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Pelvic Floor Health in Your 30's: An Interview with The 30's Guide To Life

I had the pleasure of chatting with a dear friend, Priska Jordan this week to talk all things pelvic health for her 30-something readers. Priska's mission is to help women in their 30's do less, but better. She started her blog to help women realign with their goals. She is an inspiring writer, and she brings her readers a variety of topics that are relevant in this decade of life. Check out her blog here.

For those that do not know me, I'm Dr. Mel, pelvic health Physical Therapist in Houma, LA. I started my career as an orthopedic physical therapist in the outpatient setting and transitioned to the pelvic health specialty after discovering my own pelvic floor issues and how they impacted my life so greatly.

I work with a large variety of women in my practice, including those with bladder, bowel, and pelvic pain issues during pregnancy, when trying to conceive, postpartum, and transitioning during menopause. I also work with younger patients who are not concerned with pregnancy but have painful pelvic issues like interstitial cystitis and endometriosis.

The 30's is one of the most exciting decades of a woman's life! This decade can be a time of renewal, self-introspection, and diving deeper into who you are. But what about our pelvic floors in this decade?

Question 1 - How do women in their 30's handle pelvic health?

During our teenager years and even into our 20's, you are probably not going to the doctor or physical therapist as often and are even able to bounce back faster after injury due to your young, robust immune system, which declines with age. This is also true for our pelvic health.

Exceptions would be for younger folks who have an underlying condition like endometriosis or interstitial cystitis that can show up at any age and cause significant pelvic pain and reduced quality of intimacy because of the pain.

However, in the 30's and beyond, there is an interesting shift for more preparation and prevention strategies for a future pregnancy, birth, or curiosity to find out where you stand with your pelvic health. Many of these women are also building their wellness team, like massage therapists, counselors, fitness teachers, and more. They also are likely to address their complaints sooner with a practitioner if something creeps up.

Especially due to the fact that as we age, these symptoms and injuries tend to hit us harder as our body takes longer to recover and we don't respond with the same robust immune response that we did in our 20's and teenager years.

Ten years ago, for example, you may have not even noticed an ache or a pain came up or you might have even ignored it while your immune system took care of it in a short time.

According to the research, injuries or pregnancy/birth later on in the 30's tend to cause longer healing times.

As we enter mid-late 30's the perimenopause period can also begin. This is a time of transition into menopause. This is when you start noticing the mood swings, hot flashes, night sweats, insomnia, and other symptoms caused by the hormonal fluctuations before you enter the full menopause state, where your ovaries are no longer producing estrogen and progesterone.

During the peri menopause and menopause periods, the vagina does change. A decrease in estrogen can lead to vaginal dryness, thinning of the vulvar tissues (the labia and pelvic floor muscles), and sometimes discomfort with intercourse.

Question 2 - How can painful sex be attributed to pelvic unhealth or an unhealthy pelvic floor?

Painful sex is a pretty symptom that can occur for a variety of reasons, so it's really important to get to the bottom of what is driving the symptoms. It's very common to have pelvic floor involvement with painful sex. You'll want to see your medical doctor if you think you have an infection to rule that out as well.

The pelvic floor is made up of several layers of muscles that run from pubic bone to tailbone and from sits bone to sits bone. These muscles need to be strong, coordinated, and flexible. If any one of these factors is out of balance, you may present with symptoms like pain with sex or even urinary leakage/pain and bowel symptoms.

Image courtesy of myPFM demonstrating the pelvic floor as a sling of muscles.

The superficial triangle surrounds the entrance of the vagina, which has to be flexible enough to open to allow for penetration, tampon insertion, or gynecologic exam. If there is resistance to this opening, meaning the tissues aren't flexible, you can get spasms or tension in these muscles that cause pain. Some terms you may have heard to describe this are dyspareunia, vaginismus, and vulvodynia to name a few.

If you experience some deeper pain with sex, it could be due to the deeper layers of the pelvic floor, which connect to the hip and the spine, also holding tension. This layer is also responsible for orgasm.

