Every year in May, we get the opportunity to celebrate Mother’s Day and honor the important women in our lives. May has also become a month dedicated to exploring Women’s Health issues.  The field of Women’s Health has exploded in this past decade. Women’s Health issues include; involuntary loss of urine (incontinence), fecal incontinence, pelvic pain, sexual dysfunction, infertility, postpartum recovery and cancer recovery. Women’s Health Physical Therapists have specialized training to treat the source of these problems, not just the symptoms, eliminating incontinence and pelvic floor muscle pain and dysfunction. Therapists trained in Myofascial Release have a proven higher success rate in eliminating incontinence because of their ability to get to the source of the problem.

Urinary incontinence in women has become an epidemic. The statistics have not improved since I wrote my first article on this same subject in 1994. Approximately one in 4 women suffer with stress urinary incontinence- the involuntary loss of urine when sneezing, coughing or laughing. Even more suffer with urge urinary incontinence where the urge to urinate is so strong that you can’t get to the bathroom in time. Many women will whisper about it with their close friends. Many falsely believe that it is a natural part of getting older or having children. Most women will wait at least 7 years before talking to their doctor about it. It affects women’s lives on a physical and emotional level. Many women are afraid to go out in public without knowing where the closest restrooms are. It affects their ability to have intimate sexual relations.

The sad thing about this epidemic is that it is so treatable. The information has been out there, readily available for the last 20 years. Yet, the most effective and most conservative form of treatment for eliminating incontinence is still partially hidden from the general public and often over shadowed by the pharmaceutical and surgical options which have greater side effects and less effective results.

The underlying culprit in many of the above mentioned diagnoses is an imbalance in the pelvic floor muscles. What are the pelvic floor muscles? They are a layer of muscles that stretch from the pubic bone in the front to the tail bone at the back. They form the floor that supports our pelvic organs, like a muscular hammock. They have 3 main functions- supporting the pelvic organs, sphincter control for the bowel and bladder and providing sensation to the pelvic floor. Many women are told to do kegel exercises while they are pregnant and after delivery. The kegel exercise will strengthen the pelvic floor muscle that controls the bladder sphincter and controls the flow of urine. However, it does not address the entire pelvic floor. Most often, there are muscle imbalances which cause some of the muscles to be too tight, and others to be too loose. In general, with this situation, the kegels will tighten the muscles that are already too tight and make them even tighter. Many times, this will create more pain and more dysfunction. A properly functioning pelvic floor is one that is both strong and flexible. This allows for proper blood flow which nourishes the tissues by bringing oxygen and removing waste products.

A Physcial Therapist who specializes in Women’s Health has many different ways to treat these problems. First and foremost, a thorough evaluation is necessary to identify contributing factors and develop a plan of care. The pelvic floor muscles can be affected by muscle imbalances above and below the pelvis and cause symptoms such as low back pain, sacroiliac joint dysfunction, headaches, just to name a few. Identifying these problem areas is important for eliminating incontinence and having a good long term prognosis.
Many Women’s Health Physical Therapists only look at the pelvis and do not address underlying problems. Although this could give short term success, these underlying issues may affect the optimal functioning of the pelvic floor muscles.

Other treatment tools offered by a Women’s Health Physical Therapist include:
*Strengthening of pelvic floor muscles and core stabilization
*Use of biofeedback to help identify weak muscles or quiet over active muscles
*Electrical stimulation to increase the pelvic floor muscle contraction

Do your homework and know what the available treatments are for eliminating incontinence. Not all Women’s Health Physical Therapists are the same. Unfortunately, the field of Physical Therapy has been affected by managed care which is allowing less and less one on one, holistic care. Treatment of symptoms without getting to the source of the problem has become more of our standard of care. Be your own advocate and do not settle for less. Choose a Physical Therapist who is trained in manual therapy and Myofascial Release and uses these tools as their primary approach. Myofascial Release identifies and treats muscular and structural imbalances and is the best modality for restoring muscle components to their optimal length for proper functioning. This is an essential ingredient for treating pelvic floor muscle dysfunctions and eliminating incontinence not only in women, but also in men.

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Jody Hendryx, PT