By Elizabeth Akincilar, MSPT, Cofounder, PHRC Merrimack
As we recognize International Women’s Day in March, this is the perfect opportunity to educate our community about how pelvic floor physical therapy can benefit women and folks with uteruses throughout the different phases of their lives. The truth is, virtually all women and people with uteruses will benefit from the education, guidance, and possibly manual treatment a pelvic floor physical therapist can provide. Pelvic floor physical therapists receive specialized training to understand the many physiological changes women and a body with a uterus goes through during their lifetime. That makes pelvic floor physical therapists the most appropriate medical professional to support and rehabilitate the musculoskeletal changes that occur over the lifespan of women and people with uteruses.
Menses (aka periods!)
As young people go through puberty in their teenage years, their bodies go through a myriad of changes. These changes can be both, or either, exciting and anxiety producing. There’s no question that it results in challenges both physically and emotionally. Many of these changes are due to the production of sex hormones. Sex hormones are one of the triggers of menarche, or, the start of a person’s period or menses. Unfortunately, some people will experience dysmenorrhea, or painful periods. There are a number of reasons why some experience painful periods. One of the possible causes of dysmenorrhea is a disease called endometriosis. Endometriosis is a disorder in which uterine tissue grows outside of the uterus. For a more in depth review of endometriosis, read an earlier PHRC blog post where Stephanie Prendergast explains the diagnostic process, common symptoms, treatment options and challenges surrounding the condition. Endometriosis can cause many different symptoms that can range in severity from mild to severe. Folks with endometriosis may report pelvic and/or abdominal pain, sexual dysfunction and/or bowel dysfunction. To learn more about the connection between endometriosis and the gut, check out this PHRC guest blog post by Dr. Iris Orbuch. Many people who develop endometriosis will become symptomatic in their teenage years. Endometriosis can have adverse effects on the pelvic floor muscles and surrounding tissues which can contribute to pelvic pain. Pelvic floor physical therapy can help alleviate some of the pain due to myofascial (muscle and tissue) dysfunction through manual therapy. Common treatments for endometriosis include hormonal birth control and/or laparoscopic surgery. Both of these treatments can cause changes to the tissues and muscles in and around the pelvis which could also benefit from pelvic floor physical therapy. Treating the muscle and tissue impairments with pelvic floor physical therapy, whether it is due to the disease itself, or as a result of one of the treatments for endometriosis, can help alleviate pain and dysfunction. Pelvic floor physical therapy should be part of the gold standard of care for those suffering with endometriosis.
Check out our YouTube video where Jandra Mueller, DPT and Stephanie Prendergast, MPT break down what you need to know about endometriosis.
Pain with Vaginal Penetration
Additionally, after menarche, many people will try to use tampons and some may begin to experiment with sexual activity, including vaginal penetration. Unfortunately, some people will experience pain or discomfort during vaginal penetration or not be able to achieve vaginal penetration at all. There are several reasons why a person may have pain with vaginal penetration or not be able to achieve vaginal penetration. These symptoms should be discussed with their gynecological provider first to identify conditions such as a redundant (or thick) hymen, that may require a simple surgical procedure to treat. Additionally, people using hormonal birth control typically have hormonal insufficiencies in their vulva and vagina. This is a potential cause for pain during vaginal penetration and needs to be treated with hormonal supplementation. Another cause could be dysfunctional or tight pelvic floor muscles. A pelvic floor physical therapist can evaluate the pelvic floor muscles, determine whether they are contributing to the discomfort with vaginal penetration or inability to insert something into the vagina, and can utilize manual therapy techniques to relax the pelvic floor muscles and create a home exercise program to achieve pain free vaginal penetration.
To learn more about dilators, one of the tools that can help achieve pain free vaginal penetration, check out this YouTube video!
Pregnancy, Labor and Delivery, and Postpartum
When a person becomes pregnant or is ready to deliver a baby, a pelvic floor physical therapist is an integral member of their medical provider team. Pregnancy causes an enormous number of changes to a person’s body. From weight gain, to the opening of their pelvic bones, to changes to their pelvic floor musculature, a pregnant body often needs professional guidance and manual therapy to get through the pregnancy with ease as well as prepare the body for labor and birth. A pelvic floor physical therapist is the ideal medical provider to support and advise a pregnant person to minimize physical discomfort, guide and modify exercise programs, and help prepare the body for labor and delivery. Pregnant people can experience pelvic and/or low back pain and/or urinary and/or sexual dysfunction that may be due to musculoskeletal impairments. Pelvic floor physical therapists can thoroughly evaluate a pregnant person to identify musculoskeletal dysfunction and create an effective treatment program to get them through their pregnancy as comfortably and functional as possible.
Although most births are relatively uneventful medically, resulting in a healthy baby and healthy parent, some births can incur injuries to the parent’s pelvis, pelvic organs, vagina, vulva, pelvic floor musculature, and/or pelvic nerves. Cesarean sections will obviously result in an abdominal scar, which can cause discomfort even after it has fully healed. At the very least, the pregnancy itself causes changes to the pelvic floor musculature and the abdominal wall. This is why consulting with a pelvic floor physical therapist in the postpartum period is absolutely essential. People recovering from pregnancy and birth can experience a variety of symptoms, including urinary dysfunction, sexual dysfunction, pelvic pain, abdominal pain, low back pain, pelvic organ prolapse and difficulty returning to exercise. A pelvic floor physical therapist is best suited to evaluate, assess and treat these symptoms and assist the postpartum person as they rehabilitate from pregnancy and return to their desired level of function and activity. Pregnancy is a process that occurs over several months. Rehabilitating from a pregnancy is also a process that happens over many months. A pelvic floor physical therapist is the most appropriate medical provider to assist in that rehabilitative process.
To learn more about how to reduce musculoskeletal harm during labor and birth, check out this PHRC blog post by Molly Bachmann, DPT.
Read more about how physical therapy can support a person throughout pregnancy and the postpartum period.
As folks enter the perimenopause period of their life, they may notice changes to their pelvic floor musculature and/or vulva as their hormones begin to decrease. These hormonal changes can cause urinary and/or sexual dysfunction and/or pelvic discomfort as well as changes to the pelvic floor musculature and surrounding tissues. A pelvic floor physical therapist is able to evaluate and assess whether there are musculoskeletal causes for some of these symptoms. This is another time in a person’s life that a pelvic floor physical therapist can provide guidance and relief through manual therapy for the symptoms that are due to myofascial dysfunction.
Get the facts about perimenopause in this PHRC blog post by Stephanie Prendergast, MPT.
Finally, as people enter the menopausal and post menopausal chapter in their lives, a pelvic floor physical therapist is, again, an integral member of their medical provider team. Menopause is a pivotal time in a person’s life. During menopause, hormone levels decrease drastically, having a significant impact on bones, muscles (including the pelvic floor muscles!), skin, brain, vagina and vulva. Menopausal people can experience pelvic pain, urinary and/or sexual dysfunction and pelvic organ prolapse. Some of these symptoms are directly related to hormone insufficiencies, but some are related to the changes in the pelvic floor muscle tone and motor control and changes to the surrounding tissues in the pelvis that can be rehabilitated with the guidance of a pelvic floor physical therapist.
Whatever phase of life you’re in, chances are you may benefit from consulting with a pelvic floor physical therapist. You can schedule an in-person consultation at the PHRC location closest to you, or, you can schedule a telehealth appointment with one of our experts.
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page.
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