Pregnancy and Postpartum
During and after pregnancy a woman’s body experiences many changes that affect their skeletal system. In particular, the normal increase in hormone levels during this time period contributes to joints becoming loose and abdominal muscles to stretch. Both of these factors lead to pelvic instability. The combination of pelvic instability, postural changes and poor body mechanics contribute to the etiology of the following common but not normal problems women experience during their child bearing years:
You don’t need to suffer during or after pregnancy with these conditions. The physical therapists at Back in Motion can help you resolve these conditions and get back to the activities you love!
Women’s Health and Pelvic Floor Disorders
Woman’s health physical therapists successfully treat women suffering from pelvic pain. Pelvic pain can originate from many areas in the body but still present itself as pelvic girdle, groin, vaginal, rectal or perineal pain. It can stem from many sources including the pelvic organs or from the joints in the spine, pelvic girdle or hips. All of these areas of dysfunction can present itself as similar symptoms of vaginal pain, pain with sexual intercourse or killer pain associated with menstrual periods. Other possible causes of pelvic pain are from scar adhesions from an episiotomy, cesarean or other previous abdominal surgical scars. Decreased abdominal organ mobility also known as visceral restrictions can also contribute to pelvic pain.
Pelvic pain can lead to muscle spasms in the pelvic floor muscles. The pelvic floor muscles are a group of muscles that span from the pubic bone to the tailbone. Hence, making up the floor of the pelvis. With dysfunction, these muscles can become hypertonic or result in a muscle spasm that does not relax or the opposite can occur, the pelvic floor muscles can become weak and atrophy. Both non-relaxing and weak pelvic floor muscles can be a major contributor of pelvic pain. A skilled pelvic floor physical therapist will identify and treat the root causes of your pelvic pain.
Various Diagnoses used for Pelvic Pain
Dyspareunia is pain associated with vaginal penetration during sexual intercourse. Dyspareunia often occurs after pregnancy at 3 months postpartum or it can be associated with endometriosis, menopause, pelvic congestion, interstitial cystitis (IC), levator ani syndrome, and uterine retroversion.
- *Interstitial Cystitis
Interstitial Cystitis aka Painful Bladder Syndrome is defined as chronic pelvic pain (lasting >6 months), pressure or discomfort perceived to be related to the urinary bladder and accompanied by at least one other urinary symptom such as increased urinary urge or frequency. (van de merwe et al 2008) Pain may occur in the urethra, vulva, vagina, rectum, low back and/or abdomen. It may worsen by eating specific foods.
- *Levator Ani Syndrome
The levator ani is a group of deep muscles in the pelvis. They extend from the pubic bone in the front to the coccyx in the back of the pelvis. These muscles support the bladder, rectum and uterus (in women). Symptoms occur when these deep muscles become too tight or don’t relax. Complaints of a constant or frequent pain in the rectum or anus is experienced. Patients often describe their symptoms as a feeling that they are sitting on a golf ball. Sitting frequently makes these symptom worse. Besides pain, patients may also experience sexual dysfunction as well as issues with the function of their bowel and bladder.
Vulvodynia is pain or discomfort at the vulva lasting >3 months that usually presents as burning pain.
Check out the National Vulvodynia Association website for more information: https://www.nva.org/
- *Pelvic Floor Dysfunction
The pelvic floor is a group of muscles and connective tissue that sits at the floor of the pelvis. They span from the pubic bone to the tailbone. The function of these muscles are to support the pelvic organs: bladder, uterus and rectum, prevent incontinence, allow for ease of defecation and urination and they provide a sexual function. Dysfunction of the joints in the pelvic girdle, spine or emotional stress can cause these muscles to become weak and lax or develop tightness and muscle spasms. Normal muscle tone and coordination of these muscles are vital for pelvic function and to avoid pain. Pelvic floor dysfunction can cause symptoms of constipation, painful sexual intercourse, pelvic organ prolapse, urinary frequency, chronic pelvic pain and both urinary and fecal incontinence.
Endometriosis, commonly referred to as “endo”, is a common condition that causes chronic pelvic and/or abdominal pain and painful periods. Endometriosis is a condition where the lining of the uterus (endometrial tissue) is deposited anywhere in the abdominal cavity including on the bladder, ovaries, bowel and other internal organs. Endo is a complex condition and may present differently for each woman. Symptoms can vary from mild to severe but are usually cyclical like their menstrual cycle.
To learn more about endometriosis and how physical therapy can help, click here.
Vaginismus is instantaneous and involuntary (psychosomatic) tightening of the pelvic floor muscles in anticipation of vaginal penetration causing the inability to participate in sexual intercourse.
