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women's health physical therapy

4 Common Pelvic Issues Seen by Physical Therapists

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Women’s bodies and their wellness are unique. Many factors cause problems specific to women’s bodies. Physical therapists specializing in women’s health can help female patients eliminate or manage pelvic pain or problems while restoring their quality of life. Using a comprehensive approach to evaluation and treatment, women’s health physical therapy programs can provide relief for these 4 common pelvic issues:

  • Pelvic floor pain or dysfunction
  • Pelvic organ prolapse (POP)
  • Postpartum recovery and or pain
  • Urinary incontinence

 

1. Pelvic Floor Pain or Dysfunction

Pelvic pain can occur for many reasons. One typical cause is what is called a hypertonus dysfunction or an unusual tightening of the pelvic floor muscles. This is common after a long delivery and scar tissue formation from a healing episiotomy. It can also occur from sexual abuse or when the muscles tighten to prevent the “falling out” sensation that occurs with the prolapse of the internal organs. The primary symptom is pain, but it can occur in the back, perivaginal area, lower abdomen, or thighs.

women's health physical therapy

How physical therapy can help pelvic pain patients:

Physical therapy can help to eliminate or manage pelvic pain while restoring the quality of life. This is possible through a comprehensive approach to the evaluation and treatment of the pelvic floor.

 

2. Pelvic Organ Prolapse

According to the International Urogynecology Association (IUGA) and the International Continence Society (ICS), pelvic organ prolapse is defined as the decent of one or more of the anterior vaginal wall, the posterior vaginal wall, the uterus (cervix) or the apex of the vagina (vaginal vault or cuff after hysterectomy). POP can be caused by a variety of circumstances including vaginal childbirth, increased age and/or BMI, increased abdominal pressure, and connective tissue disorder.  The symptoms of pelvic organ prolapse (POP) include:

  • Many women are asymptomatic
  • The sensation of pressure or heaviness in the vagina
  • Feeling of bulging or something coming out of the vagina
  • Urinary symptoms: incontinence, position change or manual reduction of prolapse needed to initiate or complete voiding, weak or prolonged stream, incomplete emptying, obstructed voiding symptoms
  • Bowel symptoms: incontinence, feeling of incomplete emptying, straining, digital evacuation, splinting of vagina or perineum to aid emptying
  • Sexual symptoms: decreased lubrication, sensation, arousal, or dyspareunia

How physical therapy can help pelvic organ prolapse patients:

  • Pelvic floor muscle training (recommended as the first line of treatment in stage 1-2 of pelvic organ prolapse)
  • Strength and endurance training of underactive pelvic floor
  • Stretching and relaxation of an overactive pelvic floor
  • Lifestyle modification to reduce the effect of increased abdominal pressure on the pelvic organ support system

In addition to physical therapy, other treatments for POP may include pharmacological treatment, the use of mechanical devices, and surgical intervention.

 

3. Post Partum Recovery and/or Pain

Birthing a baby is a joyful and yet very traumatic experience. Regardless of the method of delivery, whether VBAC or Cesarean Section, each birth comes with its own potential postpartum problems. From urinary incontinence to pelvic pain, there are just some things after childbirth that are not glamorous and can be embarrassing
to discuss.

While some issues will resolve over time, there may be treatments that can help. Pelvic health physical therapy can address diastasis recti (a tear in the
abdominal wall), urinary incontinence, low back/ pelvic girdle/hip pain, pain with intercourse, or scar pain to name a few postpartum unpleasantries that may benefit from physical therapy.

Potential postpartum problems that can be helped with physical therapy:

  • Urinary incontinence
  • Pain with intercourse
  • Pelvic floor pain
  • Scar pain
  • Diastasis recti
  • Pelvic organ prolapse
  • Difficulty returning to exercise

If you find yourself 6 weeks postpartum and still suffering, please discuss with your OB-GYN and decide if a referral to physical therapy may help.

 

4. Urinary Incontinence

Urinary incontinence can be embarrassing but it doesn’t have to be part of your life. Do you have to change pads every couple of hours? Do you worry
about going out because you need to know where the closest bathroom is? Do you always carry a change of clothes with you? Do you not travel or exercise because of fear of leakage? Don’t live in fear of urinary leakage.

Symptoms of Urinary Incontinence Include:

  • Involuntary loss of urine
  • Increased daytime/ nighttime frequency
  • Urgency
  • Post voiding retention
  • Straining to avoid dribble
  • Leakage with efforts like coughing or other activities.

