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“It’s all in your head”: Our Top 5 Myths of Women’s Health Physiotherapy

In today’s day and age where information is literally at our finger tips via your smart phone, laptop, and all other technology, it is no surprise when clients come into the clinic armed with excellent information.

However, it is far too common that out-dated information, old wives tales, and unfounded statements are being perpetuated. As with all information, we must be a consumer of information. How do you know what you are reading online is accurate, up-to-date, evidence based, current and progressive for treatment and care? Unfortunately, creating a critical mindset towards what is being presented, and for what purpose, and by whom, often is not taught in school until AFTER reaching university. What does this lead to? Potential difficulty consuming information.

Regrettably, it’s not just the world wide web that is spreading misinformation and falsities, but other well-meaning family members, friends, and, healthcare providers. How does this happen? Some providers must know information across a wide variety of areas, whereas some providers practice in very specific areas or specialties. In both instances the provider will have difficulty either a) keeping up with all the new information coming in through the large variety of areas they need to know or b) they are very well informed in their area of specialty, but haven’t kept up in other practice areas.

For our women’s health, prenatal and post-partum clients, we have seen a trend of misinformation come in that we would like to address piece by piece to help those that may be experiencing similar issues/symptoms figure out what is best for them.

 

Pain during pregnancy is normal and will go away after delivery

Often our prenatal moms come in with significant pain. Ranging from pubic symphysis pain (‘lightning crotch’, groin pain, etc) through SIJ pain (low back and pelvic pain) and sciatica (pain radiating down the leg) to name but a few common pregnancy-related complaints. Although pain during pregnancy is common, it should not be considered normal. We are often explained that during pregnancy the hormone relaxin ’causes’ pain – however, if this were the case, and relaxin is produced during every pregnancy, then wouldn’t every woman who is pregnant be painful? We know that this is not the case, so why do some women become painful and others do not? In my clinical population I have observed many women who are pregnant that are painful, with the start of their pain experience ranging from within the first few weeks of gestation to the last few weeks. The commonalities between these women with pelvic girdle pain in particular, is a combination of muscle length and strength imbalances around the pelvis (muscles that are tight and/or weak), common posture issues (think the typical ‘pregnant’ stance), and activity levels throughout the day (whether that be not enough or too much).

The good news is, pain in pregnancy is NOT necessarily normal! There are many factors that can be addressed, and truly our bodies are very capable of adapting and changing (I mean they grow tiny humans, that’s pretty amazing). When I was taking my prenatal courses while in the Master’s program, we were still being taught that women who are pregnant could not improve, but we could prevent them from getting worse. In a mere 7 years this dialogue is changing; women who are pregnant can and do improve and often resolve pain during pregnancy when appropriately addressed with conservative treatment such as physiotherapy!

How well we are able to do with each client depends on a multitude of factors: what do you need to do on a daily basis, how many weeks gestation are you, what is your pain level when you get started, did you have pain previously or is it new, and of course, how well are you able to do your provided homework?

Pain with intercourse post-partum is normal – just have some wine and relax

As a pelvic floor therapist, I am sad to say I have heard the recommendation for our clients with dyspareunia (pain with intercourse) to ‘just have some wine’ more times than I have kept track of. This sentiment is often expressed when clients get the courage to bring it up to friends, family and their healthcare providers; usually along with a ‘with time it’ll get better’.

Dyspareunia is something that again is common after labor and delivery, but is not normal. To the surprise of many, this pain can occur in those that have had vaginal deliveries with or without tearing, as well as those that have c-sections (scheduled or emergency). Often when we approach medical providers about dyspareunia, they search for a medical cause such as an infection. When there is no medical cause, women will begin to feel the ‘it’s all in your head’ message.

