Pelvic Floor Physical Therapy has been around for decades, but to this day I hear patients tell me they never knew it existed. They have been unaware that pelvic floor physical therapy can help them with isues such as leakage, painful intercourse, postpartum recovery, constipation, lower abdominal pain, chronic hip and back pain and symptoms with a pelvic organ prolapse. In some cases they have dealt with these issues for years. They think they are the “only one” dealing with it or have been told its a consequence of having babies or aging.
So you may ask what exactly does a Pelvic Floor Physical Therapist do? We are Physical Therapists that specialize in treating women’s health issues, including pelvic floor dysfunctions. We often perform internal vaginal exams to screen for pelvic pain, weakness, pelvic floor strength or coordination, presence of pelvic organ prolapse or ruling out other painful areas in the pelvic region.
However it’s not always about the pelvic floor. We look at the entire person to see what else could be going on.
Pelvic floor issues can also be present while
- Holding your breath with activities
- Sucking in your stomach while jogging
- Posture as with tucking your butt under during a dead lift at the gym
- Stress levels that can make your body tense, including the pelvic floor.
Let’s look at an example of a patient I see frequently at my clinic….
Ever since Mary gave birth to her third child she noticed “down there” was just not the same. For one thing sex was not cracked up to what it used to be. It was uncomfortable and it almost felt as if something was in the way. She noticed a heaviness in her vagina which seemed to worsen during exercise or after several hours on her feet at work. Not to mention the time she had to sneak out of Zumba class after peeing on herself from all the jumping. She had questioned her gynecologist as to why she was having these symptoms. He replied “Well you’ve had three babies, this comes with the territory.” Mary was frustrated that she didn’t have any real suggestions other than surgery and kegels. There has to be other solutions.
Any of this sound familiar? Believe you me, you are not alone! These issues are very common among women, some who are even too embarrassed to confide in their doctor. Many times after women have babies they are not given real guidance how to take care of their bodies, so we concede that leakage, painful intercourse and heaviness and discomfort along the vagina are “normal.”
Sometimes symptoms may not appear until later in life when our babies are grown. Hormonal changes can affect the resting tone of the pelvic floor muscles, which can result in leakage or symptoms such as feelings of “heaviness or dragging” along the pelvic floor as with a prolapse. While they may be common, they are definitely NOT normal.
Let’s answer some questions you may have about the pelvic floor so we can spread awareness that help is available.
Why am I having leakage when I exercise or just keeping up with the kids?
Leakage is known to happen in 1 out of every 3 women. This includes all ages, from teenagers, young athletes, new Moms, and postmenopausal women. While leakage is common, it is definitely not normal and something you have to live with. In most cases incontinence can be helped if not totally resolved.
If you leak with coughing, laughing, lifting or jumping with exercise, this is known as stress incontinence. While “kegels” are known to be part of the solution, there is more to it than just that. Managing intra-abdominal pressure (not holding your breath), along with proper breathing and body mechanics with exercises, or just our day to day activities, can make a huge difference with eliminating leakage.
Teenagers can have leakage while playing sports. This could be a result from holding their breath and placing pressure down along the pelvic floor as with kicking a soccer ball, or jumping up to spike a volleyball. Young athletes who lift weights as in CrossFit, can have leakage when tightning their abdominals during a squat which places pressure down to the pelvic floor.
During pregnancy our pelvic floor takes on extra pressure from the weight of carrying a baby. Then during delivery the pelvic floor muscles are streched resulting in weakness. Unfortunately alot of Moms are left on their own to figure out how to safely recover afer having thier baby.
Every new Mom should be referred to a pelvic floor physical therapist so they can be given a thorough exam including an internal exam to check on the strength of the pelvic floor muscles, as well as any prolapse or pain issues. Learning the right exercises as well as incorporating the pelvic floor muscles with activities such as lifting the car seat or stroller, can help minimize or resolve leakage.
Here is a free e-book “How to Exercise Without Peeing your Pants” I wrote with more advice and exercises that can help
Why do I feel the urge to pee a lot and in the bathroom several times a day?
Perhaps you have more of the urgency or the “gotta go” feeling that can result in leakage.
Do you ever find yourself going to the bathroom “just in case?’ Maybe you see a bathroom at the mall and even though you don’t really have to pee, you go anyway for fear of not knowing where the next bathroom will be.
Our bladders are designed to hold urine, so when we start to pee more frequently, our bladder gets used to that habit. So when the bladder has a smaller amount of pee, it tells our brain it’s time to go. We have to break that habit by training the bladder to do its job and hold longer.
In addition to changing bathroom habits, being aware of bladder irritants can help as well. Things like coffee (both regular and decaf), diet coke, milk, orange juice and even chocolate can irritate the bladder. By eliminating or cutting back on these irritants, can help give us less of those “gotta go” urges.
