What is PelvicCon?

PelvicCon is an annual conference designed to educate and empower individuals on issues surrounding pelvic health. It’s a vibrant space where medical professionals, physical therapists, coaches, pelvic health experts, and attendees come together to learn from each other, discuss challenges, and uncover innovative solutions.

The conference covers a broad spectrum of topics related to pelvic health—anything from pelvic floor dysfunctions, incontinence, male pelvic health, fibroids, PCOS, and endometriosis, to pain management, sexual health, reproductive health, and beyond. For both practitioners and the general public, PelvicCon offers practical strategies, research updates, and the chance to hear from those who have lived experiences with these often-taboo subjects.

Courses from PelvicCon 2024 & Our Favorite Takeaways

PelvicCon 2024 was a groundbreaking event, filled with thought-provoking presentations and discussions that continue to resonate in the pelvic health space. It is so hard to choose because of the WEALTH of information provided, here are some of our favorite key takeaways:

Hypermobility and Pelvic Health (Presented by Bill Taylor MSc, PT, Grad Dip Adv Manip Therap (Canada))

• Patients may experience a sensation of "stiffness", although they have increased range of motion. This is where we come in to help patients navigate the responsibility of their larger ranges of motion. There is a difference between general hypermobility and joint instability which would consist of pain, swelling, injuries, and a feeling of apprehension when loading joints.

• Those with hypermobility are often working their bodies differently, which can cause increased tone in the pelvic floor muscles or non-relaxing muscles, resulting in weakness, pain and dysfunction. Symptoms could include urinary incontinence, frequency, nocturia (urinating >1x at night), incomplete emptying or a slow stream, pelvic organ prolapse, sexual dysfunction, fecal incontinence, constipation, recurrent UTI, or pain. 

• Special shoutout to men -> men (and those assigned male at birth) with hypermobility may experience chronic prostatitis, pelvic pain syndrome, urinary/fecal incontinence, or sexual dysfunction. 

• One extremely interesting takeaway from Bill Taylor's talk at PelviCon was that he calculated that his patients who are dancers with hypermobility, decreased their injury rate by 35% after he invested in weight lifting equipment to incorporate to their treatment plans. 

• Check out the 5-Point Questionnaire in the Youtube video below which can serve as an adjunct to treating those with hypermobility. 

 Overactive Bladder Syndrome (in Women); Presented by Taryn Hallam 

• Overactive Bladder Syndrome is an umbrella term, assigned to anyone with urgency, nocturia and UUI (and maybe frequency)

• OAB is a sensory disorder that may or may not have a coexisting motor dysfunction

• People who have urgency and incontinence have very different treatment plans for those who have urgency and are dry

• Men and women are very different when it comes to determining overactive bladder causes! Many research articles determined 50% of people's reason for OAB was detrusor (the muscle of the bladder) overactivity. However, Huan et al 2023 discovered that number dropped down to only 15% evidence of DO amongst women. This is like thinking everyone with a headache is dehydrated. 

  • Among the people who showed detrusor overactivity, many of the researchers did not ask the subject if they felt urgency during the muscle contraction- therefore, we don't even know if that is still the true cause or just an incidental finding. Lowenstein et al 2009 decided to find out, and the results showed only 10% of detrusor overactivity occurrences were linked to an urgency symptom. 

  • Another study, Digesu et all 2003 even showed that 72.5% of people WITHOUT OAB showed detrusor overactivity! This means that the thought of detrusor overactivity causing OAB is looking very poor. 

• The popular drug class used to treat OAB, antimuscarinic medication, increased dementia risk (~40!!!!). However, offering topical vaginal estrogen was equally as effective and does not increase a woman's risk of dementia. 

• PTNS (Percutaneous Tibial Nerve Stimulation) which is more expensive and more invasive, did not outperform the extremely safe and inexpensive TTNS (Transcutaneous Tibial Nerve Stimulation)! 

Beyond the Beam: Post-Pelvic Radiation Therapy (Presented by Alex Hill, physical therapist who is dual certified in pelvic health and oncology)

• Cellular changes can continue for years

• Post radiation, the vagina can completely stenose (close)

  • Consistent dilator work and mobility exercises performed well beyond the completion of radiation therapy is needed

  • You also need manual work because a wand cannot get to the lateral tissue which requires dexterity of a person rather than just a wand (we can help you through this and teach you how and how often to use your dilator/wand!)