With a physiotherapy perspective, dyspareunia is approached much differently. In my clinical practice I often see women with pelvic pain that have very tight muscles of the pelvis and pelvic floor, restricted movement through scar tissue (either from the perineal tearing or c-section), as well as a variety of postural changes. Very often, it’s these tight muscles that will recreate ‘the pain’ when palpated (on internal and/or external exam). When the clients’ multiple factors are addressed such as muscle tightness, weakness, postural changes, scar mobility and breathing coordination, the dyspareunia is often improved/resolved. Contrary to our all too common advice to just ‘have some wine’, there are many factors that can be addressed with physiotherapy by a trained pelvic floor therapist. Which brings us to our next point…

You are leaking when you cough/sneeze – do your kegels

I am so thrilled to see an increase in awareness and discussion within a variety of groups and campaigns in regards to pelvic floor! The most common discussion is about leaking, usually with cough, sneeze, lifting, jumping, exercise etc (aka stress urinary incontinence). This is where typically women are told to ‘do your kegels’. GREAT! What does that mean? Often when I am seeing clients in-clinic, the understanding of kegels is incomplete – women are aiming to squeeze the pelvic floor for at least 10 seconds, 10 times in a row since that’s what they had read online or in a magazine. I ask – when you try to strengthen another area of your body, do you squeeze it (make it tight in a single position such as tightening your thigh muscle without moving the knee), hold for 10 seconds, pause and then repeat? I also wonder – when receiving this advice has anyone completed an assessment to check what the problem actually is?

I frequently discuss with my clients how differently we approach pelvic floor health versus the rest of the body. If someone comes into my office because their knee hurts, they expect for me to watch them walk, squat, and move in a variety of ways themselves, have me move it for them, take a look at all the muscles, ligaments and surrounding tissues as well as ensure they are doing whatever exercises or stretches I provide them with properly before going. When people come in for a pelvic floor issue, we are often expecting to receive advice, but do not expect to be touched or examined. Clients would not be happy if they came in and I didn’t once look at their painful knee, so why is it acceptable to expect to have no exam of the pelvic floor? A discussion for another day. Why is the exam important?

Pelvic floor analogy: if someone came into the office with an elbow that was stuck in a bent position (because the biceps is too tight), and their complaint is that they are unable to straighten the elbow to catch their cell phone for instance as it falls off the table in front of them (ie leaking), would strengthening the biceps muscle (ie kegels) be helpful? Likely it will not help, and more often than not, a worsening of symptoms may be observed. This is why it is not surprising to me as a therapist when people come into the clinic and their ‘kegels haven’t worked’. Analogy 2: if the pelvic floor to be functional needs to contract AND relax (think the arm bent as contracted and straight as relaxed), does training that muscle to squeeze help it to bend? Not likely. The pelvic floor needs to lift up and in when contracting, and move down and away when relaxing in order to be functional. To top it off, it also needs to have appropriate coordination with the rest of the muscles of the abdomen and pelvis in order to have optimal function. Having a pelvic floor that’s functional without addressing any other postural or coordination issues of the abdomen is like having a perfect pop-can bottom with crumpled sides and top – it’s just not going to be able to do it’s job.

This means, that each client will have a similar, and yet very different treatment approach to leaking. Although many things look the same, with the majority of my clients having a tight pelvic floor (possibly from all the 10 second squeezes we’ve been doing over the years), the underlying cause of tightness is extremely variable.

Having a diastasis means you’ll always look pregnant

First, what is a diastasis recti? This is commonly referred to as the ‘splitting of the abdominal muscles’. Related to women who are pregnant and post-partum, there are now countless ads, programs and ‘healing’ strategies that are being pushed on women to get rid of their ‘mummy tummy’.

I argue that almost 100% of women who are pregnant, that look pregnant at the time of labor and delivery, will develop a diastasis. The diastasis is meant to allow the growing fetus room as the belly expands rapidly, the rectus abdominis (6 pack ab muscles) just doesn’t stretch quickly enough. The size of the diastasis will be dependent on many factors such as the size of the client, the number of fetuses, how many children they have had, etc. There are things we can encourage prenatal to theoretically decrease the impact of the diastasis, including rolling to the side before sitting up, and eliminating exercises that cause what I refer to as ‘tenting’ of the abdomen (if you’ve ever seen the v-shaped tent on your tummy when you go to sit up – that’s your diastasis). The real changes and major impacts happen post-partum.

