Pilates and Women's Pelvic Health Part 3: Prolapse, Bowel Problems, Pelvic Pain, Pelvic Surgery, Menopause

 

Pilates and Women's Pelvic Health Part 3

In part 1 of this blog series, we discovered that Pelvic Health problems exist in 25% of women, and can often significantly affect their quality of life.  We showed how Pilates Instructors can be of great benefit in coaching and supporting Women with Pelvic Health Dysfunctions.  

A deeper knowledge of Pelvic Health when teaching Pilates classes encourages self-help, and preventative physical therapy in a relaxed environment with open, informed discussion on this often delicate topic. 

Having briefly listed the various Pelvic dysfunctions, in part 2 we detailed two types of Urinary Incontinence as specific and common examples - demonstrating how Pilates is particularly effective as a targeted, physical therapy for the Pelvic Floor and Core.

In this concluding part, we will explore, the other Pelvic dysfunctions you may hear about in more detail.  Pilates is equally appropriate as a targeted physical therapy to prevent, treat and rehabilitate all of these problems, for the same reasons as already outlined.  

It should be noted that for most of these conditions, Pilates can be considered a first-line therapeutic or preventative therapy.  Practising Pilates proactively can potentially prevent conditions from deteriorating to the point where they are needing treatment by more specialist physiotherapists and the use of pharmaceuticals.  Finally, in severe cases of some of these complaints, necessity may lead to invasive surgical intervention which may then further exacerbate overall pelvic health going forwards.  

PELVIC ORGAN PROLAPSE

WHAT IS PELVIC ORGAN PROLAPSE?

When the muscles and ligaments supporting a woman's pelvic organs weaken, the pelvic organs can drop lower in the pelvis.  "Prolapse" refers to this descending or drooping of organs causing a bulge.  Specifically, Pelvic Organ Prolapse refers to the descent or drooping into or outside of the vaginal canal or anus, of any of these pelvic floor organs, 

Bladder:  Cystocele: A prolapse of the bladder into the vagina, the most common condition

Uterus: Urethrocele: A prolapse of the urethra (the tube that carries urine)

Vagina: Vaginal vault prolapse: Prolapse of the vagina

Small Intestine: Enterocele: Small bowel prolapse.

Rectum: Rectocele: Rectum prolapse

Women most commonly develop pelvic organ prolapse in the years after childbirth, after a hysterectomy, or after menopause.  It is unfortunately very common and affects 1 in 3 of all women and 50% of women that have given birth.

WHAT ARE THE SYMPTOMS OF PELVIC ORGAN PROLAPSE

Some women notice nothing at all, but others report these symptoms with pelvic organ prolapse:

• A physical bulge
• A feeling of pressure, dragging, ache and heaviness in the pelvic area
• A backache low in the back
• Painful intercourse
• A feeling that something is falling out of the vagina
• Urinary problems such as leaking of urine or a chronic urge to urinate
• Constipation or loss of bowel control
• Spotting or bleeding from the vagina

Symptoms depend somewhat on which organ is drooping. If the bladder prolapses, you may leak urine.  If it's the rectum, you may have constipation and uncomfortable intercourse.  A backache, as well as uncomfortable intercourse, often accompanies small intestine prolapse.  Uterine prolapse is also accompanied by backache and uncomfortable intercourse.

In most cases, symptoms are mild in the morning but get worse as the day goes on.

Prolapse may come on suddenly or progressively over time.  As it is also linked to oestrogen levels symptoms are often worse at certain points in the menstrual cycle.  

Overall it has a significant impact on quality of life.

CAUSES AND CONTRIBUTORS TO PELVIC ORGAN PROLAPSE

• Obesity
• Pregnancy
• Childbirth
• Pelvic trauma –Pelvic Floor muscles
• Hysterectomy
• Impact exercise
• Chronic coughs/vomiting bugs
• Repetitive heavy lifting
• Constipation and straining
• Age-related tissue changes [tensile strength/hormones/collagen]
• Genetics/Hypermobility
• Poor management of intra-abdominal pressure

TREATMENTS FOR PELVIC ORGAN PROLAPSE

•  Pelvic floor muscle training –“Supervised pelvic floor muscle training for at least 16 weeks as a first option for women with symptomatic stage 1 or stage 2 pelvic organ prolapse.” 
• Lifestyle modifications
• Weight management
• Pessaries
• Surgical management where repeat surgery is required in 30% of cases 

BOWEL PROBLEMS: 

Bowel problems are often linked with underlying conditions and their medications, and can also be linked to emotional stress due to the relationship between intestinal function and stress hormones like cortisol or conversely the influence of gut bacteria on neurotransmitter production such as serotonin (known as the brain - gut axis.)  The range of complaints that occur is as follows:

• Irritable Bowel Syndrome
• Haemorrhoids
• Flatulence
• Faecal Incontinence
• The brain-gut axis (stress hormone linked)
  
• Obstructed defecation
• Hard to empty, pelvic pressure and bloating or pain, straining
• Constipation:  defined as <3 x stools per week 
• Rectocele/Enterocele
• Pelvic floor dyssynergy, weakness and tightness
• Rectal prolapse

CAUSES AND CONTRIBUTORS TO BOWEL PROBLEMS

As intestinal issues can be linked to both physical and neurological dysfunction, there are a wide variety of contributory factors:

• Pregnancy
• Childbirth including Obstetric Anal Sphincter Injury [OASI]
• Pelvic surgery/trauma
• Defect of pelvic support or abnormal function of the pelvic floor musculature [POP]
• Age
• Medications
• Stress/anxiety/depression
• Chronic illness
• Inflammatory bowel conditions
• Cumulative nerve damage from chronic and repetitive increases in intra-abdominal pressure, such as chronic cough
• Pelvic floor dysfunction
• Hormonal changes
• Neurological disorders
• Obesity
• Lifestyle [Work, hobbies]
• Previous rectal surgery

TREATMENTS FOR BOWEL CONDITIONS

• Specialised management and referral are required 
• Medication
• Investigations: Gastroenterology/ Colorectal e.g. Colonoscopy
• Dietary modifications
• Weight management
• Stress management/mindfulness/meditation
• Pelvic floor training
• Biofeedback
• Electrical Stimulation
• Botox
• Rectal Irrigation
• Surgery
• Lifestyle changes

In addition to the physical benefits for the Pelvic floor, Pilates is a particularly suitable exercise therapy for bowel conditions, as it also promotes stress-reducing mindfulness, breathing and relaxation as part of the exercise philosophy.

 PELVIC PAIN

Pelvic pain varies. It may affect a small area around your lower pelvis (abdomen) or the entire area.

Chronic Pelvic Pain is defined as persistent, pain within the pelvis and associated structures lasting more than 6 months duration.

• The prevalence ranges from 6-27% of Women Worldwide 
• It is a condition arising from many factors, often having overlaps with gynecological, urological, gastric, musculoskeletal, and psychological systems 
• It is often associated with a pelvic floor that doesn't relax sufficiently 

Types of pelvic pain include:

• Sharp, stabbing, or burning pain that comes on suddenly
• Pain that comes on slowly but persists
• Dull or heavy ache, or feeling of pressure
• knotted and twisted feeling
• Cramps or throbbing pain, which may be transient
• Pain only occurs during activities such as exercising, having sex, or urinating

CAUSES AND CONTRIBUTORS TO PELVIC PAIN

• Pelvic surgery
• Pregnancy and childbirth
• Endometriosis
• Pelvic Adhesions
• Irritable Bowel Syndrome
• Bladder Pain Syndrome
• Vulvodynia
• Post-traumatic stress disorder
• Psychosocial/emotional factors
• Stress/anxiety/depression
• Pelvic floor dysfunction
• Chronic Low back pain
• Pain during intercourse [dyspareunia]
• Central sensitisation – Allodynia, Hyperesthesia
• Sexual/Physical/Emotional trauma

TREATMENTS FOR PELVIC PAIN

• Local steroid injections e.g. spine/pelvis/nerves
• Laparoscopy
• Surgical procedures –don’t always help with pain
• Medications
• Acupuncture
• Meditation/mindfulness
• Pelvic floor therapy
• Sacro neuromodulation (medical implant to aid control of bladder function)
• Biofeedback
• Behavioural therapy
• Relaxation and co-ordination of pelvic floor muscles

PELVIC SURGERIES: and postnatal problems.  

There are many types of female pelvic surgeries performed on women of all ages.  Surgeries may influence Pelvic Health and overall health.  Major examples are 

• Hysterectomy, 
• Caesarean Section
• Pelvic Organ Prolapse repair

If surgery can be avoided it is best for overall Pelvic health and will avoid exacerbation of any of the other pelvic disorders.

Practising Pilates-based Pelvic Floor strengthening and relaxation in a proactive manner may help to avoid surgery in some cases, or it may mean that the surgery required is less severe than might have been necessary.   In all cases, a well-toned pelvic floor will minimise recovery times when surgery is unavoidable.  Pilates is, of course, an excellent physical therapy for rehabilitation following any Pelvic surgery.

