Understanding pelvic organ prolapse

Pelvic organ prolapse (POP) is a common yet under-discussed medical condition that affects many women around the world. It occurs when pelvic organs, such as the uterus, bladder, or rectum, descend and protrude into the vaginal canal due to weakened pelvic floor muscles and tissues. In this blog, we will delve into the prevalence of POP, its potential causes, and highlight treatment options and exercises that can aid in managing this condition.

POP is a prevalent condition, with varying statistics across different populations. According to the American Urogynecologic Society (AUGS), approximately one in three women in the United States will experience some form of POP during their lifetime (AUGS, 2021). In a study conducted in Nigeria, the prevalence of POP was found to be as high as 46.8% among women (Odigie et al., 2017).

Causes and Risk Factors:

Several factors contribute to the development of POP. These include childbirth, menopause, aging, obesity, chronic coughing, heavy lifting, and genetics. Pregnancy and vaginal childbirth, in particular, are significant risk factors due to the strain they place on the pelvic floor muscles and tissues.

Treatment Options:

Treatment options for POP depend on the severity of the condition, the associated symptoms, and the patient's overall health. Non-surgical interventions often involve lifestyle changes, pelvic floor physical therapy, and the use of pessaries, which are devices placed in the vagina to provide support.

For more severe cases or when conservative methods fail, surgical intervention may be recommended. Surgical options range from traditional open surgeries to minimally invasive approaches, such as laparoscopic or robotic-assisted procedures.

Exercises for Pelvic Organ Prolapse:

Pelvic floor exercises, also known as Kegel exercises, are just one component of managing POP. These exercises aim to strengthen the pelvic floor muscles, providing better support to the pelvic organs. Regular and proper execution of Kegel exercises can help alleviate symptoms and potentially prevent further prolapse.

To fully protect the pelvic organs from further prolapse, you need to look beyond the pelvic floor. Strengthening the abdominals and the hip muscles are essential to supporting the pelvic floor muscles and the pelvic organs. Looking at your breathing pattern is also a very important component to the pressures on the pelvic organs. Learning to exhale during a strenuous activity, such as lifting something, can help to prevent excessive downward pressure on the pelvis. Pelvic floor physical therapy will address the strength of your pelvic floor as well as working to strengthen the core and hip muscles and retrain any faulty breathing patterns.

Pelvic organ prolapse affects a significant number of women worldwide, impacting their quality of life. Understanding the prevalence, causes, and available treatment options is crucial for those experiencing or at risk of developing this condition. By adopting specific and targeted exercises and seeking appropriate medical advice from a pelvic floor physical therapist, women can manage POP effectively and regain control over their pelvic health.

References:

1. American Urogynecologic Society (AUGS). (2021). Pelvic Organ Prolapse. Retrieved from https://www.augs.org/p/bl/et/blogaid=351

2. Odigie, V. O., Yusufu, L. M., & Awolola, N. A. (2017). Prevalence and risk factors for pelvic organ prolapse in Ilorin, Nigeria. Journal of West African College of Surgeons, 7(1), 1-18.

How often should you pee?

Have you ever found yourself asking, "How often should I be peeing?" or wondering if your bathroom habits are normal? Well, you're not alone. Urination is a natural bodily function that helps our bodies remove waste and excess fluids. But how often should we be doing it? And what happens if we go too frequently or not frequently enough?

First…….how often should you pee?

The frequency of urination varies from person to person, but on average, most people urinate four to eight times a day. However, it's important to note that this can be influenced by a variety of factors, including fluid intake, medications, and medical conditions.

For example, if you're drinking more water than your body really needs (more than 1/2oz per pound of body weight), you'll naturally need to urinate more frequently. Or if you are making one too many trips through the Starbucks line, the caffeine is going to cause increased urinary frequency. On the other hand, if you're dehydrated, you may urinate less frequently. Additionally, certain medications, such as diuretics, can increase urine production, while other medications, such as anticholinergics, can decrease it.

Why is it bad to go too frequently?