The size of the diastasis, the amount of space between the muscles, is what the majority of women who come into my clinic are worried about. “How BIG is the GAP?” “Has it CLOSED enough yet?” In my clinical experience the size of the space is not as important as what the muscles are doing. The function of the muscles is key;  both independently, and as a working group of muscles. This is where everyone wants a short answer “What should and shouldn’t I be doing?” “What exercise is going to fix my diastasis?” – and this is where I say; I won’t know unless I am able to do an exam. Not all bodies are created equal and some bodies adapt much more quickly than others from a rehabilitation and healing stand point. This means that for one client doing something like a down-dog in yoga could create excellent and appropriate tension, whereas the next person it could be very dysfunctional and problematic.

If we imagine the diastasis like a zipper that’s undone, the zipper being down doesn’t matter so long as you aren’t straining into it with the abdomen from behind (pushing into the open zipper). Think of doing a crunch, when you go to lift your head and shoulders off the ground what does your tummy do? Does the tummy stay relatively flat while you move, or does it push/balloon forward and become more round? From a movement perspective your tummy should not push forward as you do ‘core’ exercises, and this can be an indication of dysfunction and a potential factor for pain and problems. Now, someone may see me at the clinic and have a 3-4 finger ‘gap’ but be able to keep the abdominals coordinated without any pressure forward, whereas another client may have a 1-2 finger gap but be unable to hold appropriate tension.

Endometriosis – young girls, women; painful menses is ‘normal’

A diagnosis for endometriosis requires a surgical procedure to examine for the presence of lesions of uterine-like tissue outside of the uterus. What happens is this tissue continues to work the same as the tissue that is within the uterus, and can lead to fibrous tissue and issues within the pelvis. Often women live with common symptoms of endometriosis starting in their teens and it takes years to achieve a diagnosis. In addition, young women and teens often have difficulty being believed about the pain that they are experiencing.

Although physiotherapy cannot change endometriosis, just like we cannot reverse arthritis, there are many factors that a therapist can look at to help manage, reduce and improve symptoms. Think of the first thing you do when something is painful, say get a paper cut on your finger. You will pull the hurt hand/finger into your body, grasp it with the other side and squeeze. This instinct to protect the area that is painful is pretty universal throughout the body. What will this increase in tone and tension of the surrounding muscles of the pelvis do when repeatedly, month after month, the pain continues to return, do to the muscles? Determining the underlying factors, which muscles are more tense, what the surrounding tissue is doing, and helping come up with a home program can be beneficial in managing pain. Just as addressing muscle length and strength imbalances around an arthritic joint can make a difference in the clients’ pain, it doesn’t change the arthritis, it changes some of the other factors.

Managing these symptoms as soon as possible, will help to reduce the chronic pain cycle that often develops and persists for years.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Officially adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Adding pediatric pelvic floor. Warman Physiotherapy & Wellness has been nominated as a finalist for the 2018, 2017, & 2016 WMBEXA, is a WMBEXA award recipient of 2017, and a finalist in the ABEX 2017 & 2016, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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Why is Continuing Ed so Important? Reflecting on The Female Athlete Course

At Warman Physio our therapists focus on excellence. Providing excellent, comprehensive, up-to-date care, as well as a personable and compassionate care.

This is why going to courses, reading research, is so important… and being a little bit “nerdy” comes in handy 😉

 

This past weekend I took a course from Antony Lo, an outstanding therapist and physiotherapy educator from Australia, called The Female Athlete. This course was designed to challenge the status quo on current standard practice recommendations for women’s health related to Diastasis Recti, Prenatal, & Postpartum care.

During this course my belief system was challenged in some ways, and affirmed in others. My take-away from this course? First, we need more research in pretty much everything – we have far more questions than we do answers, and although we would like to have specific YES and NO answers for our clients’, everyone is individual with unique needs (not surprised here!) – basically, you are your own person, and the rules may not apply, and may need to be broken in your instance.