• Be educated about pelvic cancer-related lymphedema signs and symptoms

  • Abdomen: heaviness, firmness, pitting across waistband, sensation of bloating, underwear fitting tighter, skin changes, dimpling of skin

  • Genitals/pelvis: swelling, fullness, "sitting on a ball", bowel/bladder dysfunction, sexual dysfunction, skin changes

  • Legs: heaviness and aching, numbness or tingling, pitting, skin changes

• When choosing garments for lymphatic management, make sure it does not stop at the thigh or it will get worse. 

The Nuts & Bolts of Prostate Cancer (Pre & Post Rehab: Maximizing Outcomes) Presented by Dr. Jo Milios (PhD) and specialist in men's physiotherapy

• Men's chance of enlarged prostate and erectile dysfunction increases proportionately as they age. 40% of men at 40 years old experience these symptoms, 50% at age 50, and so on. 

• There are 4,000 cases DAILY and if we can increase our screening capabilities we can make a great impact to catch these cases early!

• Men need to talk to each other about their experiences, 50% chance of first line relative having this. Family history matters! 

  • By the time you can feel it via digital exam, the extent of the cancer has progressed to advanced. We want to catch it early while it is still localized. 

• PSA Guidelines: if PSA is elevated, the doctor will wait 1 month to repeat the test to confirm it is still elevated and then they will refer you to a specialist for further workup. 

• The importance of PREHAB: attending pelvic floor therapy prior to surgery to get to max strength capacity demonstrates greater outcomes post surgery including decreased urinary leaking, pain, erectile dysfunction, AND depression! 

• Keep an eye out for a post specifically for this coming soon! 

IBD & IBS: Getting Good Outcomes (Presented by Michelle Lyons)

• Understanding IBD:

  • Ulcerative colitis: affects females and males in the colon and rectum. Diarrhea is the main symptom, often accompanied by rectal bleeding

  • IBD is different than regular or "normal" gut health because it is the inability to downregulate inflammatory responses. The mucosal immune system remains chronically activated, and the intestine remains chronically inflamed. 

  • Common accompanied symptoms: Persistent pain, diarrhea, body image, distress. Increased risk of these specific symptoms if female. 

• Women-specific pearls:

  • During the luteal cycle of menstruation, some women are more prone to constipation where other women due to increased proteoglycans, they have increased diarrhea the first few days. 

  • 40% of young women are iron deficient in the US! 

• What to do?!

  • A shout out to fiber: Yannai et al 2022 proposed results that 57% of people at week 6 were in remission of their IBD symptoms and sustained remission in 67% of those people, without medications. The diet they followed was the Crohn's disease exclusion diet. 

  • Liselot et al 2021 published a paper highlighting the importance of a personalized strategy: Improvement of Fatigue and Quality of Life in Patients with IBD Following a Personalized Exercise Program

• Pelvic floor specifics

  • Contracted pelvic floor muscles due to pain, fear, frequent bowel movements

  • Pelvic floor muscle training and biofeedback can teach patients how to restore length and coordination 

  • We can use tibial nerve and sacral stimulation

  • Pelvic wands and dilators 

• Understanding IBS

  • Irritable bowel syndrome is a gastrointestinal sensory and motility disorder characterized by abdominal pain or discomfort associated with a change in bowel habits. It is a functional disorder of the gut-brain axis. 1/10 people are impacted globally, for every 3 people with IBS, 2 are female.

  • Patel et al 2017 suggested a close link between sleep disturbance and increased IBS symptoms

  • Be on the lookout for misdiagnoses 

    • Endometriosis

    • Abdomino-phrenic dyssynergia

    • PFD

    • Ovarian Cancer: silent killer. Symptoms: fatigue, change in toilet habits, abdominal bloating, feeling full quicker (BEAT)

  • Subtypes of IBS & where to start with treatment (always try to get a 20 minute walk and chew your food. Keep an eye out if you are rushing your meals or delaying your bathroom trips. We can help you with this!!!)

    • Diarrhea dominant -> optimize stool consistency, EAS coordination, TTNS

    • Constipation dominant -> EAS coordination, mobility, movement, TTNS

    • Both: lifestyle, stress, time management 

• Irritable bowel syndrome or irritable brain?!

  • Bowel factors: abnormal motility, visceral hypersensitivity, role of infection, role of inflammation, role of bacterial overgrowth, role of serotonin, role of brain-gut axis interaction

  • Brain factors: biological factors like neuroanatomical and neuroimmunological factors, role of psyche, social factors like environmental influences and role of stress

  • Liu et al 2022 found that 6 weeks of SBD (slow deep breathing) exercises improved symptoms and altered rectal sensation in IBS-C patients. Also, enhanced vagal activity was found suggesting IBS-C may be due to mechanisms involving autonomic responses. 