While it's important to stay hydrated, going to the bathroom too frequently can be a sign of an underlying medical condition or lifestyle habit that needs attention.

Frequent urination can be caused by overactive bladder syndrome, urinary tract infections, interstitial cystitis or pelvic floor dysfunction. Overactive bladder syndrome is a condition in which the muscles of the bladder contract involuntarily, causing a sudden urge to urinate. Urinary tract infections can cause a similar sensation, as well as pain or burning during urination. Interstitial cystitis is a chronic condition that causes bladder pain and frequent, urgent urination. Pelvic floor physical therapy is a very effective treatment option for overactive bladder syndrome and interstitial cystitis because it addressed the pelvic floor muscle dysfunction as well as working on behavior modifications.

In addition to being uncomfortable, frequent urination can disrupt your daily routine and even interfere with your sleep. Waking up multiple times during the night to use the bathroom can lead to fatigue and daytime drowsiness. Prior to menopause, you should be able to sleep through the night without needing to empty your bladder (pregnancy is the one exception to this). After menopause, it is normal to wake once per night to pee.

Why is it bad to not go frequently enough?

Not urinating frequently enough can also be a sign of an underlying medical condition or lifestyle habit that needs to be addressed.

If you're not urinating enough, it can be a sign that you're not drinking enough fluids. Dehydration can cause a variety of symptoms, including headache, fatigue, and dizziness. It can also lead to more serious health problems if left untreated. Aim for approximately 1/2oz of water per pound of body weight per day. The one caveat to this is if you eat a lot of very water based fruits and vegetables (think watermelon or cucumber), or if you eat a lot of soup, then you wouldn’t need quite as much water because all non-caffeinated liquid counts towards your total.

If you have a job where you don’t have the opportunity to use the bathroom frequently (i.e. teacher, nurse, etc), then you may have trained yourself to ignore bladder urges and are actually be training your bladder to overfill, which in the long run can lead to a bladder muscle that is unable to contract well when you do need to urinate.

In addition to dehydration, not urinating frequently enough can be a sign of bladder outlet obstruction, a condition in which the flow of urine is blocked. This can be caused by a variety of factors, including bladder stones, or a tumor.

What can you do to maintain healthy bathroom habits?

To maintain healthy bathroom habits, it's important to pay attention to your body and take note of any changes in your urinary habits. If you notice that you're urinating more or less frequently than usual, or if you're experiencing any discomfort or pain during urination, it's important to talk to your healthcare provider.

In general, it's a good idea to drink fluids spaced throughout the day to stay hydrated. Avoid chugging your entire water bottle at the end of the day because you went all day without drinking anything. Caffeine and alcohol can both increase urine production, so it's a good idea to limit your intake of these beverages if you're experiencing frequent urination.

Try to limit “just in case voiding” or the “tactical wee” because this may train your bladder to contract too frequently when it isn’t actually full yet. Normal voiding time throughout the day is every 2-4 hours.

Additionally, it's important to practice good hygiene habits to prevent urinary tract infections. This includes wiping from front to back after using the bathroom, urinating after sexual activity and not pushing to urinate.

If you think you are having some pelvic floor dysfunction, contact us or your local pelvic floor physical therapist for treatment. You can also contact us to help find someone local to you.

THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE. The information provided in this blog, including but not limited to text, graphics, images and other material are for informational purposes only. No material on this site is meant to be a substitute for professional medical care, treatment or advice. Always speak to your health care provider with any questions you may have regarding a medical condition or treatment. Never delay or disregard professional medical advice because of something you have read on this website.

Urinary Incontinence Treatment Options

Urinary incontinence, the involuntary leakage of urine, affects millions of people around the world, particularly women. It can significantly impact quality of life and lead to social isolation, depression, and even urinary tract infections. Fortunately, there are several treatment options available for urinary incontinence that can help manage the condition and improve your quality of life.