When you come for an internal pelvic floor assessment, the physical therapist is going to find which muscle is producing the pain that you are experiencing and then find what else in your musculoskeletal system is driving these muscles to stay in this tense state. The goal is to address the muscles directly producing the pain AND the contributing factors that are placing those muscles in non-optimal positions so they can work more efficiently without causing pain.

One example is someone who has a history of a labral tear in the hip and has lost some hip mobility. Because of this loss of motion in the hip, the pelvic floor can sit in a shortened position and not to want to stretch during sex. with Pelvic Floor Physical Therapy, we address both the labral tear and the pelvic floor for optimal results (and yes, pelvic PT's treat labral tears and the contributing orthopedic findings! It's a common question).

Priska says that it sounds like a domino effect if you experience one injury somewhere and then it trickles down into the nearby pelvic floor. And she's exactly right - this is the basis of biomechanics and how our muscle and joint function affects our whole body.

Priska asks what about urinary incontinence?

Bladder symptoms are also common!

Advice from the internet often tells you to do kegels because your pelvic floor is really week. What you're doing with a kegel is pulling the entire pelvic floor up and in and contracting it. Think about a bicep curl in your arm, which is analogous to a kegel in the pelvic floor.

BUT what benefit does a kegel give? Is your pelvic floor actually weak? Many with weakness in the pelvic floor do benefit from kegels and muscle training, however it's not often I see people doing them accurately.

Another situation is if your pelvic floor is actually holding tension, a kegel can worsen your symptoms, including your painful sex and urinary incontinence.

Urinary incontinence can occur from BOTH a tense pelvic floor or a weak pelvic floor.

This is because there are muscles that go around the urethra to hold it closed to stop urine from coming out when it's not supposed to. These same muscles also have to let go and relax when you are on the toilet in order to start the stream of urine. If the muscles are weak, then they are not able to hold the urethra closed, and urine can leak out. If the muscles are too tense and they can't let go of the urethra, a pressure gradient is created when the bladder is filling, and eventually the bladder needs to let out some of the pressure. A little dribbling of urine can result. Some of these muscles are what you are contracting when you are doing kegels, so you can see how you wouldn't want to do these exercises if the muscles were too contracted, causing the leakage.

Priska asks to explain the hammock analogy.

The pelvis houses our bladder, rectum, and uterus, which are supported by the pelvic floor. If you think of the sling of pelvic floor muscles as a hammock, and the hammock is falling, these organs won't have as much support. Everything is falling downward, and you could experience pressure or prolapse. You may see this following vaginal birth, for example.

If your hammock is tight and tense, like from endometriosis, interstitial cystitis, or following cesarean birth, these organs are squished up and do not have as much freedom to move, causing pain.

Priska asks if my clients come in having heard of the pelvic floor.

I've seen a mixed bag, honestly! Some have heard about it from their doctor or social media. There can be some apprehension for obtaining a pelvic floor assessment, so I want my clients to be comfortable and informed about what the exam could entail.

There is a shift taking place where people are talking about pelvic health more due to social media, blogging, and hearing more about it from friends.

Question 3 - When should someone see a pelvic floor Physical Therapist?

The gold standard is an internal pelvic floor assessment if you experience urinary or fecal leakage, bladder pressure, urgency, pain, or frequency, have back pain/sciatic pain, have fallen on your tailbone, pain with sex, constipation, or IBS. If you experience any of these symptoms, it's best to come in to get an individualized assessment, diagnosis, and treatment plan.

If you want to join a wellness program to keep your pelvic floor and musculoskeletal system healthy for birth or general fitness, I also do a lot of work for these types of sessions. Birth prep is recommended in the third trimester over three sessions to address preparing your pelvic floor for both a vaginal and cesarean birth and to recover postpartum faster.

If you're interested in seeing a pelvic floor Physical Therapist for your concerns, give us a call at 985-228-6961.

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