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

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

3. 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.

4. 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

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

6. Pelvic Floor Anatomy

7. 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

8. 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

9. 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!

10. 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

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

12. 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.

13. 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 

14. 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

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

16. 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!