Here are some of the most effective urinary incontinence treatments:

1.     Pelvic floor physical therapy: This is often the first-line treatment for urinary incontinence. It involves bladder training, pelvic floor muscle exercises, and lifestyle changes such as reducing caffeine and alcohol intake. Working with a pelvic floor physical therapist, you can improve bladder control and reduce the frequency of urinary incontinence episodes.

2.     Medications: There are several medications available to treat urinary incontinence. These include anticholinergics, which help reduce bladder contractions, and alpha-adrenergic agonists, which increase the tone of the urethral sphincter. It is essential to consult a doctor before taking any medication, as some can have side effects and interact with other medications. Medications can sometimes be helpful while you are going through pelvic floor physical therapy to help manage your symptoms until you gain some strength.

3.     Medical devices: For people with more significant urinary incontinence, medical devices such as a pessary can help provide support to the urethra and reduce urine leakage. There are some temporary over the counter supports that you can try, but you will need to see a physician or a pelvic floor physical therapist to be fit for a pessary, and it may take a couple of different sizes and styles to find one that works best for you.

4.     Surgery: For people with severe or persistent urinary incontinence, surgery may be an option. Surgery often includes some type of support to the prolapsed organ and depending on your age, may also include a hysterectomy. There is significant downtime in recovery so you should discuss this option thoroughly with your pelvic floor physical therapist and physician to determine if this is your best course of treatment. It is recommended that you try a course of pelvic floor physical therapy before considering surgery.

It is essential to speak with a healthcare professional (often will be a gynecologist, urologist, urogynecologist, or pelvic floor physical therapist) before pursuing any urinary incontinence treatment option. They can help determine the underlying cause of the condition and recommend the most appropriate treatment for your unique situation.

If you think you are having some pelvic floor dysfunction, contact us or your local pelvic floor physical therapist for treatment. You can also contact us for help finding someone local to you.

THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE. The information provided in this blog, including but not limited to text, graphics, images and other material are for informational purposes only. No material on this site is meant to be a substitute for professional medical care, treatment or advice. Always speak to your health care provider with any questions you may have regarding a medical condition or treatment. Never delay or disregard professional medical advice because of something you have read on this website.

So you had a baby…….now what?

One thing we are never quite sure of after having a baby is what is “Normal” down there. Sometimes the question is what is a normal part of the process in postpartum healing or what is a common dysfunction that can occur. Let’s talk about what may be commonly happening but needs to be addressed. Leaking of urine or feces can happen especially if there is significant tearing that occurs in the perineum. Pressure or heaviness in the perineal region can be related to the pelvic organs not sitting in the right way. Pain in the pelvic region can be related to tearing, pelvic girdle dysfunction or hypertonic pelvic floor muscles. It is important to look above the pelvis as well at the abdominal wall to see if there is any separation or doming happening since these muscles work with the pelvic floor. While these are not considered “normal”, they are common and sometimes the most important thing is to give our bodies time to heal and recover.

What can you do to aid the recovery?

1. Get rest as much as you can, even if that doesn’t mean sleeping.

2. Ask for help in order to make sure you are taken care of as well as baby.

3. Make healthy food choices and hydrate properly

4. Move your body in ways that feel right including walking, stretching and strengthening exercises.

5. If you still are having concerns at your 6-week check-up ask for a referral to a pelvic health Physical Therapist.

What can I do to start moving my body?

1. Walking. The CDC recommends that health pregnant and postpartum women do at least 150 minutes of moderate-intensity aerobic physical activity per week. Using this guideline can be helpful for setting up walking goals initially.

Breaking it down into smaller sections if key early on!!!

2. Pelvic floor exercises or Kegels as many people know them are great to start early on as long as wounds have healed. The goal is to hold the contraction for 10 seconds and do 10 reps but that may be too much to start. Try a shorter hold like 3 seconds and see if you can get all 10 reps without the pelvic floor feeling fatigued. 3. Diaphragmatic breathing for up to 5 minutes a day can be helpful since the pelvic floor, abdominals and diaphragm all work in relationship together. Focus on a 360-degree expansion of the rib cage and then knit it all back together on exhale.

