Conversations about Pelvic Floor health are hushed, especially if we are in public places like the gym or the coffee shop. I’ve had many talks with women about Pelvic Floor Dysfunction (PFD) over the years. You might wonder, “What does that even mean?” or “Does that only affect Moms?” and “Will it ever go away?” All great questions. The purpose of this blog post is to educate about PFD and what we can do about it.
Why did I choose to blog about this topic? I’m not a midwife, a doula or a physical therapist (PT). I am a yoga instructor, a personal trainer and a thirty-something Mom who loves to move. I’ve done extensive training on postnatal exercise and how to coach women to regain strength after they have babies. I have three young children, and I experienced Pelvic Organ Prolapse (POP) after my younger two were born. I sought pelvic floor therapy after each birth and I received excellent care right here in the Capital Region.
When physical therapists and trainers who specialize in postnatal exercise talk about the core and pelvic floor, this is what they are referring to:
Diaphragm – known as your breathing muscles
Multifidus – muscles surrounding your spine, key for trunk stability
Transverse Abdominis – the deepest layer of abdominal muscles
Glutes – muscles surrounding your hips that support your pelvis and lower back
Pelvic Floor Muscles – the last place in your trunk that supports your pelvic organs
In order for the organs in your pelvic floor to function well, all parts of the core and floor must work as a team. When there are problems somewhere in the system, such as weakness or too much tension, there is dysfunction. PFD can show up in various ways: incontinence (urine or fecal), pelvic pain, or Pelvic Organ Prolapse.
Fecal incontinence is more common in women and elderly people of both sexes. Pelvic floor physical therapists (PFPT) can provide education on dietary changes and daily bowel movement patterns, along with biofeedback.
Urinary incontinence is broken down into two categories: stress and urge. Stress incontinence refers to leaking urine when you cough, sneeze, run or lift something. This results from pressure or a weak pelvic floor. Urge incontinence refers to an intense need to urinate, followed by loss of control and leaking. The lack of control can be due to the pelvic floor muscles being too tight.
It is important to note that Kegels are not the answer for all pelvic floor issues. Kegels may be part of the solution for strengthening weak muscles, but incontinence and other PFDs can be caused by too much tension. In that case, a pelvic floor physical therapist can do manual tension release. For some patients, a balanced approach of both Kegels and manual tension release is necessary.
Pelvic Organ Prolapse (POP) occurs when one or more of the pelvic organs drops lower in the pelvic basin than it should. There are many types of prolapse that women experience, including uterine prolapse, cystocele or rectocele. Childbirth is one of many causes of POP, yet it is not the only reason women suffer from this. Other causes are hormonal decreases at menopause, chronic illness, ligaments loosening, and being overweight. Some symptoms of POP are incomplete emptying of the bladder, low backache, constipation, irritable bowel syndrome, and painful sex.
Pelvic Pain is defined by any pain between the ribs and hips. This could show up as low back pain, pain in the hip, tailbone, sacroiliac joint, or painful sex. Pain may creep up after exercise, perhaps after you increase activity levels. This is pain you should not push through. For women who are beginning to exercise after childbirth, pelvic pain may be a sign that the pace should slow down.
After hearing about various symptoms and types of PFD, you may wonder if you should see a PFPT. Some experts recommend that all women who give birth be examined by a PFPT. I agree, and I strongly suggest that women I work with visit a PFPT to get a sense of how the pelvic floor and core muscles are functioning as they recover from childbirth. During this time a therapist can perform an internal exam to insure the pelvic floor is intact and functioning well.
I’ve spoken with hundreds of women about pelvic floor health, yet a few stories stand out. One woman has three children and put her own health on the back burner for twenty years while raising her family. It wasn’t until she was living in absolute misery that she sought help from a PFPT. She was anxious, worried all of the time, embarrassed, unable to travel and unable to enjoy life. After five months of physical therapy she is doing very well, and she has found a great deal of relief, comfort and peace in her life.
Another woman broke down in tears at my local YMCA, whispering to me why she cannot run anymore. She cried because she was embarrassed, yet relieved to share something that she had not felt comfortable saying before. She is ten years postpartum. I mentioned PT and provided names. She is happy that she felt empowered to seek treatment.
Stories like these highlight what we have known all along – PFD causes emotional distress on top of physical pain. Women today are more likely to exercise, and to feel more strongly connected to movement than our mothers and grandmothers. This connection to movement helps many of us cope with everyday stressors, and it has a positive impact on our mental health. The inability to move the way we once did results in repercussions for our families, our jobs, our health and our spirit, just to name a few.
The women I have talked with seem surprised to learn that they do not have to live with these problems. I want to shout it from the rooftops so you all can hear me: Don’t settle with incontinence! Why suffer with pain? Don’t ignore prolapse! There are PTs out there doing amazing work, and there is a very good chance they can help you. This field has grown tremendously over the last five years and there is a great need for it.
28.1 million American women have at least one pelvic floor disorder, and that is expected to rise to 43.8 million by 2050. More numbers that may surprise you:
-One in two women who exercise will be incontinent
-One in three women age 41-64 will be incontinent
-One in two women who have had a baby will experience some type of prolapse
-55% of women over 65 will experience incontinence
-Pelvic pain affects one in seven women between the ages of 18-50
These statistics are probably much higher, but PFD is not discussed as often or openly because it is embarrassing and causes people shame. Living in a house with three kids means I see my share of accidents. Grown women (or men) should not have to live with this. All of this creates a vicious cycle: the worse the issues are for people, the more they become a barrier to exercise.
Physical Therapy may prevent the need for surgery. It is a lot less expensive and carries lower risk. Surgical failure rates are estimated at 30%, and once failed the chance of a repeat failure is higher. Another woman shared with me about her mother-in-law’s ninepelvic floor related surgeries, none of which reduced her symptoms or enhanced her life. She still sat on the couch, unable to play with her grandchildren, and complained of chronic pain.
In short, if you experience any of the symptoms above, don’t settle. Whether you have recently given birth or your baby is 15 years old, PT could make a difference. I hope you will see that although symptoms like incontinence, POP or pelvic pain may be common, they are not normal. If you have struggled for years, it’s not too late to seek help and live a more comfortable, enjoyable life.
To learn more from Pelvic Floor Physical Therapy expert, Tracy Sher, visit: What is Pelvic Floor Physical Therapy
This article originally appeared in the The Albany Times Union Holistic Health blog on October 12, 2017.