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Pelvic Floor Strength and Womenís Health Education Pelvic Floor Strength and Womenís Health Education

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  #1  
Unread 02-21-2021, 12:14 PM
Pelvic Floor Strength and Womenís Health Education

Today marks the one year anniversary of my total hysterectomy and I partly regret the decision. I wish I had more education on pelvic floor health and issues BEFORE I had my hysterectomy.

A year ago, I decided to go forward with the hysterectomy due to fibroids, uterine prolapse, and irregular periods. Now Iím left with urinary incontinence. This means to me that I traded the periodic problems to a daily problem. I made that decision after multiple years of conversations with my gynecologist, family doctor, and highly reputable gynecological surgeon. The conversation about pelvic floor health and strength was practically a footnote and not part of the main conversation with these guys. I truly believe that I would have asked different questions had I been better educated on the subject and had known that urinary incontinence could be an outcome of the hysterectomy.

Iíve spent this last year investigating the true root cause of the incontinence and trying to find the best, safest, and long term solution. Iím of the mind right now that my doctors havenít fully found the root cause of my problem, so Iím not done investigating yet. I also believe that treatment options for urinary incontinence arenít ideal because of other side effects or surgical risks. The biggest thing that I am frustrated about is what I feel was a lack of education on womenís pelvic health for me to make wise decisions about what I should do to maintain my pelvic health. So Iím going to give my story and what Iíve learned in this last year.

Please keep in mind that Iím a woman in my late 40ís, so the ease of internet information on womenís health was non-existent when I came of age and gave birth to my children. My knowledge was based on some basics taught in freshman year high school sex education classes, some information my mother passed down to me, the 5 minute conversations with ob/gyn doctors (all men) during my annual exams, and the ďwhat to expectĒ type books.

I was faithful doing my annual exams starting from when I was 18 years old. Over the years I heard all the womenís education that focuses on the cancer screenings, Pap smears, pink ribbons and beast health, birth control, and abortion debates. The basic pelvic health and pelvic floor strength education was usually summed up in one line ďDo your kegel exercisesĒ. I had no idea what that meant other than it was the feeling of stopping pee midstream, so I never really tried doing kegels. Occasionally a doctor would comment that I had things like ďtipped pelvisĒ, ďtipped uterusĒ, and in the last 7-8 years, uterine prolapse was part of the annual visit discussion. Now Iím thinking that these were clues to pelvic floor dysfunction but the education and discussion on it was missing.

I gave birth to two children. The first birth, my son, included lots of low back pain during labor, a long 9+ hours of labor, and a difficult delivery where forceps were used. About 6 months following that birth, I had an episode of severe lower back pain that radiated to the top of my pelvis on the right side and my right hip bone. My upper torso was pulled to the right from the muscle spasms, which my family doctor could see upon examination. That issue was treated with muscles relaxers, pain killers, and ultimately chiropractic adjustments that brought some more immediate relief. That scenario of pain would revisit on occasion in the decades since my sonís birth and I would treat it the same. Back then I thought the pain was caused by a very minor fall and never thought that it could have been connected to the trauma of my sonís birth. Looking back now, all of this was clues that I may have pelvic floor dysfunction but it was never brought up as a possibility when I sought medical or chiropractic care.

My second pregnancy, my daughter, was a lot harder leading up to birth. I felt low back pain and hip pain a lot throughout the last half of pregnancy. Later in the third trimester it became hard for me to stand and walk. I would slowly rise from a chair or couch and have to hold onto the piece of furniture to steady myself because I felt pain and like my hips would give out. I joked around about needing walker if that continued. I assumed it was part of being pregnant so I never really discussed it with my doctor because I didnít want to be the complainer. The birth was easier than the first, but the baby was a lot bigger. The pain and hip instability all went away immediately after giving birth. Again, looking back at that experience, I would question if it was related to pelvic floor dysfunction. At that time pre and post pregnancy exercise classes were a few years away from catching on in my area.

