Women’s Health Conditions – Details

Prenatal pain During pregnancy, numerous changes occur to a woman’s body that can cause discomfort or pain. Pain may be experienced for a variety of reasons including: blood volume increases, hormone level changes, changes in rib cage dimensions, weight gain and breast changes.

Some of the symptoms experienced may include:

  • Back pain
  • Pelvic pain
  • Hip pain
  • Headaches
  • Carpal Tunnel syndrome
  • Thoracic Outlet syndrome
  • Piriformis syndrome/Sciatica

Physical therapy during pregnancy can help to alleviate the pain and discomfort through:

  • Joint and soft tissue mobilization to optimize musculoskeletal alignment and reduce muscle guarding
  • Exercises to re-educate and strengthen weak muscles
  • Education about proper posture, symptom management and relaxation techniques
  • Bracing/supports to add external support to reduce the stress on the body

Source: APTA Section on Women’s Health

Postpartum pain During pregnancy and childbirth, numerous changes occur to a woman’s body that can cause discomfort or pain. Pain may be experienced for a variety of reasons including: musculoskeletal misalignment, muscle weakness, injury to pelvic floor muscles during vaginal delivery, scarring/pain from Cesarean delivery.

Some of the symptoms experienced may include:

  • Back pain
  • Pelvic pain
  • Hip pain
  • Urinary Incontinence
  • Pain associated with scars (episiotomy or Cesarean)
  • Pain with intercourse
  • Diastasis recti (separation of abdominal muscles)
  • Prolapse (lack of support in the pelvic area that allows the organs to fall from their normal position)
  • Coccydynia (tailbone pain)

Physical therapy after pregnancy can help to alleviate pain and discomfort through:

  • Joint and soft tissue mobilization to optimize musculoskeletal alignment and reduce muscle guarding
  • Exercises to re-educate and strengthen weak muscles
  • Education about proper posture, symptom management and relaxation techniques
  • Biofeedback to re-educate and strengthen muscles in order to reduce pain and reduce or eliminate incontinence
  • Scar mobilization/massage

Source: APTA Section on Women’s Health

Pelvic pain Pelvic pain is a general term used to describe discomfort in the pelvic region. The pelvis serves many roles in the body. Nearly every movement of the body depends on the pelvis. Proper activity and balance of the muscles, joints and tissues of the pelvis are essential for normal, pain-free function. The pelvis also plays a role in the support and protection of the internal organs, control of bladder and bowel function, and in sexual function.

Pelvic pain Pelvic pain is a general term used to describe discomfort in the pelvic region. The pelvis serves many roles in the body. Nearly every movement of the body depends on the pelvis. Proper activity and balance of the muscles, joints and tissues of the pelvis are essential for normal, pain-free function. The pelvis also plays a role in the support and protection of the internal organs, control of bladder and bowel function, and in sexual function.

Some of the symptoms experienced may include:

  • Pain with intercourse
  • Pain with tampon use
  • Difficulty with normal activities such as sitting, standing, walking
  • Difficulty with recreational activities such as walking, jogging, golfing or other exercise
  • Chronic constipation or difficulty passing a bowel movement
  • Pain in the groin or buttock region
  • Chronic low back, hip or sacroiliac pain

Physical therapy can help to alleviate pelvic pain and discomfort through:

  • Joint and soft tissue mobilization to re-align the pelvis and surrounding joints and tissues
  • Exercises to re-educate and strengthen weak muscles
  • Biofeedback to re-educate and strengthen pelvic muscles
  • Relaxation techniques to re-educate overactive pelvic muscles

Source: APTA Section on Women’s Health

Pelvic floor weakness The muscles of the pelvic floor form a sling from the pubic bones to the coccyx (tailbone). This muscle group has three very important functions: support, bladder and bowel function, and sexual function. If there is low strength in these muscles, pain or problems with bladder and bowel function, and/or problems with sexual function may result.

Physical therapy can help to alleviate pelvic floor weakness through:

  • Muscle re-education to increase abdominal strength and strengthen the pelvic floor
  • Postural education
  • Retraining of activities that stress the pelvic floor
  • Biofeedback to re-educate and strengthen the pelvic floor muscles
  • Spinal and pelvic misalignment corrections

Source: APTA Section on Women’s Health

Urinary incontinence

Stress Incontinence

Leakage of small amounts of urine when there is increased pressure on the bladder. This can happen during exercise or with sneezing, coughing, lifting or other activities.

It usually results from weakness and lack of support in the muscles of the pelvic floor. These are the muscles that attach to the bottom of the pelvic bones and run front to back, forming a bowl-like structure that lifts to support the internal organs and controls the sphincter muscles. The pelvic floor muscles also work to strengthen the low back, stabilize the pelvic bones, and help with sexual function.

Causes: Pregnancy and childbirth, injury or trauma, surgery in the vagina or rectum, episiotomy, lack of exercise or lack of use of the pelvic floor muscles

Urge Incontinence

Leakage of medium to large amounts of urine when a person feels a sudden strong urge to urinate.

Causes: Poor sensation and not being aware the bladder is full, nerve damage, pelvic floor weakness.

Physical Therapy treatment for Urinary Incontinence may include:

  • Education on diet and nutrition to avoid food and drinks that may irritate the bladder
  • Advice on how to change behaviors that make symptoms worse
  • Techniques to help you find the right muscles and learn to use them correctly
  • Exercises to strengthen the pelvic floor muscles
  • Exercises to stretch and strengthen other important support muscles
  • Biofeedback training to re-educate and strengthen pelvic floor muscles

Source: APTA Section on Women’s Health

Pelvic organ prolapse Pelvic organ prolapse occurs when the pelvic floor muscles and surrounding connective tissues become weakened and the adjacent organs protrude into the vagina. The types of prolapse include: cystocele – when the bladder descends into the vagina; uterine prolapse- when the uterus descends into the vagina; enterocele – when the small intestine descends into the vagina; and rectocele – when the rectum descends into the vagina.

