Pelvic Health & Orthopedic Physical Therapy
Addressing your questions about pelvic, women's, and musculoskeletal health. Health is a journey. Movement is healing!
One of my biggest pet peeves as a pelvic health PT is when runners or weight lifters think they need to leak urine to prove a good work out. Ugh! First of all it's gross. Second of all we don't see a problem with having an accident? If you are peeing unintentionally during any activity which does not include you sitting on a toilet you should see a pelvic and women's health physical therapist. Let me explain why.
The abdominal cavity has four sides to it. The top is the diaphragm. The front is the abdominal wall. The back is the spine and back musculature. The bottom is the pelvic floor. When you leak urine with exercise it indicates to me that something in this system is not operating to its best ability. In fact there may be more than one thing. Urine leakage generally indicates pelvic floor weakness. Weakness in this area means that one key aspect to the "core" is not optimally functioning. When we take a closer look what a pelvic and women's health physical therapist may find is that other aspects of the abdominal cavity are working less efficiently or compensating due to lack of coordination with pelvic floor musculature. Okay, okay you don't leak all the time. Just after the 10th mile on the pavement. Or just when you hit your rep max with dead lifts. This is still something we can work on. Yes it could still be a deficiency in pelvic muscle strength or endurance. It could be that the force of running on pavement or your form as you start to tire change your ability to activate pelvic floor muscles. It could be you don't even realize you are holding your breath with lifting which creates increased pressure on the bladder. So the moral of the story remains the same. You still should not accept urine leakage with exercise. A pelvic health physical therapist can help assess and treat this type of urine leakage and improve your work outs.
Chronic pain can be life altering. It is complex in nature with multiple variables and subtleties that contribute to it. Pain can be difficult to treat and manage. Women's health related pain conditions may require a myriad of Physical Therapy, medication, counseling, changes to diet, and other treatments.
There are a number of conditions that can cause pelvic pain. Here is a list of just a few examples:
A women's health PT can help you to manage pain related to many of these conditions. They can help to address the restrictions to the structures of the anatomy, educate you on self stretching, oscillatory exercises, massage, and techniques to properly engage your pelvic floor (just to name a few things). A women's health PT will help guide you through how to properly modulate your pain and give you techniques so that YOU are in control of your body. Sometimes the most frustrating part is finding the right practitioner to diagnose your pain or refer you to women's health PT if your state requires a referral to visit a PT. It can at times be an isolating experience for a patient if they feel their experience of pain is not being taken serious or properly addressed. Please rest assured that you are not alone. Many individuals experience pelvic pain, however, that does not normalize the pain. Pelvic pain is not a normal experience with urination, bowel movements, intercourse, sitting, exercise, using feminine hygiene products, or wearing pants. You should seek treatment. Just because you are a woman does not mean you have to grin and bear pelvic pain. I encourage you to utilize the Section on Women's Health PT Locator to find a PT near you if you are experiencing pelvic pain symptoms. They can help get you connected with the appropriate resources or schedule you for an evaluation.
http://www.womenshealthapta.org/pt-locator/
I've been reflecting a lot on transitions lately. With graduation quickly approaching (it's only TWENTY days away) there are a lot of exciting opportunities on the horizon. It also has me thinking on other transitions in life for people. One really big transition for the human body is giving birth, preparing to give birth, and then recovering from the birth process.
Your body goes through a lot of changes in order to prepare for birth. It produces a variety of hormones one of which is relaxin, a hormone that increases the laxity in your ligaments throughout your body. By increasing the laxity of your ligaments, your body makes it easier for the baby to pass through the pelvis, it can also alter the alignment of your sacroiliac joint. As the baby grows it changes your center of gravity. Essentially you are now carrying this growing basketball in the front of your abdomen as your baby grows it changes the way that forces are transmitted through your spine because it changes your posture in sitting, standing, and walking. This change in position and force in the spine can lead to back pain. As the baby grows it also changes the pressure on your abdominal and pelvic floor musculature as well as your bladder, it is constantly stretching these structures in order to make room. This can contribute to urinary frequency and urgency. Overall, your body is preparing to make space for your baby. A Women's Health Physical Therapist can help you to manage different musculoskeletal pain that arises during pregnancy as well as helping you to prepare for the birth of your child. Following childbirth those muscles and structures that were changed during pregnancy and the birthing process require time for rehabilitation. A Women's Health Physical Therapist can help to facilitate this process and return you to your baseline. Childbirth is a leading cause in developing urinary incontinence issues down the road so properly rehabilitating your pelvic floor as well as your back, hips, and abdomen following birth can be important in preventing symptoms of urinary frequency, urgency, and leakage. The pelvic floor is a bit of an enigma to most outpatient Physical Therapists. They know it exists, but they don't completely understand the function of that musculature or how it can impact other aspects of the body. This can make screening or evaluating the role pelvic floor in a patient's symptoms a little overwhelming or even daunting at times. It is so crucial to ask about changes in bowel and bladder as well as changes with intercourse with patients who come in with pathologies like generic low back pain or hip pain. The musculature and fascia of the pelvic floor is all interconnected with internal organs, abdominal musculature, spine, pelvis, hip, sacrum, as well as trunk musculature (as you can see with some of the pictures below). When you have an imbalance in one area the other areas of the body are affected. It's important to know based on what gender and age group, what types of women's/ men's health questions to ask your patients in order to screen them for services. In order to know what dysfunction looks like it's crucial to know what health bowel and bladder health looks like. Just to give a general overview an individual:
Clinical Considerations: Some musculoskeletal presentations could be referred pain or have contributions from imbalance in the pelvic floor. Consider the pelvic floor in patients with persistent or chronic history of symptoms in low back, hips, and abdomen (especially if they have a history of pelvic floor dysfunction or answer yes to any of your screening questions). Clinical presentations to be on the lookout for include:
References:
Herman & Wallace (2000). Female Pelvic Floor Dysfunction 2010 to 2050. https://hermanwallace.com/images/docs/HW_Female_Pelvic_Floor_Dysfunction_White_Paper.pdf Irion, J. M., & Irion, G. L. (2010). Women's Health in Physical Therapy. Philadelphia, PA: Lippincott Williams & Wilkins. |
AuthorHello! I am Caitlyn, Doctor of Physical Therapy and Board Certified Women's Health Physical Therapist working in St Louis, Missouri. Faculty in developing residency program. Endowarrior Categories
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