Thank you to the Pacifica Mothers Club for featuring this article in their Oct. 2019 Newsletter!
How often do we seek regular check ups? And are we seeking the right provider for the right kind of check up?
Physical therapists specialize in musculoskeletal and neuromuscular health- it is what we do! We are there to keep your body in-tune and moving strong. I hope the article gives insight into what Pelvic Health Physical Therapists specialize in and what we can help our clients with most.
“I thought leaking was normal, so I never thought it could be treated”
“I heard pain with sex was normal after pregnancy so I never sought help”
“Having back pain during pregnancy is normal, right?”
Ever heard or maybe even had these thoughts yourself? There is misinformation surrounding pelvic and abdominal health; let’s get to the bottom of this.
Pregnancy and postpartum periods can cause significant changes to a woman’s body; leaving postural, musculoskeletal, and neuromuscular dysfunctions that can last a lifetime. While pelvic health conditions are commonly experienced; this does not make them “normal” to experience. The misinformation surrounding pelvic health has been passed down for decades- sadly even by some trusted healthcare providers.
As a pelvic health physical therapist, professor of Kinesiology, and mama of 2 young boys, it is my passion to help women understand the changes and conditions they are experiencing during and after pregnancy. I enjoy educating and bringing awareness to pelvic health - the “taboo’ed” area of the body; essentially making what is uncomfortable, comfortable to talk about. For me, talking about “down there” is no different than talking about an arm or leg. These are anatomical structures made of the same tissues. Talking about this area of the body reinforces the respect it deserves.
The lack of discussion and awareness around pelvic health perhaps has led to the long list of
dysfunctions related to it. The changes experienced during the pregnant and postpartum periods can cause several dysfunctions including:
- Orthopedic/sports injuries - pain in the neck, shoulder, back, hip, knee, sacroiliac (SI), etc.
- Bladder:
o Urinary urgency - feeling of losing control over the bladder
o Urinary Frequency -using the toilet several times throughout the day/night,
o Stress Urinary Incontinence (SUI) - leaking of urine with cough, sneeze, laugh, or exercise
- Bowel: incontinence - loss of bowels
- Diastasis Recti
- Prolapse
- Pelvic pain - pain with sex, tampon insertion, or gynecological speculum exam
- Constipation
The impact pelvic and abdominal dysfunction has on a woman’s life can be devastating; affecting their relationships, career, and overall livelihood. Some women won’t go to a party in fear of leaking. Or she can’t be intimate with her partner because of pain. Or she feels she can’t be the mother she wants to be because of the pain or leaking. In addition to the physical pain these conditions cause, there is often emotional and psychological pain too.
Often women are told that these dysfunctions will “go away with time” only to find that 3+ years later…they haven’t. In fact, often by choosing to wait- several other conditions have started too. Research shows that women who experience incontinence at 3 months postpartum are more likely to experience incontinence at 5 years postpartum. (1) Research shows many of these conditions, such as incontinence and pelvic pain, can be resolved with physical therapy. (2–4) Clinically, I see this first hand. The benefits physical therapy has for patients, getting them back to their activities without pain, curing their leaking, helps them lead a fuller life. The research is clear that pelvic health physical therapy remains the
mainstay of first line treatment. (2–5)
So what is pelvic health physical therapy? Physical therapists diagnose and treat musculoskeletal and neuromuscular conditions. They are trained, and licensed, to administer treatment techniques of joint mobilization, soft tissue mobilization, therapeutic exercise, neuromuscular re-education, biofeedback, behavioral and lifestyle modification, and other manual techniques like myofascial release, and trigger point. The impact of physical therapy treatment can facilitate recovery by leaps and bounds- I can attest to this myself both personally and clinically. I explain to my postpartum patients that sometimes the
muscles in a certain area (such as after injury or pregnancy) “go on vacation” and sometimes don’t want to come back from vacation. Physical therapy can help “remind” the brain about a body region and help “wake it up.” It would take pages to explain the scientific principles behind this phenomenon, but to summarize: when our body experiences injury/trauma, or a significant change such as pregnancy, it goes into “protection” mode. The brain and nerves are sent messages to “protect” the body. This changes the sensory messages the brain receives- furthering the “protection” of the injured area. This can cause compensation in healthy areas of the body too. Ever notice that you walk differently when you are injured? And then after you don’t have pain, even years later, you are still walking with that limp? Or, as I commonly hear from my postpartum patients- their posture is different and they don’t feel as connected to their core muscles like they did prior to pregnancy. A common complaint is when they do a plank they feel it everywhere except in their core muscles. There are natural changes that will happen to the body with pregnancy, however many of these changes can become exaggerated during the pregnancy/postpartum periods- setting the stage for injury and dysfunction. Re-training the muscles in a proper posture can help relieve the pain and dysfunction.
So does this mean just do “kegels” and you are good to go? Absolutely not. Pelvic health physical therapy employs several techniques other than exercise. Physical therapists work with their hands, applying hands on treatment to muscles, connective tissue, viscera (organs), and nerves. Regarding “kegels” or Pelvic Floor Muscle Exercises- studies show, and from my own clinical experience too, that 50% of women - who say they know how to perform pelvic floor muscle exercises – perform them incorrectly. (6) It is important to understand that not all exercises are appropriate for all women to do. The “one size fits all” approach does not apply for any injury or condition whether it is pelvic health, or back/hip/shoulder/knee pain. Having an individualized treatment program for your body is important for your recovery.
If you are experiencing a pelvic health condition, please know you are not alone and that there are treatment options for you. And most importantly, feel comfortable reaching out to get care. If you had knee pain, wouldn’t you seek help? Pelvic health conditions deserve the same attention and care.
Dr. Jennifer Kinder PT, MS, DSc.
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1. Viktrup L. The risk of lower urinary tract symptoms five years after the first delivery. Neurourol Urodyn. 2002;21(1):2-29.
2. Dumoulin C, Hay-Smith EJC, Mac Habee-Seguin G. Pelvic floor muscle training versus no
treatment, or inactive control treatments, for urinary incontinence in women. Cochrane
database Syst Rev. 2014;(5):CD005654. doi:10.1002/14651858.CD005654.pub3
3. Starr JA, Drobnis EZ, Lenger S, Parrot J, Barrier B, Foster R. Outcomes of a comprehensive nonsurgical approach to pelvic floor rehabilitation for urinary symptoms, defecatory dysfunction, and pelvic pain. Female Pelvic Med Reconstr Surg. 2013;19(5):260-265. doi:10.1097/SPV.0b013e31829cbb9b
4. Burgio KL, Locher JL, Goode PS, et al. Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA. 1998;280(23):1995-2000.
5. Burgio KL. Behavioral treatment of urinary incontinence, voiding dysfunction, and overactive bladder. Obstet Gynecol Clin North Am. 2009;36(3):475-491. doi:10.1016/j.ogc.2009.08.005
6. Kandadai P, O’Dell K, Saini J. Correct performance of pelvic muscle exercises in women reporting prior knowledge. Female Pelvic Med Reconstr Surg. 2015;21(3):135-140.
doi:10.1097/SPV.0000000000000145