Women's Pelvic Health - InvigoPhysio

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Did you know that 1 in 3 Canadian women suffers from pelvic floor dysfunction at any given time? Urinary incontinence was reported even in women who have never given birth and the frequency increases after pregnancy and with age (from just 10% in women under 40 years old to almost 50% in women 80 years old and above).

Yet, sometimes women brush these symptoms under the rug because we are either too busy to take care of everyone else, or we simply think that these are common issues in women. It is important to take care of your pelvic health whether you experience pelvic floor problem in your 20s or in your 70s. No matter where you are at, pelvic physiotherapy can help you reverse the issues and regain your pelvic health.

Why is the Pelvic Floor so important?

The pelvic floor forms a supportive trampoline at the bottom of the pelvis, spanning from the pubic bone in the front to the tailbone in the back, and from one sitting bone to the other. They are essential in supporting your pelvic organs, the bladder, uterus and bowel. The sphicters allow you to have conscious control over bladder and bowel movement, as well as passing of gas. Contraction of the pelvic floor muscles tightens the openings of the urethra and anus to help delay emptying. Relaxation of the pelvic floor muscles permits the passage of urine and stool. Contraction of the pelvic floor is also important for sexual sensation and arousal in women.

Pelvic Floor Dysfunction in Women

Many factors can lead to pelvic floor weakness or tension. It is important to recognize the signs and symptoms of pelvic floor disorder so that you can get professional help to reverse it and regain your pelvic health:

Urine leakage when you cough, sneeze, laugh, or exercise
Frequent urination during the day and/or night
Inability to control passing gas
Strong and uncontrollable urgent need to empty bladder or bowel
Constipation, pain, or straining to pass a bowel movement
Pain with sex
Heaviness or pressure at the perineum
Feel a bulge at or near your vaginal opening or a sensation of something falling down

Pelvic Floor Physiotherapy for Women

A woman’s body goes through many transitions in a lifetime with many of the physical changes affected by hormones, lifestyle, and social environment. The pelvic floor as an essential part of the body is also sensitive to these changes and requires attention and care so that it can continue support the body.

During Pregnancy

Pregnancy puts a significant amount of physical stress on the woman’s body and especially the pelvic floor. It can be overwhelming dealing with many changes in such a short time. At InvigoPhysio, we are here to help you on your motherhood journey, from addressing your prenatal needs to setting you up for speedy postpartum recovery.

Diastasis Rectus Abdominis (DRA)

DRA is described as a condition in which the two rectus abdominis muscles are separated by an abnormal distance. It is characterized by a thinning and gradual widening of the linea alba. Signs of DRA during pregnancy includes doming, coning, or bulging at the belly with lifting head off a pillow, carrying heavy things or exercising.

DRA happens in almost all pregnant women in response to your baby growing inside your belly. Even though this is a normal process, it is necessary to identify and address the muscle imblance caused by DRA for a pain-free pregnancy and a smooth recovery postpartum.

Bladder issues

The constant pressure from a growing baby can put a significant strain on your pelvic floor, which can lead to bladder trouble. Stress incontinence is when you experience urine leakage with coughing, sneezing, laughing, and exercising while urge incontinence is a urine leakage in the presence of a strong and uncontrollable urge to void. Some women can also experience both.

Pelvic girdle pain (PGP)

The pelvic girdle is the portion of the pelvis without the sacrum and tailbone. PGP is pain in the front (typically at the symphysis pubis joint and groin) and/ or the back of your pelvis (around the sacroiliac joints). PGP is common, affecting 1 in 5 pregnant women with negative impact on your mobility and quality of life. Symptoms of PGP include pain when you are walking, climbing stairs, and turning over in bed. PGP typically goes away after your baby arrives but it can also persist. Early diagnosis and treatment can relieve your pain and the treatment is safe at any stage during or after pregnancy.

Birth preparation

Preparing for birth can be overwhelming because there is so much information out there. No matter how you are preparing for birth, don’t forget about your pelvic floor! It is instrumental in helping your baby come to the world. At InvigoPhysio, we will guide you through different exercises to balance the muscles in the pelvis to create room for your baby as well as various birth positioning strategies that are appropriate for your body and pre-existing injuries such as disc herniation and hip labral tear.