• Major takeaway: If you can't already tell, each one of these topics will have their own blog posts higlighting all of the amazing pearls and treatment options. IBS & IBD have a LOT of research out there with options to help each person. You need a provider who will listen and help you through the journey to recovery! 

Uterine Fibroids Presented by Yeni Abraham

• Uterine fibroids, also known as leiomyomas, or myomas, are non-cancerous (bengin) growths of the uterus that often appear during childbearing years. These fibroids are made up of smooth muscle cells and fibrous connective tissue and can vary in size, from microscopic to large masses that can distort and enlarge the uterus. 

  • Location matters: intrauterine vs extrauterine

• Based on ultrasonography, the estimated cumulative incidence of fibroids in women <50 years is higher to black (>80%) versus white (~70%) women. 

  • Although US may be fine for straightforward fibroids, some women would benefit from an MRI to determine the characteristics, number, size, and location of fibroids and to assess for other pathological conditions such as adenomyosis. 

• Pain is not necessarily correlated with the size of the fibroid, and pain can disappear despite size.

• Symptoms: 

  • Heavy menstrual bleeding 

  • Urinary frequency or retention

  • Constipation

  • Infertility and pregnancy complications

  • Pelvic pain and pressure

  • Lower back pain

  • Recurrent miscarriages

  • Dyspareunia (painful intercourse)

  • Abdominal enlargement

• How to manage in pelvic floor therapy:

  • Muscle training, manual therapy techniques like myofascial release and visceral work, pain management strategies, TTNS or sacral stim, and addressing any associated symptoms like pelvic organ prolapse, urinary incontinence, and painful intercourse. 

  • How to gauge success

    • Bladder symptoms usually improve first and if your cycle symptoms worsen, this should be temporary. 

• Broader view of management

  • Must decide with your doctor what options to take to preserve fertility if that is a concern for the woman.

  • Overall, if the fibroids are asymptomatic, the best this is clinical surveillance with an MRI (gold standard) or transvaginal ultrasound annually to monitor size/change of fibroids. 

  • Interdisciplanary care

    • Gynecologist: Adeno/Endo specialist

    • Colorectal surgeon or GI specialist

    • Urologist/Urogynecologist

    • Pelvic floor therapist

    • Nutritionist

    • Hormone specialist (if the gynecologist does not perform this)

    • Interventional radiologist

    • Psychologist/mental health counselor 

Menopause Mastery (Presented by Michelle Lyons)

• Again, this needs its very own blog post from the amazing wealth of information! Here are some of our favorite takeaways: 

• There's more to the successful management of menopause than hormone therapy/anti-depressants

  • Pelvic rehab is an essential component in the management of GSM

  • Strength training is non-negotiable

    • Resistance training releases myokines which are anti inflammatory 

  • Knowledge is power!

• Key relationships to understand

  • Estrogen -> decreases during menopause, insulin receptors become less sensitive to insulin in general can increase 

    • Estrogen and insulin are reciprocal 

    • Could result in tendon issues/pain

    • There are 4x more cortisol receptors in fat cells than anywhere else in the body

  • Cortisol -> increases, crave sugar and fat

• Estrogen

  • Estradiol: mainly during reproduction

  • Estrone: post menopause

  • Estriol: during pregnancy

  • Phytoestrogens: plant based

  • Xenoestrogens: chemically similar, can bind to estrogen receptors 

• Progesterone (pro-gestation)

  • Progesterone prepares the endometrium for the potential of pregnancy after ovulation. It triggers the lining to thicken to accept a fertilized egg. It also prohibits the muscle contractions in the uterus that would cause the body to reject an egg. Influences smooth muscle relaxation in pregnancy. Works to balance estrogen, important for mood and sleep, and starts to taper off at perimenopause. 

  • Can be a valuable tool to help women having sleep disruption in perimenopause 

• Testosterone

  • In women's bodies, testosterone is produced in the ovaries, adrenal glands, fat cells, and skin cells.

  • Generally, women's bodies make about 1/10th-1/20th of the amount of testosterone as men's bodies

  • Testosterone helps musculoskeletal health, breast health, fertility, sex drive, menstrual health, vaginal health, and brain health/cognitive function (focus and clarity)

  • Resistance training increases testosterone whereas long endurance based aerobic training may decrease testosterone!

