak up, others may feel embarrassed or scared to share their experiences—even with their doctor. However, Guerrero wants these women to know that they are not alone and they should speak up to get the treatment they need.
“Probably 95 percent of patients who walk through my door had no idea that this therapy existed,” Guerrero says. “It’s so heartbreaking because I just want people to know that there’s help out there.”
If you experience painful intercourse long term, talk with your doctor about treatment options. Physical therapy may help.
Callie Rainosek is a graduate student in the Science & Technology Journalism program at Texas A&M University. Her special interests include women’s health and sexual health education. Callie can be reached at callierainosek@yahoo.com.
Upcoming Dates
January 8
UsToo Prostate Support Group: Mike Jones Memorial Chapter will be
at 7pm to 8:30 pm at St.David's South Austin Medical Center
January 12
Pelvic Pain Support Group 10 to 11:15 am 4131 Spicewood Springs Road Suite M-1 Austin, Texas 78759
RSVP prior to joining the group: brittanyneece@gmail.com or 512-814-6027
January 19
Dr. Deborah Dunn, MD, MPH will be presenting to the physical therapists on PRP (Platelet Rich Plasma) treatments for pelvic floor conditions.
January 30
Amethyst will be presenting at the Austin Area Birthing Center-South to discuss common pelvic floor dysfunctions during and after pregnancy.
UsToo Prostate Support Group: Mike Jones Memorial Chapter will be
at 7pm to 8:30 pm at St.David's South Austin Medical Center
January 12
Pelvic Pain Support Group 10 to 11:15 am 4131 Spicewood Springs Road Suite M-1 Austin, Texas 78759
RSVP prior to joining the group: brittanyneece@gmail.com or 512-814-6027
January 19
Dr. Deborah Dunn, MD, MPH will be presenting to the physical therapists on PRP (Platelet Rich Plasma) treatments for pelvic floor conditions.
January 30
Amethyst will be presenting at the Austin Area Birthing Center-South to discuss common pelvic floor dysfunctions during and after pregnancy.
Updates from the Physical Therapy Team
The physical therapy team was busy in December. Here are some highlights:
- Amethyst Guerrero attended Neurologic Conditions and Pelvic Floor Rehab in Philadelphia on December 7-9th. She was able to network with neurologic and pelvic floor physical therapists across the country and learn more about pelvic floor health in relationship to bowel, bladder and sexual function.
- Becky Maidansky and Rachel Madera went to a course in Denver, CO titled "Top Down Bottom Up" that discussed ankle, knee and hip biomechanics and its relationship to dysfunction.
- Anissa Akrout finished taking a continuing education course about neural tension testing, which she shared with the physical therapy team. This course allowed Anissa to delve further into neurodynamics, basically how well a nerve moves within its sheath, in order to gain a new perspective on how to approach chronic pelvic pain. Being that the lumbar spine plays a key role in pelvic dysfunctions, this was helpful to pinpoint at which specific level of the lumbar spine problems could arise from. In addition to learning more about isolating which lumbar spine level dysfunctions could come from, Anissa also learned about how to isolate which lower extremity nerve could be involved. Overall, the course content included theoretical information on neuropathology, thorough evaluating assessments, treatment plan, and what patients can do at home to help decrease their pain.
- Rachel and Amethyst presented in the month of December to the physical therapists. One topic was geared towards neurogenic conditions and how they relate to sexual function while the other covered how ankle and feet mechanics can impact the pelvis (or vice versa).
- Christina McGee will be going on maternity leave starting February 1, 2019. She will be home with her new baby for 12 weeks. We have hired one of our past students, Nicole Rodgers, PT, DPT, to shadow Christina for January and treat her patients in February, March and April.
PT Below the Waist
Jamille Niewiara and Jessica Chastka are co-hosts of Sullivan Physical Therapy's podcast called "PT: Below the Waist", a patient oriented podcast discussing topics related to pelvic floor physical therapy and how it addresses bladder, bowel, and sexual function issues. The podcast features two pelvic floor physical therapists casually conversing about their experiences and thoughts towards pelvic floor related issues.
Every few weeks, they will be posting podcasts about different diagnoses, tips/recommendations to address symptoms, and interviews with medical professionals. Subscribe to their podcast on iTunes, follow them on Twitter @PTBelowTheWaist, and like them on FaceBook. Leave comments and questions on their email: PTBelowTheWaist@gmail.com.
Sullivan Physical Therapy encourages you to listen to their podcasts and get enlightened about "Better Pee, Better Poo, Better Sex".
To listen to our latest podcast please click here.
Every few weeks, they will be posting podcasts about different diagnoses, tips/recommendations to address symptoms, and interviews with medical professionals. Subscribe to their podcast on iTunes, follow them on Twitter @PTBelowTheWaist, and like them on FaceBook. Leave comments and questions on their email: PTBelowTheWaist@gmail.com.
Sullivan Physical Therapy encourages you to listen to their podcasts and get enlightened about "Better Pee, Better Poo, Better Sex".
To listen to our latest podcast please click here.
Sullivan Physical Therapy & Austin Area Birthing Center
Postpartum pelvic floor physical therapy is standard in some other countries, with health systems recognizing that preventative care during the crucial healing period following delivery can save women from future suffering and save the system hundreds of thousands of dollars in medications and surgeries farther down the line. Problems such as incontinence, prolapse, scar pain, diastasis recti, back or hip pain, and pain with intercourse can be addressed and eliminated or even prevented all together with a post partum evaluation and recommendations or exercises from a pelvic floor physical therapist trained in postpartum health. To this point, these services are rarely offered in the United States.
Sullivan Physical Therapy is excited to partner with Austin Area Birthing Center in creating this type of whole- person care for clients. Christina McGee PT, DPT, will be on site at Austin Area Birthing Center South Thursday afternoons to provide physical therapy evaluations and treatments to pregnant and postpartum AABC clients to maximize health and healing and allow patients to get back to activities safely following delivery. At this time, insurance will not be accepted for visits performed at AABC.
Please contact Sullivan Physical Therapy to learn more about this service and schedule an appointment or email christina@sullivanphysicaltherapy.com.
Sullivan Physical Therapy is excited to partner with Austin Area Birthing Center in creating this type of whole- person care for clients. Christina McGee PT, DPT, will be on site at Austin Area Birthing Center South Thursday afternoons to provide physical therapy evaluations and treatments to pregnant and postpartum AABC clients to maximize health and healing and allow patients to get back to activities safely following delivery. At this time, insurance will not be accepted for visits performed at AABC.
Please contact Sullivan Physical Therapy to learn more about this service and schedule an appointment or email christina@sullivanphysicaltherapy.com.