How physical therapy can help urinary incontinence patients:

  • Behavioral interventions (urge suppression techniques, dietary modifications, appropriate fluid intake, weight loss, habit training)
  • Pelvic muscle re-training (for overactive) as well as underactive pelvic floor
  • Bladder training (bladder diary or scheduled voiding)
  • Neuromuscular re-education (NMES) and biofeedback devices

 

What to expect during a women’s health physical therapy session:

Each person will be individually evaluated and treated in a quiet, private, safe space. The initial evaluation may include an internal exam if the patient is comfortable in order to properly assess the patient’s musculature and symptoms.

  • Musculoskeletal assessment: An evaluation to identify causes of poor postural alignment, strength, flexibility and movement patterns which cause orthopedic pain Soft Tissue Mobilization – to release adhesional restrictions.
  • Observation and palpation of the pelvic floor to the patient’s comfort level
  • Stretching and strengthening techniques
  • Relaxation techniques
  • Soft tissue and joint mobilization
  • Modalities: Interferential electrical stimulation, ultrasound, heat or cold therapy.
  • Biofeedback: Provides measurable assessment of the pelvic floor muscles ability to contract and relax in function.
  • Behavior modification
  • Educational instruction: Home exercise programs and information concerning diet, sleep, work and rest positions and self-management of symptoms.

If you find yourself in need of women’s health physical therapy, talk to your doctor or physical therapist and see if physical therapy would be a good fit for your symptoms. To find a physical therapist near you visit our Find A PT page.

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Contributions to this blog post were provided by Spring-Klein Physical Therapy (Spring, TX), Therapy Partners of North Texas (North Richland Hills), and STAR Physical Therapy (65 locations throughout TN)

women's health

The Benefits of Physical Therapy for Women’s Health

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Women’s health can cover a multitude of subjects, from pregnancy to aging – the female body undergoes many changes. Physical therapist’s most common women’s health clients come in experiencing incontinence, osteoporosis and pregnancy related back pain.

URINARY INCONTINENCE
Urinary incontinence is a loss of bladder control that results in leakage when the muscles of the pelvic floor are weak or overactive. Causes include child birth, hormonal changes, surgical trauma, pelvic fractures, chronic cough, obesity, muscle weakness or even repetitive lifting. Physical therapy can help decrease or resolve urinary leakage, identify bladder irritants and strengthen pelvic floor muscles through an individualized exercise program.

OSTEOPOROSIS
Keeping the bones strong as you age, especially after menopause, is a challenge many women face. An excessive decline in bone mass is called osteoporosis, and it is a leading health care concern for women. A physical therapy program can help improve your posture and strength, prevent falls, and decrease your risk for fractures.

A physical therapist that specializes in women’s health treating pelvic floor dysfunction can help as well.

older_woman

PELVIC FLOOR DYSFUNCTION 
Exhibits Several Symptoms: 

Urinary Incontinence
Fecal Incontinence
Constipation
Diarrhea
Pelvic Floor Pain

PREGNANCY RELATED BACK PAIN
Many women experience low back pain during pregnancy. This is due to several factors such as:

Hormonal Changes – this causes increased looseness of the pelvic ligaments to prepare your body for birthing your baby.
Increased Weight Gain – This places increased stress on all the joints of the body. Increased breast weight can overload
the neck and upper back.
Postural Changes – Body weight shifts forward as the baby grows and this increases the arch in the lower back. Stomach
muscles and the lower pelvic muscles become weaker which decreases support for the lower back.
Altered Movement Patterns – Due to your changing body, women often begin to move in different patterns that can increase stress to the low back or pelvic joints.

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy group with 24 locations in Georgia and Florida. Advance Rehabilitation is a physical therapy practice that focuses on providing the highest quality rehabilitation services. We specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. Our staff includes highly-trained professionals that serve as a bridge between injury and recovery to help patients get back to pre-injury status as quickly as possible. For more information click here.

bladder control during pregnancy

Bladder Control During Pregnancy

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Aside from a growing belly, you may notice other changes in your body now that you are pregnant. One thing you may notice is the loss of urine when you are not trying to urinate. Loss of bladder control, also called incontinence, is common during pregnancy and after childbirth. Needing to run to the bathroom often or leaking urine can make you feel embarrassed. Do not feel shy about asking for physical therapy for incontinence. They can help you understand and manage bladder control, and make sure there are not other conditions causing your incontinence. Here is some information to help you learn more.