As years went on, the uterine prolapse worsened and the hysterectomy recommendations stated becoming the topic at my annual visits. ďDo your kegelsĒ was said but no guidance was given in the importance of it or how to do it. There was never a mention of physical therapy as an option of training. So once the peri-menopause years set it and the fibroids developed, I couldnít wait to get rid of it all so I could feel better. I still didnít know anything about pelvic health and that pelvic floor weakness could leave me incontinent. Whatís worse is my own grandma suffered from pelvic floor issues and bladder and bowel incontinence later in life, but we didnít talk about it and i assumed she had more issues because she gave birth to 8 kids. I didnít make the connection that I could have the same problem for the same kinds of reasons.

The post hysterectomy regret started creeping not long after the healing period was done and I realized I had an urinary incontinence issue. Iíve seen multiple doctors, had urodynamic studies done, tried a medication, and then the doctor suggested a surgery recommendation. Iím resistant to another surgery, especially this one because a mesh is required. There is a lot of well publicized lawsuit information on failed meshes in the lower abdominal and pelvic regions. The current claims have only about 80% success rate meaning a 20% chance of failures, and even the 80% success is not a guarantee of a permanent long term fix of no leaks or complications. So I pushed for more alternatives and the doctor finally recommended pelvic floor physical therapy.

Iím currently in the pelvic floor therapy and learning more every day. Iím not convinced that it will be a cure all, but it will give me pelvic strength I didnít have before. Iím learning about the interconnection of the muscles, including that my low back pain, pelvic hip pain, and side twisting spasms were most likely from the psoas major muscle, illacus muscle, and other hip flexor muscle groups. Iím learning how itís all an interconnected chain that has an effect on our internal pelvic organs, including the reproductive system, bladder, and bowels. Iím learning the things to do and donít do to improve this pelvic health.

Looking back over these experiences shows me that there were so many missed opportunities to discuss pelvic floor health. I didnít know what I didnít know and the general education about it isnít easily accessible. Fortunately, its not too late for me to share this information with my daughter to spare her some future troubles. I also hope my story can spare others from some trouble too.

I recommend that all women consider these points and questions when conserving pelvic floor health:
1. What is the pelvic floor anatomy? How is it interconnected? How do the problems or dysfunctions show symptoms? Examples are: low back pain could be caused from an assorted list of issues all with different treatments.
2. Whatís a kegel? How is it done properly? How is it done incorrectly? How often in duration and repetition is needed to build strength? Are there more kinds of exercises that relate to it and help it? Iíve learned I did the kegels wrong because I didnít have the right coordination or strength. I didnít know that good frequencies are probably in the range of 10-50 depending on situations and goals.
3. Look into pelvic floor physical therapy before and after any surgery in the pelvic region and any pregnancy. PT helps build strength, flexibility, and coordination in targeted muscle groups and may contribute to better outcomes of surgeries. Historically, PT wasnít always as easily accessible as it is now. In the United States, it is now accessible without a doctorís order. Each state has different rules on how many visits before a doctorís order is required, but at least there is an option for a visit or consultation. My state was the last one to open up direct access to PT in 2013. Take advantage of it!
4. Are there more alternatives to surgery? Ask and ask again for alternatives and/or complementary treatments to ensure the best outcomes for the situation. Consult doctors in different, but related professions, for alternative opinions such as the family doctor, internist, or/gyn, urologist, gastroenterologist, colorectal, oncologist, and physical therapist to name a few. Of course this all depends on the situation. Itís good to remember that pelvic health is the sum of all of the parts.

In the end, surgery may not be optional for everyone, but going in educated and prepared helps in dealing with the long term outcomes. I hope this helps open the conversation and education on pelvic health.
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  #2  
Unread 02-27-2021, 04:57 PM
Re: Pelvic Floor Strength and Womenís Health Education

  Quote:
Originally Posted by Lilpeace View Post
Today marks the one year anniversary of my total hysterectomy and I partly regret the decision. I wish I had more education on pelvic floor health and issues BEFORE I had my hysterectomy.

