Women’s health is increasingly becoming an important topic. The implications of having a uterus (and associated hormones) can influence many aspects of our quality of life. From the start of menarche (menstruation), to becoming sexually active, to having babies and going through menopause; the woman’s body goes through immense changes. It can be hard to know how to support it and maintain pelvic floor health through the different phases of our lives.
Doctors, naturopaths, even a good pharmacist can be great allys. In addition, a pelvic floor physiotherapist—a specialist of the internal and external muscles of the pelvic floor— can support you and your family through these changes.
Here is a list of the common reasons people see a Pelvic Floor Physiotherapist:
- Painful Sex
- Prenatal health concerns
- Post-Partum care
- Urinary Incontinence
- Prolapse
- Menopausal concerns
- General health and wellbeing of the pelvic floor
Dyspareunia: Pain with Sex
Regardless of your age and experience, painful sex can be uncomfortable for both you and your partner. It can make a beautiful and intimate experience undesirable. There could be many physical, and even psychological reasons one might have discomfort or pain with vaginal penetration. A pelvic floor physio might be able to help!
Have you ever heard of the term Vaginismus? This condition is characterized by an involuntary contraction/spasm, or tightening of the muscles around the vagina. It makes vaginal penetration anywhere from uncomfortable to deeply painful.
A couple of strategies a pelvic floor physiotherapist might use to work with someone with vaginismus include things like:
a) guided imagery and breath work to help relax the muscles of the pelvic floor
b) graded exposure to penetration
c) stretching techniques to calm the nervous system.
Prenatal Health
Pregnancy is beautiful and sometimes scary time of changes! Beyond the changes happening in and around the pelvic floor, the entire body starts to change to accommodate the growth of the baby.
Pelvic floor physiotherapy can be a useful tool through the trimesters to help reduce discomforts associated with this change. Physio’s who specialize in the pelvic floor and women’s health might create a plan of care centering around the person. This often includes taking the time to teach and explain the various ways to manage the changing body and hormones during this time.
They may also include teaching and prescribing strengthening and stretching techniques for the muscles of the pelvic floor, They can also provide posture awareness exercises and ways to stay active during pregnancy. A pelvic floor physio will often use myofascial release, manual therapy, and breathwork to help reduce tension and discomfort associated with tight or restricted tissue and joints. A pelvic floor physio can also help with discussing different positions for labour and delivery. This can include breathing exercises and how to “push” when it comes down to it!
Post-Partum Care
The initial weeks following delivery are for the mother to rest and recovery (as best as one can with a little one!) Whenever mom is feeling ready (a suggested time-frame being six to eight weeks following birth), a pelvic floor physiotherapist is here to help with post-delivery care and returning to life/activities.
Post partum, the body is adjusting to yet another change. This stage will likely move differently and come with another set of symptoms and discomforts. A therapists would reassess posture and movement patterns, including feeling engagement of the abdominal wall and pelvic floor muscles. A pelvic physio will also teach and coach through different movement strategies and prescribe gentle post-partum exercises. And they will address any muscle and joint aches and pains through manual therapy and stretching.
After about 12 weeks, the mother can start to engage more in their desired physical activities or sport. At this point they can start to reintroduce strengthening exercises for the core and pelvic floor again.
Urinary Incontinence
A common problem associated with pregnancy, but also outside of pregnancy, is the issue of urinary incontinence—leakage or urine. It could happen during a sneeze or a cough. Occasionally could be the feeling of being unable “hold your bladder” on the way to finding the nearest toilet. The fact of the matter is, living with urinary incontinence has the ability to seriously impact one’s quality of life. But it doesn’t have to be a normal part of life!
A pelvic floor therapist is able to take the time to learn about the specific difficulties a person with urinary incontinence is going through. They can assess the external and internal muscles to see if they are contributing the involuntary loss of urine. They can prescribe and coach a person a program to help strengthen and relax their pelvic floor muscles. Sometimes this can even mean providing mindfulness and guided imagery to assist in the urgency associated needing to run to the closest washroom.
Pelvic Organ Prolapse
Pelvic organ prolapse occurs when the tissue (muscles and ligaments) of the pelvic bowl are unable to support the internal organs. This causes a change in position of the bladder, uterus and cervix, and rectum and results in a protrusion through the vaginal opening. Other symptoms include difficulty with peeing or bowel movement, and a feeling of heaviness or pressure in the pelvic region.
This problem can occur when people who have had a lot of tearing from vaginal deliveries, or even those with chronic constipation. 50% of women over the age of 50 experience some feeling associated with pelvic organ prolapse. They can be due to hormonal and age related changes.
The good news is, there are ways to manage signs of prolapse early. With pelvic floor physiotherapy, one can really reduce the grade of prolapse! A pelvic floor physio will go through different techniques and strategies to manage the prolapse. The focus is to help develop a strengthening exercise for the muscles of the pelvic floor, and is also able to refer on to other health care practitioners for additional and necessary support.
Menopausal Concerns
Most people tend to have a broad understanding of the word “menopause,” but technically speaking, menopause is an exact date— 12 months following a person’s last period.
The average age is about 51, but symptoms of peri-menopause can begin to occur before this age. Symptoms tend to vary, and are related to the changing hormone levels in the body. Some of the issues of concerns might include pelvic organ prolapse, urinary incontinence, dyspareunia, vaginal dryness, constipation and fecal incontinence.
While this list may seem concerning, getting to know one’s body and pelvic floor health better can dramatically reduce problems associated with peri-menopause. Managing these problems can lead to a greater quality of health during these years.
General Health and Well-being of the Pelvic Floor
Just like any other area of the body, the pelvic floor plays a vital role in our health and wellness and quality of life. Getting to know more about this part of our body can help manage the inevitable changes of womanhood as we age. Whether you’re thinking about starting a family, or interested in improving your core stability and get back to sport, a pelvic floor physio is here to help!
By Isha Sharma, PT