HOW DOES THE BLADDER WORK?
Urine is stored in your bladder, which is an organ located in the pelvis. The muscles of the pelvis help keep your bladder in place. When you urinate, urine travels from your bladder and out of your body through a tube called the urethra. Ring-like muscles (sphincter muscles) keep the urethra closed so urine does not pass until you are ready to urinate. Muscles at the end of the urethra (sphincter muscles) and in the pelvic floor also help to hold back urine.

HOW CAN BEING PREGNANT CAUSE BLADDER CONTROL PROBLEMS?
The weight of a baby in your belly and the act of giving birth will put pressure on your bladder and may cause your pelvic muscles to stretch and weaken. This causes your bladder to sag, and your urethra to stretch. Nerves can also be damaged. It is this damage to muscles and nerves that can cause bladder control problems to persist.

pregnant woman

HOW CAN I CONTROL MY BLADDER?
The good news is that incontinence may go away once your pelvic muscles heal, usually 6 weeks or so after giving birth. But you can take steps after childbirth to minimize bladder control problems by doing exercises to strengthen your pelvic floor muscles. Kegel exercises are one type of pelvic floor muscle exercise.

Kegel exercises do not require equipment and can be done anywhere—while sitting at your desk, standing in line at the bank, or even lying down in bed. They are done by squeezing your sphincter muscles in the same way you would when stopping urine flow. After 6-8 weeks of doing the exercises, you may find that you have fewer leaks.

Talk to your doctor to learn more about how to correctly do Kegel exercises. Following pregnancy, if Kegel exercises do not control the incontinence, your doctor may discuss other treatments or refer you to a specialist who can help.

Here are some general steps for doing Kegel exercises from the American Pregnancy Association:

• Squeeze your pelvic floor muscles as if you were trying to stop the flow of urine. Do not squeeze the muscles in your belly, legs, or buttocks.
• Hold for 5-10 seconds, then relax.
• Repeat 10-20 times.
• Try to do at least 3 sets per day.

If incontinence is still bothersome, talk to your doctor about other options, such as wearing absorbent pads or briefs. With support from your healthcare team, you will be able to manage incontinence, as well as other bodily changes that come with pregnancy.

by Marjorie Montemayor-Quellenberg, MA

RESOURCES:
American Congress of Obstetricians and Gynecologists
http://www.acog.org

Office on Women’s Health
http://www.womenshealth.gov

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Women’s Health Matters
http://www.womenshealthmatters.ca

REFERENCES:
Kegel exercises. American Pregnancy Association website. Available at: http://americanpregnancy.org/labor-and-birth/kegel-exercises. Updated Aug. 2015. Accessed Feb. 10, 2016.

Treatments of common complaints in pregnant women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 1, 2016. Accessed February 10, 2016.

Urinary incontinence fact sheet. Office on Women’s Health website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/urinary-incontinence.html. Updated July 16, 2012. Accessed February 10, 2016.

Urinary incontinence in women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 9, 2015. Accessed February 10, 2016.

What I need to know about bladder control for women. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-incontinence-women/Pages/ez.aspx. Updated June 2012. Accessed February 10, 2016.

3/5/2013 DynaMed’s Systematic Literature Surveillance: http://www.ebscohost.com/dynamed: Boyle R, Hay-Smith EJ, Cody JD, et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2012;10:CD007471.

Last reviewed February 2016 by Michael Woods, MD Last Updated: 2/10/2016

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

Pediatric Incontinence

Treating Pediatric Incontinence with Physical Therapy

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UNDERSTANDING PEDIATRIC INCONTINENCE 

Bed wetting is almost as common as asthma, but it is often not discussed, even with doctors.
The pelvic floor is made up of muscles and other tissues that form a sling from the pubic bone to the tailbone. They help to support the abdominal and pelvic organs and assist with the control of bladder and bowel activity.

Pelvic floor dysfunction refers to a wide range of problems that occur when these muscles are weak and/or in spasm. The tissue surrounding the pelvic floor organs may have increased sensitivity and irritation or decreased sensitivity, causing the resulting dysfunction seen in children.

Although millions of children suffer from pelvic floor dysfunction, most don’t get the help they need. Typically, children are toilet trained by age 4 with only very occasional accidents. After age 4 childhood bowel and bladder dysfunction is considered a major medical problem and greatly affects quality of life for the whole family. Every day, five million American children wake up not knowing if their bed will be wet or dry. Many of these children feel embarrassed and ashamed. Bed wetting is almost as common as asthma, but it is often not discussed, even with doctors, because of its embarrassing nature.