Physical Therapy treatment can help in the strengthening and re-education of the pelvic floor muscles. This can help to improve symptoms of fatigue, pressure and pain in the groin and low back, and decrease urinary incontinence that is occurring as a result of the pelvic floor weakness and prolapse.

Source: Beyond Kegles Book II, Janet A. Hulme, M.S., P.T.

Levator Ani syndrome Levator Ani syndrome is pain in the sacrum, coccyx (tailbone), rectum and/or pelvis that may increase with sexual intercourse, sitting, defecation and constipation.

Physical Therapy treatment may include:

  • Joint and soft tissue mobilization to improve musculoskeletal alignment and reduce muscle guarding
  • Exercises to strengthen weak muscles
  • Biofeedback training to re-educate and strengthen pelvic floor muscles
  • Relaxation techniques to help quiet overactive pelvic muscles.

Source: Overview of Pelvic Pain, Constance Perry, P.T.

Dyspareunia Dyspareunia is pain in the vagina or lower pelvis with sexual intercourse.

Physical Therapy treatment includes biofeedback for re-education of the pelvic floor muscles. This may include relaxation and/or strengthening of the pelvic floor muscles.

Source: Overview of Pelvic Pain, Constance Perry, P.T.

Vaginismus Vaginismus is involuntary spasm of the vaginal entrance.

Physical Therapy treatment includes biofeedback for re-education of the pelvic floor muscles. This may include relaxation and/or strengthening of the pelvic floor muscles.

Source: Overview of Pelvic Pain, Constance Perry, P.T.

Vulvodynia/ Vulvar Vestibulitis

Vulvodynia

Chronic vulvar pain or discomfort characterized by burning, stinging, irritation or rawness that lasts longer than six months.

Vulvar Vestibulitis

Chronic, severe vulvar pain upon touch or attempted vaginal intercourse.

Physical therapy treatment for both vulvodynia and vulvar vestibulitis may include:

  • Joint and soft tissue mobilization to improve musculoskeletal alignment and reduce muscle guarding
  • Exercises to strengthen weak muscles
  • Biofeedback training to re-educate and strengthen pelvic floor muscles
  • Relaxation techniques to help quiet overactive pelvic muscles.

Source: Overview of Pelvic Pain, Constance Perry, P.T.

Interstitial cystitis Interstitial cystitis is a chronic inflammatory condition of the bladder with symptoms of severe frequency and urgency to urinate and lower abdominal pressure and pain. Individuals may need to urinate every 20-30 minutes during the day, as well as frequently waking to urinate at night. Pain may be present in the low back, lower abdomen, vagina and inner thigh s. Fatigue is also a common symptom.

Physical Therapy treatment may include:

  • Joint and soft tissue mobilization to improve musculoskeletal alignment and reduce muscle guarding
  • Biofeedback training to re-educate and strengthen pelvic floor muscles
  • Relaxation techniques to help quiet overactive pelvic muscles

Source: Beyond Kegles Book II, Janet A. Hulme, M.S., P.T.

Endometriosis Endometriosis is a disorder of the female reproductive system in which the endometrium, which normally lines the uterus, grows in other places in the pelvis such as on the fallopian tubes, ovaries or tissues lining the pelvis. This tissue acts normally during a menstrual cycle, thickening, breaking down and bleeding. When this occurs the surrounding tissues can become irritated. The most common symptom is pelvic pain, especially during a period.

Physical therapy treatment may include:

Joint and soft tissue mobilization to improve musculoskeletal alignment and reduce muscle guarding and pain

Source: www.mayoclinic.com

Post-surgical scars

  • Cesarean section Cesarean section, commonly called a C-section may cause abdominal weakness, low back pain, scar adhesions, poor posture and poor body mechanics.Physical therapy can help to reduce scar adhesions, address postural problems, provide exercise instruction to re-educate and strengthen abdominal muscles, and ensure proper alignment of the spine and pelvis.
  • Episiotomy An episiotomy may cause scar adhesions, pelvic floor muscle weakness, pain and dyspareunia.Physical therapy can help to reduce scar adhesions, as well as re-educate and strengthen pelvic floor muscles.
  • Laparoscopy Laparoscopy is a type of abdominal surgery that uses small incisions and cameras to guide the surgeons during the operation. It can result in painful abdominal and visceral scar adhesions.Physical therapy can help to reduce the scar adhesions and alleviate pain and dysfunction post-surgery.
  • Hysterectomy Hysterectomy is vaginal or abdominal surgery to remove the uterus. It may cause weakened abdominal muscles, scar adhesions, and/or pelvic floor tension or weakness.Physical therapy can help to alleviate scar adhesions, re-educate pelvic floor muscles and strengthen abdominal muscles post-surgery.
  • Abdominal surgery Abdominal surgery may cause painful abdominal and visceral scar adhesions. Physical therapy can help to reduce scar adhesions and alleviate pain and dysfunction post-surgery.
  • Mastectomy Mastectomy can cause scar adhesions, lymphedema, and restricted shoulder range of motion. Physical therapy can help reduce scar adhesions after surgery, can help to prevent lymphedema and can prevent or help alleviate restricted shoulder range of motion.

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