Burning Questions You Have Been Wanting To Ask
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 of how pelvic floor physical therapy can help them with certain issues, such as leakage, chronic pelvic pain including painful intercourse and pelvic organ prolapse. In some cases they have dealt with these issues for years, concluding that they are either the “only one” dealing with their issue or perhaps it’s 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 perform internal vaginal exams to screen for pain, weakness, presence of pelvic organ prolapse or ruling out other painful areas in the pelvic region.
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 discuss some questions you may have so we can spread awareness that help is available once and for all.
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, not so 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 stress incontinence.
With postpartum Moms, making the connection between our pelvic floor and “core” abdominal muscles is important in the recovery progress after having a 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.
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. Changing bathroom habits, being aware of your bladder irritants, and avoiding constipation are just some things you can implement to eliminate leakage. 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 pain “down there” including painful sex?
Women can experience pelvic floor muscle pain which can make activities like sitting, going to the bathroom, and intercourse painful. Vaginismus is one example of a condition 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 website that I recommend to my patients that discusses Vaginismus more in detail…. https://www.vaginismus.com/
What if I have pain from Endometriosis or Interstitial Cystitis, Can PT Help?
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 scar tissue. However pelvic floor physical therapy can help manage the pain with soft tissue mobilization along the abdomen and surrounding areas, address any internal pelvic pain, suggest exercises to promote flexibility 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, 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 even aware of it, 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 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 or in person consultation, please call me at 317-689-0073 or email Camille@indywomenpt.com
Camille Fenwick, DPT,CLT,WCS