A ring of fire. That’s what it can feel like.
You have pain with inserting a tampon. You’ve always dreaded pelvic exams because they hurt. Every time you try to have sex it burns and stings. Sound familiar? Pain with sex may be due to a lot of reasons – one of those may be vulvodynia.
A bit of history – pain with sex has always been an issue, but the cause has not always been well-known. It’s really only the past 20-30 years that our current understanding of it as a condition has been truly recognized, labeled, studied and appropriately treated. Knowing the true cause of the burning is critical in successfully treating it.
What is “Pelvic rehab” anyway? Basically we help the pelvis work right. It may be defined generally as physical therapy to restore the pelvic region to a more functional and/or less painful state. Pelvic rehab treats anything from pain to leakage to lack of coordination. Treatment of bladder, genital, abdominal, pelvic girdle and bowel dysfunction with physical therapy is well-studied and proven effective (especially incontinence, prolapse, urgency and frequency). It is thrilling to know we can regain control over our bodies, in many cases without surgery and medication. Physical therapy is one of the least invasive and most beneficial methods for treating functional abdominal, bowel, bladder and sexual dysfunctions.
Do you just treat the pelvis? The pelvic region encompasses the areas from the abdomen/mid-back to the upper thighs (this includes all of the organs, muscles, nerves, joints/bones, connective tissue and lymphatics). Evaluation and treatment for pelvic conditions should include more than just the pelvis. Complete treatment must address issues from head to toe since all areas of the body affect each other. Effective treatment also may include more disciplines than physical therapy alone. A good PT will address all aspects of care required for a client’s full recovery, including working closely with other providers (physicians, performance specialists, counselors, chiropractors, massage therapists, nutritionists, etc).
As much as we would like to avoid the topic, poop happens. Or in many uncomfortable cases, it doesn’t. According to the statistics, approximately 20% of adults between 40-75 have constipation. And those numbers are just the base level, run-of-the-mill, stopped-up versions. The actual numbers increase significantly with additional factors:
- Older > Younger
- Female > Male
- Psychologic factors – stress or anxiety
So are you constipated? Many consider themselves not to be constipated if anything at all is coming out. However, the actual Rome IV definition (most recent consensus of the medical community – May 2016) might surprise you.
In addition to leaking, why do I have to go to the bathroom more often (urgency and frequency)? Why does almost nothing come out when I get there (hesitancy)?
There are many causes for urinary frequency, hesitancy and urgency. Although they may seem to be opposing symptoms, frequent voiding and urinary hesitancy may actually drive each other.
Regarding urgency/frequency: When the bladder is emptied too often (or not enough), the bladder itself may become less compliant. That compliance, or flexibility within the bladder walls, helps define when the body senses urgency. To clarify: the bladder is really a small muscular sack that stretches as it fills with urine. It needs to be stretched to a certain point to trigger urgency (correlating with bladder contraction). If the bladder is emptied too often (or conversely, not enough), then the ability of the bladder to register that “critical point” is lessened. The body will send signals that it is “time to go” by starting bladder contractions at inappropriate times, either before necessary or way too late. The result may become frequent urinary urges.
Regarding hesitancy: Since the bladder contracts when it should not, it also relaxes inappropriately. This can lead to urinary hesitancy and retention. The bladder starts to release the urine, but then the urethra closes and/or the bladder stops contracting to push the urine out. Included in this scenario may be contractions within the urethra itself, preventing full release of urine. One danger of retention is that some urine may remain in the bladder, leading to an increased risk of bladder infections.
Urge, stress and mixed UI all respond very well to physical therapy interventions, usually with a high percentage of improvement noted – if not complete resolution of symptoms. The outcome of further medical interventions, should they be necessary, will only be helped by strong pelvic floor training. Just as someone having knee surgery is encouraged (or even required) to get physical therapy for a few weeks prior to surgery, the pelvic region also benefits from a little “advance training.”
Only you and your doctor can determine the best route for your particular condition. No matter how long it has been going on, symptoms CAN improve! Should you have any questions regarding physical therapy for UI, hesitancy, frequency or other pelvic conditions, please discuss it with your physician.
Your doctor will discuss various medical interventions appropriate to your condition that may include medication, surgery, or uroplasty.
Should she prescribe physical therapy for UI, your initial PT evaluation visit will include a thorough history followed by an orthopedic and pelvic examination that determines pelvic floor strength and coordination.
In treating urinary incontinence, physical therapy interventions are directed toward the pelvic floor muscles first. Appropriate use of the pelvic muscles is required to reduce leakage regardless of the cause.
Therefore, your subsequent physical therapy treatments will likely include some combination of the following:
- Instruction in urgency control techniques. There are simple, effective methods for getting those sudden, strong urges under control (often without surgery)!
- Training of pelvic floor muscles (those muscles that surround the urethral/vaginal openings). This may include manual training, biofeedback, vaginal weights, and modalities to increase coordination and strength.
- Instruction in bladder health, dietary considerations, and lifestyle modifications to reduce urinary frequency. It is impossible to treat a condition by only addressing the muscles – dietary influences and years of habitual training may need to be addressed for full success in bladder retraining.
- Training in body mechanics to reduce strain on the pelvic muscles and organs. Increased strain on the pelvic organs and pelvic muscles due to inappropriate body positioning or movements may reduce the body’s ability to maintain continence and increase prolapse.
- Instruction in techniques to reduce nighttime frequency, urgency and leakage. Decreased leakage at night is often one of the first areas of improvement noted with conservative measures.
The most common types of UI are “stress,” which involves increased abdominal pressure (sneeze, cough, laugh, etc) and “urge,” which is accompanied by urgency and/or bladder contractions. Mixed incontinence has both stress and urge components. This is the most common form of UI, and people will exhibit a higher percentage of one component over the other. For example, you may have frequent, sudden strong urges with leakage most of the time but occasionally also leak with a strong cough. That would be considered mixed UI with urge dominance.
Urinary Leakage, Urgency and Frequency – A Physical Therapy Perspective
Some feel that if urinary leakage is infrequent or only happens a few drops at a time, then it’s not considered incontinence. In fact, urinary incontinence (UI) is defined as experiencing involuntary loss of any amount of urine, at any frequency. Leakage does not result from “just getting older” and should not be regarded as inevitable. It is a physical condition that is treatable. If you find that you are going to the bathroom all the time just to avoid leakage/urgency then you likely fall in the UI category as well.
The list of websites below is not meant to be exhaustive, but they are each reliable sources of information and support.
- PopUp Lifting is an amazing online exercise program designed for women with prolapse. It’s run by Haley Shevener and Annemarie Everett, PT. It’s an amazing, informative program – lots of options!
- Intimate Rose is a company that helps all-things-pelvic. It includes resources for education, supplies, and many other pelvc-related. Using this link gives you $5 off too!
General Men’s / Women’s Health:
Pelvic and Abdominal Pain:
- www.nafc.org – National Association for Continence – information regarding products, treatments, professional listings.
- www.aboutincontinence.org – website spin-off from IFFGD for urinary dysfunction.
- www.iffgd.org – International Foundation of Functional Gastrointestinal Disorders website for information regarding bowel, colo-rectal, abdominal dysfunction.
- www.awomanstouchonline.com – Website for sexual health – books, supplies, information.
- http://tallirosenbaum.com/en/blog – Great website, blog, information source for all things sexual health. AASECT certified sex therapist – leader in national and international education regarding sexual health.