Another thing that we need to consider is pain. What is pain exactly?

 

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

What does this mean? Sensory and emotional experience – does anyone find they have more pain when they have more stress? How about if you have pain with something that doesn’t actually damage your tissue – like when your foot falls asleep and you get the painful pins and needles. We do not need tissue damage for pain, and no matter what is going on, your pain is exactly that, YOUR PAIN. Not the therapist, not your family, yours. No one can tell you that you don’t have pain, because it is your experience alone. Because of this reason, some pain can be resolved and changed very quickly, and some may take longer.

Last, our bodies are extremely strong, capable, adaptive, and resilient (SCAR)! We can change our perspective and make our weaknesses into strengths.

It boils down to WHY is continuing education so important? Why do we at Warman Physio put such an emphasis on continuing education? The answer is that it is our belief that being up to date, learning new information, making sure we are at the forefront of practice changes benefits our clients. We are open to education, views that challenge our current beliefs, and learning something new in expected, as well as unexpected ways. There are more ways than one that I find myself learning not only from colleagues and coworkers, but also from my clients and those I meet in day to day life. The curious mind, and attitude of intrigue, and being able to take new information and integrate it into practice is something that at Warman Physio we are striving for, not just on weekends we are learning formally, but every single day!

Do you think this is AMAZING? Have some questions? Want to tell me how it resonates with you? Send me a message!

 

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2018 WMBEXA, is a WMBEXA award recipient of 2017, and a finalist in the ABEX 2016, 2017, & 2018. Haylie was also recognized as YWCA Women of Distinction for Health & Wellness in 2017. 
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A Journey with Endometriosis… From someone WITH Endo

For Endometriosis Awareness Month, we wanted to give our readers a true story to hear from. The individual that wrote this story has not been seen at the clinic, and is in no way affiliated with Warman Physiotherapy & Wellness. She, like many others, wants to raise awareness, give some of her symptoms, and hopefully, help people understand that pain is NOT normal. Onto her story….

My journey with endometriosis began many, many years ago. I just didn’t know it. As a teenager I was riddled with crippling periods involving an extremely heavy flow, and excruciatingly painful cramps that I remember eating handfuls of Midol to help get through the day. I was told “welcome to being a woman, this is normal”. Hindsight is 20:20. It was the furthest thing from normal. Thankfully, I was put on birth control, which seemed to make my periods manageable. My actual diagnosis of endometriosis was not until Oct of 2017. 6 Months prior to this I started developing excruciating stabbing pains in my right lower abdomen. A walk in doctor triaged me to the emergency room thinking my appendix had ruptured. Blood work showed no signs of infection, IV pain meds were given and an x-ray image did not show anything concerning. I was sent home with pain meds and told that I needed to poop. Exactly one month later (a month between my period) I ended up in excruciating pains where once again I ended up in the emergency room. This ER doctor again thought for sure it was my appendix but this time ordered an ultrasound. The ultrasound showed a 4cm hemorrhagic cyst on my right ovary. I was sent home with pain meds, and another ultrasound requisition. I was told to go see my family doctor in 6 weeks. I was told that a hemorrhagic cyst is nothing to worry about that it can happen with ovulation. My anatomy background and my knowledge of how a body works from also being a vet tech gave me a feeling that something more was wrong. The pain experienced during this time nearly made me pass out. Breathing hurt so I would hold my breath. I knew something wasn’t right. A 2nd ultrasound 30 hrs later showed that my cyst had grown by a couple of centimeters but that the radiologist wasn’t concerned as it’s just a hemorrhagic cyst and they can happen during ovulation. I wasn’t ovulating, I was at the end of my period. Something wasn’t right.

