Understanding Pelvic Floor Dysfunction and Treatment

Dr. Jennifer Perna of Vivid Women's Health

What is pelvic floor dysfunction and what kinds of issues does it cause?

The muscles that sit in the bottom of the pelvis make up the pelvic floor. Pelvic floor dysfunction is a general term describing a problem with these muscles. The pelvic floor affects and controls bowel, bladder and sexual function, so a problem with the muscles of the pelvic floor can cause a variety of things like urinary incontinence or leakage, constipation, bowel or gas leakage, abdominal bloating, pain with sexual intercourse, low back, hip and pelvic pain. 

Although these issues are fairly common, there seems to be a misconception that there is little that can be done to help. What options are there?

Pelvic floor issues can affect men, women and even children. For women, issues are most notable during or after pregnancy and after menopause. Symptoms are often the result of hormone changes, posture changes and trauma to the pelvic floor muscles.

Often, women are told that their pelvic floor symptoms, whether it be back pain, urine leakage, constipation or pain with sexual intercourse are “par for the course” and that they have to live with them. Pelvic floor therapy is a conservative and effective option to manage pelvic floor dysfunction and pain at any age and any gender. 

What is pelvic floor therapy and how is different from other types of treatment? 

Pelvic floor therapy is done by a licensed physical or occupational therapist that has post-graduate training specifically in assessment and treatment of pelvic floor conditions. Just like physical therapists can treat a strained knee, we can also assess and treat the joints and muscles that sit around the pelvis. These joints and muscles work with the joints and muscles of the hip, back and core.

Often people think that pelvic floor therapy is only about performing Kegel contractions. Kegel contractions are repetitive contractions of the pelvic floor muscles. However, performing Kegels without addressing other parts of the body will likely not improve symptoms, and in cases where muscles are tight (e.g. often with constipation, urine retention, or painful intercourse), performing Kegels can actually make your symptoms worse.

So if we don’t do Kegels, what do we do?

In pelvic floor therapy, we utilize a variety of techniques - all of them are hands-on with a goal of retraining the muscles around the pelvis and the core to work together. This includes things like massage, joint mobilization, muscle retraining and strengthening and stretching of the muscles in the core and hips.

What are some ways that women can protect the pelvic floor?

  • Never hover over the toilet when toileting. Sitting allows the pelvic floor muscles to relax.
  • Drink plenty of water (6-8, 6 to 8 ounce servings daily). This helps keep the system hydrated, and helps flush out bladder irritants (such as caffeine, alcohol, artificial sweeteners, acidic liquids, etc).
  • Don’t strain while toileting. Instead of holding your breath to push, try huffing like you are fogging up a mirror while pushing. This helps to keep the pelvic floor relaxed.
  • When exerting yourself (picking up a heavy box, lifting your child, etc.) try to exhale. Often we hold our breath which causes us to bear down on our pelvic floor. 
  • Manage stress and meditate 5 minutes per day. Stress changes how we breathe which can result in increased tension throughout the pelvic floor.

How did you become interested in this specialized area of physical therapy?

After pregnancy, I struggled with pelvic pain and felt ignored. I was told that my pain was expected because I had just given birth and that doing Kegels was all I needed to do to improve. I wanted to develop a deeper understanding of pelvic pain, so I took advanced coursework in physical therapy management of pelvic floor conditions. 

After treating many women with pelvic floor dysfunction, unfortunately this story is all too common. Women are either too bashful to mention it to their physician, or feel that when they do mention it, their symptoms are explained as a normal result of childbirth. 

I founded Vivid Women’s Health to provide women with a safe, private space to discuss any concerns regarding their body. Women should have a healthcare specialist that takes time to listen to all of their concerns, and provides real solutions for them. At Vivid Women’s Health we look to determine the source of the problem. We treat the pelvic floor with the rest of the body to figure out the true cause of the problem. We provide our patients the time they deserve and the ability to contact therapists between sessions.

Do you have any final words of encouragement or advice for women who are suffering in silence with these issues?

I want all women to know that if you are having any concerns with bowel, bladder or sexual health, that pelvic floor physical therapy can help manage or completely eliminate your symptoms. It is important for women to be treated by a licensed therapist skilled in assessing and treating the pelvic floor so that they may live their lives pain free and leak free.

For more information, contact Vivid Women's Health (267) 685-6368. 4 Terry Drive, Suite 19, Newtown PA.

Pelvic disorders are common concerns, affecting almost one-third of women in the United States. We asked Dr. Jennifer Perna to help shed some light on pelvic floor dysfunction and explain treatment options available for those who may be suffering in silence. Dr. Perna, owner of Vivid Women's Health, is a Doctor of Physical Therapy (DPT) who specializes in orthopedic and pelvic floor conditions in women. She lives in Newtown with her husband and two children.

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