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Can Physical Therapy Help Pelvic Organ Prolapse?

 

 

CAN PHYSICAL THERAPY HELP PELVIC ORGAN PROLAPSE?

Physical therapy can be a great first line conservative approach for pelvic organ prolapse (POP).  Let’s first talk about what POP is and some of the causes as well as treatment options, including a more in depth discussion about physical therapy.

Pelvic organ prolapse is the descent (falling) of one or more of the pelvic organs from its original position in the body in the pelvic cavity.  Three types of prolapse can occur (see illustration):  bladder (anterior vaginal wall), the rectum (posterior vaginal wall), the uterus (cervix), or the top of the vagina (vaginal vault) after hysterectomy.

An important thing to remember about prolapse is that if you notice a bulge in the vaginal canal, it is not the actual organ you are seeing but the wall of the vagina.  The organ falls and presses on the vaginal tissue which then falls towards the vaginal opening.

 

 

 

 

 

 

 

 

 

 

 

 

 

The cause of prolapse can be from a lot of factors but is primarily associated with:

  • Pregnancy and vaginal delivery, which leads to direct pelvic floor muscle and connective tissue injury
  • Increased age due to the hormone loss of estrogen which weakens vaginal support tissue
  • Hysterectomy
  • Pelvic surgery
  • Conditions associated with sustained episodes of increased intra-abdominal pressure, including obesity, chronic cough, constipation, and repeated heavy lifting.

Most women with pelvic organ prolapse are asymptomatic. Symptoms may become more bothersome as the bulge of the organ protrudes to or past the vaginal opening. In these instances it is not uncommon that a woman experiences aching in the pelvis, particularly at the end of the day, or a feeling that you are sitting on something in between your legs.

Urinary incontinence (loss of urine), particularly stress urinary incontinence, can be common in women with prolapse. Stress incontinence occurs when any kind of pressure is put on the bladder such as coughing, exercising, walking or rising from a chair.

 

Treatment options include for prolapse:

  • Pelvic floor physical therapy.   A pelvic health physical therapist will do an evaluation to determine an individualized treatment plan for you.  Evaluation includes posture and strength (especially in the hips and core). A an internal vaginal evaluation can also be performed to assess the level of prolapse as well as the strength of the pelvic floor muscles.  Treatment can include specific strengthening exercises for hips and core, lifestyle modifications to manage prolapse, pelvic floor muscle rehabilitation, and treatment of chronic constipation.

 

  • Vaginal pessaries are soft removable device that goes inside the vagina to help support the vaginal tissues displaced by the prolapsed organ. You gynecologist should evaluate you and fit you with a pessary to decide which one best suits you.  (See illustration below on examples of pessaries and how they are positioned in the vagina).

 

 

 

 

 

 

 

 

 

  • Surgery. Available surgical options for prolapse are reconstructive pelvic surgery with or without mesh augmentation.

Please call our clinic to speak with a pelvic health specialist if you have any questions about prolapse or any other pelvic health conditions. (847)550-9784.

 

 

 

 

 

 

 

Am I Performing Kegels Correctly?

A pelvic floor contraction, or Kegel (named after gynecologist, Arnold Kegel) is a way to improve and maintain the strength of the pelvic floor.   Like any exercise, it can be difficult at first to know that you are performing Kegels properly, but with practice they become second nature. Here are a few tips to ensure you are performing them correctly:

