Monthly Knowledge Drop - September
Each month for our newsletter, the Lady Blurb, we'll share answers to some 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 taken 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'll be answering:
When is the best time to see a pelvic floor physical therapist when I'm pregnant if I have no issues?
Why do prolapse symptoms seem to come and go without a clear link as to why?
If you have mild pelvic organ prolapse after your first baby, is it safe to have a second baby? Is it likely for it to get worse?
3.5 weeks postpartum - is it normal to experience pain and pressure only when sitting on the toilet?
Is peeing when I orgasm normally?
When is the best time to see a pelvic floor physical therapist when I'm pregnant if I have no issues?
For a deep dive into this topic, check out our blog post and video on the benefits of seeing a PT during pregnancy. In a perfect world, if you're feeling great, I'd recommend everyone sees a PT for a preconception visit, then around the 25-week mark or around the time, your body starts to significantly change. The best time to see a pelvic floor PT during pregnancy is when you're not having any symptoms. The benefits of this include:
getting a baseline assessment of your pelvic health and how it may impact your pregnancy, birth and postpartum recovery
talking through and planning for birth and recovery
learning how to reduce the risk of injury during pregnancy, birth and recovery
creating a personalized program to help meet those goals
Wherever you are in your pregnancy journey, PT can help you get a better understanding of where your body is and how you can support yourself through movement as your body continues to change. I genuinely believe, deep in my bones, that everyone had access to pelvic floor PT during pregnancy/postpartum, we'd be able to improve birth outcomes and prevent so much pain and fear. There are answers to your questions. Pregnancy does not need to be a guessing game.
Why do prolapse symptoms seem to come and go without a clear link as to why?
Almost always, there actually is a clear link as to why symptoms come and go, however, identifying it may take some careful attention! Additionally, it's important to note that it's perfectly normal for prolapse symptoms to fluctuate.
Prolapse occurs as a result of strain to ligaments supporting the prolapsed organ, causing the organ itself to hang lower. As a result of the strain, the body turns to the pelvic floor and surrounding muscles to better support this prolapsed organ. But these muscles, just like all other muscles, can be impacted by their environment making it harder for them to do their job. Identifying the thing aggravating your symptoms is important so you can train your pelvic floor and supporting muscles around that task. That's where PT can come in - to help you identify your triggers and create a plan around solving them.
A few common factors that can aggravate prolapse symptoms include:
constipation
lack of sleep/general fatigue
anything that causes you to cough/sneeze a lot (allergies, any respiratory virus)
a busier day (more physical activity, more time on your feet)
babywearing or carrying a baby more than usual
increasing your exercise load (running distance, weights, higher impact
*We have a blog post that dives deeper into this question coming out soon, so be sure to check back!
If you have mild pelvic organ prolapse after your first baby, is it safe to have a second baby? Is it likely for it to get worse?
Prolapse, particularly mild prolapse, is incredibly common with some estimates ranging as high as 85% of people having some degree of prolapse after vaginal birth. We do not have clear evidence that someone with mild prolapse will have a worsening of symptoms with future pregnancies and births. There is no evidence that indicates that having a mild prolapse impacts the safety of a future pregnancy or vaginal birth. A mild prolapse should not be the limiting factor when family planning.
With that said (read the question and answer above for more context) if you have prolapse and are planning on a future pregnancy, it can be incredibly helpful to get a better understanding of your prolapse symptoms and the strength/tone of the muscles supporting your prolapse. This knowledge and awareness of what's happening with your body can help you rehab from your previous birth and train for your future pregnancy. While we often talk about working on pelvic floor relaxation for birth, for someone with asymptomatic prolapse, strengthening the pelvic floor may be an important part of training for birth.
Some basic ideas for managing prolapse during a subsequent pregnancy include:
Manage constipation
Learn about and practice pushing techniques if planning for a vaginal birth
Ask your provider about using a pessary during pregnancy
Check-in with a pelvic floor PT prior to conception and during pregnancy to create a personalized home exercise program
3.5 weeks postpartum - is it normal to experience pain and pressure only when sitting on the toilet?
If you're experiencing pain and pressure that isn't improving by week 3 or 4 postpartum, I recommend speaking with your medical provider and seeing a pelvic floor physical therapist for an evaluation if possible. Any pain and pressure experienced postpartum should consistently be improving throughout the first few weeks and should not be considered a necessary part of healing past that time.
With that said, it's not uncommon to feel more pressure and pain when sitting on a toilet postpartum. This can happen for a few reasons. When sitting on the toilet, your pelvic floor muscles are typically relaxed which can make things feel heavier due to decreased support. Additionally, any straining during bowel movements and/or urination can trigger heaviness symptoms. I recommend that folks avoid pushing and straining postpartum whenever possible and do their best to keep stool soft in the early weeks.
Regarding pain, while sitting on the toilet, the most common pain people describe while sitting on the toilet postpartum is perineal pain - or pain between the vaginal and anal opening. This is particularly common for those who experience perineal tearing or an episiotomy due to scar tissue leading to sensitivity in the area. This may feel like stretching, tearing or stinging but should improve consistently during those early weeks.
If you're experiencing pain and pressure after childbirth, PT can help by using manual therapy in the clinic and teaching you exercises to perform at home. Contact us here for in-office or virtual care.
Is peeing when I orgasm normal?
Peeing when you don't mean to is considered urinary incontinence, including during orgasm. Leakage during sexual activity is called coital incontinence (CI), which specifically refers to the loss of bladder control during sexual activity. CI is common, with a 2008 lit review dinging the incidence occurring in up to 27% of participants.
It's important to take leakage during sexual activity seriously due to the impact this can have on an individual's life. Folks who experience leakage during sex may be less inclined to participate in sexual activity, may have poorer body image and self-esteem.
Due to lack of research in the area (an all too common phrase you’ll hear when discussing women’s health and pelvic health), the reason this occurs is still not entirely understood. Some theorize that leakage specifically during orgasm is due to detrusor muscle overactivity. The detrusor is the muscle that surrounds the bladder and contracts to squeeze the bladder while you pee. This theory places leakage during orgasm into the urge incontinence category. Others theorize that leakage during penetration and orgasm is due to urethral function, lumping CI during orgasm into the stress incontinence category.
Fortunately, pelvic floor physical therapy is effective at treating both urge and stress incontinence. Leaking during penetrative sex and orgasm are both common and treatable. If you experience leakage during intercourse or orgasm, you are certainly not alone.
Thanks so much for reading this month's knowledge drop! Don't forget to submit your questions for next month in the comments below or by emailing contact@ladybirdpt.com.
Ready to take control of your pelvic health? Contact us here or call us at 512-766-2649 for a free phone consultation to learn more about how pelvic floor PT can help you.