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Pelvic Floor & Core Therapy

The pelvic floor is a complex network of muscles and connective tissues that form a hammock at the base of your pelvis and structurally lay the foundation of your core. The pelvic floor works closely with your diaphragm and abdominal, deep back, and hip muscles to stabilize the pelvis and entire spine (which in turn affects the way your whole body moves and functions).

In addition to providing core stability, the pelvic floor supports your organs, controls urination and bowel movements, allows for optimal sexual function, aids in blood and lymph circulation, and makes pregnancy and childbirth possible. In short, the pelvic floor and core are a pretty big deal and are intricately involved in- and influenced by- multiple body systems. This is why at Femwell Dr. Brussee takes a functional and integrative whole-body approach to pelvic health instead of using outdated methods that focus on the pelvic musculoskeletal system in isolation. As an athlete and mom who has experienced pelvic health complications herself, she is passionate about providing transformative care that empowers women to confidently engage in roles and activities that are meaningful to them without fear, pain, or embarrassment. Prevention is optimal and recovery is possible; it is never too late or too early to improve pelvic and core health.

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Conditions Treated

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Who is Pelvic Floor/Core Therapy For?

Any woman who wants skilled and transformative care to navigate:

  • Pelvic organ prolapse

  • Frequent and/or urgent urination

  • Leaking urine when laughing, coughing, sneezing, or exercising

  • Incomplete bladder emptying

  • Pressure or pain in the vagina, bladder, or rectum

  • Painful sex

  • Mechanical or unexplained infertility

  • Interstitial Cystitis/Painful Bladder Syndrome

  • Chronic UTIs/UTI symptoms

  • Recurrent bacterial vaginosis or yeast infections

  • Straining with bowel movements

  • Chronic constipation

  • Irritable Bowel Syndrome

  • Bowel incontinence

  • Endometriosis

  • Sacroiliac (SI) joint pain

  • Tailbone pain

  • Pubic pain

  • Pregnancy-related back and pelvic pain

  • Sciatica

  • Pudendal neuralgia

  • Diastasis Recti/abdominal separation

  • Pelvic/abdominal surgery preparation & rehabilitation (hysterectomy, prolapse repair, hernia repair, etc.)

  • C-section and episiotomy/perineal tear recovery

  • Childbirth preparation and birth injury prevention

  • Postpartum recovery 

  • Menopausal issues

  • Prevention of developing pelvic floor and core issues

Initial Evaluation

 

The initial evaluation is a 55 minute 1:1 appointment in which Dr. Brussee will complete a comprehensive evaluation of your history, symptoms, concerns, and goals. Evaluation sessions include an in-depth interview, comprehensive head-to-toe musculoskeletal assessment, posture and functional movement assessment, breath assessment, and patient education. During the evaluation it will be determined if an internal pelvic floor assessment and/or rehabilitative ultrasound imaging may be necessary. Dr. Brussee will provide you with a customized home program and will collaboratively develop a treatment plan with you based on her evaluation findings and your personal goals.

 

*All intake forms and questionnaires are required at least 24 hours prior to your evaluation appointment so that Dr. Brussee can review your history beforehand to guide the assessment process and best utilize your time together.

Birth Prep Sessions 

 

Childbirth is a monumental physical and mental endurance event that women should not be expected to complete without training. While pregnancy, labor, and delivery often involve situations that are beyond our control (like many other aspects of parenting), we can prepare well to increase the likelihood of having a birth and post-partum experience we desire.

 

Babies are able to get into the best position possible when the mom's body is balanced. Sometimes restrictions in core and pelvic muscles, fascia, and ligaments can create a torsion in the uterus and affect the position of the baby- making it difficult to descend into the pelvis with ease. Specialized manual releases and positioning strategies can aid in a smooth delivery by creating balance and symmetry in the mom's body so that her baby is positioned well for birth.