Urinary incontinence is an involuntary leakage of urine. Over 13 million Americans suffer with this disorder, 25% of them are young women and 44-57% are middle-aged postmenopausal women. Although this is common problem, most people don’t talk about it, nor do they seek help for this condition until it gets severe. Delaying treatment occurs because most women are embarrassed to talk about incontinence and they falsely believe the only cure is invasive surgery. Well there is great news; physical therapy is an effective conservative treatment for four types of urinary incontinence.
- *Stress Urinary Incontinence
Stress urinary incontinence is the involuntary leakage of urine that occurs during coughing, sneezing, laughing, exercise and lifting. Leakage occurs when the intra abdominal pressure exceeds the urethral closure pressure. A combination of weak pelvic floor and abdominal muscles contribute to this disorder. A history of low back pain and pelvic pain can also add to inhibition and weakness of these muscles, which can exacerbate this condition.
- *Urge Urinary Incontinence
Urge urinary incontinence is the involuntary leakage of urine associated with a strong urge to urinate. Those suffering with this condition will frequently leak urine on the way to the bathroom or during the sound of running water.
- *Mixed Urinary Incontinence
Mixed urinary incontinence is a combination of both stress and urge urinary incontinence. Those suffering from mixed incontinence leak during coughing, sneezing laughing and while experiencing a strong urge to urinate.
- *Functional Incontinence
Functional incontinence occurs when you are functionally limited and can’t get to the bathroom in time. An example may be elderly woman who has severe arthritis or other medical condition contributing to slow ambulation, too slow to get to the toilet in time.
What to Expect During Therapy
A woman’s health physical therapist will provide a thorough subjective and objective evaluation and develop a treatment program specific to your problems and goals.
Treatments may include one or more of the following:
Manual therapy is used to reduce muscle guarding and spasms, joint mobilization or muscle energy techniques to correct a rotated pelvis, sacroiliac joint or misaligned cervical, thoracic or lumbar vertebrae.
Visceral mobilization treatments may also be needed to improve mobility of restricted abdominal organs.
Therapeutic exercises will be prescribed to correct areas of muscle weakness, muscle imbalances or muscle tightness.
Neuro-muscular reeducation is provided to instruct patients on proper posture alignment, spine stabilization and facilitation techniques for weak muscles such as those in the pelvic floor.
Specific Functional Training
Specific functional training will be provided geared toward your specific goals. Functional activities may include instructions on proper posture while nursing your infant. Correct body mechanics education to learn how to correctly lift or bath your toddler to eliminate undue stress to your joints. For a woman suffering from urine leakage, functional training may include education on bladder training or foods that may irritate their bladder and cause urgency and frequency. Constipation tips such as fiber, hydration and positioning tips will be provided for those suffering with any pelvic floor condition. Constipation tips such as fiber, hydration and positioning tips will be provided for those suffering with any pelvic floor condition.
A device that utilizes electrodes to pick up, measure and treat muscle weakness in pelvic and abdominal areas. The electrodes transmit this electrical signal to a computer screen so the patients can see when and how strong their muscles are contracting so they can learn to strengthen very weak muscles.
If pelvic muscles are very weak it may be difficult to find and exercise the correct muscles. Physical therapists may utilize EMG biofeedback or manual techniques to help women identify and strengthen the correct muscles.
Another device that may be utilized is electrical stimulation. This device utilizes a vaginal electrode that stimulates the pelvic floor muscles to contract artificially. With this facilitation, the patient can identify the correct muscles and begin their rehabilitation process.
For more information here are a list of reputable websites:
- The International Pelvic Pain Society
- National Vulvodynia Association
- International Continence Society
- National Association for Continence
- American Urogynecologic Society
- American Academy of Obstetrics and Gynecology
Back in Motion PT no longer offers treatment for Pelvic floor disorders. This includes:
- Pelvic and Vaginal Pain
- Pelvic Organ Prolapse
- Urinary and Bowel Dysfunction
However, our sister company, Physical Therapy Your Way and Advanced Specialty Care PLLC offers treatments for all of these services. Physical Therapy Your Way performs internal pelvic floor evaluation and treatments for bowel, bladder and sexual dysfunction.
For further information please visit their website: www.PhysicalTherapyYourWay.net or call them at 571-312-6966.
Back in Motion PT does however continue to treat women of all ages including prenatal and post-partum women suffering from pelvic girdle pain, upper and low back pain, sacro-iliac dysfunction and pubic symphysis separation, osteoporosis, lymphedema, carpal tunnel syndrome and more. Back in Motion PT offers more traditional spine and pelvic girdle treatments which can be treated externally.