If I’ve heard this once, I’ve heard it a hundred times. Women who have accepted their “new norm” of peezing (peeing while sneezing) and painful sex (dyspareunia). Most of my patients have been referred by their friends to address these issues after having multiple children or after experiencing pelvic floor dysfunction (PFD) for years. Pelvic floor physical therapy is not a hot new trend. In fact, France mandates 20 sessions of pelvic floor PT 6-8 weeks postpartum and has been doing so since 1985; their rates of urinary incontinence and postpartum depression are a fraction of ours in the United States.
The goal of this blog is to inform, empower and help make pelvic floor physical therapy the standard of care for women and mothers. Let’s start the conversation, get a little uncomfortable and get treated for pelvic floor dysfunction!
The pelvic floor consists of three layers of muscles that sit at the base of the pelvis like a bowl. They SUPPORT our pelvic organs (bladder, uterus, rectum), aid in continence through SPHINCTERIC control and play a role in SEXUAL pleasure. The pelvic floor works with the diaphragm (breathing muscle), deep abdominals (transversus abdominis) and low back extensors to comprise the deep core. Just like any other muscle in the body, it can be weak, tight, uncoordinated and/or have trigger points. Muscles that are too lengthened or are too tight cannot function effectively. Imagine doing bicep curls with your elbow fully flexed – OUCH! Keep in mind the pelvic floor can be tight AND weak.
“Isn’t it just doing kegels?”
NO! Being able to contract the pelvic floor is just one piece of the puzzle.
We need to be able to both CONTRACT and RELAX the pelvic floor. Peeing, pooping, childbirth and sex requires the pelvic floor to drop and lengthen. More often than not, this is a skill many patients have to learn. How do we teach our patients? Believe it or not, the gold standard to assess pelvic floor muscles is an internal exam. This is typically done vaginally, but occasionally a rectal exam is warranted. A pelvic PT will use gloves and lubrication to assess tone, tenderness, strength, coordination and motor control. If you are uncomfortable with an internal exam, there’s plenty of other pieces of the puzzle to work with; posture, breathing, visceral or organ mobility, muscle restrictions, and strengthening just to name a few.
“How do I know if I need pelvic floor physical therapy?”
The following symptoms are common, but NOT NORMAL. They can be assessed by a pelvic floor PT and can often be treated.
1) Heaviness or falling out feeling in the vagina: may be indicative of pelvic organ prolapse (POP). More likely to be diagnosed in postpartum and menopausal women as the tissues are lengthened or have less estrogen to bulk them up.
2) Losing urine with activity, sneezing, laughing; also known as stress urinary incontinence. This is often a combination of the pelvic floor being tight and weak.
3) Painful sex AKA dyspareunia: sex should never be painful. I repeat. SEX SHOULD NEVER BE PAINFUL. A pelvic floor PT will assess for trigger points, possible scarring, pelvic floor guarding and screen for prior trauma as these can all relate to painful penetrative sex.
4) Constipation: This can be due to diet but can also be muscular in nature. We have deep pelvic floor muscles that kink around the colon that can be in spasm and can make it difficult to push stool out. A pelvic floor PT will also discuss techniques to help maximize your intra-abdominal pressure to help fully empty your bowels (without straining or holding your breath)
5) Urinary urge or frequency: The norm is to void your bladder 6-10 times a day (about every 2-4 hours). A pelvic floor PT will assess your diet, water intake, bladder habits and pelvic floor muscle endurance so that you are not racing to the bathroom.
If you are experiencing any of the above symptoms, you may benefit from pelvic floor physical therapy! You can find a directory of practitioners at www.pelvicrehab.com. Also feel free to contact us and see how we can help.
To greater self and community love,
Dr Katie & Dr Carly