When it comes to women’s health physical therapy, the focus is often on pelvic floor rehabilitation, but women are more than just their pelvis, which is why I recently discussed back pain associated with breastfeeding. You are looking for relief from back pain and neck pain, you want relief from the embarrassment that comes from bladder leaks (i.e., stress incontinence, urge incontinence, and mixed incontinence), and you want someone who understands how your body works as a unit rather than as individual parts and pieces. It is for these reasons that your women’s health physical therapist is an ideal partner in your healthcare experience.
What is Women's Health?
Broadly speaking, Women’s Health refers to all topics relating to the well-being of a woman (or girl). Women’s Health practitioners are going to specialize in the things that make a woman unique including physical traits such as the breasts or vagina, but women’s health will also include reproductive health. Women’s health physical therapists should be one such member of your healthcare team.
Why See a Women’s Health Physical Therapist?
Your physical body is an extremely important part of what makes you uniquely a woman. Physical therapists are the experts in the physical movement of your body, so when it comes to understanding the movement and pains associated with your body, your physical therapist should be the first person you consider. You need a physical therapist who can assess your body holistically, that is look at all of the structures of your body and how they connect. (Did you just start singing “Dem Bones?” I sure did). Just because you have back pain does not mean that your issue starts and ends in your back. In fact it is possible, even likely, that your back pain may be attributed to pelvic floor dysfunction or a disturbance in your gait (i.e., how you walk). You may be able to get temporary back pain relief if you address the symptoms, but if your pelvic floor dysfunction isn’t addressed then you are going to continue to have recurring back pain. By looking at your specific issue and assessing the supporting tissues, you physical therapist can identify issues that can be treated and help you to Love Your Life.
If all physical therapists are movement experts, you might be asking what makes a pelvic floor physical therapist different. One great thing about a specialist is that they were a generalist first. Your pelvic floor physical therapist had to understand the whole body and the movement of all of your muscles and joints before she could become an expert in the pelvic floor and women’s health challenges. She chose to seek out additional training and mentorship to specialize in the pelvic floor and to specializing in providing women’s healthcare. The pelvic floor is an extremely important component of your body, responsible or contributing to almost all of your daily functions. By focusing on the challenges of the pelvic floor, your women’s health physical therapist can work backward to the hips, the low back, the legs, the neck and beyond to find the underlying mechanism of pain. She has the experience to understand all of your challenges, but she has the expertise to put the different factors of your condition together to provide treatment and care unique to your challenges.
What are some Women’s Health Issues?
The women who come to me for pelvic floor physical therapy are seeking relief for some women’s health issue. They may have been dealing with it for some time, or it may be an acute problem that has only recently come to light. Either way, each woman’s journey to a women’s health physical therapist is unique and personal, but there are some commonalities across the lifespan. Generally, women can be grouped into the stage of life they are in and what they hope to accomplish with physical therapy for the pelvic floor.
Childhood (What is Dysfunctional Voiding?)
Pelvic floor dysfunction in childhood might not occur to many, but when it comes to a young girl who has trouble with voiding, she is an excellent candidate for pelvic floor physical therapy. At this young age, the most common consideration for a pelvic floor physical therapist is dysfunctional voiding.
Dysfunctional voiding in children can present in a comes in a couple of different forms, but it is believed to commonly have physical, psychological, and social components. Dysfunctional voiding in adults occurs, but it is more commonly considered to be a problem of childhood. Dysfunctional voiding is like any other form of incontinence. It can impact the child’s bowels or bladder, and it can occur either during the day (e.g., enuresis) or at night (e.g., nocturnal enuresis). Often times the child has not learned how to properly start and stop the flow of urine, or constipation has made a bowel void so painful that she doesn’t want to try. Often times pediatricians will suggest a wait-and-see strategy, but this doesn’t address the root causes and there may be real structural or functional deficits that can be addressed. The bottom line is if pelvic floor dysfunction is treated properly early, a young lady will have the knowledge and tools to prevent recurrence even as her body changes.
Pre-Birthing Years (What is Vaginismus?)
Pelvic floor dysfunction can occur across your lifespan. But the type of pelvic floor dysfunction observed across the lifespan is not equally distributed. While prior to adolescence incontinence (including bladder leaks or diarrhea) is the most common reason a young lady will get referred to pelvic floor physical therapy, things change once the young lady reaches puberty.