• Menopause

  • GSM: irregular periods because you can bleed, but not ovulate. 

  • How will you know? Track your cycles!

    • Track ovulation (basal body temperature, cervical mucus)

    • Blood work --> not if you are 45+ because you will have too many fluctuations 

      • If you are under 45, expect FSH to be <40iu/l

      • We need to be aware of PCOS/REDs/POI

  • Late perimenopause/menopause: low estrogen and progesterone --> insomnia, musculoskeletal changes (heel pain, hip pain, shoulder pain), arterial stiffening, brain fog, insulin resistance causing weight gain and belly fat

    • Estrogen balances insulin sensitivity 

    • A case-control study reports bilateral plantar heel pain is principally associated with increased waist gifth (systemic inflammation) rather than the actual foot factors. This could be correlated to menopausal insulin resistance. 

    • Adipose/fat tissue is pro inflammatory which can cause increased pain to tendons 

• Myth busting time!

  • Ovaries still cycle estrogen just at very low amounts during menopause. Brain and breasts produce estrogen locally. 

  • You can menstruate without ovulating, women stop producing progesterone during perimenopause

  • Transdermal estrogen does not increase your risk of DVT or PE 

  • Due to increased estrogen and FSH building up during perimenopause, you could get pregnant! Need to wait 12 months of consistent change. 

  • If we used vaginal estrogen as a gold standard, it is estimated that Medicare would sae 6-22 billion dollars (annually) due to the prevention properties that vaginal estrogen has against UTIs 

  • Postnatal hormones results in an increase in prolactin (especially when breastfeeding) and decreased estrogen. This is nature's way to decrease change of another pregnancy so soon. 

• Hormone therapy

  • When estrogen decreases, the bladder and associated structures become sensitive and can benefit from vaginal estrogen

    • The urinary bladder, trigone, urethra, vagina, and vulvar vestibule all have a common embryological origin and because of this -> the levator ani muscles, genitals, lower urinary tract, uterosacral ligaments and the fascia, are all estrogen receptive! 

      • Blood vessels also respond positively to estrogen 

  • Inconclusive if hormone therapy can help prevent dementia 

    • We know lower extremity strength is correlated to dementia 

  • 30% bone loss during menopause transition 

  • 1/5 women experience anal incontinence 

• Vaginal symptoms

  • Estrogen depletion can lead to vaginal atrophy, due to the impact on collagen and elastin, leading to a decrease in vaginal length and width.

  • More prone to injury of vaginal canal 

• What can we do?

  • Stress management! 60-65% of women who had a heart attack reported experiencing a stressful event 10-15 minutes prior. 

  • Strength training is non-negotiable!

  • Vaginal estrogen takes 4-6 weeks to see effects and if you stop the symptoms will return. It is beneficial and works best when combined with pelvic rehab (Mercier 2023)

  • Diet changes

    • Animal protein does not have fiber! It is important to learn about fiber and protein requirements (~100g/day) without adding inflammation provoking foods to the mix. 

  • Click here to check out Michelle Lyon's awesome podcast about hormones, perimenopause, and postmenopause! 

  • Check out Dr. Rachel Rubin- a wonderful doc specializing and researching this conversation to propel us forward! (Click here) 

  • A whole person approach: find a provider and therapist that will listen to you! (We are here to help you!)

  • Be on the lookout for future blog posts discussing each in more detail including perimenopause, postmenopause, menstruation, and postpartum! 

Central Sensitization: Presented by Michelle Lyons (Global educator and activist for women's health, founder of Celebrate Muliebrity and the Celebrate Muliebrity Podcast)

• All pain is both emotional AND physical, whether current or potential; pelvic pain in particular. 

• Safety is vital: the nervous system can't hear you if it's scared, or tired, or hungry and knowledge is power!

  • We need safety in everyday life. If we don't have this, it feels like a threat. Normal sensory then turns to elicit abnormal painful responses such as the feeling of something warm = feeling bladder pain. The body's fire alarm is telling us FIRE, FIRE, FIRE... when really we just made some toast in the kitchen. 

    • This DOES NOT mean pain is all in your head. 

• Pain that has persisted for >3 months has an increased chance of nociplastic pain. The good news is, plastic = able to change!

• Nociceptive pain is driven by inflammation

  • We used to believe diagnoses like fibromyalgia were "not real"

• We include the central sensitization screening (part A and part B) in our intake form- please email us for a copy if you are interested that this topic pertains to you! 