 

I have a really amazing gynecologist. Let me say that again. I have an amazing gynecologist. When I went into pre-eclampsia with my daughter, this gynecologist delivered my daughter and I met the most compassionate doctor who actually listened. I knew I had to get in to see her and that as long as I could get in to see her everything would be ok. But of course because I hadn’t seen her in over a year I would need a new referral. Off to another walk in dr. Unfortunately, my gynecologist didn’t have an available appointment for months. My stomach ached, and my guts ached, I would bloat up as if I was 8 months pregnant. There was a time at work where I came to work wearing jeans and by the end of the day I left in scrubs because my button wouldn’t do up. I begged the receptionist to send my gynecologist a message, begging her to understand that every month I will end up in the ER from passing out pain due to this “no big deal cyst on my ovary.” My compassionate gynecologist heard my message and within days, I was booked an appointment with her. She ordered more tests, another series of ultrasounds. Cysts usually burst and go away or at least shrink; mine wasn’t. I was still having daily pelvic pain, daily gut aches. I was put on a birth control to hopefully stop my cycle and stop the stabbing/ passing out pain that came at the end of my period. My gynecologist mentioned that she thought I had a disease called endometriosis. I had honestly never heard of it before. I went home that night and did what most people do– I took to google. Symptoms of this disease was pelvic pain, which I did have prior to these episodes but chalked it up to the many bladder infections that I’ve suffered from. Extremely painful periods was another symptom, which again I had when I was not on birth control. Surely, this disease couldn’t have started at the age of 16. I kept reading, “many women with endometriosis suffer from infertility.” 2 years prior, I had a beautiful baby girl so I couldn’t much relate to that. Back pain can also be a sign of endometriosis. Sure, my back hurt, but I had also been diagnosed with scoliosis of my spine years earlier so my back pain was from that. “The feeling of your insides being pulled down”. My gynecologist asked me during one of my appointments how I was feeling. I told her “it’s like I’ve eaten Chinese food for all 3 meals a day. Like my guts are just so heavy they are all hanging below my belly button.”

I wasn’t convinced. I kept thinking that this disease would have shown up on my previous CT scan, my previous abdominal ultrasounds I’ve had for a tumor I have in my liver. Surely, it would have shown up when I had a previous laparoscopic surgery to remove my gall bladder.

I went in for surgery in October to have this cyst removed. Upon waking up from surgery, I was told I had endometriosis bad. Really, really, bad. I was told that it was so bad another surgeon had to be called in to help. I heard the words “you are the worst case of endometriosis I have ever seen”. My surgeon(s) spent hours cutting out the endometriosis that they could. They removed the cyst on my ovary that was larger than my uterus. They spent hours and hours cutting off endometriosis off major blood vessels, my uterus, this cyst. I was told when they opened me up they found a pool of blood in my abdomen. That is the thing with endometriosis, when you have your period and shed your endometrial tissue from the inside of your uterus, your endometriosis that has grown outside of your uterus also bleeds.

The bad news didn’t end there. If someone is going to have endometriosis it usually stays in your pelvic area. Attaching to and growing on your uterus, ovaries, bladder, colon, pelvic floor. In rare cases, endometriosis grows outside of the pelvis. I happen to be one of the rare ones. Many, many endometriosis lesions were found along my ribs and my diaphragm. My gynecologist had no idea that I had this disease this bad, and neither did I. After all the first ER doctor told me that pooping would solve all of my pain.

I read online that someone compared endometriosis to cancer. That it can spread like cancer does, the only difference is that there is no cure for endometriosis. There were days I was in denial that the diagnosis seemed like a bad dream. The one thing that brought that dream back to reality is that I still suffered pain. You see this disease has two options, cut it out and try to suppress it with medication. I am doing both. And yet it seems with myself and many others even with excision surgery and suppressive medication, there is still pain.

I look back at my journey of my diagnosis and I thank God each day that I did not accept “it’s nothing to worry about” for an answer. Thank God I insisted on seeing my gynecologist sooner vs months later. I am thankful every day for the medical background I have in my personal career that gave me the knowledge that “something isn’t right.”