Postpartum Recovery

The fourth trimester and beyond is often regarded by most moms as the most challenging time. Juggling between caring for your baby and healing your body is never easy. At InvigoPhysio, we understand the struggle and are committed to support you through your postpartum healing.

Diastasis Rectus Abdominis (DRA)

DRA is described as a condition in which the two rectus abdominis muscles are separated by an abnormal distance and characterized by a thinning and gradual widening of the linea alba. Signs of DRA includes doming, coning or bulging at the belly in standing, lifting your child, or doing abdominal exercises.

DRA can lead to compromised abdominal wall strength which can affect other areas such as low back, hip, and pelvic floor. At InvigoPhysio, we use an evidenced-based and holistic approach to help you recover and get stronger. Our DRA program focuses on alignment and posture improvement, optimal movement strategies, pelvic floor rebalancing, proper breathing pattern, and progressive loading of the abdominals.

Bladder and Bowel Issues

Women who delivered vaginally have two to three times the risk of experiencing stress incontinence compared with women who have never given birth. Factors such as perineal tearing or an episiotomy during vaginal birth can affect the pelvic floor strength and lead to bladder trouble. Some women also experience poor bowel control or passing wind when they don’t want to. All of these issues can be reversed with pelvic physiotherapy.

Pelvic organ prolapse (POP)

POP is defined as the descent of one or more of the vaginal compartments as a result of inadequate pelvic floor support. Women usually notices a bulging sensation or heaviness sensation. POP is a common condition that affects more than half of adult women. Mild to moderate prolapse responds well to pelvic physiotherapy and returning to your physical activities with prolapse is possible.

Pain with sex (dyspareunia)

About one-third of women reported experiencing persisting pain with sexual intercourse at 18 months postpartum. Stress and injury at the pelvic floor can lead to tension resulting in aching pain or burning during intercourse. If you are breastfeeding, low estrogen level can cause vaginal dryness as the lining of the vagina produces less mucus. At InvigoPhysio, we take all these factors into consideration when addressing dyspareunia so that you can regain your sex life.

C-section scar therapy

Taking care of your scar, whether it is from a perineal tearing, an episiotomy, or a Cesarean delivery, can prevent adhesion at the scar tissue. Any restricted mobility at the scar area can affect pelvic floor function, abdominal strength recovery, and sexual activities.

Mom’s aches and pain

Along with strengthening your core system, we can help alleviate your other discomforts from caring for your child such as low back pain, neck and shoulder tension, wrist pain, and thumb strain. We understand the physical demands of motherhood and want you to enjoy the journey, pain-free.

Persistent Pelvic Pain

If you are suffering from pelvic pain, you are not alone. It is estimated that 20% of women will experience pelvic pain at some points in their lives and the pain can be provoked by a series of events. There are many pelvic pain diagnoses and it can be overwhelming and confusing. At InvigoPhysio, we are committed to help you navigate through this healing journey.

Vulvodynia

The vulva is the part of your genitals on the outside of the body and includes the mons pubis, opening of the vagina, the labia majora (outer lips), the labia minora (inner lips), the clitoris, and the perineum. Vulvodynia is persistent discomfort at the vulva for 3 months or longer and is not caused by an infection, skin disorder, or other medical condition. The vulvar pain is commonly described as burning, stinging, irritation, and rawness. Aching, soreness, throbbing, and swelling may also be felt. Pain can be continuous without any specific triggers and not restricted to the vulvar area. Causes for vulvodynia can involve tension at the pelvic floor muscles and surrounding tissues.

Vestibulodynia

The vestibule is defined as the area of the vulva containing the openings of the urethra and vagina, the hymenal tags, the inner edge of the inner surfaces of the labia minora. It is a sensitive part of your body containing the Bartholin’s gland (which secretes vaginal lurication) and small vestibule glands (which produce vaginal discharge).The pain usually occurs with light touch at all or part of the outer edge of the vestibule and is described as burning, stinging, or cutting with pain sometimes feel deeper within the vagina. Vestibulodynia can be elicited when the area is touched with a tampon, during sex, during pelvic exam, when tight clothes are worn, or even when sitting for a long time.

Vaginismus

Vaginismus is an involuntary pelvic floor muscle contraction and spasms with any attempted vaginal penetration such as speculum insertion or sexual intercourse due to fear of being hurt. Some women develop vaginismus with loss of estrogen after menopause or after a surgery or past trauma. At InvigoPhysio, we take both the physical and emotional component into consideration when treating vaginismus.

