The Pelvis, defined.
Every human has a pelvic floor, yet pelvic health is a topic that doesn't get enough attention, especially around childbirth. I think it's often assumed, that we as women need to be tough, so suck it up no matter what. Plus, talking about "down there" can be uncomfortable and embarrassing. There are a wide range of injuries and dysfunctions that can happen in the pelvic region, including the pelvic floor. Today I want to highlight some of the most common diagnoses and what they are, specifically surrounding pregnancy and childbirth. This is by no means a comprehensive list, nor is this blog intended to be dedicated to pelvic floor dysfunction. The idea is to briefly define some terms in case this is YOU!
Together we can raise awareness and get these problems solved!
From Urban Dictionary, a mom is the woman who loves you unconditionally from birth, the one who puts her kids before herself, and the one you can always count on above everyone else.
Alternatively (also from Urban Dictionary...), a crazy loon who loves you so much, yet she she drives you insane! She cares for you, but embarrasses you in front of all your friends and makes you want to scream and cry. She is someone you want to throw out the window every so often, but is someone you truly can't live without.
Womens Health Physical Therapy, or Pelvic PT
Most people have never heard of it or don't know what it is. Even your obgyn might not know what a womens health therapist does.
It's a specialty of physical therapy focusing on patients with pelvic and abdominal health issues, this often includes internal exam and treatment of the vagina and rectum. This might include everyone from childbearing women to peri-menopausal mothers, young athletes to men with incontinence, or other pelvic health complications.
Separation of the rectus abdominus muscles (vertically), essentially a gap between the right and left abdominal wall. May see a protruding pooch; Common but not exclusive to women post partum
Urinary and fecal incontinence
In general, incontinence is leaking of urine or feces at an inappropriate time.
Stress incontinence is urinary leakage when there is increased pressure on the bladder, often during exercise, sneezing, coughing, or lifting, etc.
Urge incontinence is urinary leaking when a person feels the urge to go.
Functional incontinence can occur when you can't get to the bathroom in time.
Urinary frequency and urgency
The need to urinate many times during the day, at night (nocturia), or
both but in normal or less-than-normal volumes. Frequency may be accompanied by a sensation of an urgent need to void (urinary urgency).
Pain in the lower abdomen, pelvis, or perineum and is considered to be chronic when symptoms have been present for more than six months
Pubic symphysis pain
Pain at the pubic symphysis (right in between your legs), often during pregnancy, and possibly from misalignment or instability.
During pregnancy hormones that soften the ligaments create less stability through the pelvis, including the tailbone, which can become sore. When the baby passes through the birth canal during childbirth it can cause injury to the tailbone, resulting in bruising, dislocation, or even fracture.
High hamstring pain
This is an injury to the upper (proximal) attachment of the hamstring to the pelvis, and can be from acute traumatic injury (tear or strain), or overuse (tendonitis/osis).
Pain with intercourse (dyspareunia)
Experiencing pain in the vagina or pelvic area during or right after sexual intercourse
A tear involving the perineal tissue and possibly associated muscles during childbirth, that often requires stitches. After initial soreness, the scar tissue can become restricted causing pain once it's healed.
Abdominal pain secondary to scar tissue from surgery
Tender and/or restricted scar tissue which can contribute to dysfunctional movement patterns and pull on surrounding tissues. Can be post any abdominal surgery, but common after C-section
Difficulty emptying the bowels, and often associated with hard and dry feces that can be painful to pass
Pelvic floor or rectal prolapse
Pelvic floor prolapse is when one or more pelvic organs herniate through the vaginal opening, and are no longer fully supported by the pelvic floor.
Rectal prolapse is when the intestine protrudes from the anus.
A type of long-term (chronic) pelvic pain that originates from damage or irritation of the pudendal nerve.
Pregnancy and post-partum
Many women experience aches and pains throughout their body during pregnancy, but commonly in their back and pelvis. This can be contributed to hormonal changes, strength and flexibility imbalances, and a quickly changing body.
Similarly, women post-partum often have pelvis and back pain, partly from the physical demands of childbirth and caring for a newborn, fluctuating hormones, but also from loss of strength, especially through the core.
Lastly, what is a kegal?
A Kegel is a contraction of your pelvic floor muscles.
The APTA Section on Women's Health describes that it is actually performed by a group of several muscles that encircle the urethra (bladder tube), vagina, and rectum. When the contraction is performed correctly, these “openings” of the body should close. No outward sign of effort should be visible with a pelvic floor muscle contraction. For example, you can perform these contractions while standing in line at the grocery store and nobody would know you are doing them! There should be no closing the legs together, no squeezing the bottom, and no pressing your stomach outward. All you should feel is a lifting of those pelvic floor muscles and a slight tensing or drawing in of the lower abdominal muscles.
Sound familiar? If you think any of the above diagnoses could be you, know that it can be treated, don't just ignore it!! There are great resources out there to help women during pregnancy and post-partum, but we have to spread the word!
Here are some of my favorite resources:
Other diagnoses treated by womens health PTs include, but are not limited to: Fibromyalgia, Bladder pain, Endometriosis
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