The Pelvic Floor Monologues

As I sit here, nine-and-a-half months pregnant, I have a bone to pick with the Sisterhood. By "Sisterhood," I mean women. My girlfriends, college roommates, sisters, aunts, Mom. And my contention is this: not one of you ever mentioned that along with the glow of expectant motherhood would come a laughable inability to giggle, jump or cough without wetting my pants. Ha, ha, girls. So funny I forgot to pee.

But I'm not the only one who needed the memo. An estimated thirty percent of all women experience incontinence at some time or other—a percentage that increases after menopause. And one in nine of us will experience some form of chronic pelvic pain, defined as pain that occurs at least five days per month over a period of six months or longer. Of course, those numbers are conservatively based on the population of women who will even talk to a gynecologist about their problems.

The good news is that we are actually starting to talk more about these women's health issues that previously have been taboo. As a result, more women are finding solutions to pelvic pain and incontinence that don't necessarily involve surgery or drugs. Just in the course of researching this story, a string of young women referred me to a string of their friends with whom they had discussed sensitive pelvic problems, from incontinence to pain during intercourse. And each young woman I called was eager to share her experience in the hope of saving others the discomfort, embarrassment and frustration of a misdiagnosis, or worse, a "just-live-with-it" prognosis likely to come to those who aren't aggressive in managing their health care.

Take, for example, 27-year-old Susan. (OK, that's not her real name, but it's going to take the Sisterhood a little longer to go totally public with this kind of stuff.) Before her wedding, Susan was experiencing consistent and severe pelvic pain that was exacerbated by everything from sex to a snug pair of pants. After several trips to the gynecologist and a fruitless regimen of oatmeal baths, lotions and topical treatments for what was first diagnosed as a dermatological condition, Susan went to a specialist. To Susan's surprise, the doctor associated the pain with possible nerve damage from a hip injury when Susan was a child. The physician prescribed physical therapy to treat a common condition known as vulvodynia, a general pain in the external genital area. Based on the new diagnosis, Susan visited Lynne Odom, a physical therapist at Physiotherapy Associates in Green Hills, who evaluated her for muscular-skeletal complications that could be affecting nerves in the pelvic region.

Working with Odom, who has advanced training in pelvic floor dysfunction, Susan began a course of physical therapy to strengthen the network of muscles known as the pelvic floor, which supports the abdominal cavity and the reproductive and digestive systems. Susan ultimately weaned herself from a medication the specialist had also prescribed and relied solely on the physical therapy, including massage, physical exercise and biofeedback to teach control of hard-to-manipulate muscles. The therapy succeeded, cutting her pain in half. "I would recommend physical therapy to anyone," Susan says. "I think there are tons of people who have this same condition, and they just think that's how sex is supposed to be."

Not gonna take it any more

Fueled by the Internet and ready access to medical information, women are becoming proactive about finding relief for pelvic floor dysfunction. They are coming to know, for example, that incontinence does not have to be a normal part of postpartum life, and they are not accepting diagnoses that tell them the pain is "in their heads." At the same time, women's health providers are getting creative, thinking outside the, er, box for alternatives to surgery and drugs.

Grayson Woods, an obstetrician-gynecologist at St. Thomas Hospital, says, "Gynecological problems have not traditionally been thought of as muscular problems. Down there, people tend to think it all has to do with reproductive organs, as opposed to pelvic floor muscular problems. In the past, many physicians would see these problems and just say, 'Good luck. Have an extra glass of wine,' but now there are options for women where there haven't been before." Physical therapy treatments may range from the old standby Kegel exercises to electrical stimulation, ultrasound, relaxation training, massage and postural assessment. Woods says she frequently refers women to outpatient rehabilitation providers, like Tracy Caulkins Physiotherapy Centers and SpeechPath Staffing, to work on pelvic floor strengthening for incontinence and pain. Woods notes that while an estimated twelve percent of all hysterectomies are performed to alleviate chronic pelvic pain, that number could be significantly reduced by conservative efforts like physical therapy.

Dr. Harriette Scarpero, who specializes in female urology in the Department of Urologic Surgery at Vanderbilt University, agrees that the last five or so years have seen physical therapy emerge as a mainstream treatment for urinary incontinence and pelvic pain. "Pelvic floor exercises, either with or without biofeedback, are being used more frequently in our female urology practices as primary therapy or as an adjunct to medical therapies for stress urinary incontinence...and pelvic pain disorders," Scarpero says. "I routinely discuss pelvic floor exercises with my patients as a viable noninvasive option for treatment."