MENOPAUSE:  

Menopause is a normal process in life when a woman’s ovaries stop producing eggs.  Production of sex hormones oestrogen, progesterone, and testosterone decline, and menstruation ceases to occur. Menopause:

• Menopause usually occurs in a woman’s ’50s
• it is defined as the day whereby a woman has not had a period for 12 months
• It may occur earlier [premature menopause] or later as it affects all women differently
• The stage leading up to menopause is called the peri-menopause and this may last up to 10 years

The hormonal change at menopause is also associated with weakening muscles in the Pelvic region because Oestrogen plays a pivotal role in Pelvic Health as follows: 

• Oestrogen receptors are present in the bladder, urethra, vagina, and pelvic floor muscles 
• Oestrogen receptors help to control the synthesis and breakdown of collagen and so play a role in muscle support 
• Oestrogens may increase the pressure existing in the urethra during urination (urethral resistance) controlled by the detrusor muscle
• Oestrogens are thought to raise the sensory threshold of the bladder and promote relaxation of the detrusor muscle 

MENOPAUSAL SYMPTOMS

• Irregular bleeding
• Hot flushes and night sweats
• Headaches or dizziness
•  Vaginal dryness, itching, burning, atrophy
• Sleep disturbances/insomnia
• Depression
• Mood and emotional changes
• Memory problems
• Loss of libido
• Weight gain –particularly around the middle
• Fatigue, lack of energy

MENOPAUSE TREATMENTS

• Hormone Replacement Therapy [including Bio-identical hormones]
• Vaginal moisturisers, Lubricants, topical oestrogen
• Pelvic Floor Therapy
• Counselling
• Cognitive Behavioural Therapy
• Exercise
• Supplements

Pilates Instructors with a Pelvic Health Qualification can provide health support to all Women practicing Pilates

It can be clearly appreciated from this blog series, just how detrimental to Women's quality of life and how common Pelvic Health dysfunction is, for a large proportion of Women.  By gaining a detailed understanding of Women's Pelvic Health and how Pilates exercises can be so beneficial in your studio teaching; You are enabled to provide vital and safe therapeutic support for your clients of all ages:

 Mbodies Pilates and Female Pelvic Health Specialist Qualification 

Launched in 2021, this 4-module, evidence-based specialism is aimed at Pilates Instructors and Physiotherapists who work with women.  

Mbodies educates Pilates instructors to further support women with these widespread issues and therefore encourages more openness and positive action to address these problems:

The qualification is in 4 parts, the overall aims being:

1.      Offer an in-depth analysis of key anatomy and physiology coupled with up-to-date research evidence, to increase your understanding and knowledge about common Pelvic Health conditions.

2.      Solidify understanding of the importance of the client screening process in relation to Pelvic Health by identifying red flags, understanding contraindicated Pilates exercises and how to modify them, and also when to refer to a medical specialist.

3.      Improve practical assessment and Pilates programming for women with Pelvic Health conditions.

4.      Provide a toolbox of assessment and exercise strategies immediately applicable to Pelvic Health clients in a class or one-on-one setting.

5.      Challenge thinking about current Pilates practice & assist in your professional development as a teacher.

Alex Chapman checks a client for a Diastasis Recti

The 4 separate modules, which may be taken as stand-alone modules or as one complete course, have content as follows:

Module 1: The Pelvic Floor and Core: Foundations in Anatomy and Function 

Module 2: Dysfunctions in Pelvic Health: Can PilatesHelp? 

Module 3: Diastasis Rectus Abdominis: Core Restorationusing Pilates 

Module 4: Functional Pilates Programming for Pelvic Health 

This course is for you if:

•        You teach Pilates to women!
•        You want to broaden your knowledge of Pelvic Health conditions.
•       You’re keen to develop your Pilates practice in relation to Pelvic Health.
•       You are open to reflecting on, changing, and expanding your own Pilates practice.
•       You concur with the importance of considering the latest research findings.

This Mbodies Pilates and Female Pelvic Health course is taught by Alex Chapman:

Alex is a specialist women's health physiotherapist working in the NHS as well as in private practice. She originally qualified as a Chartered Physiotherapist from the University of Birmingham in 2003 and initially worked in the NHS in a variety of Physiotherapy fields including Stroke rehabilitation, Amputees, Orthopaedics, Surgical, and Medical wards, and Intensive Care, before going on to specialise in the Musculoskeletal Outpatient sector.

Over the years, Alexandra has worked in a number of private practices, has become trained in Acupuncture, and has gained a Masters Degree in Manual Therapy from Coventry University, in order to provide advanced management and treatment to those with musculoskeletal disorders. Since then, she has also undergone advanced training for the management of specific Women’s Health conditions and Breast Cancer rehabilitation after surgery.  Alexandra has been teaching Clinical Pilates since 2008. She also holds a comprehensive studio certification with Mbodies Training Academy. She has a special interest in the role of ‘The Core’ and how its weakness or altered function can impact on the rest of the body.

For information about Mbodies Training Academy visit: https://www.mbodiesacademy.com/

For Online Pilates Teacher Training and to enrol visit:  https://mbodies.thinkific.com/