A year ago, I decided to go forward with the hysterectomy due to fibroids, uterine prolapse, and irregular periods. Now Iím left with urinary incontinence. This means to me that I traded the periodic problems to a daily problem. I made that decision after multiple years of conversations with my gynecologist, family doctor, and highly reputable gynecological surgeon. The conversation about pelvic floor health and strength was practically a footnote and not part of the main conversation with these guys. I truly believe that I would have asked different questions had I been better educated on the subject and had known that urinary incontinence could be an outcome of the hysterectomy.

Iíve spent this last year investigating the true root cause of the incontinence and trying to find the best, safest, and long term solution. Iím of the mind right now that my doctors havenít fully found the root cause of my problem, so Iím not done investigating yet. I also believe that treatment options for urinary incontinence arenít ideal because of other side effects or surgical risks. The biggest thing that I am frustrated about is what I feel was a lack of education on womenís pelvic health for me to make wise decisions about what I should do to maintain my pelvic health. So Iím going to give my story and what Iíve learned in this last year.

Please keep in mind that Iím a woman in my late 40ís, so the ease of internet information on womenís health was non-existent when I came of age and gave birth to my children. My knowledge was based on some basics taught in freshman year high school sex education classes, some information my mother passed down to me, the 5 minute conversations with ob/gyn doctors (all men) during my annual exams, and the ďwhat to expectĒ type books.

I was faithful doing my annual exams starting from when I was 18 years old. Over the years I heard all the womenís education that focuses on the cancer screenings, Pap smears, pink ribbons and beast health, birth control, and abortion debates. The basic pelvic health and pelvic floor strength education was usually summed up in one line ďDo your kegel exercisesĒ. I had no idea what that meant other than it was the feeling of stopping pee midstream, so I never really tried doing kegels. Occasionally a doctor would comment that I had things like ďtipped pelvisĒ, ďtipped uterusĒ, and in the last 7-8 years, uterine prolapse was part of the annual visit discussion. Now Iím thinking that these were clues to pelvic floor dysfunction but the education and discussion on it was missing.

I gave birth to two children. The first birth, my son, included lots of low back pain during labor, a long 9+ hours of labor, and a difficult delivery where forceps were used. About 6 months following that birth, I had an episode of severe lower back pain that radiated to the top of my pelvis on the right side and my right hip bone. My upper torso was pulled to the right from the muscle spasms, which my family doctor could see upon examination. That issue was treated with muscles relaxers, pain killers, and ultimately chiropractic adjustments that brought some more immediate relief. That scenario of pain would revisit on occasion in the decades since my sonís birth and I would treat it the same. Back then I thought the pain was caused by a very minor fall and never thought that it could have been connected to the trauma of my sonís birth. Looking back now, all of this was clues that I may have pelvic floor dysfunction but it was never brought up as a possibility when I sought medical or chiropractic care.

My second pregnancy, my daughter, was a lot harder leading up to birth. I felt low back pain and hip pain a lot throughout the last half of pregnancy. Later in the third trimester it became hard for me to stand and walk. I would slowly rise from a chair or couch and have to hold onto the piece of furniture to steady myself because I felt pain and like my hips would give out. I joked around about needing walker if that continued. I assumed it was part of being pregnant so I never really discussed it with my doctor because I didnít want to be the complainer. The birth was easier than the first, but the baby was a lot bigger. The pain and hip instability all went away immediately after giving birth. Again, looking back at that experience, I would question if it was related to pelvic floor dysfunction. At that time pre and post pregnancy exercise classes were a few years away from catching on in my area.

As years went on, the uterine prolapse worsened and the hysterectomy recommendations stated becoming the topic at my annual visits. ďDo your kegelsĒ was said but no guidance was given in the importance of it or how to do it. There was never a mention of physical therapy as an option of training. So once the peri-menopause years set it and the fibroids developed, I couldnít wait to get rid of it all so I could feel better. I still didnít know anything about pelvic health and that pelvic floor weakness could leave me incontinent. Whatís worse is my own grandma suffered from pelvic floor issues and bladder and bowel incontinence later in life, but we didnít talk about it and i assumed she had more issues because she gave birth to 8 kids. I didnít make the connection that I could have the same problem for the same kinds of reasons.

