Physical Therapy for Your Lady Parts
By Corrie Pikul
When something's not right "down there," it affects how we feel everywhere else. Fortunately, there's a growing field of medicine devoted to treating these unique complications. Practitioners of women's health physical therapy help women (and some men) who have problems with sexual intercourse, urination, fertility, pregnancy preparedness, postpartum recovery and cancer recovery. They deal with the stuff we're too embarrassed to talk about, and because they've seen it all, they can reassure patients that their issues are at least treatable, if not always curable.
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This specialty started in 1995, when a group of orthopedic physical therapists recognized that their clinics were filling up with women whose concerns weren't being addressed. Women's heath physical therapists (WHPT) are often the problem solvers that gynecologists, obstetricians, urologists and other doctors call when confronted with a gender-specific medical mystery, like discomfort during sex, after childbirth or while going to the bathroom. All WHPTs (find one near you by going to the American Physical Therapy Association locator) have stories about patients who were told by a former doctor that their problem was just "part of being a woman."
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Like other types of physical therapists, they specialize in treating functional problems, but they say they also offer proactive services, like helping pregnant women prepare for an easier delivery and preventing complications like C-sections. Here are six situations where a women's health PT might be able to help you.
Incontinence
"Fifty percent of adult women will have incontinence at some point," says Jennifer Klestinski, MPT, communications director for the Section on Women's Health of the American Physical Therapy Association, who has a private practice in Madison, Wisconsin. "Because of anatomic differences, the effects of pregnancy and childbirth, and the effects of decreasing estrogen, women leak far more often than men. But with proper strengthening, the data shows there's an 85-percent chance of complete resolution."
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The regimen: Weak pelvic muscles are a major factor in incontinence, so in addition to Kegel exercises, Klestinski recommends doubling up: "Engage the pelvic floor muscles while doing other daily core exercises-like Pilates-to strengthen the abs, back and hips." Another surprising cause is osteoporosis, because a rounded back causes our thoracic cavity and abdomen to press on the bladder. A WHPT would recognize this during an evaluation and could prescribe appropriate exercises for bone density loss.
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Pregnancy and Recovery
Pregnancy causes profound anatomical and hormonal changes to our bodies. "Some women's bodies accommodate those changes quite well, and some women require a fair amount of work and assistance," says Jill Boissonnault, WCS, PT, PhD, past president and founder of the International Organization of Physical Therapists in Women's Health.
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The prenatal regimen: Pushing out a baby is never going to be easy, but some WHPTs say that massaging the perineum with a lubricant, as well as stretching the hip and pelvic muscles, can help a woman "open up" during delivery, which could make her less likely to tear. There's also evidence that pregnant women can be taught how to bulge and flex their pelvic muscles correctly during labor, which can help avoid C-sections.
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The postpartum regimen: "There are things a woman can do to mitigate some of the risk for future dysfunction, like strengthening her pelvic floor with Kegels throughout her pregnancy and after she delivers," says Boissonnault. She adds that in France, where postpartum wellness visits are included under national health coverage, new mothers are likely to be advised by a WHPT about strengthening their pelvic floor muscles, their abs and their posture.
KEEP READING: Physical Therapy for Pelvic Pain
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