  1. Finding the pelvic floor muscles. If you can stop your urine flow mid-stream, you have identified your pelvic floor muscles. This is the most difficult part of the exercise.  **Do not perform daily Kegels while urinating, only perform contraction while urinating initially to identify the correct muscles.
  2. Isolating the pelvic floor muscles. Now that you found the muscles in step one, we want to be careful we don’t bring in all our other hip muscle “friends” with the Kegel. This means no contraction or your glutes (butt) muscles, thighs or abdomen, you really want to just isolate the pelvic floor. The wonderful thing about Kegels is that no one in the room should know you are doing them if you are doing them correctly.
  3. Don’t forget to breathe. Holding your breath or inhaling while you squeeze can increase pressure on your pelvic floor, which will not optimize your contraction. A good tip is to count quietly while you squeeze the muscles to ensure you are breathing.
  4. Ensure good range of motion. It is very important you relax the muscles completely with each repetition of the Kegel. Counting to 4-5 seconds in between squeezes can help ensure your muscles relax fully.
  5. Building your routine. Performing with an empty bladder, your first goal should be to tighten your pelvic floor muscles for 5 seconds. When this becomes easy, increase to 10 seconds. Increase your repetitions gradually to reach 30-40 repetitions per day. Pair your Kegels with something you do daily like brushing your teeth, driving (think stop lights) or eating.  This way they will become part or your lifestyle and you will ensure you get your repetitions in throughout the day.

 

**While Kegels are an important part of maintaining pelvic health, they may not be for everyone.  If you are experiencing pelvic pain or have difficulty fully emptying your bowel or bladder, Kegels may not be for you at this time.  An evaluation by a pelvic health physical therapist can ensure you are performing Kegels properly as well as help with any bladder, bowel or sexual function problems you may be experiencing.

Direct Access in Illinois

In pain? Direct Access means relief on your terms — now available in Illinois

We are thrilled at Pelvic & Orthopedic Physical Therapy Specialists that on August 16, 2018, Governor Bruce Rauner signed the Illinois Direct Access law.

What Does Direct Access Mean to You?

Now, instead of having to make an appointment with your physician to get a referral for physical therapy, you can make the appointment directly with a physical therapist.  In other words, quicker access to help to decrease your pain and improve your quality of life.

Who Direct Access Helps

All Illinois residents are now eligible, which helps patients of all walks of life go to physical therapy faster than ever before.  Examples include:

  • Weekend warriors who overdid yard work
  • Pregnant women experiencing pain with changes in their bodies
  • Postpartum women who just aren’t bouncing back like they want to
  • Aging adults who don’t have the balance and stability like they used to

What Conditions are Typically Treated?

Our highly-trained, specialized physical therapists can help you alleviate:

  • Back and hip pain
  • Neck and arm pain
  • Pelvic pain
  • Urinary Incontinence (female and male)
  • Pre- & post-childbearing conditions
  • Shoulder pain, bursitis, tendonitis and tears
  • Foot and ankle pain, including plantar fasciitis, sprains
  • Headaches and migraines

Who Direct Access Helps

All Illinois residents are now eligible, which helps patients of all walks of life go to physical therapy faster than ever before.  For example, this can reduce wait times for postpartum moms who need help before their 6 week checkup, weekend warriors who overdid their yard work, and busy people who want to start PT don’t have time to visit their primary care physician.

How Does This Work With Our Clinic?

Give us a call at 847-550-9784.  One of our friendly staff members will schedule your initial appointment.  You don’t have worry about calling your insurance company – we will verify your insurance benefits to confirm your treatment coverage before your first appointment.

What’s stopping you?  Don’t suffer any longer — call today.

 

 

The Role of Visceral Manipulation in PT

Visceral manipulation is not familiar to many people, including physicians.  It is one treatment modality in physical therapy that can be very effective in helping with many conditions including post surgical scarring (ie. c-section, appendectomy, hysterectomy) as well as abdominal problems such as constipation or bloating.

The organs, fascia and ligaments in our stomach are not something most of us think about on a daily basis. Fascia is a band or sheet of tissue (think saran wrap) that attaches, covers and separates our internal organs.  When all is well, everything in our stomach slides, glides and rotates on each other like it should and our body functions normally.  At times in life, however, events such as surgeries, injuries, infections, food intolerances, chronic bad posture and pregnancy can cause inflammation and impair these movements.

Over time, this can result in adhesions/scar tissue will attach to either the organs, ligaments or fascia.  This can slow down the passage of food waste through your digestive system and can cause constipation, bloating or even shoulder/back/hip/sacro-iliac or abdominal pain.  Visceral manipulation is a gentle, manual technique that can release the adhesions created by these surgeries allowing the organs to move freer again which can decrease pain and return the body back to normal function.