4. Abdominal activations to cue the inner layer of the abdominals or the “corset” layer can help to get strength and stability back. Practice this in different positions such as sitting, lying down or standing.

With all these tips, hopefully all postpartum moms can feel ready for the next stage in recovery… Return to running and higher impact activities!

If you think you are having some pelvic floor dysfunction, contact us or your local pelvic floor physical therapist for treatment. You can also contact me for help finding someone local to you.

THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE. The information provided in this blog, including but not limited to text, graphics, images and other material are for informational purposes only. No material on this site is meant to be a substitute for professional medical care, treatment or advice. Always speak to your health care provider with any questions you may have regarding a medical condition or treatment. Never delay or disregard professional medical advice because of something you have read on this website.

Get to know your pelvic floor

Most women have heard of their pelvic floor, but what actually IS “down there”? 

You can think of your pelvic floor as a bowl that goes from your pubic bone to your tailbone and from one sit bone to the other. Basically, it is what is touching the chair when you are sitting. And even though you can’t see it, the pelvic floor is just a group of regular muscles, like anywhere else in your body. 

There are two groups of pelvic floor muscles, the urogenital diaphragm and the levator ani. Each of these groups have a few smaller muscles within them, but they really act as a whole group so it isn’t super important to separate out each little muscle. 

The urogenital diaphragm is the more superficial group, or the muscles that are closer to the vaginal opening. These muscles work to squeeze around the urethra to prevent urine from coming out (urinary incontinence). This is also the first muscle that gets cut in an episiotomy or rips during a perineal tear during a vaginal delivery. If your tear is a little more extensive, then it may go all the way down to into the levator ani group, which is the deeper muscle layer. 

The Levator Ani group of pelvic floor muscles is responsible for holding your organs up in place (cough, cough…….we are looking at you bladder prolapse). These muscles need to have a little more endurance than the urogenital diaphragm because they are providing support all day long. 

Your pelvic floor muscles have 5 main jobs:

1. Support: Provide support to the pelvic organs

2. Sphincter: Close off the urethra and anus until you want to pass urine, stool or gas

3. Sexual: Relax to allow for penetration and contract during orgasm

4. Stability: Help to stabilize your pelvis on your lumbar spine and to your legs

5. Sump Pump: Assist in pumping fluid from your legs up to the abdomen 

So you can see that the pelvic floor muscles are part of a much more complex system than just Kegels. The muscles have important functions, and they need to be able to contract and shorten as well as relax and lengthen all throughout the day. When the muscles don’t do their job properly, you may experience:

• Urinary incontinence

• Constipation

• Pelvic organ prolapse

• Fecal incontinence

• Pelvic pain with sitting

• Pain during intercourse

• Low back pain

• Hip or SI joint pain

• Tailbone pain

All these conditions are due to some sort of pelvic floor muscle dysfunction and if left untreated, may progress into other issues. 

If you think you are having some pelvic floor dysfunction, contact us or your local pelvic floor physical therapist for treatment. You can also contact me for help finding someone local to you.

THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE. The information provided in this blog, including but not limited to text, graphics, images and other material are for informational purposes only. No material on this site is meant to be a substitute for professional medical care, treatment or advice. Always speak to your health care provider with any questions you may have regarding a medical condition or treatment. Never delay or disregard professional medical advice because of something you have read on this website.

Postpartum Return to Run

You have been cleared to exercise…but what does that mean and how do you get back to that?

You have hopefully been staying active by walking and childcare but now the fun begins. Remember that it is important to stay on top of selfcare with quality sleep, hydration and health food choices. At your 6-week postpartum appointment, you were cleared to resume what you were doing before becoming pregnant but that was over 10 months ago so it is important to ease back in.

