Women can develop urine leaks from many causes. We tend to think it is “normal” after having children or surgeries. Urine leakage IS common, but definitely NOT normal! Stress urinary incontinence is when a woman leaks urine after a stressful maneuver, such as laughing, coughing, sneezing, jumping or running. The biggest risk factor for this is having a vaginal birth, but can have many reasons. Urge urinary incontinence is when a woman has a sudden severe urge to urinate, and cannot make it to the restroom on time. Many women also have Mixed urinary incontinence, which is when they suffer from symptoms of both stress and urge incontinence. These problems have an average 80% or better improvement with physical therapy conservative care!
Many women are told that they have “dropped” or low organs – typically their bladder, rectum or uterus. This can occur after childbirth, chronic constipation, chronic cough, work requirements that include heavy lifting, or just from having weak pelvic floor muscles. Research shows that pelvic organ prolapse can be effectively treated with conservative physical therapy.
Pelvic pain is a very common, but not usually spoken about, problem that many women suffer from. Women may have vaginal pain with penetration, pain with just sitting or having clothes touch their skin, or be restricted from doing work or exercise activities that they would like to do. Some of the pelvic pain diagnoses that we treat are vaginismus, vulvodynia, vestibulitis, pudendal neuralgia, endometriosis and similar dysfunctions.
Constipation is one of the most common complaints for individuals when they go to see their primary care provider. Sometimes the GI tract moves slower than it should due to abdominal surgical adhesions, poor dietary habits, poor abdominal strength/compression, or improper breathing and movement patterns. Constipation can also impact urinary incontinence, organ prolapse and pelvic pain in a negative manner. By using manual techniques such as bowel massage and visceral mobilization, teaching proper toileting mechanics and discussing dietary impact, physical therapy can be very effective in improving or resolving constipation.
Fecal incontinence is the loss of fecal matter with either physical activities, or with a feeling of urgency and the inability to make it to the restroom on time. This can happen due to weak or damaged pelvic floor muscles (such as after childbirth tears or episiotomies) or also from poor bowel movement consistency. Physical therapy addresses core and pelvic floor strengthening, dietary habits and any co-existing bladder concerns with great success in resolving fecal incontinence issues.
When a woman goes through pregnancy and delivery, sometimes the midline connective tissue between the long abdominal muscles separate. After pregnancy, this has a good chance of self resolution, but in those cases where it does not resolve on it’s own, targeted physical therapy that addresses retraining the transverse abdominus muscles and improved control over intra-abdominal pressures, leads to good success.
Many women have low back, pelvic pain, or other complaints of pain in their muscles or joints during pregnancy or immediately after. All of our therapists have advanced training on how to evaluate and treat the most common conditions that appear during the childbearing year!
After pregnancy, most women are eager to get back to exercise and regain the strength that they lost. We offer a postpartum return to fitness evaluation that looks at a woman’s current level of fitness and how for them to safely return to their sport or exercise of choice.
Often we find that women have abdominal pain that is not easily diagnosable. As musculoskeletal experts, we assess whether that abdominal pain could be related to muscle dysfunction, nerve dysfunction, or scar tissue from surgeries.
With IC/PBS, women often develop secondary dysfunctions, such as high tone spasming pelvic floor and pelvic girdle muscles, poor bladder habits, and deconditioning overall. At times, bladder pain is truly muscle spasm that is referring pain to the bladder.
Typically, women who have surgeries on areas such as their shoulder, knee or hip get referred immediately to physical therapy. Women who have abdominal surgeries, whether for C section delivery, hysterectomy or other bladder or gynecologic surgery also deserve to come to physical therapy for rehab and to learn how to protect themselves from other complications such as pelvic organ prolapse, poor scar mobility, low back pain from weakened abdominal muscles. We encourage surgeons to refer patients to physical therapy 6 weeks after their surgeries for optimal rehab potential, but often see women up to several years later for post-op complications.