• Plan:

  • Calm the system down

    • use the drug cabinet in the brain: muscles are endocrine organs. Building muscle has an anti-inflammatory effect on your body. 

  • Engage in conversation

  • Build resilience 💪 

Click here to check out this book to help improve your sleep quality! 

PCOS: demystifying the hormonal web (Presented by Yeni Abraham, physiotherapist specializing in fertility, hormones, and female pelvic pain)

• The medical community has to step it up and ask more questions about periods and hormone health!

• Diagnosis PCOS --> presence of excess androgen hormones near the ovaries. You no longer require imaged polycystic ovaries to be diagnosed. You do need to meet the following criteria: oligo-anovulation (cycles that are longer than 35 days or fewer than 10 period per year) OR polycystic ovaries, AND hyperandrogenism (blood test). 

• Lab findings in PCOS: elevated LH (Luteinizing hormone), testosterone levels (>70), AMH (anti-mullerian hormone)

• Metabolic assessments: fasting glucose and insulin levels, lipid profile abnormalities, oral glucose tolerance test (OGTT)

• One of our favorite products to support our patients to decrease inflammation is Psyllium Husk Powder - Click here to check it out!

• Distinctly different but often partnered: PCOS & Endometriosis

  • Be on the lookout for an upcoming blog explaining this further! Often resulting in irregular periods. 

• PCOS & Urinary dysfunction --> women with PCOS often have higher rates of urinary incontinence compared to the general population. This can be due to insulin resistance and hyperandrogenism, which are prevelent in PCOS and can weaken pelvic floor muscles. ALSO, elevated androgen levels can affect the smooth muscle and connective tissue integrity of the bladder and urethra, leading to dysfunction like incontinence and OAB. 

• People with PCOS tend to feel their best while they are pregnant due to an estrogen surge! This decreases body pain, anxiety, depression, and other PCOS-symptoms. 

• Best thing for this? Decrease your processed sugar intake & stress reduction!  If we can help your body manage insulin, we can help your hormones, and help your gut. Try taking out at least 2-3 carbs per week as a start. Look to increase fiber and protein (protein: 100g/day)! 

Returning to Sport & Exercise Postpartum (Presented by Grainne Donnelly, doctoral researcher at Cardiff Metropolitan University and Editor-in-Chief of the Journal of Pelvic Obstetric and Gynaecological Physiotherapy)

Considering the pelvic floor muscles stretch 2.5x their usual amount and the abdominals stretch 1.5x their usual amount, you would think each woman would be referred to a professional for guidance to return to spot and exercise (and even just life activities) postpartum. However, many women are finding out way after the fact that pelvic floor therapy exists and may have helped them in their times of need. 

1/3 of women will have persistent Diastasis Recti Abdominis (DRA) postpartum. Women are also facing sleep deprivation, nutrient and energy deprivation, and pressure to get back to a postpartum body. Faced with this accumulative load and an identity change, women have little-no guidance on return to exercise and sport. After a knee surgery consisting of inserting mini instruments to repair a tear, patients are told to avoid twisting on the knee, impact sports and deep squatting for 3 months, then you are discharged to outpatient PT for further guidance. Versus...

"Hi Mam, congratulations! After 9+ months of progressive physical, physiological and psychological bodily changes, relative deconditioning, limited education and major abdominal wall surgery and or vaginal trauma.. here is your baby! You have a NEW JOB to go home to with immediate start. Part of your job description is to figure it out all by yourself.." - Grainne Donnelly 2024

Due to physical deconditioning of the average person in 2024, we have to look at each person differently when considering exercise prescription. Take a look at the Get Active questionnaire, supplying further guidance on this topic. Factors that we would consider for postpartum women looking to get back to running would include being 12 weeks postpartum, did you run prior, experiencing fatigue, vaginal pressure, incontinence or pain; having a previous injury, lack of sleep, and more! 

In Conclusion: A Bold Step Forward

PelviCon 2024 solidified its place as a pivotal event in the world of pelvic health. As the conversation around pelvic health continues to grow, events like PelviCon are essential for creating an informed, supportive, and empowered community. PelviCon is setting the stage for a future where pelvic health is prioritized, celebrated, and better understood by continuing to break down barriers, normalize discussions, and advocate for better care.

For those dealing with pelvic health challenges, PelviCon represents a beacon of hope and a reminder that you are not alone. The more we learn, the more we empower ourselves and others to take control of our pelvic health. If you haven’t already, mark your calendars for next year’s PelviCon—it’s an event you won’t want to miss!