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Women’s Health

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Did you know?

  • Nearly 1 in 4 women in the U.S. will have a pelvic floor disorder. This includes incontinence, pelvic pain, and pelvic organ prolapse.
  • 87% of people can significantly reduce or eliminate incontinence with pelvic muscle exercises.
  • Men who participated in pelvic floor muscle strengthening prior to prostatectomy have improved continence outcomes.
  • Pelvic floor exercises started during pregnancy result in less incontinence and pain after delivery.


Incontinence
Incontinence is defined as the involuntary leaking of urine or feces, usually as a result of underactive pelvic floor muscles. There are many types of incontinence, but most fall under the categories of urge, stress, and mixed incontinence. Urge incontinence occurs when one has a sudden desire to pass urine, which is difficult to defer. People with urge incontinence generally report having a difficult time “making it to the bathroom.” Stress incontinence is leaking that occurs when one exerts an effort (such as moving, exercising, or jumping) or has a sudden increase in abdominal pressure, such as during laughing, sneezing, or coughing. Mixed incontinence has characteristics of both urge and stress incontinence.

Causes of incontinence include injury during childbirth (both vaginal and cesarean deliveries), obesity, chronic cough, asthma and smoking, repetitive lifting, chronic constipation, high impact exercise (52% of female athletes experience urine loss during sport or daily activities), joint malalignment of the low back and pelvic girdle, sexual abuse, bowel and bladder disorders, infection/disease, and age, and surgical history (hysterectomy, prostate, and colon surgical intervention). Although there is variability in studies, it is generally thought that the prevalence of incontinence is 30-50% in women and 3-10% in men. Men have a chance of developing urinary incontinence after radical prostatectomy or transurethral resection of prostate.

Physical therapy treatment of incontinence involves bladder retraining techniques, education on bowel health (if you struggle with constipation), lifestyle changes, pelvic floor muscle re-education, and progressive core (abdominal and pelvic floor), electrical stimulation to facilitate muscle activity, and hip strengthening. Men who experience erectile dysfunction may also benefit from performing pelvic floor exercises. Your physical therapist may also suggest other treatment options, specific to your symptoms and lifestyle including the use of continence products, medications and surgical interventions.

 

Pelvic Pain
Pelvic pain is burning, aching, and/or sharp pain in the abdominal, pelvic, trunk, or pelvic floor region that lasts longer than 6 months duration. Both men and women have pelvic pain, and it can make gynecological examinations and sexual intercourse painful.

Oftentimes pelvic pain is caused by problems in pelvic alignment, muscles and nerves. Asymmetries and dysfunction of the pelvic can cause changes in the length and tension in muscles, leading to overactive and underactive muscles. Overactive trunk, hip, and pelvic floor muscles can contribute or cause tender points and discomfort in the pelvic floor. In some cases, pelvic pain can be causes by entrapment or pressure on nerves within the pelvis. Scarring from birth, surgery, and prior trauma to the pelvic floor can also produce pain.

Physical therapy treatment of pelvic pain involves correcting pelvic asymmetries through muscle energy techniques, stretching and strengthening muscles, core muscle strengthening to decrease pressure on the pelvic floor, downtraining/uptraining pelvic floor muscles, and manual therapy to help correct imbalances in muscle activity. Other treatment options include autonomic nervous system quieting, use of dilators, and education on lifestyle changes. Your physical therapist may also suggest other treatment options, specific to your pain.

 

Pregnancy-Related Pain
Many women experience low back and lower extremity pain during pregnancy. Posture changes, hormonal changes, and altered body mechanics may contribute to increased discomfort. Physical therapy provides help in establishing specific exercises to reduce pain and prevent injury. Manual therapy may also be used to relieve pain in muscles or gently correct trunk and pelvic muscle imbalances. Pelvic floor exercises started during pregnancy result in less incontinence and pain after delivery. Physical therapists can help in finding good birthing positions, not only to help with delivery but also to reduce discomfort and promote relaxation during labor. Physical therapy can also help with instruction on how to perform perineal massage, gently stretching of the tissue between the vagina and anus, prior to delivery. Controlled studies show that perineal massage does seem to result in a greater likelihood that the perineum will be intact at the time of delivery.

After delivery, many women continue to experience low back pain and pain at incision sites. Manual therapy is used to decrease pain and promote incision mobility. Proper body mechanics are very important for reducing pain and injury after delivery. Physical therapists provide instructions for improving postures and reducing stresses placed on the body during repetitive infant care activities such as holding, lifting/carrying, nursing/feeding, changing diapers, carrying car seats and pushing strollers. Pelvic floor muscle exercises are important prior to and after delivery, especially if a new mother is experiencing incontinence. Exercises can usually start within 1 week of an uncomplicated, vaginal delivery and after 6 weeks in cases of cesarean sections. Physical therapy can also be helpful in addressing diastasis recti (a separation of abdominal muscles) and screening for postpartum depression in new mothers. Resuming exercise and finding way to exercise with a new baby is important in helping new mothers bond with their baby, return to their pre-pregnancy weight, improve cardiovascular fitness, decrease urinary incontinence, and promote energy and feelings of well-being.

 

Rachael-skiingTestimonials

“Prior to PT, I experienced urinary leakage and suffered pain with intercourse. Physical therapy eliminated both issues beyond my expectations, and I am truly grateful for these results.”

“I’m proud of myself. I can’t believe after all these years of having incontinence and being told its normal, that I no longer leak.”

“I saw results quickly, and Rachael was very attentive, sincere, and caring. I am a strong proponent of PT after this experience.”

“Rachael was extremely nice and very helpful. I’m happy that she helped me fix my problems.”

“She was very professional and went right to the root of my problem. I would recommend her to anyone. Thank you so very much.”

“Rachael was always extremely kind, attentive, and helpful. Her demeanor, combined with her expertise and professionalism made my physical therapy sessions always productive, worthwhile, and even enjoyable. Thank you for such a pleasant and successful PT experience.”