Adolescence may be the least talked about time for pelvic floor dysfunction. Young women are starting to undergo changes in their body and exploration really begins. For some, pelvic floor dysfunction arrives during or just after puberty and may be first noticed when dealing with the care of a young woman’s period. In particular for young women trying to use a tampon for the first time. In these years, pelvic pain is the most common reason I see young women. Unfortunately, it is still probably not often enough. It is all too common that young women are told that their first sexual experiences are going to be painful, or that pain with tampon insertion is normal. I want girls and young women to know neither of these is true. Pain around vagina may be a medical condition known as vaginismus, and it can be isolating for young women interested in the physical aspects of a romantic relationship, but it can be a real issue for the young athlete who doesn’t want to worry about the embarrassment of a pad shifting while she is playing. More often than not when you hear “you just have to deal with it” or “that’s just part of being a woman” it is time to have a conversation with an expert, and if you are speaking with an expert it might be time to get a second opinion.
Birthing Years (What is Exercise Incontinence?)
You may notice it when you cough, sneeze, or laugh. Maybe you are having baby number two and whenever you go to pick up your first child there is just a little leak. You are facing exercise incontinence (formally known as stress urinary incontinence or simply, stress incontinence). One in three women under the age of 65 has faced some type of bladder leaks, or urinary incontinence; while common, leaks are not normal.
Exercise incontinence is a funny name because it does not occur only with exercise and targeted exercise can help with incontinence. During the birthing years, strain or stress is placed on the muscles of your pelvic floor. Think about that 10-pound baby using your pelvic floor muscles as a trampoline all day. But even consistent jarring exercises like running or jumping are putting this strain on your body. Your muscles stretch out, and if they were not at optimal functioning to begin with, they are not going to magically get better after your baby is born. Your pelvic floor muscles are stretched, but they can be strengthened. You can be taught to properly coordinate your breathing, you can be taught how to perform a proper pelvic floor muscle contraction, and you can Love Your Life without leaks.
Menopause (What is Prolapse?)
After the child-birthing years, incontinence remains a concern and will remain a concern for the rest of the lifespan if not treated, but new problems arise. Pelvic pain may reoccur for a variety of reasons, not the least of which is muscle strength. Back pain associated with a weak pelvic floor may occur. But the problem that starts to arise at this time and is most troubling to women and a common reason for a referral to women’s health physical therapy is pelvic organ prolapse.
Pelvic organ prolapse occurs when the muscles of the pelvic floor are too weak to support the organs inside the abdominal cavity (e.g., bladder, uterus) and these organs begin to push out of the vagina (prolapse of the rectum can also occur). Prolapse is not generally a dangerous condition, but it can be extremely uncomfortable and for some women painful. Surgical intervention is common and necessary for the highest grade (Grade 4 Pelvic Organ Prolapse), but for lower grades pelvic floor physical therapy can provide the strength necessary to reduce the prolapse and eliminate the pain and discomfort.
Beyond Menopause (How do I prevent falls?)
The most common diagnoses and challenges associated with pelvic floor or women’s health physical therapy are 1. Incontinence, 2. Back Pain, 3. Pelvic Pain, and 4. Prolapse, but these all leave a gracefully aging woman at risk for falling. If you have to get up in the middle of the night to use the restroom, if you have pain that keeps you from sleeping or requires pain medication, if you have to reduce movement to stop yourself from having a bladder leak, you have increased your risk of falling.
As we age, the challenges of our youth do not disappear they magnify, and as you just seen, new challenges arise. Falls risk becomes a very serious consideration for older adults, it can limit their ability to enjoy their retirement, their grandkids, or even their weekly golf game. A women’s health physical therapist should treat women across the lifespan, she should be able to recognize the challenges associated with aging and provide the solutions to keep you mobile, independent, and loving life. A women’s health physical therapist will recognize the physical deficits (e.g., poor leg strength, pain in your back), the pelvic floor dysfunction (e.g., urgency of urination), and the balance deficits (e.g., visual, inner ear, and body awareness) keeping you from the life you want to lead.
Women are more than just a pelvis, they are a special group that needs care and attention specific to their healthcare challenges. Women’s health physical therapy, or a pelvic floor physical therapist, can provide the care and attention a woman needs to get the most out of her life.
-FYZICAL Therapy & Balance Centers of Oklahoma City
FYZICAL Oklahoma City specializes in pelvic floor dysfunction and balance rehabilitation. Our clinicians are experts in their field and are happy to answer your questions about pelvic floor physical therapy, balance rehabilitation, or physical therapy in general. By taking a holistic view of our patient’s well-being, we can help them get the most out of their healthcare experience. If you are unsure about your pelvic health, or you want to see the FYZICAL Difference for yourself, schedule a free consultation today.