Dysfunctional elimination in children occurs when the pelvic floor muscles are not working together with the bladder and /or bowel and the normal voiding or emptying reflexes can be disrupted. This can lead to a chronic abnormal pattern of elimination which does not allow the bladder or bowel to empty completely. Some children experience difficulty urinating or controlling their bladder function, frequent bladder infections, constipation, not urinating enough during the day, or sensing bladder fullness. Children may periodically have leakage during the day or wake up wet in the morning or both. This can be embarrassing and uncomfortable.

If your child has experienced any of the above symptoms they may have been seen by a physician or specialist, who is now recommending therapy to relax and retrain the pelvic floor muscles. Therapy can provide the tools your family needs to take control of your child’s bladder and bowel functions.

PHYSICAL THERAPY CAN HELP
If any of the below problems sound familiar, then PT can help:
• Urinary incontinence (loss of urine)
• Urinary urgency (constant/strong need to urinate)
• Urinary frequency (urinating over 8 times in a 24 hour period)
• Urinary retention (not fully emptying your bladder)
• Bed-wetting (nocturnal enuresis)
• Fecal urgency, frequency and/or retention
• Bowel incontinence, pain with defecation, inability to empty bowels
• Excessive gas, abdominal bloating
• Constipation, diarrhea with/out soiling/staining

How do we treat pediatric incontinence?
We meet with a child and their parent/s or guardian about pediatric incontinence we  get a thorough knowledge of history and current problems. We then do a physical examination, looking at the muscles of the abdomen, legs, back and others we feel applicable to the specific problem. This exam is with an adult present and over clothing. Finally, we consult with the referring physician to develop an individualized treatment plan. Treatment is one-on-one, hands on, with the child dressed and lasts about one hour-in comfortable, private treatment rooms. We work with each child and family member very closely and modify our treatment according to what works best for each individual. We incorporate a holistic approach, looking at diet, sleep patterns, and other behavioral issues that could be contributing to the current problem.

What exactly do we do?
Treatment includes:
• Biofeedback-surface electromyography (external electrodes or “stickers”)
• Behavioral and diet modification
• Soft tissue mobilization, myofascial release and deep tissue massage if needed
• Hot and cold therapy
• Stretching and strengthening of pelvic floor and surrounding muscles as appropriate
• Relaxation techniques.
• Scheduled bladder retraining
• Pelvic floor muscle re-education

super_kid

THE FACTS
Medical research has shown that proper pelvic floor muscle training and biofeedback drastically improves voiding dysfunctions in children.

We use animated biofeedback used a computer program with images of dolphins or space shuttle to get children to activate and relax the pelvic floor muscles.

Your child is not alone
• 20% of pediatrician visits are for incontinence problems
• 15% of visits to gastrointestinal doctors are for lower bowel dysfunction
• 3% of visits to pediatricians are for constipation
• 5 million children complain of nocturnal enuresis (nighttime bedwetting)

Common Myths
Myth: Decreasing my child’s fluid intake will decrease their incontinence?
Fact: Decreasing fluids can actually lead to dehydration, which can actually increase incontinence.

Myth: Once my child has been diagnosed with incontinence, nothing can be done about it?
Fact: Incontinence can almost always be successfully resolved, treated or managed. Physical Therapy can help!

Myth: All children gain control of their bladder and bowels at the same age?
Fact: Children develop control at different ages depending on their physical and cognitive development, as well as their environment. It is typical for a child to develop bladder and/or bowel control between two and five years of age.

HOW COMMON IS BED WETTING?
It might reassure you to know that around 19% of school-aged children wet the bed. It’s really one of the most common of all childhood problems. To give you an idea, in a class of 30 children:

Aged 5 years: 5 wet the bed at least twice a week
Aged 7 years: 2 wet the bed at least twice a week
Aged 12 years: 1 wets the bed at least twice a week
Aged 15 years: 1 child in every two classes wets the bed at least twice a week.

HEALTHY BLADDER TIPS:
1. Maintain adequate fluid intake
2. Practice prompted voiding
3. Practice bladder retraining
4. Limit intake of colas, root beer and other dark soft drinks
5. Limit caffeine intake
6. Avoid constipation
7. Exercise on a regular basis
8. Drink fluids throughout the day and limit fluids at night (2 hours before bed)
9. Keep a bladder diary