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.
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."
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.
"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."
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.
Make sure you're practicing Kegels correctly and learn the other pelvic workout you should be doing
Think of prolapse as a hernia that mostly affects women. When the muscles that hold the pelvic organs become weak or stretched, the organs—the bladder, uterus, small bowel, rectum—can drop from their normal spot and push against the wall of the vagina. As many new mothers know, pregnancy is the most common cause of prolapse. However, it's not just the trauma of the childbirth that's a factor—it's also the extra pounds. "There could be 15 to 25 pounds plus the weight of a baby pushing on the perineum," says Klestinski. This means that excessive weight gain (no baby necessary) can also put you at risk. Weight maintenance is key to avoid risk of prolapse.
The regimen: Klestinski explains how a WHPT would take a holistic approach to address organ prolapse. "We work from the top down and from the bottom up. From above you may have extra body weight and extra downward pressure from poor posture, dysfunctional bladder habits or from adhesions due to prior surgeries or injuries. From the bottom up, we have the pelvic floor muscles, which act as a supportive hammock to the pelvic organs." Many WHPTs can help women work on weight management through exercise. To further improve the "top down" issues, the therapist would use manual techniques, patient education and posture training. At the other end of the, um, spectrum, she'd put the patient through workouts to strengthen and tone the pelvic muscles. This gives us yet another reason to do those darn Kegels.