Coccydynia (tailbone pain)

The coccyx is a small but important bone. It is the insertion site for multiple muscles, ligaments, and tendons. Together with the sitting bones, it provides weight-bearing support to the body in sitting position. Coccydynia is described as a dull and achy pain located at the tip of the tailbone between the buttocks. Tenderness at the tailbone can be felt with touch or prolonged sitting, standing, or lying down. Tailbone pain can be a result of a fall or pushing a baby out for a long time in the lithotomy position. Coccydynia can be treated effectively with pelvic physiotherapy.

Pelvic Issues Due to Other Conditions

Pelvic floor dysfunction often coexists with other complex pelvic conditions such as Interstitial Cystitis (IC), endometriosis, irritable bowel syndrome (IBS), and lichen sclerosus (LS). The organs involved in these conditions are intricately connected with all the pelvic floor muscles, ligaments, and tissue that surround them. Addressing the pelvic floor imbalance is one of the pieces that help manage these conditions successfully, and it is well-supported by the current medical research. Another condition that can benefit from pelvic physiotherapy is Ehlers-Danlos Syndrome (EDS).

At InvigoPhysio, we understand the complexity of these conditions, which requires an integral treatment approach to alleviate your pelvic symptoms. You can expect one-on-one physiotherapy care with hands-on internal and external work, self-care program for managing pelvic floor and promoting pelvic mobility. We also recognize the importance of a multidisciplinary approach and will work with you to communicate with other practitioners in your healthcare team.

Interstitial Cystitis/ Painful Bladder Syndrome (IC/ PBS)

Bladder and/ or pelvic pain are often presented patients with IC/ PBS. Did you know that hypertonic/ tight pelvic floor and pelvic girdle muscles (e.g. hip adductors, abdominals) can mimic symptoms of urinary tract infection (UTI), urinary urgency, frequency, and burning with urination? Pelvic physiotherapy can help reduce or eliminate these debilitating symptoms associated with IC/ PBS.

Endometriosis

Common symptoms associated with endometriosis are painful cramping before or during menstruation, painful intercourse, bladder pain, bowel movement discomfort, and infertility. Inflammation and pain caused by endometriosis can negatively impact all the organs/ muscles/ fascia in the pelvic and abdominal region, leading to pelvic dysfunctions. At InvigoPhysio, your individualized treatment plan will include manual therapy (to mobilize myofascial system, release muscle tension, and increase mobility of visceral organs), gentle acupuncture (for pain management), and therapeutic exercises (Pilates and yoga fusion).

Irritable bowel syndrome (IBS)

People with IBS often experience abdominal pain, bloating, gas, chronic constipation, or diarrhea, or both. This can lead to pelvic floor dysfunction such as dyssynergia/ anismus, bowel urgency and/ or incontinence. Dyssynergia/ anismus happens with chronic constipation, usually when the pelvic floor is not relaxed while you strain to evacuate stool. Bowel urgency and/ or incontinence occurs when your pelvic floor muscles are not able to hold your stool in. Pelvic physiotherapy can treat these issues effectively and help you with regaining your bowel control.

Lichen sclerosus (LS)

LS is a chronic inflammatory skin condition that occurs around the vulvar and anal area. Reported symptoms are itching, painful intercourse, and painful urination. Scarring from inflammation flares can cause fusion of the labia minora and narrowing of the vaginal introitus. Pelvic physiotherapy can identify the underlying muscular impairments and create an individualized treatment plan to target the pelvic pain associated with LS.

Ehlers-Danlos Syndromes (EDS)

EDS are a diverse group of connective tissue disorders, usually associated with connective tissue fragility, particularly in the skin, tendons, ligaments, blood vessels, and hollow organs. Due to the collagen-rich tissues in the pelvic organs and ligaments, people with EDS often experience bladder-related dysfunctions (e.g. incontinence, bladder pain, voiding issues), pelvic organ prolapse (POP), and persistent pelvic pain (e.g. vulvodynia, vestibulodynia, dyspareunia). Pelvic physiotherapy can help you reinforce the stability at the pelvis, restore bladder function, and improve POP and pelvic pain.

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