Monica White, PT, DPT, PRCP Pelvic Floor Health Monica White, PT, DPT, PRCP

Cedar Valley Medical Specialists A little about me Cedar Valley Medical Specialists

What is Pelvic Physical Therapy? Pelvic floor physical therapy involves treating the pelvic floor muscle group, which is responsible for a variety of functions related to the vagina, bladder and bowels.

Common Conditions I treat Urinary incontinence, urgency, frequency Fecal incontinence Constipation Postoperative prostatectomy Postoperative hysterectomy symptoms prolapse of the bladder, rectum or uterus Coccyx pain Irritable bowel syndrome Pelvic and genital pain Pain with intercourse bedwetting in children

What is the Pelvic Floor? The pelvic floor is a hammock of muscles that suspend from the front to the back of your pelvis.

Pelvic Floor Anatomy

Functions of the Pelvic Floor Sphincter Control:The pelvic floor muscles contract to prevent incontinence(leaking), relax to allow us to urinate or defecate. Support of pelvic organs-the pelvic floor forms a shelf holding up your internal organs.---bladder, uterus, colon Postural stabilizer-the pelvic floor contracts prior to or with most movements to assist with postural core stabilization These ‘core’ muscles work to support you during movement like standing

Functions of the Pelvic Floor Sexual Appreciation-The pelvic floor muscles in women must relax to receive comfortable penetration and deliver babies. They are also very important for arousal and orgasm Sump Pump-Functional use of these muscles throughout the day helps pump venous and lymphatic fluid around the legs and abdomen back to the heart for circulation

Okay, so what happens when the pelvic floor isn’t functioning properly Urinary incontinence &/Or fecal incontinence- can be caused by weakness or poor coordination of the pelvic floor muscle No amount of incontinence is acceptable LADIES!

Pelvic Floor Dysfunction Symptoms of Prolapse Frequent UIT/bladder infections Feeling of incomplete emptying Low back pain 50% of women that have had at least 1 child have POP, thought many are asymphomatic Only 10-20% of women actually seek treatment Pelvic Floor Dysfunction Loss of the support system: the ‘shelf’ starts to sag leading to Pelvic Organ Prolapse

Loss of Postural control/stability Stress Urinary Incontinence Diastasis Recti -Pregnancy Stretches out the abdominal muscles Loss of Postural control/stability

Painful Intercourse This is something that I wanted to talk a little more in detail about as it is a common side effect for cancer survivors. Many women are treated with Tamoxifen women diagnosed with hormone-receptor-positive, early-stage breast cancer after surgery (or possibly chemotherapy and radiation) to reduce the risk of the cancer coming back (recurring) Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group.

Atrophic Vaginitis  Atrophic vaginitis is a survivorship issue that affects nearly 70% of postmenopausal breast cancer survivors as compared to 50% of postmenopausal women without breast cancer 

Vaginal Atrophy Thinning, drying and inflammation of the vaginal walls due to your body having less estrogen.  Vaginal atrophy occurs most often after menopause. For many women, vaginal atrophy not only makes intercourse painful, but also leads to distressing urinary symptoms- urinary frequency and urgency

PT Treatment for Atrophic Vaginitis Manual therapy Biofeedback Use of Vaginal dilators Education on vaginal moisturizers and lubericants.

TAKE AWAY POINTS On average it takes a women 6.5 years to speak to her physician about urinary incontinence 50% of women that have had 1+ child will have a POP, only 10-20% seek treatment. Of those that have have surgical repairs, 29% will require another surgical repair at some point in their life Use of biofeedback, manual therapy and vaginal dilators can improve painful sex and even better there are no side effects to these treatments!