The Doctor Women Don't Know They Need

12/08/2017 12:31 PM ET
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Updated Mar 01, 2018
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It’s no secret that there are problems with our healthcare system. But what if I told you there is also something good happening, you just don’t know about it?

I’m talking about pelvic floor physical therapy.

Haven’t heard of it? Don’t know when or why you might need it? You are not alone.

When most people think of physical therapy, they think of common sports injuries such as rotator cuff tears or post-op rehabilitation for a torn ACL. It’s true — we treat every musculoskeletal condition you can probably imagine. But doctors of physical therapy (DPTs) specialize in treating many other systems in the body, including the cardiopulmonary, integumentary and neurological systems. Which brings me to one of the most important and under-discussed muscle groups: the pelvic floor.

Often considered “women’s health,” both men and women have pelvic floor muscles. These are muscles that you use throughout every day but never see. Only when they are weak or dysfunctional do people begin to learn more about them. Injury to the pelvic floor muscles can contribute to many other problems, including urinary incontinence (leakage with sneezing, running, laughing), low back pain and dyspareunia (pain during sex). One third of women experience diastasis recti ― a separation of the rectus abdominis muscles ― and many others experience organ prolapse. Pelvic floor weakness can contribute to core weakness, which often leads to postural deficits and injuries to the upper or lower extremities. Pain doesn’t always originate where you think it does, which is why it is so important for a specialist to consider these muscles.

Let’s talk about babies. During pregnancy, a woman’s body goes through obvious physical changes that literally shift their organs and bones, change their center of mass and redistribute their blood flow. The physical changes of pregnancy are so normal, yet they are also extreme. Our bodies are incredible and are designed to accommodate and adapt to these changes. But sometimes, the process is not as comfortable as we’d like it to be.

Then comes childbirth. As beautiful and wonderful as it may be, pushing a bowling ball through a key hole can also be physically traumatic. There is often tearing, stretching and cutting that requires sewing back together and may lead to debilitating scar tissue formation or weakness. Just like any muscle in the body that gets torn, stretched or cut, proper rehabilitation can help guide the healing process and protect the injured tissue so that it can return to its strongest state.

After months of pregnancy followed by childbirth — be it vaginal or by caesarean section — the body has to heal and return to a new “normal” state. Our focus shifts quickly to the baby, that adorable little treasure. But often the mother is left with a body she doesn’t recognize, both inside and out.

How can we as a society recognize the importance of physical therapy for a sprained ankle, and not realize the need for physical therapy after pregnancy and childbirth? In some countries, women receive free postpartum physical therapy because, well, it is obvious that it can help. But here in the United States, women barely know pelvic floor physical therapy exists.

The purpose of this article is not to detail the process of childbirth or to go on a rant about the many problems with our healthcare system. I am writing this because, as a Doctor of Physical Therapy and a woman myself, I am determined to help as many people as possible live without pain. I want to make sure that women know there is a specialist who can help them with the aches and pains they don’t fully understand and may not want to talk about with their friends.

So what exactly is a pelvic floor specialized physical therapist? A pelvic floor specialized physical therapist is a trained expert in the pelvic floor anatomy, as well as the entire musculoskeletal system. By performing an internal exam and assessment of the internal anatomy, they can help women strengthen the muscles that have been stretched, torn and weakened during pregnancy and childbirth. They can help men, too. Physical changes caused by enlargement of the prostate, prostate surgery or any other dysfunctions of the muscles of the pelvic floor often translates into bladder dysfunction or pain and weakness elsewhere. Like injuries to any other part of the body, physical therapy can help ensure that the weak or damaged structures return to their optimal function.

During an exam, a pelvic floor DPT may ask you questions about your pain, when you notice it the most, how it affects your daily life and what your goals might be. Questions may arise about your sexual health and behavior, exercise regimen and urinary/bowel movements. If you are a mother, you will likely be asked what kind of delivery you had (how long did it take? were there complications? was it vaginal or by c-section?). The more information you can give, the better the physical therapist can help determine the right course of treatment for you. After a conversation, there will be an external and internal exam to asses range of motion and strength of different muscle groups. Internal exam consists of palpation of the superficial and deeper pelvic floor muscles to assess muscle function, strength, and endurance as well as check for any soft tissue restrictions. Just like an orthopedic physical therapy appointment, a diagnosis is made and each patient is given a plan of care, with specific tips, tools and exercises to help them address the structural issues.

So where do we go from here?

The first step is educating men, women and healthcare providers that pelvic floor specialized physical therapists exist. If nothing else, I hope this article has helped do that.