Pelvic Floor

Physical Therapy for Menopausal Pelvic Floor Health Is Trending–Here’s Why

Menopause is associated with a lengthy list of symptoms, including hot flashes, night sweats, muscle pains, migraines, weight gait, pelvic pain, urine leakage, urinary frequency, urinary urgency, constipation, pain during intercourse, decreased libido, difficulty sleeping, and various mental health concerns, plus osteoporosis and cardiovascular and metabolic changes. The cause? A decrease in estrogen! Estrogen is a magical hormone that affects almost every part of our body, including our heart, brain, and musculoskeletal system. Some experts believe that estrogen plays over 400 roles in the body.  No wonder when we lose a large amount of this hormone, we can develop so many symptoms and don’t feel like ourselves!

Several menopause symptoms like pelvic pain, urine leakage, urinary frequency, urinary urgency, constipation, and pain during intercourse are related to the pelvic floor. The pelvic floor is a less well-known part of our anatomy but has received quite a bit of attention in the last year. Pelvic floor disorders affect nearly twenty-four percent of women in the U.S. While pelvic floor disorders can occur at any age, many women begin to experience these issues during the menopause life stage.

What is the pelvic floor?

The pelvic floor is a group of muscles that sits in your pelvis like a hammock. When contracting, the pelvic floor prevents urine, feces, and gas leakage. When relaxed, it allows us to urinate, defecate, and release gas. If these muscles are not functioning properly and optimally, it can lead to dysfunction, which can manifest as pain, pelvic pressure, and urinary or bowel symptoms.

What causes pelvic floor dysfunction?

Several factors influence the pelvic floor. The pelvic floor muscles can be underactive or overactive. When the muscles are weak, they cannot prevent leakage. Besides strength, these muscles also need endurance, power, and proper coordination to function–just like our other muscles.

  • Overactive muscles: When the muscles are overactive and overused, they do not live and function at the correct length and tension and, therefore, cannot generate enough force to prevent leakage. Like our other body parts, the pelvic floor must work through a full range of motion to function optimally. Imagine doing a bicep curl only in the last 20 degrees of that movement. There is no force generation! Pelvic pain can be due to an overactive pelvic floor and sometimes an overactive nervous system.
  • Underactive muscles: When the pelvic floor contracts too much of the time, it also becomes fatigued and cannot fire when you need it to, leading to leakage.

Factors that influence the pelvic floor can vary from person to person and include the following:

  • Posture
  • Alignment
  • Movement Mechanics
  • Weight (Body Mass Index)
  • Pregnancy
  • Childbirth (vaginal/c-section)
  • Hormones (particularly estrogen)
  • Stress
  • Trauma (physical/psychological)
  • Diet
  • Activities such as heavy lifting, exercise, and daily tasks

Because estrogen plays a significant role in muscle and connective tissue health, this change in hormone levels will likely affect your pelvic floor muscles. Besides the muscle belly not being quite as plump as when it had loads of estrogen, the connective tissues (tendons and ligaments) that support the pelvic floor muscles and pelvic organs may not be as supportive due to lower estrogen levels.

The Benefits of Menopause-Focused Pelvic Floor Physical Therapy

As a pelvic floor and women’s health physical therapist (PT), I have the pleasure of assisting patients in alleviating many bothersome menopause symptoms. If you are experiencing urinary leakage (incontinence), urgency, increased frequency (day or night time), difficulty emptying the bladder, pain during intercourse, constipation, rectal, pelvic, or abdominal pain or pressure, or if you are interested in prevention of these symptoms, find a pelvic floor physical therapist. She will likely be one of your favorite healthcare providers. Pelvic P.T.s understand how disruptive and even isolating these symptoms can be. We’ve heard various histories and complaints and are fortunate enough to be part of the solution to help clients return to their favorite activities and, most importantly, improve their quality of life.

Pelvic P.T.s are a special breed of healthcare professionals. Even within the physical therapy community, we are a little “different.” Poop, pee, and sex are terms we throw around as casually as we talk about the weather. We routinely perform internal vaginal exams and rectal exams to gather information about our clients’ conditions and treat findings accordingly. We educate our patients on how to sit on the toilet properly, what sexual positions will be the least painful, and how to manage their symptoms independently. Most pelvic PTs tend to be hands-on and attentive and have likely experienced similar symptoms at some point in their lives. WE GET IT. We hear complaints similar to yours Every. Single. Day. My clients frequently say, “ok, you will probably think this is weird, but I….” No question and no symptom is “weird” to us. And we talk about “weird” stuff all day long. Your sessions with your pelvic PT are a safe space to say anything you’re feeling or experiencing.

Establishing care with a pelvic floor physical therapist will allow you to participate in a thorough examination and evaluation to develop an individualized treatment plan to alleviate and hopefully resolve your symptoms. Your therapist will encourage you to do some exercises specifically related to your exam findings. Sometimes this means strengthening the pelvic floor muscles, but it is also common to need to focus on relaxation and down training exercises for this group of muscles. Specific hip and core exercises can also be a recommendation, along with several lifestyle tips and tricks.

Finding a Pelvic Health Physical Therapist

Because of the high success rate in treating urinary incontinence, pelvic pain, and other perimenopausal and postmenopausal symptoms, participating in pelvic floor physical therapy should and will be part of the standard of care for all women as preventative, conservative, and curative management of pelvic health conditions. Experiencing menopause does not mean you have to live with these unpleasant symptoms. You can find a pelvic health physical therapist by asking your provider for recommendations or searching the following databases for someone located near you.

Thanks to more women speaking openly about their pelvic floor problems, there’s been an increase in women seeking education and pelvic floor physical therapy, including women in the menopause life stage. You could say that pelvic floor PT for menopause is trending, and that’s a very good thing for women 40+!

For more expert education, tips, and exercises for pelvic floor health, download Midday from the App Store or visit us at Midday.Health.

Katie Ruebush, PT, D.P.T. is a women’s health physical therapist specializing in pelvic floor and obstetric physical therapy. As a lifelong athlete and now mother, she enjoys helping clients reach their personal goals of returning to their activities of daily living, hobbies, and exercise routines after injuries, surgeries, or childbirth. Dr. Ruebush graduated with a doctorate of physical therapy from Washington University in St. Louis and completed a clinical rotation in women’s health at Rush Hospital in Chicago, Illinois. She earned a B.S. in exercise science and a B.S. in human performance and fitness from St. Ambrose University in Davenport, Iowa, where she received the Major of the Year award. She is currently completing her M.B.A. from Louisiana State University.

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