Starting with lower impact cardiovascular exercises including:

• Swimming

• Cycling (stationary)-if in class setting make sure to ride your own

  ride and not get pushed to hard too soon

• Elliptical trainer

Make sure that you have introduced strength training into your sessions as well. Muscle strength is important with returning to running and higher impact exercise. Key areas to focus on for strength training include:

• Lower extremity: Squats, lunges, heel raises, bridging, dead lift,

  step downs

• Core: plank, side plank

• Upper body: rows, lat pull downs

As you progress through these areas and feel stronger, adding in plyometrics can be helpful. Trialing some of the following:

• Jog in place

• Double leg hop in place, double leg hop to front and sides

• Single leg hop in place, single leg hop to front and sides

• Jumping jack: legs only then and lower arms and lastly full range arms

Running progression can begin once you have been cleared but keep aware of any signs of leakage of urine or feces, pelvic heaviness or pressure or pain. Goal would be to start with a run/walk interval. Make sure not to progress faster than 10% per week. If you have some of the symptoms listed above, this may benefit from a referral to a pelvic physical therapist.

If you think you are having some pelvic floor dysfunction, contact us or your local pelvic floor physical therapist for treatment. You can also contact me for help finding someone local to you.

THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE. The information provided in this blog, including but not limited to text, graphics, images and other material are for informational purposes only. No material on this site is meant to be a substitute for professional medical care, treatment or advice. Always speak to your health care provider with any questions you may have regarding a medical condition or treatment. Never delay or disregard professional medical advice because of something you have read on this website.

What is Pelvic Floor Physical Therapy

Maybe you have heard this term, maybe you have not. But if you are here, then you must have some pelvic floor concerns and a pelvic floor physical therapist is the best place for you to start! 

Let’s start at the beginning. A physical therapist is usually a Master’s or Doctorate level practitioner who has gone through 2-4 years of education beyond a Bachelor’s degree. By definition from The Oxford Languages, a physical therapist is “a person qualified to treat disease, injury or deformity by physical methods such as massage, heat treatment and exercise rather than by drugs or surgery”. We are the movement and musculoskeletal experts to help improve the quality of life in people of all ages.

A Pelvic Floor Physical Therapist (or also called a pelvic health physical therapist) is a physical therapist who has taken additional training beyond that Master’s or Doctorate level degree to learn about the pelvic floor, bladder dysfunction, bowel dysfunction, pelvic pain, pregnancy and post partum issues and more. Pelvic floor physical therapy is a highly specialized segment of physical therapy and although it is looking at specific pelvic floor dysfunctions, the physical therapist will still look at the person as a whole because everything above and below the pelvis can affect and be affected by the pelvis. 

I have been a physical therapist since 2003 and have been working with pelvic floor patients for nearly that entire time. Since 2003, I have taken on average 2-3 advanced training courses per year to learn more and more techniques to help women with pelvic floor dysfunction. 

Some things that I see frequently:

• Urinary incontinence

• Urinary frequency

• Night time frequency

• Urinary urgency

• Pelvic pain

• Constipation

• Bowel urgency

• Pain during intercourse

• Prenatal pelvic, back and hip pain

• Postpartum pain 

• Diastasis Recti Abdominus

As a pelvic floor physical therapist in the clinic, I look at everything from the head to the toes because it can ALL affect or be affected by the pelvic floor. I do also assess your pelvic floor muscles both externally and internally (yep……internally!) to see if you can contract AND relax your muscles. So many women think pelvic floor physical therapy is just Kegels but did you know that if you cannot relax your pelvic floor muscles, you should absolutely not be doing Kegels?! 

I also work with many women virtually but this looks a little different than in the clinic. There is no exam so I rely on information from you about how you feel. There are a few conditions that really need the hands on treatment so I sometimes will refer women who come to me virtually to a local pelvic floor physical therapist for that hands on treatment but there is much that can still be done without that examination. 

One last little tid bit of information on pelvic floor physical therapy………in many European countries, every woman that delivers a baby gets 6 pelvic floor physical therapy visits to help heal her body after pregnancy and delivery!!! Doesn’t that sound amazing?!

If you think you are having some pelvic floor dysfunction, contact us or your local pelvic floor physical therapist for treatment. You can also contact me for help finding someone local to you.