January Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
1. What are genitourinary symptoms of menopause?
2. Are hypermobile people more likely to experience pelvic pain?
3. What can I do about leakage with running and jumping?
1. What are genitourinary symptoms of menopause?
There are two key times in the lives of people with vulvas that significantly increase the risk of pelvic floor dysfunction: pregnancy and menopause. Because of similar hormonal changes during these two periods in our lives, there’s an overlap in common symptoms associated with postpartum recovery and menopause. A key differentiator however, is that a few months after a postpartum person stops lactating, hormones tend to return to pre-pregnancy levels. Click here to learn more about how lactation impacts your pelvic health.
On the other hand, once these hormonal changes occur during menopause, hormonal levels do not return to pre-menopausal levels without the support of hormonal supplementation.
During menopause, estrogen levels in the body decrease significantly. As a result, estrogen becomes less available for use by vulvovaginal tissue. These tissues are highly reliant upon estrogen to stay healthy and happy. When deprived of estrogen during menopause, folks can develop symptoms known as genitourinary symptoms of menopause. These symptoms include:
Vaginal dryness and burning
Genital itching and irritation
Burning with urination and penetration
Urinary urgency, frequency and leakage
Recurrent UTIs and UTI like symptoms without infection
Genitourinary symptoms can massively impact the quality of an individuals life, but they don’t have to. Fortunately, a combination of pelvic floor physical therapy and topical hormone treatment can be remarkably effective at treating these common symptoms. If you’re experiencing any of the symptoms listed above, contact us here to learn more about how PT can help.
2. Are hypermobile people more likely to experience pelvic pain?
Possibly. Hypermobility is considered to be a risk factor for a number of pelvic floor conditions, including pelvic organ prolapse and pelvic pain. Ehlers-Danlos Syndrome (EDS) characterized by hypermobile connective tissue. People with EDS have hypermobile, or overly flexible, connective tissue which can contribute to a host of symptoms, potentially including pelvic floor dysfunction. Connective tissue does a lot of stuff in the human body, including but certainly not limited to suspending organs in place, contributing to skin elasticity and creating support structures around joints.
The extra flexibility in their connective tissue predisposes folks with this condition to diagnoses like pelvic organ prolapse. Prolapse can occur because the ligaments that suspend their organs in place are more flexible, which makes them more susceptible to injury and thus reduced capacity to support the organ. People with hypermobile connective tissue are also more likely to experience joint dislocation and subluxation, increasing their risk for developing injuries to structures surrounding their joints like labral and meniscal tears.
This hypermobility also has a secondary side effect. When joints have extra movement in them, surrounding muscles have to work a harder to create stability in the joint. This extra work can lead to muscle fatigue and tension, leading to soreness and contributing to conditions like pain with penetration, generalized pelvic pain, hip and back pain.
While hypermobility is a risk factor for certain pelvic floor conditions, there’s so much that we can do to support your body and reduce your symptoms and risk. Strength training, pelvic floor training and movement modifications can make a huge difference for someone with hypermobility experiencing pelvic floor symptoms.
3. What can I do about leakage with running and jumping?
Here are a few reasons people leak with running and jumping (this is not an exhaustive list):
Pelvic floor weakness or tension
Poor coordination of the pelvic floor
Pressure management issues
Suboptimal form
Let’s dive into how each of these can impact your leakage and what you can do about it:
1. Pelvic floor weakness or tension
Your pelvic floor muscles are responsible for contracting to hold pee in when you want to and relaxing to allow pee out when you want to. If you’re leaking with jumping and running but not with any other activity, this may be because your pelvic floor is struggling to live up to the demands of that activity. Weakness and tension are two reasons they may fail at living up to the demands of these activities.
If weakness is the problem, the answer is strength training! This can include strengthening the pelvic floor itself as well as strengthening the muscles that support the pelvic floor like your glutes and abdominals. Your pelvic floor is part of your core, so strengthening all of these muscles together helps create the most support for your pelvic floor muscles.
If tension is the problem, we may need to focus on stretching and relaxing these tight muscles. Using tools like a pelvic wand can help.
I’ll like to explain this with a bicep analogy. If I want to drink water from my water bottle, my bicep needs to be flexible enough to allow me to stretch my arm out and reach the bottle, and it needs to be strong enough to lift my big, heavy Yeti to my face. If my bicep is tight, I can’t reach the bottle so I can’t drink. If my bicep is weak, I can’t lift the bottle so I can’t drink. Muscles need to be flexible AND strong to do their job. The pelvic floor is no different.
2. Poor coordination of the pelvic floor
Some folks have excellent pelvic floor strength but they can’t access it because their muscles don’t turn on and off when they need them to. Coordination is all about your brains ability to utilize your muscles strength at the times your body needs it.
Let’s go back to my bicep analogy. If my bicep is flexible enough to reach my bottle, and strong enough to lift it, but my brain doesn’t know where my bottle or face are in space than even with all the flexibility and strength in the world I can’t drink water. Once again, your pelvic floor is the same.
We need our pelvic floor to be coordinated so that it automatically engages when we need it to and relaxes when we’re not using it quite as much. If your muscles aren’t automatically engaging and relaxing of their own volition when you’re running and jumping, this can contribute to leakage.
If coordination is where your problem lies, I recommend working with a pelvic floor physical therapist who can help you figure out what’s going on and create a personalized plan to address your coordination deficits.
3. Pressure management issues
Once again we’re going back to my bicep. Even if my muscles are strong, flexible and coordinated, they could still get overpowered. Say I’m bringing my water bottle to my face and all of a sudden, my water bottle turns to iron and triples in weight (I have no idea what iron weighs so just go with it). I may drop it because I wasn’t expecting it to triple in weight and maybe I’m not strong enough to hold that new weight.
Pressure works similarly. If your pelvic floor muscles are strong, flexible and coordinated but you’re holding your breath as you jump, it’s like adding that 50 pound dumbbell to your pelvic floor. By simply exhaling or counting out loud while exerting yourself, you can significantly reduce the amount of force your pelvic floor has to work against to maintain control of your bladder.
4. Suboptimal form
Some of this section is running specific but some applies to any impact activity. While everyone participating in impact exercise moves slightly differently, there are a few common movement patterns runners fall into that may contribute to leakage, heaviness in the pelvis, knee pain and other symptoms during running. Some of these suboptimal movement patterns include:
limited thoracic rotation
sucking in your gut and keeping tension in the abdomen
producing a lot of up/down movement rather than channeling that force forward
reduced hip extension at push off
landing behind your foot instead of over the foot
clenching your pelvic floor the entire run
Figuring out which of these common patterns you’re defaulting to and how to modify your form can significantly reduce the stress on your pelvic floor, allowing your muscles to more successfully do their job of supporting your bladder while running.
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.