Ask an Expert: Can PT Relieve My Pelvic Pain?

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Question: Can physical therapy relieve my pelvic pain?

Answer: Yes! A pelvic health physical therapist is trained to evaluate and treat the possible causes of abdominal and pelvic pain to include muscle tightness, joint dysfunction, irritation of nerves, weakness, and scar tissue.

After the evaluation is complete the therapist will design a plan of care that may focus on manual therapy to address scar management or tenderness, stretching for muscle tension to improve flexibility and strengthening for added stability for daily tasks. Other treatments may include the use of modalities such as TENs for pain management, biofeedback to gain awareness of muscle tension, pelvic floor relaxation exercises and posture retraining.

Every plan of care is individualized for each patient to assist them with relieving their pelvic pain in order to return to all desired daily activities.

 

Amy Hauerstein, PT, CAPP-Pelvic

Easy Steps to Keep Your Bladder Healthy

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Good bladder habits can improve bladder control whereas poor bladder habits can lead to poor bladder control. Here are four steps to keep your bladder healthy!

Step 1 — Use Good Toilet Habits

  • It is normal to go to the toilet four to six times per day (approximately every 3 ½ to 4 hours).
  • You shouldn’t get up to go to the toilet more than once a night.
  • Don’t get into the habit of going to the toilet “just in case.” Try to go to the toilet only when your bladder is full. Going to the toilet just before you go to bed is fine.
  • Women should sit down to go to the toilet. Do not hover over the toilet seat.
  • Take your time, relax when you are on the toilet. This helps your bladder to empty out fully. If you rush, you may not empty your bladder fully and over time can result in a bladder infection.  You may even need to rock your body while on the toilet and then relax again for a second urination. This is called the double void technique.

Step 2 — Look After Your Pelvic Floor Muscles

  • Keep your pelvic floor muscles strong with pelvic floor muscle training.
  • Practice your Kegels after every bathroom trip (for example, while washing your hands), when you sit at a stoplight, check your watch, or wait on tv commercials. Contact a pelvic physical therapist to make sure you are doing Kegels correctly.
  • Return to physical therapy if you feel you are regressing in any significant way. Remember, you will have “good days and bad days,” but you should feel like you are in control of your bladder for the most part.

Step 3 — Keep Good Bowel Habits

  • Avoid constipation.
  • Do not strain when using your bowels. This puts extra load onto your pelvic floor muscles and may weaken the muscles. The pelvic floor muscles help with bladder and bowel control.
  • Eat two pieces of fruit and five servings of vegetables daily.
  • Keep active. Physical activity helps to keep your bowels regular.

Step 4 — Drink Fluid Every Day

  • Fluid is everything you drink. Fluid includes milk, juice, and even soup, but the best fluid to drink is water.
  • Cut down on how much caffeine and alcohol you drink, as these may upset your bladder. There is caffeine in chocolate, coffee, and tea. Avoid fizzy drinks which contain caffeine, including cola and sports drinks.

Christie DeCraene, PT is an outpatient Physical Therapist who has over 25 years of experience treating not only Women’s Health issues but also orthopedic and neurological deficits. Christie uses a variety of treatment approaches with an emphasis on education, function-based therapeutic exercises, and manual-based treatments.

Exercise During Pregnancy

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Amelia Iams, DPT

aquatic exercise during pregnancy

Exercise is important to include in everyone’s daily life, but it becomes even more important when you are pregnant. Pregnancy causes many changes in a woman’s body.  Hormone changes in the body cause softening of the ligaments, joint laxity, and instability in the ankles.  Hormones and anxiety can be the reason for increased mood swings.  Changes in the center of gravity due to a growing belly can cause increased occurrence of back pain.  Increased retention of fluid in the body causes swelling in both the hands and feet and can amplify complaints of constipation.

Exercise during pregnancy provides similar benefits to your body as it does during other times in your life, but it also can prevent and minimize changes in the body and pain or discomfort that occurs when you are pregnant. Some of the proven benefits that exercise during pregnancy includes are:

  • Avoidance of excessive weight gain
  • Maintenance or improvement in endurance, muscle strength, and flexibility
  • Reduction of the likelihood of gestational diabetes
  • Decrease or reduction in symptoms of low back pain or pelvic girdle pain
  • Reduction in occurrence of preeclampsia
  • Decrease in the risk of cesarean delivery
  • Reduction in psychological stress

The American College of Obstetricians and Gynecologists (ACOG) states “for healthy pregnant and postpartum women, the guidelines recommend at least 150 minutes per week of moderate-intensity aerobic activity (ie, equivalent to brisk walking). This activity should be spread throughout the week and adjusted as medically indicated.”  That is equal to about 30 minutes 5 times a week of moderate exercise.  Research also indicates that including both strengthening and aerobic exercise to your routine is important to help support the changes that occur in your body with pregnancy.