The post hysterectomy regret started creeping not long after the healing period was done and I realized I had an urinary incontinence issue. Iíve seen multiple doctors, had urodynamic studies done, tried a medication, and then the doctor suggested a surgery recommendation. Iím resistant to another surgery, especially this one because a mesh is required. There is a lot of well publicized lawsuit information on failed meshes in the lower abdominal and pelvic regions. The current claims have only about 80% success rate meaning a 20% chance of failures, and even the 80% success is not a guarantee of a permanent long term fix of no leaks or complications. So I pushed for more alternatives and the doctor finally recommended pelvic floor physical therapy.

Iím currently in the pelvic floor therapy and learning more every day. Iím not convinced that it will be a cure all, but it will give me pelvic strength I didnít have before. Iím learning about the interconnection of the muscles, including that my low back pain, pelvic hip pain, and side twisting spasms were most likely from the psoas major muscle, illacus muscle, and other hip flexor muscle groups. Iím learning how itís all an interconnected chain that has an effect on our internal pelvic organs, including the reproductive system, bladder, and bowels. Iím learning the things to do and donít do to improve this pelvic health.

Looking back over these experiences shows me that there were so many missed opportunities to discuss pelvic floor health. I didnít know what I didnít know and the general education about it isnít easily accessible. Fortunately, its not too late for me to share this information with my daughter to spare her some future troubles. I also hope my story can spare others from some trouble too.

I recommend that all women consider these points and questions when conserving pelvic floor health:
1. What is the pelvic floor anatomy? How is it interconnected? How do the problems or dysfunctions show symptoms? Examples are: low back pain could be caused from an assorted list of issues all with different treatments.
2. Whatís a kegel? How is it done properly? How is it done incorrectly? How often in duration and repetition is needed to build strength? Are there more kinds of exercises that relate to it and help it? Iíve learned I did the kegels wrong because I didnít have the right coordination or strength. I didnít know that good frequencies are probably in the range of 10-50 depending on situations and goals.
3. Look into pelvic floor physical therapy before and after any surgery in the pelvic region and any pregnancy. PT helps build strength, flexibility, and coordination in targeted muscle groups and may contribute to better outcomes of surgeries. Historically, PT wasnít always as easily accessible as it is now. In the United States, it is now accessible without a doctorís order. Each state has different rules on how many visits before a doctorís order is required, but at least there is an option for a visit or consultation. My state was the last one to open up direct access to PT in 2013. Take advantage of it!
4. Are there more alternatives to surgery? Ask and ask again for alternatives and/or complementary treatments to ensure the best outcomes for the situation. Consult doctors in different, but related professions, for alternative opinions such as the family doctor, internist, or/gyn, urologist, gastroenterologist, colorectal, oncologist, and physical therapist to name a few. Of course this all depends on the situation. Itís good to remember that pelvic health is the sum of all of the parts.

In the end, surgery may not be optional for everyone, but going in educated and prepared helps in dealing with the long term outcomes. I hope this helps open the conversation and education on pelvic health.
Lilpeace ... thank you for your post and sharing your heart dear. I agree ... women need to be educated in Pelvic Floor Health. I am 69 and way back then, these "issues" were never discussed. I had my first prolapse in 1991 ... I had a uterine suspension and my bladder was tacked up. Even then, I wasn't educated in pelvic health and had no idea I could prolapse again. After my hysterectomy I went through months of PFPT ... I learned so much in a few months. I never realized that Pelvic Floor muscles hold everything in place and, like any other muscle, they can be strengthened. I'm so glad you are in Physical Therapy ... you're right, it's not a cure all but it will help you.

Best wishes on your therapy dear ... please keep us posted.
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