 

At Femwell we highly recommend EVERY woman has a birth prep session (or three!) with Dr. Brussee in addition to our childbirth education class series. These 1:1 55 minute sessions are customized according to your goals and concerns, and may include the following:

  • Manual release of the back and pelvic girdle musculature, fascia, and ligaments to position the baby well and prepare for a smoother, quicker labor

  • Customized exercises and strategies to position baby optimally

  • Customized manual release work and positioning techniques for breech and transverse lying babies

  • Personalized positioning techniques for labor that take your specific anatomy and baby's position into mind

  • Home exercise and functional strategies to prepare the pelvis for birth without trauma

  • Push education to reduce the likelihood of tearing and reduce the pushing phase of labor

  • Energy conservation techniques for labor

  • Pelvic floor assessment

  • Preparation of the perineum for birth through manual massage techniques

  • C-section management techniques

  • Education on important early post-partum strategies for optimal recovery of the core and pelvic floor

  • Education on posture and functional movement patterns/body mechanics during pregnancy and postpartum to maintain strength and prevent injury to the pelvic floor and core

Comprehensive Postpartum Evaluation

 

Congratulations mama! You just accomplished an absolutely incredible feat. Whether you delivered your baby vaginally or via c-section, your body experienced significant trauma. If you gave birth vaginally, your pelvic floor muscles stretched 1.5-3 times their normal length. If you gave birth via c-section, you experienced a major abdominal surgery that involved cutting through 6 layers of tissue. Not only that, but after growing a baby for 9 months, your core muscles stretched and you inevitably developed different movement patterns throughout your body to accommodate for your growing belly and altered center-of-gravity. In short, your muscles are not firing the same way they did pre-pregnancy. Which, by the way, is okay! They did what they were supposed to in order for your body to create a new life.

 

While specific ways of exercising and moving your body can be extremely beneficial for healing post-partum, many recommended exercise methods can actually cause further injury and prolong healing. Your body is not magically ready to return to rigorous exercise 6 weeks after giving birth, and there is no one-size-fits all to postpartum healing. A comprehensive postpartum evaluation and treatment session can ensure you have a positive postpartum experience and that your body heals optimally. We strongly believe that EVERY single woman, regardless of how they gave birth should have a comprehensive postpartum evaluation 6-12 weeks postpartum. These 55 minute 1:1 sessions include the following:

  • Full body musculoskeletal assessment (including posture and functional body mechanics)

  • Breath assessment

  • Diastasis recti assessment

  • Pelvic floor assessment

  • Scar tissue assessment

  • Prolapse assessment

  • Customized exercise and home program

  • In-depth education on postural, ergonomic, and lifestyle recommendations

  • In-depth I/ADL training considerations for the postpartum body (eating, toileting, dressing, breastfeeding, sex, use of baby equipment, etc.)

Treatment Sessions

 

Follow-up treatment sessions are 55 minute 1:1 appointments of hands-on care. Each session includes a brief reassessment and progress report, updates to your customized home program, and a combination of some of the following treatments:

  • Rehabilitative Ultrasound Imaging and Biofeedback

  • External and internal manual techniques: myofascial release, soft tissue mobilization, trigger/tender point release, visceral mobilization, and scar tissue mobilization

  • Functional range of motion and strengthening exercises

  • Functional neuromuscular coordination exercises

  • Personalized home programs

  • Functional posture and movement training

  • Breath training

  • Ergonomic training and environmental modifications

  • Lifestyle habit training for optimal pelvic health

  • Stress management and nervous system regulation techniques

  • Bladder and bowel retraining

  • Cupping

  • Pelvic therapeutic tool training

  • Lymphedema management

  • Positioning and sleep strategy education

  • Fitting and training in use of abdominal and pelvic supports 

  • Kinesio-taping

  • Non-pharmaceutical pain management techniques

  • In-depth education on surgical and procedural options

  • Birth preparation strategies to improve labor experience, prevent injury and decrease recovery time

  • Postpartum recovery exercises, ADL training, and scar tissue mobilization

  • Postpartum return-to-sport training​

Mercier Therapy/Gyno-visceral Manipulation

 

Mercier Therapy is a deep external pelvic organ visceral manipulation technique that addresses scar tissue, adhesions, malalignment, and decreased mobility of the pelvic organs and surrounding soft tissues in order to improve their blood flow and function. 

