Patient: 24-year-old female, 12 weeks postpartum after second degree perineal tear, nursing.
Chief Complaint: Painful vaginal entry 6 weeks postpartum, bleeding with bowel movements.
Past Medical History: Crohn’s disease, low thyroid, irritable bowel syndrome.
Physical Therapy Treatment: education on bowel health, manual pelvic floor and abdominal tissue release, perineal scar mobilization, pelvic alignment, vaginal dilators, hip stretches, core strengthening, postural education.
Results: Pain-free intercourse in 15 visits, 0 bleeding with bowel movements after the first 2 visits!
Written by Becca Ironside, PT. Becca is also a published Author of Fiction.
I met a woman named Eva* at the Pelvic Floor clinic. She came for physical therapy to address urinary leakage, which she has endured for over ten years. I had to glance at her date of birth to make sure of her age. Eva is 85 years old, and she looks spectacular. “What is your secret to looking so young and vibrant?” I asked her. “Maybe it is having good friends. Wonderful children and grandchildren. Or maybe it is just my good Danish genes,” she replied.
Eva told me that she began leaking urine several years ago, but her condition is getting worse. She told me that she cannot go to the beach anymore at Point Pleasant, which is her favorite thing to do. In her medical history, I learned that Eva had had three pregnancies with vaginal births. She does not drink enough water, mostly in fear of losing even more urine. Based on her age and prior history of childbearing, I was working under the assumption that Eva had weakness in her pelvic floor muscles. Maybe a little prolapse of the bladder.
“A lot of young women come here with complaints of pain with sex,” I told her. Eva’s eyes opened wide. “Do you mean to tell me that there is treatment for that? I had two husbands and sex was awful with both of them. The pain was unbearable. I never understood what the big fuss about sex was all about.”
Here was a woman in her eighties who had lived with pelvic floor dysfunction her entire life. The painful intercourse made sense, given how much tension she was holding in her musculature. I devised a treatment program for Eva to allow the muscles of her pelvic floor to elongate. She was given a home program of self-stretching, diaphragmatic breathing exercises, and an activity known as the pelvic floor drop, which is the opposite of the famed Kegels we have all read about in McCall’s Magazine.
Eva has returned several times to our clinic. She has far less urinary leakage, is drinking more water (she has retrained her bladder to accommodate this), and practices yoga and deep breathing. She is planning a month-long trip to Florida, wherein she will be able to go to the beach in a bathing suit encasing her lithe body without fear.
I learned something wonderful during my treatment of Eva. I rejoice in living in a time when help is now possible for these things that have plagued women for centuries. I also learned that it is never too late to change. Eva is 85. And if she responded so readily to this therapy, then anything is possible.
*The name and some personal details of this patient have been changed, according to the laws of the Health Care Portability and Accountability Act. But the symptoms of Eva and the outcome of her treatment are true. Pelvic Floor Physical Therapy works!
Connect PT hosted “The Pelvic Floor: There’s More to Your Core - A Guide for Personal Trainers.” Our therapists were thrilled to educate personal trainers about pelvic floor dysfunction and how they can help clients that have it. It is important that women and men with pelvic dysfunction feel safe while exercising and achieving their fitness goals.
Written by Michelle Dela Rosa, PT
A 2015 systematic literature review showed that yoga was not only effective in decreasing depression and anxiety in perinatal women, but also improved: pain, anger, stress, gestational age at birth, birth weight, maternal-infant attachment, optimism, and well-being. If you are pregnant or just had a baby and are unsure how to progress with exercise, our therapists who are also certified yoga instructors can help you make the leap into fitness.
Sheffield KM, Woods-Giscombé CL. Efficacy, Feasibility, and Acceptability of Perinatal Yoga on Women's Mental Health and Well-Being: A Systematic Literature Review. Journal of Holistic Nursing 2015:34(1)64-79.