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What is the Pelvic Floor?

The pelvic floor is part of the deep trunk stabilizers that create a canister of stability, working to support internal organs, optimize respiratory function, stabilize the pelvis and spine, and assist in bowel/bladder and sexual function.  The pelvic floor needs a balance of strength and flexibility, as with any other muscle group in the body to perform these functions. 

Pelvic floor model with question mark

Conditions

Postpartum Care

There are many natural changes your body goes through to grow a baby.  It is common during pregnancy and even after, to have pain or discomfort related to these changes. 

 

It takes 40 weeks to grow a baby, and takes just as long for your body to return to your pre-baby body. Even then, your body will still be different because it grew a baby, which is amazing! Many therapists (ME!) feel that physical therapy should be required after having a baby, and even before your next pregnancy.    

 

There is weakness in the core and pelvic floor postpartum, and can sometimes create pain in the hips, low back and groin.  Changes to the pelvic floor muscles and vaginal canal from carrying the baby and then delivery can create pain in the pubic bone/tailbone/vaginal area, symptoms of incontinence and pain during intercourse.   As you care for your newborn, some of the postures you are in from supporting the head and feeding can create excess stress to the shoulders and neck.  If you have had a C-section, that is a major surgery and deserves the proper rehabilitation!

Pelvic Organ Prolapse

This is when one or more of the pelvic organs begin to descend into, and sometimes out of the vaginal canal, due to loss of support.  It is estimated to affect up to 50% of women.  Symptoms of prolapse can include heaviness in the abdomen or vaginal area, low back or pelvic pain, difficulties urinating or completely emptying the bladder, and/or feeling a bulge at external vaginal opening.  

 

The type of prolapse is described by the organ that is descending:

Cystocele: bladder (most common)

Rectocele: rectum

Uterine prolapse

Urethrocele: urethra

Endocele: small intestine

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There are many conservative treatment options for pelvic organ prolapse including:

 

  • Physical therapy to strengthen the pelvic floor and hip musculature and improve stability and support

  • Management of constipation (constant bearing down encourages descent)

  • Addressing pressure management during transfers, squatting, sit/stand to decrease valsalva and bearing down effect

  • Pessary: orthotic for the vaginal wall, most often prescribed and fitted by a urogynecologist

Menopause Transition

There are so many hormones in the human body, responsible for maintaining homeostasis, or a balanced resting state. As the body begins to transition to menopause, the female sex hormones begin to fluctuate. This can lead to imbalances in the resting state. Depending on the overall state of your health and body going into this period, this change can cause a variety of symptoms, or sometimes none at all. Severe symptoms related to these changes can be reduced with the right interventions, and many times conservative care can be extremely helpful.  

 

Early symptoms of perimenopause:

  • change in menstrual cycle

  • mood swings

  • difficulties sleeping

  • weight gain/changes

  • anxiety

  • brain fog

  • joint pain

  • bloating​

This transition happens over several years with the following periods:

  • Perimenopause: the years leading up to menopause where your estrogen levels begin to decrease and symptoms begin, can be 10-15 years prior to actual menopause ​

  • Menopause Transition: the 12 months from your last menses to menopause

  • Menopause: the instance in time the marks 12 months from last menstrual cycle

  • Post Menopause: all the days, months and years following menopause

Urinary Incontinence

Incontinence is the involuntary loss of urine or feces. There are different types of incontinence:

 

  • Stress incontinence: the involuntary loss during coughing, laughing, or sneezing

  • Urge incontinence: the inability to make it to the bathroom in time

  • Mixed: combination of both stress and urge

 

Incontinence is common, but is not NORMAL. There are many interventions that can reduce and often resolve these symptoms.

Pelvic Pain

Pelvic pain is more common than it is talked about.  It presents in many forms - lower abdominals, tailbone, pubic bone, vaginal or rectal spasms, vulvar pain.  It also causes many dysfunctions - pain with sitting, pain wearing underwear or clothing, sexual dysfunction, pain with urination, unable to completely void urine or stool, pain or difficulties with tampon use or gynecological exams - and many more.

It can be extremely debilitating, of insidious onset, or chronic in nature. There are many reasons for pelvic pain (hormones, pre existing conditions, trauma) but more importantly there are many ways to treat pelvic pain. Pelvic floor physical therapists, like me, specialize in pelvic pain and can help with other resources such as educational tools, home programs and referrals to pelvic pain physicians.

Sexual Dysfunction

Sexual dysfunction is something that is not often talked about, but occurs in many women throughout their lives. It is seen more commonly in early to mid twenties, and then during the postpartum and menopause phases.

There are many causes of sexual dysfunction including hormone changes, stress, activity/lifestyle changes and muscular dysfunction. Women experiencing pain are commonly diagnosed with vulvodynia, vaginismus, or vestibulodynia. There are many treatment options to help resolve this pain, including conservative options with pelvic floor physical therapy. Education on vulvar care, home exercises and other techniques can resolve sexual dysfunction.

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