 

 

My journey with endo isn’t over, I don’t think it will ever be over. I will be on hormone suppressing pills for the rest of my life. I will have more surgeries in the future, some life threatening ones where they shut down your lungs one side at a time. I’ve been sent for MRI and CT scans to see if they can find endo in my lungs. Yes, this endo can invade your lungs. I’ve often told people that endo is a silent disease. From the many support groups that I have joined; I’ve learnt that it’s not uncommon to go years without a proper diagnosis. Endo isn’t always detectable on MRI, CT, Ultrasounds, or X-rays. A laparoscopic surgery performed by an endo specialist is the proper way to diagnose endometriosis. I’ve even heard of some peoples endo only being found under a histological biopsy.

 

I truly believe there needs to be more endometriosis awareness seeing as how 1 in 10 women suffer from this disease. Heck, I was that 10% and I didn’t even know it. I am very open with others about my endometriosis hoping that maybe I can raise awareness and make someone realize that pain doesn’t have to be “being a woman.”

 

Wonder how Physiotherapy can help you with endometriosis? We will be completing our follow-up on what physiotherapy is capable of assisting with for those that have endometriosis before the end of the month. If you want to start now, schedule in with Kendra HERE.

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POP: Getting Those Pesky Organs to Stay Put!

This past weekend I received several messages related to pelvic floor dysfunctions that are not being taken at face value. “Well you’ve had kids”, “it’s all in your head”, “this is a psychosocial problem not  a physical problem”. I have said it before and I will say it again, women need to be listened to, trusted, and most importantly, respected when they bring problems to healthcare providers, family, and friends. Although it may seem helpful to say that “this is something that happens when you have had kids”, it can be less than helpful AND is often not the case.

Pelvic Organ Prolapse (POP), is becoming a more well known topic of discussion in various mom groups, and in particular postpartum fitness groups. A large part of the impression I get as I am tagged, mentioned, and participating in these various forums is there seems to be significant panic associated with POP. People become paralyzed, hyper vigilant, and fearful of movement (also known as Kinesiophobia). So let’s break it down to dispel some of the hysteria that seeps into many pelvic health related issues.

Your top three organs that prolapse are (typically) your bladder (cystocele), your rectum (rectocele), and your uterus (uterine prolapse). Although most commonly occurring after child-birth, even those without children can have POP. Let’s focus on pregnancy and post-partum phase.

During pregnancy your uterus grows from approximately 5cm in size (which would hang out below your pubic bone), to what seems impossibly large to house the tiny little growing miracle (all the way up to the rib cage). This feat in and of itself does a few things, but thinking of organs specifically – they get moved, pushed and pressed all over the place because there just isn’t room.

How is this possible? Imagine your organs are like little boats at the dock. The boats (organs) wouldn’t do well in inclement weather (movement) if they were tied tightly or cemented to the dock; instead they have ropes (ligaments) to attach and hold them in a relatively stable position relative to the dock (abdominal wall/pelvis/ribs), and the other boats. Your organs aren’t cemented in place either, they essentially float being guided by ligaments, general positioning and support from other organs and the pelvic floor, as well as all the other connective tissue. So, when you are pregnant and the uterus is forging its way through the pelvic and abdominal cavity, everything else is able to move into new positions to compensate.

 

Once baby is born (vaginal or C-section), the organs suddenly have a lot more space to move around in – their ligaments and fascia have stretched, and there is no longer a tiny human occupying the extra space. As everything settles into a ‘new normal’, if everything is coordinating well, the organs will be situated in a similar position to pre-pregnancy with some slight variance. If the pelvic floor isn’t able to support, or other muscles around the rib cage are having difficulty relaxing, we can get changes in pressure that contribute to pushing these organs down and create POP and various symptoms.

What do we watch for? Feeling of heaviness, falling down or falling out, pressure, discomfort, or bulging, difficulty inserting a tampon, or keeping a tampon in, are all common complaints of POP.

There is much that Pelvic Floor Physio can do to assist with POP, and in many instances resolution of symptoms is possible.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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What YOU want to know about the Pelvic Floor: Part 1

Q: How do I know if I should see someone?

