You do what again?? Where?? WHY??
What is Women's Health Physical Therapy?
Women’s Health Physical therapy is a specialized physical therapy practice. Physical therapists are trained to look from several different perspectives at the patient as a whole. The therapist is certified with unique training to address and assess the body as a whole including the spine, hips, abdomen, pelvic floor musculature, legs, pelvic bones and even the viscera (guts!). An internal assessment of the pelvic floor is unique to this niche which allows us to determine strength, coordination, connection, muscle tone, and sensitivity of the region. Some are trained to treat males and females but I am only currently treating women (which is why I call it Women’s Health though it is synonymous with Pelvic Floor Physical Therapy). Your Physical Therapist will ask you questions about your symptoms related to peeing, pooping, sex and overall pain as it pertains to your goals. It's not as scary as it sounds and our training only allows us to more fully address all aspects of the body!!
Like what? Here are a few of the “stories” we often see…
Let's say a woman has had frequent urinary tract infections. She goes so often that the doctors just write her a prescription of antibiotics and as soon as they're done- within a week or so her symptoms come back. Frustrated, she goes to the MD and this time it's another doc who makes her do a urine test. Surprisingly, the urine tests negative!! She is furious they will not give her more antibiotics and she is having pain. What now? Can a WH PT help with that?
YES! Often we see that the tissue round the bladder, muscles around the urethra and even through the belly can create more tension and become inflamed from frequent bladder irritation and infections. Performing manual techniques (hands-on techniques) can help with this. Also learning triggers and getting help figuring out the "WHY" behind the bouts can really help give you control over your symptoms as diet, stress, and other lifestyle changes may contribute.
Let's say a woman has had pain with intercourse since her first time with being intimate with her husband. She tries and tries to relax and enjoy it but just doesn't seem to be able to. She gets frustrated with how her mind and body are not doing what she's feels like she should just "do." Because of this self-doubt, she begins to doubt her relationship and feels she is less of a woman because she cannot enjoy sex. It even gets to the point where she dreads date-night and the expectation of sex that comes with a night alone. What can PT do to help?
This is a sensitive subject. Sometimes there are things in the woman's past she needs to address such as an abuse situation or something to have created an unknown muscle spasm (fall on her tailbone for instance). Often, if she can reflect and figure it out, this can be a huge help in determining our course of action. She may also need some help with general core activation or over-activation, spine mobility, breathing and relaxation techniques, or/and pelvic floor release to suggest a few. Occasionally, education on lubrication, foreplay and other tips to help her feel more relaxed can be discussed. What we know about pain science is that when we associate pain with a movement or action, we tend to physically react to it (in this case most likely perform a pelvic floor contraction) even if it's not really going to hurt. We will work on trying to get her to recognize this and work on identifying the source of pain (Scar tissue? Pelvic floor muscle spasm? Prolapse? Hypersensitivity?). Physical therapy can definitely help with this and should be one of the first lines of action when identified.
Let's say another woman reports worsening symptoms with standing at work as a nurse for her 12 hour shifts - symptoms that feel like her bottom just feels heavy, something wants to fall out or even when she urinates, she feels like she has to push something back in to help the urine flow. She is able to work out and may leak occasionally with coughing or sneezing but her main concern is that her back hurts on her long work days as well. Her OB/GYN reports that she has a prolapse and that it's not bad at this point but she is concerned it will get worse because as a nurse, she is in the medical field and has a good understanding of the body. She has followed a PT on Facebook and tried Kegels but still doesn't feel like she's able to make any changes. What now?
This patient is most likely experiencing symptoms of pelvic floor weakness or pelvic organ prolapse. This occurs when the pelvic floor muscles are not as strong and are not able to hold her organs up and in as they once did. She can be evaluated by the PT to determine if the pelvic floor muscles, abdominal muscles, hip muscles and spine muscles are strong enough or if they are firing on demand, in sequence, or coordinated manner. She will also be evaluated for proper lifting techniques as bearing down with lifting can lead to this type of issue. Breathing, posture, and general movement will be addressed to see if there are other things she can do to reduce strain on the pelvic floor. Most of the time the pelvic floor contractions performed are not being performed at a high enough volume to make a difference or they are being performed incorrectly (most often seen!!).
Let’s say another woman has just had her second child. She had a C-section with her first delivery and even ran a marathon a few months before she became pregnant with her 2nd. She was able to deliver vaginally with her second and doesn’t recall needing more than a couple stitches after delivery. She wants to get back to running but she notices a separation in her belly muscles. She reads a lot online on this belly split and pelvic floor strength and really wants to get things "right" before training and starting back into running more consistently. Who is the best to turn to as her goal is to run again and feel strong?
A PT of course! That’s a great patient for a WH PT. We are able to assess her pelvic floor, core and overall posture. She will most likely need to be given some specific core retraining exercise to help the deep core muscles turn back on and create tension across the abdominal muscles. Once this is taught, she can be progressed to higher level activities and exercises or a Pilates class. She just needs to be aware of things that make the belly bulge and can worsen these symptoms. Bowel and bladder health are important as she begins to run as well and we want to make sure her muscles are strong enough to prevent incontinence or prolapse. Mama's can start as soon as delivery to reconnect breath and their pelvic floor and a PT will help you to make sure you are doing this correctly!
Another women reports every time that she laughs really hard she has to go pee - to the point where she has to cross her legs if its such a hard belly laugh! This is definitely embarrassing as she's been at the gym and performed a squat with some leakage too. She report jumping on the trampoline with the kids and having a little trickle too. Coughing and sneezing during allergy season are awful. She is almost to the point of where she feels like she needs to wear a pad EVERY day. She reports trying to do her kegels too but isn't sure if she's doing them correctly and feels frustrated that she can't lift her normal weights like before for fear or leaking. Is she resolved to use adult diapers or thick pads for the rest of her life?
NO!! Women's health physical therapists are trained to assess her techniques with the pelvic floor contractions during a cough, sneeze, lift and other movements. SOME people do NOT need Kegels, while others do. She may be holding so tightly creating more tension in the pelvic floor and even into the inner thighs for fear of leaking, the muscles are not able to actually contract when they are needed to control the urine. Others have a sequencing problem and the muscles are not weak but just do not turn on at the right time. While there are still some who purely need help figuring out how to perform a Kegel/pelvic floor contraction appropriately , there are also some needing to increase the endurance, control, sequencing, and force of their pelvic floor. Just think - who else is better at addressing this? WHPT can look at your back, pelvic floor, hips, core, abs, legs, breathing patterns, lifting patterns and general posture to help YOU determine if where your system is not ideal. Bear in mind, our body is slow to remember and we just need CONSISTENCY! This is often why we tend to get frustrated with the process and give up way before our muscles are given a chance to appropriately improve in these matters.