Sometimes if the pelvic floor muscles are staying “tight” or contracted throughout the day, as a result of chronic pain, stress or just from habit, this can contribute to urgency. Here is a link to another one of my blogs which deals with how to handle urge incontinence…. http://www.indywomenphysicaltherapy.com/pelvic-floor/3-ways-to-train-your-bladder-like-a-boss
Why do I have pelvic floor pain with intercourse?
Women can experience pelvic floor muscle pain which can make activities like sitting, going to the bathroom, and intercourse painful.
Trauma like a fall on the butt can be the start of pelvic floor pain. Muscles around the area become inflammed, and then the muscles become tight and painful. Prolonged sitting or having a bowel movement can become painful. Intercourse can also be difficult because the muscles are unable to relax. The pelvic floor then wants to guard or tighten “in fear” of the pain, and so the cycle continues.
Postmenopausal women may experience painful intercourse as a result of changing hormones. Decreased estrogen can make the pelvic floor muscles less elastic and fragile. A sign of this could be after having intercourse and you go pee, you notice a little blood or spotting on the toilet paper. Estrogen cream could help in this case, and research shows it is not related to incidences of cancer as has been thought of in the past.
Postpartum Moms can also have pain with intercourse as a result of damage to the pelvic floor during delivery. The perineum which the area between the vaginal opening and rectum can tear when the baby is born. As a result scar tissue can develop making intercourse painful. The muscles can also start to “guard” as well during intercourse to help protect the pelvic floor, and then the musces have a hard time letting go. Awareness of muscle tension can be helpful as well as scar tissue massage to help loosen up any adhesions to allow less friction or pain.
Young women can have something called Vaginismus where the vaginal muscles will spasm or tighten up for no apparent reason. This can prevent the ability to tolerate tampons, gynecological exams, and sexual intercourse.
Pelvic floor physical therapists have been able to help women overcome this including those who have experienced this pain for many years. Many women either never knew help was available or thought they were the “only one” going through it. Learning how to relax the vaginal muscles through relaxation techniques, manual therapy, biofeedback, and use of dilators can help women overcome this. Here is a free e-book I wrote that talks more in detail about ways to treat Vaginismus. Painful Intercourse – Indy Women Physical Therapy
A website that I recommend to my patients that discusses Vaginismus more in detail…. https://www.vaginismus.com/
What if I have pelvic floor pain from Endometriosis or Interstitial Cystitis?
Endometriosis is when the tissues that normally line within the uterus starts to grow outside the uterus. Tissues starts to grow on other organs such as the ovaries, fallopian tubes and intestines. The gold standard of care will normally involve surgery to remove the adhesions.
Pelvic floor physical therapy can help manage or lessen the pain with soft tissue mobilization along the abdomen and surrounding areas, address any internal pelvic pain, suggest exercises to promote flexibility, look into stress management with importance of self care and even assist with nutritional advice.
Interstitial Cystitis (IC) is typically diagnosed based on 2 main criteria…pelvic pain or lower abdominal pain which is accompanied by urinary frequency or urgency. It some cases the pain is relieved after urination, but then can swiftly return. Since many of the pathways that our bladder follow include the same for parts of our musculoskeletal system and nerves, the same symptoms that we contribute to being “IC” can be reproduced during an exam.
This could include palpating over past surgical scars, along the abdominal area, a result of tight hip muscles or with palpation of painful pelvic floor muscles as with a vaginal exam. In some cases treating those areas along with ways to manage stress, exercise and dietary changes can greatly reduce any symptoms of IC.
Why do I feel heaviness or pressure along my vagina? Do I have to give up certain exercises?
This may be as a result of something called a pelvic organ prolapse. This is when the uterus, rectum or bladder loses its support due to either pelvic floor muscle weakness or soft tissue changes. The bladder for example starts to protrude against the vaginal wall, which can result in a feeling of heaviness or pressure “down there”. This can result from having babies, heavy lifting as with job duties, obesity, chronic constipation and perhaps hormonal changes overtime.
Some women are not aware they have a prolapse, but if you are involved in a lot of weight lifting or activities that involve placing excessive pressure down below (such as with holding your breath) it can potentially become worse overtime. Education is a huge part of managing a prolapse.
You should be able to exercise and do most of the things you enjoy, however you may have to make some modifications. For example If you enjoy lifting heavy weights but feel pressure along the vagina while doing that, you will need to modify or stop that activity until you can be further assessed by a pelvic floor physical therapist. We can even do an internal exam while you are squatting to see if we can detect a prolapse, and in turn give you cues to help correct.
Giving up activities you love in most cases should not be totally eliminated, but ways to tweak how and what you are doing should be encouraged and taught.
So what should you do if you are experiencing any of the above issues? Seek out a physical therapist that specializes in pelvic floor physical therapy.
Here at Indy Women PT we are huge advocates on behalf of women to spread the word about issues that women don’t have to live with.
If you would like to set up a free phone consult, please call me at 317-689-0073 or email Camille@indywomenpt.com
Camille Fenwick, DPT,CLT,WCS Owner of Indy Women Physical Therapy
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