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Women's and Pelvic Health

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Women’s Health and Pelvic Floor Disorders

Physical therapy for women’s health needs and pelvic floor disorders specializes in the unique needs of women throughout their lives. Physical therapists are specialists in musculoskeletal disorders and their specific training allows them to provide effective management for women with various problems across the lifespan. From the young female athlete, before, during and after pregnancy, to menopausal woman -- all can benefit from intervention by a physical therapist.

During pregnancy and the postnatal period

A woman’s body experiences many changes that affect their skeletal system during pregnancy and in the postnatal period. In particular, changes in hormone levels to assist the body with the pregnancy and prepare the body for delivery can contribute to lower back pain, pelvic pain, sacroiliac dysfunction, sciatica, upper back pain, diastasis recti (abdominal muscle separation) carpal tunnel syndrome, urinary incontinence (involuntary leakage of urine), dyspareunia (painful sexual intercourse) and organ prolapse. These are some of the women’s health conditions a physical therapist can successfully treat.

Urinary Incontinence

An involuntary leakage of urine. Four types of urinary incontinence are successfully treated by physical therapists.

Stress Urinary incontinence

Leakage of urine that occurs during coughing, sneezing, laughing, exercise and lifting. Leakage occurs when the intra abdominal pressure exceeds the urethral closure pressure and can also be contributed to by tight muscles in the pelvic floor that change the angle of the muscles around the bladder. These muscles can than “push” on the bladder instead of assist with bladder closure.  A history of low back pain and pelvic pain can also add to a change in these muscles and exacerbate this condition.

Urge Urinary Incontinence

Leakage of urine can be associated with a strong, sudden urge to urinate. Those suffering with this condition will frequently leak urine when they hear the sound of running water or as they are running to the bathroom.

Mixed Urinary Incontinence

A combination of both stress and urge urinary incontinence. Those experiencing mixed incontinence may leak during coughing, sneezing, laughing, as well as have a strong urge to urinate.

Functional Incontinence

Occurs when you are functionally limited in mobility and cannot make it to the bathroom in time. For example, someone with severe arthritis moves slowly and may not be able to remove her clothing fast enough or slow mobility due to hip or knee pain may limit the ability to reach the toilet in time.

Incontinence Treatment

Physical therapist care for incontinence may include a combination of therapeutic exercises to strengthen and relax the pelvic floor and abdominal muscles, as well as muscles surrounding the hips and spine. Other treatment options may include bladder training and education on bladder irritants.

Pelvic Pain:

Dyspareunia, Interstitial Cystitis (IC), Levator Ani Syndrome, Vulvodynia, Pelvic Floor Dysfunction

In addition to urinary incontinence, a woman’s health physical therapist can treat women suffering from pelvic pain, including vaginal pain, pain with intercourse, buttock pain or pain in the pelvis that radiates to the front or back of the thighs. Some woman experience burning vaginal or anal pain. A variety of musculoskeletal problems through out the low back, hips, pelvic girdle, and even the knee and ankles can contribute to changes in the pelvic floor musculature, sometimes leading to pain. A physical therapist can help address these limitations and help the body work efficiently with less pain.

Men can also experience pelvic pain, also called pelvic floor dysfunction or levator ani syndrome. They may experience similar symptoms, frequently described by them as testicular pain, pain at the base or tip of the penis, or in the perineum. Symptoms may “feel like I am sitting on a golf ball” and include symptoms of urinary frequency and sexual dysfunction. 

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 or dry needling to reduce muscle guarding and tightness, joint mobilization or muscle energy techniques to influence the joints in the pelvis, hips, ribs or spine. Specific therapeutic exercises will be prescribed to address muscle tightness and improve strength. Meditation and breathing techniques may be utilized to  relax muscles and change blood chemistry. Neuro-muscular reeducation improves the coordination between muscle contractions and relaxations so that joints and muscles are used efficiently with less pain and increased function. Depending on your particular problem, specific functional training will be geared toward your specific goals. Functional activities may include changing posture while nursing your infant or changing the mechanics for lifting or bathing your toddler to change the neurological and motor pathways used and decrease pain. Treatment may also include education on bladder training or foods that may irritate their bladder and cause urgency and frequency.

 

For more information, review some of the following websites:

  • pelvicpain.org: The International Pelvic Pain Society
  • nva.org: National Vulvodynia Association
  • ics.org: International Continence Society
  • nafc.org: National Association for Continence
  • augs.org: American Urogynecologic Society
  • acog.org: American Academy of Obstetrics and Gynecology

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