Despite all the benefits to exercising while pregnant, most women do not begin an exercise program and those who were exercising prior to pregnancy actually decrease their activity during pregnancy.   Through several studies and surveys, women have stated various reasons for decreasing their activity during pregnancy.  The two most common reasons are: not enough time and pain with movement associated with the pregnancy.

Choosing an exercise program that is safe, can be maintained during the entire 40 weeks of pregnancy, and can fit into a busy work and family schedule is a difficult task.   It is recommended that pregnant women avoid high contact sports and activities that have an increased risk for falls or impact, such as soccer, basketball, hockey, snow skiing, water skiing, and off road cycling.  Exercises that require jumping and quick changes in directions, such as Zumba, Cross fit, and trail running, are not recommended due to joint instability brought on by hormones.  Also high impact aerobics can be difficult to and uncomfortable to perform later in pregnancy.

An underutilized exercise avenue is aquatic exercise programs. Several research studies have advocated the use of pool exercises for women who are pregnant.  The natural properties of water help alleviate many of the adverse changes associated with pregnancy.  The buoyancy of the water will help to eliminate the stresses on the joints and to support the abdomen.  Women have reported feeling more comfortable moving in the water and able to assume better postures as a result of the additional support.  Hydrostatic pressure is an additional benefit when exercising in the water.  The pressure that the water exerts on the body helps to decrease the swelling in the limbs brought on by pregnancy.

Aquatic exercise is non-weight bearing and low impact, so stress on the joints is minimized. Water provides natural resistance to movement which helps to strengthen muscles and thereby incorporating both strengthening and aerobic exercise into one session.  This can help you meet both suggestions for a healthy body during pregnancy without increasing the time you spend at the gym.  Many women stop exercising as their pregnancy progresses because of decreased balance, increased swelling in their feet, or pain and discomfort in their back.  The water helps to support the body, and it is not likely that you will be injured falling in the water. Several studies have proven that exercising in the water during pregnancy helps to decrease low back pain and reduce time off from work due to pain and discomfort.  There are many benefits to exercising in the pool that cannot be achieved with land based exercise, therefore making it an excellent option for women during pregnancy.

There are many fitness centers as well as physical therapy centers that offer aerobic exercise classes in a pool and individualized pool exercise sessions. Choosing the right one for you should be based on several factors, such as cost, location, available time, and expertise of the instructor.  In some cases aquatic therapy can be covered through your health insurance when provided by a physical therapist.  A physical therapist can help design an exercise program that is individualized to you.  Other options to consider when choosing a pool are temperature of the water, depth of the water, and air temperature of the pool area.  Exercising in the water decreases your ability to sweat but there is increased loss of heat through skin contact with both the water in the pool and the air temperature difference in the pool room.  It is recommended that pools utilized for aerobic exercise for pregnant individuals be at about 80-86 degrees Fahrenheit.  Most pools at a gym are cooler to allow for longer time and more intense exercise while therapeutic pools at rehabilitation clinics will be warmer and offer increased comfort for those suffering from back pain.

Safety and monitoring your exercise regimen in the pool is important. The properties of water will naturally decrease the heart rate by increasing the volume the heart pumps out.  If you use your heart rate to gauge your exercise, it is suggested that you decrease your heart rate guidelines by 15 beats per minute.  When exercising in a pool is better to gauge your exercise intensity by using a scale called Borg Rating of Perceived Exertion.  A physical therapist can provide you with the scale and educate you on how to use it.  Dehydration with exercise can occur in the pool as easily as it can on land.  Having access to water during exercise can be important to avoiding any complications with exercise.

All exercise programs are most effective when you can choose an activity they enjoy and a program that is individualized to your needs and goals. We highly recommend water aerobics or any aquatic exercise for women during pregnancy. Aquatic exercise is an exercise program that women would be able to follow throughout the entire 40 weeks of pregnancy.

 

Amelia Iams, DPT is a Physical Therapist at FMH Rehabilitation Aspen Ridge in the treatment and management of sports related and orthopedic injuries.