PELVIC FLOOR CARE

Pre and Post Pregnancy Care

The prenatal period is a time of great change for a woman, physically, emotionally, and hormonally. As the fetus grows, the overall musculoskeletal system is challenged by altered posture, shortened muscles, potential muscle imbalances, and changes in spinal mobility. These changes may cause pain and dysfunction. In the postpartum phase, fluctuating hormone levels combined with additional physical changes as a result of delivery may also result in musculoskeletal problems such as excessive joint mobility, weakness of the core stabilizers, and altered spinal mobility and function. Symptoms of dysfunction may include pain in the joints of the pelvis or spine, muscular pain in the hips and L/E’s, or numbness into the extremities. Weakness may be present in the abdominals, resulting in pain with transitional movements or lifting.  Weakness may also be manifested as urinary incontinence in the postpartum period. We are skilled in evaluating and providing patient centered treatment of musculoskeletal problems. We are trained in the area of women’s health have further knowledge about issues directly related to women as they move through different stages of life, from childbearing years to the post-menopausal years. We can provide hands on treatment to address spinal and pelvic joint dysfunction, instruct in exercises to address muscle weakness and imbalance, and provide guidance and instruction related to modifications of activities of daily living that may be difficult during the prenatal and postpartum phases.

Pelvic Pain

Pelvic pain is described as pain in the lower abdomen, pelvis, or perineum and is considered to be chronic when symptoms have been present for more than six months. Symptoms of pelvic pain, in addition to pain in the lower abdomen and pelvis, may include: pain in the hip or buttock, pain in the tailbone, limited sitting tolerance, pain in the joints of the pelvis, pain with sexual intercourse, tender points in the muscles of the abdomen, reduced range of motion in the hips and lumbar spine, urinary frequency, urgency, or incontinence, painful bowel movements, constipation and/or straining with bowel movements. Pelvic pain can be caused by problems such as pelvic joint dysfunction, muscle imbalance within the muscles of the pelvic floor, trunk, and/or pelvis, incoordination in the muscles related to bowel and bladder function, tender points in the muscles of the pelvic floor, pressure on one or more nerves in the pelvis, and weakness in the muscles of the pelvis and pelvic floor. Pelvic pain can also be related to the presence of scar tissue after abdominal or pelvic surgery.

Biofeedback in Pelvic Floor PT

Biofeedback is a fundamental tool in pelvic floor rehabilitation. Biofeedack can be used to train tight pelvic floor muscles to relax and also strengthen weak pelvic floor muscles. It makes physiological change possible through conditioning, a method based on trail and error, and reinforcement through repetition. Once the brain to pelvic floor connection is made through biofeedback, the patient is able to go home and repeat the excercises on their own with greater confidence. For clinicians, biofeedback provides a valuable source of information that can be documented to view progression and recommend modification.

Incontinence

There are several types of urinary incontinence, but in general, incontinence refers to the leakage of urine at inappropriate times. Stress incontinence usually results from weakness and a lack of support in the muscles of the pelvic floor. These are the muscles that attach to the bottom of the pelvic bones and run front to back, forming a bowl-like structure that lifts to support the internal organs and controls the sphincter muscles. The pelvic floor muscles also work to strengthen the low back, stabilize the pelvic bones, and help with sexual function. Women with stress incontinence often have “under active” pelvic floor muscles. Causes of underactive pelvic floor muscles include Pregnancy and Childbirth, Injury or trauma, Surgery in the vagina or rectum, Episiotomy (during childbirth), Lack of exercise and lack of use. Women with urge incontinence often have weak and “overactive” pelvic floor muscles. Functional incontinence can be caused by Joint pain or muscle weakness, problems with mobility, confusion, dementia or delirium, environmental barriers, and psychological problems such as depression or anger.

If you have trouble leaking urine during normal daily activities, urine leakage with sneezing, coughing, or laughing, trouble starting the urine stream, trouble holding urine when feeling a strong urge to go, trouble with frequent urination (more than every 3-4 hours during the day, up more than once to urinate at night), trouble getting to the bathroom because of other problems such as knee or hip pain or balance problems, then you would benefit from Pelvic Floor therapy. Because many symptoms of urinary incontinence are caused by pelvic floor muscle weakness and dysfunction, a specially trained Women’s Health Physical Therapist is the ideal provider to help you gain control over your symptoms. (We also treat men with urinary incontinence as well). We use our specialized medical training to completely evaluate and design a treatment program that is individualized for each patient.

What Is Pelvic Organ Prolapse?

“Prolapse” refers to a descending or drooping of organs. Pelvic organ prolapse refers to the prolapse or drooping of any of the pelvic floor organs, including:

• • Bladder
  • Uterus
  • Vagina
  • Small bowel
  • Rectum

These organs are said to prolapse if they descend into or outside of the vaginal canal or anus. You may hear them referred to in these ways:

• • Cystocele: A prolapse of the bladder into the vagina, the most common condition
  • Urethrocele: A prolapse of the urethra (the tube that carries urine)
  • Uterine prolapse
  • Vaginal vault prolapse: prolapse of the vagina
  • Enterocele: Small bowel prolapse
  • Rectocele: Rectum prolapse

What Causes Pelvic Organ Prolapse?

Anything that puts increased pressure in the abdomen can lead to pelvic organ prolapse. Common causes include:

• • Pregnancy, labor, and childbirth (the most common causes)
  • Obesity
  • Respiratory problems with a chronic, long-term cough
  • Constipation
  • Pelvic organ cancers
  • Surgical removal of the uterus (hysterectomy)

Genetics may also play a role in pelvic organ prolapse. Connective tissues may be weaker in some women, perhaps placing them more at risk.

What Are the Symptoms of Pelvic Organ Prolapse?

Some women notice nothing at all, but others report these symptoms with pelvic organ prolapse:

• • A feeling of pressure or fullness in the pelvic area
  • A backache low in the back
  • Painful intercourse
  • A feeling that something is falling out of the vagina
  • Urinary problems such as leaking of urine or a chronic urge to urinate
  • Constipation
  • Spotting or bleeding from the vagina

Symptoms depend somewhat on which organ is drooping. If the bladder prolapses, urine leakage may occur. If it’s the rectum, constipation and uncomfortable intercourse often occur. A backache as well as uncomfortable intercourse often accompanies small intestine prolapse. Uterine prolapse is also accompanied by backache and uncomfortable intercourse.