 

Blood is the lifeline that ensures every organ, muscle, nerve, and tissue in your body receives oxygen, nutrients, hormones, and efficiently disposes of waste.  When blood flow to your pelvic organs is obstructed due to malposition or scar tissue/adhesions from congenital anomalies, genetics, surgical procedures, endometriosis, or pregnancy/childbirth, it can lead to a spectrum of symptoms including pelvic pain, hormonal imbalances, pain during ovulation and menstruation, infertility, and disruptions in bladder or bowel function. 

 

Why is this? The position and mobility of an organ can directly affect how it functions mechanically and chemically. How? Let’s look at endometriosis as an example:

 

Endometriosis often leads to the development of scar tissue adhesions, which can attach the uterus, ovaries, and fallopian tubes to nearby structures such as the bladder, bowel, and other surrounding soft tissues. This can cause mechanical issues like organ compression, nerve irritation, and pelvic floor muscle tension. Additionally, it can result in chemical issues like pelvic inflammation and altered estrogen/progesterone production in the ovaries. Together, these factors can lead to symptoms including infertility, pelvic pain, persistent constipation, abdominal distension, heightened urinary urgency/frequency, and discomfort during intercourse.

 

Gyno-visceral mobilization helps to revitalize blood flow and realign the pelvic organs for optimal mechanical and chemical function. Dr. Alyssa Brussee is the sole certified Mercier Therapy pelvic health practitioner in North Carolina, providing specialized expertise in this technique to assist with the following concerns:

 

  • Infertility

  • Recurrent miscarriage

  • Pelvic pain 

  • Painful intercourse

  • Amenorrhea (lack of period)

  • Anovulation (lack of ovulation)

  • Dysmenorrhea (painful periods)

  • Mittelschmerz (painful ovulation)

  • Premature ovarian failure

  • Endometriosis

  • PCOS (Polycystic Ovarian Syndrome)

  • Pelvic/abdominal scarring from previous trauma or surgery (c-section, laparoscopy, laparotomy, D&C, LEEP, prolapse repair, hysterectomy)

  • Incontinence (involuntary loss of urine)

  • Urinary urgency/frequency

  • Blocked fallopian tubes

  • Follicle quality

  • Uterine Fibroids

  • Pelvic organ prolapse

  • Chronic GI issues (bloating, cramping, constipation)

  • Chronic urinary tract infections

 

The Protocol

 

The Mercier Therapy protocol consists of 6 total hours of therapy performed in 1-hour weekly sessions over 6 consecutive weeks. Prior to the 6 treatments, an in-depth 1-hour initial consultation is held with Dr. Brussee in which you will review your medical history, lifestyle, symptoms, and goals and have a pelvic organ mobility exam. Treatment intensives completed over a condensed amount of time are available for women who are traveling to see Dr. Brussee from out of town or for those wanting to have the protocol done prior to an upcoming scheduled assisted reproductive technology (ART) procedure. For in-depth information on Mercier Therapy for infertility, click here.

Rehabilitative Ultrasound Imaging (RUSI)

 

Femwell is the only clinic in western North Carolina that offers Rehabilitative Ultrasound Imaging (RUSI).  RUSI can help identify drivers of core and pelvic floor dysfunction and help clients retrain key muscles for continence, spine stability, sexual function, and pain prevention. Due to the pelvic floor and deep core not being as visible as other muscles in the human body, it can be quite difficult to form a mind-muscle connection with them. RUSI is an advanced technology that provides real-time imaging during assessment and functional exercise for clients to see exactly which muscles of the pelvis and core they are (or aren't) recruiting. This significantly increases recovery time and prevents improper muscle coordination patterns that can worsen symptoms. Because we believe so strongly in the therapeutic benefit of RUSI, it is included (if indicated) in evaluation and treatment sessions at no additional cost.

Benefits of RUSI:

  • Identify drivers of pelvic floor and core dysfunction

  • Provide visual biofeedback for retraining the pelvic floor and core muscles

  • Accurately measure and track progress of diastasis recti

  • Tackle breathing impairments

  • Determine drivers for urinary urgency, frequency, and incontinence through assessment of bladder capacity, void/post-void volumes, and structural anatomy

Out-of-Town Program 

 

Looking for answers and lasting relief, but not local to WNC? Dr. Brussee works with out-of-town clients through remote virtual consultations on a secure video conferencing platform. She also offers an intensive multi-day in-person program with daily treatment sessions for out-of-town clients.

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