Vaginismus and dyspareunia.
These are two personal conditions women experience and often have difficulty reaching out directly for support. Let this be a comfortable space for people experiencing one or both of these conditions to learn about the diagnoses and how physical therapy can help.
Vaginismus refers to difficulty with penetration and a feeling of “something blocking the entrance” or a “tight spot.” This could be related to overactivity of the superficial and deep muscles of the vagina. A muscle that should be looked at first is the bulbocavernosus, which can be closed tightly.
Dyspareunia is associated with recurrent pain or discomfort related to attempted or complete vaginal penetration.
Superficial dyspareunia involves pain or discomfort upon vaginal entry or at the vaginal introitus.
Deep dyspareunia involves pain or discomfort during deeper penetration.
Pelvic therapy can help address trigger points in the vagina that affect the pain women experience during this activity. Relaxation training, avoiding muscle tension, and using vaginal trainers can help improve outcomes for these patients.
Bladder Health
It's important to take care of your bladder and practice healthy bathroom etiquette. This includes going to the bathroom regularly (5-8 times a day), drinking water throughout the day (though the amount varies for everyone; you don’t need to drink half your body weight in water, as this can actually confuse your bladder muscles and cause incontinence), and completely emptying your bladder when you use the restroom.
Here’s a bladder reference guide for you to follow:
DO
Void every 2-4 hours during waking hours.
Sleep through the night. You should not need to wake up to void (unless you are pregnant, over 65, or have a medical condition that causes frequent urination).
Sit on the seat, relax, and breathe; do not push aggressively.
Consider using a step or squatty potty to ensure the recommended hip and lumbar position.
Stay hydrated and drink water throughout the day.
Consider reducing or eliminating irritants if you experience regular leaks. These irritants include caffeine, teas, alcohol, carbonated beverages, and acidic and spicy foods.
DON’T
“Just because” pee.
“Power pee,” or push the pee out.
Let constipation go untreated, as it can put pressure on your bladder.
Do Kegel contractions on the toilet; you should be relaxing your pelvic floor.
Run to the bathroom at every urge. You are in control of your bladder.
Limit fluids during your waking hours to avoid bathroom trips.
Pregnancy and exercise
The million-dollar question: What is okay during pregnancy? Can I lay down and strengthen my stomach muscles? Yes, you can. (think knee to chest) Can I draw my belly in and activate my transverse abdominal muscles? Yes, you can. (think you are holding a precious coin in your navel). Can I strengthen my back in a quadruped position? Yes. There is so much you can do in this position that I could put together a 30-minute exercise session easily. All these things most women can do during pregnancy, and with a modification if it is more comfortable for you. Women can also learn stretches for releasing the tight muscle in the front of their hip and the irritating muscle in the groin. These exercises will feel sooo good on your body!!
Hip strengthening is also a key component of healthy strength training during pregnancy. That means doing exercises to work on three main glute muscles: the gluteus maximus, the gluteus medius, and the gluteus minimus. These three muscles are crucial for women as their bodies change during pregnancy. Good glute strength is crucial for back health and hip health and a happier mommy and baby. In addition, working out during pregnancy helps your body get ready for the marathon of labor and prepare for delivery. Pregnancy is a perfect time to get started with your pelvic health and be followed by a Pelvic Health therapist. What you are able to do in the first trimester differs from the second and third, and it is important to perform key exercises and strengthening exercises throughout your pregnancy.
Prolapse
The first time you hear this word you may have a negative association with it. When in fact prolapse may not be a “bad” thing. Prolapse in the context of pelvic health relates to when an organ moves a calculated amount from its starting position. It is normal for muscles to descend when a person bears down, but sometimes the increased pressure can trigger more significant movement. Two common types of prolapse are bladder and bowel. Anterior prolapse is used in reference to bladder descending, and posterior prolapse is the rectum descending. Uterine prolapse is when the uterine slips down and protrudes outside the vaginal wall. A common sign you are experiencing prolapse that needs to be addressed is when you notice you have trouble on a daily basis and you constantly notice a feeling of heaviness. For example, you use the restroom and then need to use the restroom again right after you stand up. This is not a normal way organs should work and pelvic rehab can teach you ways to use your muscles to improve it. YES! There are also devices and non-surgical interventions that can help. If you are thinking of surgery to fix your prolapse PLEASE first get evaluated by a specialist.
Is my pelvic floor too tight or too loose?
It is difficult to assess this without having a pelvic floor evaluation, and many of us don’t know what is occurring in there. Sometimes it’s hard enough to pay attention to whether we ate breakfast or exercised 3-5 times a week as the doctor recommended.
The pelvic floor is essential for reproduction in addition to bladder and bowel health. It starts working the moment we are born and evolves throughout our life span changing as a woman’s or man’s body evolves. We might not notice an issue until a problem arises and we can’t do a basic life function, go to the bathroom, jump or laugh without incident, have enjoyable sexual intercourse, or get pregnant. These problems are related to what is happening to the muscles inside. Are the pelvic floor muscles holding on for dear life, are they relaxed and open, are they working as a co-contraction with our back and hip rotators? The short answer is the muscles change in length during each of these activities, and even if you are currently experiencing an undesirable experience, it can change with guided instruction. In pelvic floor therapy, I can teach you how to exercise your pelvic floor muscles to achieve the outcomes you are looking for.
Breathing.
A simple thing we do each day and without thinking. But what most of us don’t realize is how we breathe affects our state of being. When we breathe from our chest and upper shoulders, our breathing is rapid and shallow. This breathing will cause our sympathetic nervous system to speed up and prepare our body for a term known as “fight or flight.” We need our “fight or flight” response when our body is being attacked and needs to defend itself. When we exercise using our cardiovascular system, it is common to breathe rapidly as the workout intensifies, but this can cause our pelvic floor muscles to tighten and not support our core system. What we want to do is perform deep, long breaths, belly breaths, where our stomach is moving up and down, and our chest is staying still. This breathing will allow for equal length to contraction of the pelvic supportive structures and make it easier to sustain endurance challenges. Try it next time you’re trying to run or bike up that tough hill.
Dr. Tarah Joseph
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