During menopause, women can experience urinary and bowel incontinence – and pelvic floor physical therapy can help!
Pelvic floor physical therapy uses specialized exercises, manual therapy, and education to help women strengthen the pelvic floor muscles and improve muscle coordination.
Therapy can also help with symptoms including pain during sex, vaginal discomfort, and lower back or hip pain.
One of the most disruptive symptoms women experience during menopause is one they’re least comfortable talking about: urinary and bowel incontinence.
While it might be an uncomfortable topic, it’s important to bring it up with your provider so they can design a treatment plan that meets your needs and goals. At Regional One Health’s East Campus Center for Rehabilitative Medicine, Jamie Hanskiewicz, PT, DPT, CLT helps women address these symptoms and others through pelvic floor physical therapy.
Hanskiewicz talked to Regional One Health’s Menopause Support Group about when to consider pelvic floor physical therapy and what to expect.
“Around 50 percent of post-menopausal women have urinary symptoms, and around 84 percent have genitourinary symptoms,” Hanskiewicz said. “The average age of menopause is 51, but the symptoms can start in your 40s or even 30s.”
Pallavi Khanna, MD, an OBGYN and certified menopause practitioner who leads the Menopause Support Group, encouraged women to ask about a referral for pelvic floor physical therapy.
You can access therapy without a referral, but it is best for your therapist and provider to work jointly on a treatment plan.
“Talk to your primary care provider. Talk to your gynecologist. Talk to your physical therapist. We can answer your questions and make personalized treatment recommendations so you don’t have to live with these symptoms,” Dr. Khanna said.
“Around 50 percent of post-menopausal women have urinary symptoms, and around 84 percent have genitourinary symptoms,” Jamie Hanskiewicz, PT, DPT, CLT said. “The average age of menopause is 51, but the symptoms can start in your 40s or even 30s.”
Hanskiewicz said women are most likely to need pelvic floor physical therapy when they first become sexually active, during pregnancy or after childbirth, in perimenopause or menopause, or after a surgery in the pelvic region. These are all times when symptoms can develop or worsen.
Urinary symptoms include stress incontinence, or leakage during actions like jumping, sneezing or coughing; and urge incontinence, or leakage when the bladder is full. Other urinary conditions include overactive bladder, recurrent UTIs or UTI symptoms, and a sensation of bladder fullness.
Genitourinary symptoms include vaginal dryness, itching and burning, as well as pain during sex. Other symptoms pelvic floor physical therapy addresses include bowel incontinence, lower back or hip pain, and prolapse, which is the sensation that the organs are dropping.
Hanskiewicz acknowledged a lot of patients feel anxious about pelvic floor physical therapy, and she strives to put them at ease.
“At our first session, first and foremost I use the time to talk. That can take the whole hour; sometimes it goes into the second appointment,” she said. “I want to know what’s going on and what’s bothering you. I want to know your main areas of concern and focus.”
Early on, she does a physical exam and tests a patient’s core, muscle, hip and lower extremity strength. It is ideal to perform an internal pelvic exam, but this is based on each patient’s personal preference: “It does give me the best information about what’s going on, but it’s up to each patient if she wants to have an internal exam,” Hanskiewicz said.
Once Hanskiewicz has a clear understanding of her patient’s symptoms and diagnosis, she designs an individualized treatment plan that includes exercises, manual therapy and education. Sessions are held one-on-one in a private room, although some patients may use the Center for Rehabilitative Medicine’s gym facility to perform overall strengthening exercises.
Exercises focus on not only the pelvic floor muscles, which are located inside the pelvis; but also the hips and lower back.
Pelvic floor physical therapy can help with urinary and fecal incontinence, pain during sex, lower back and hip pain, and other symptoms. Most women experience relief in as little as 12 therapy sessions.
Kegel exercises are probably the most familiar. They help improve pelvic floor muscle strength and coordination and retrain the bladder: “The pelvic floor is the only muscle in the body that moves in two different directions. It needs to be able to contract, relax and lengthen as needed, and that’s what these exercises focus on,” Hanskiewicz explained.
She teaches patients how to perform the exercises properly, and recommends they do them not only during therapy sessions, but at home on their own. There are apps that can help remind you to do the exercises.
Manual therapy, meanwhile, can improve blood flow, relax the pelvic floor, and improve muscle coordination, and Hanskiewicz also puts a strong focus on education. Improved awareness of the pelvic floor muscles can help manage symptoms, as can support for lifestyle changes like eating a healthy diet and improving overall strength and fitness.
She also advises patients not to fall for DIY pelvic floor therapy tools. Devices and chairs that claim to exercise the pelvic floor muscles do not create lasting benefits, and vaginal weights can actually harm a patient by making it difficult for the pelvic floor muscles to relax.
Hanskiewicz said patients are in therapy for an average of 12 weeks, and some may also be treated by a PCP or gynecologist at the same time with prescription hormone therapy or topical vaginal estrogen. “It’s a combined effort to help these symptoms go away,” she said.