A: There are many different signs or symptoms that children, women and men can watch for to know if they should be seeing a pelvic floor therapist. Some of the big things to think about include:

  • leaking (urine or feces)
  • urgency and frequency (many trips to the bathroom, or getting to the bathroom and voiding small amounts)
  • pain with intercourse
  • pressure in the pelvic floor
  • feeling like things are falling down or falling out
  • needing to ‘lift’ the pelvic floor or ‘help down there’ to void the bladder or evacuate the bowel
  • inability to increase activity due to any symptoms
  • low back, pubic symphysis, hip or SIJ pain
  • recurring tightness of the hips and pelvis
  • you have been pregnant
  • you have delivered a baby (vaginally or via c-section)

… and this isn’t necessarily an exhaustive list, just the first things that come to mind for clientele that frequent the clinic. Essentially if you feel there is something that is ‘off’ or ‘wrong’ within the pelvic floor, abdomen or pelvis, seeing a pelvic floor therapist may be of benefit.

 

Q: Do you recommend that all women see a pelvic floor physio? Or just if they are “leaking”?

A: There are a great many symptoms that can be indicating factors for pelvic floor dysfunction that doesn’t have anything to do with leaking in particular. To answer this question in short: yes. In long, I would say that many women would benefit from a pelvic floor assessment regardless of their “leaking” status, especially for women who have had children, or anyone who experiences pain with intercourse.

A big reason for the general answer of “yes” is the fact that what we know about pelvic floor is not necessarily functional working knowledge. Rather, most women ‘know’ they are supposed to do ‘kegels’, and yet no one has taken the time to explain or ensure that they are being done correctly. What we know about kegels is that they are meant to strengthen the pelvic floor, and most women describe that they imagine SQUEEZING the pelvic floor. As my clients know, the pelvic floor to work functionally needs to LIFT UP and IN, not squeeze, as well as RELAX down and out.

Just because you aren’t leaking, doesn’t necessarily mean that the pelvic floor is functioning well. Just the same as even though many people do not have knee pain, they often have weakness or tightness that could be addressed to prevent issues arising in the future.

 

Q: When do you recommend women be seen? During pregnancy? Post-partum?

A: Women can and should be seen whenever they are having issues. Issues are bound to arise during pregnancy and post-partum. So long as there aren’t any contraindications to a pelvic floor exam by the treating physician or OB, assessment during pregnancy is possible as well (after the first trimester). During pregnancy some women will choose to attend an assessment for labor and delivery preparation after 32 weeks gestation to help get a better handle on relaxing the pelvic floor; we do want a baby to come down and out after all!

Post-partum we are able to see women that are painful as soon as they feel up for leaving the house, and specific for pelvic floor assessment approximately 6-8 weeks post-partum. Pelvic Floor Therapy is able to address c-section healing and recovery, as well as perineal healing and recovery. Tearing, surgical incisions, other birth traumas can all be addressed in the post-partum phase.

Q: What if I haven’t had children in a few years but am experiencing problems? Can physio still help?

A: YES YES YES! The absolute best thing about the body is it’s propensity to change. It is never too late to see a pelvic floor physio, 8 weeks, 8 months, 8 years or longer we can always see what changes can be made to help resolve any complaint

Q: What are some signs of a weak pelvic floor?

A: The simple answer for this one is leaking or incontinence. The long answer is – it depends on whether it is loose and weak (not very common) or tight and weak (much more common). Often we equate something being tight or taught with being strong, but this is definitely not the case with the pelvic floor. A tight but weak pelvic floor often progresses through one or a combination of: discomfort or pain with intercourse, constipation or difficulty completely emptying the bowels, discomfort or bruised feeling through the perineum or tail bone, hip tightness and restricted movement, low back pain… and more. One client had neck pain (right by the shoulders) that she had had since her second was born (5 years previous) and nothing seemed to help. Ultimately this client had pelvic floor weakness that was driving her neck pain!

Do you know someone having issues with this area? Maybe they have some of the complaints listed above – share with them! Are YOU someone suffering with these symptoms? Contact us today to get started your path to resolution!

Do you have some BURNING questions you want answered that wasn’t covered? Send them our way and we will get them going in Part 2!

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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