Blog Post #106: Pelvic Health
On our most recent podcast, we were delighted to host Molly Bachmann, Doctor of Physical Therapy at the Pelvic Pain and Rehabilitation Center of San Francisco. The conversation was riveting - there was so much good info for Type Cer’s and we want to share the highlights for our readers:
Pelvic health therapy is not widely known, not widely discussed, but there is so much need for it across the gender spectrum. Molly was drawn to the practice in physical therapy (PT) school after observing a patient overcome debilitating pelvic pain caused by childhood sexual trauma - to the point where the patient is now able to conceive and carry babies. Molly now specializes in pelvic pain.
When thinking about pelvic health and Type C people, the first thing that comes to mind are people who are in very stressful situations and are in the midst of burnout. If we exist for someone else or some other goal, our bodies will suppress signs of dysfunction in order to achieve the goal we are working toward. In other words, I have this thing I have to attend to, it’s urgent, and if my body is giving me information that is not related to the goal, my brain will suppress this info.
The muscles of the pelvic floor all have sympathetic and parasympathetic nerve endings which are part of the fight or flight stress response. When you are chronically stressed, your pelvic floor is affected. There may be signs of dysfunction or pain in the pelvic floor but your brain suppresses these feelings because they are not classified as necessary for survival. Your brain and nervous system focus on only what's essential during a chaotic time.
Childbirth has significant impacts on pelvic health. You can’t get through childbirth without an injury to the pelvic floor. And you may not have social support systems and resources that you need to be a mom, which can exacerbate problems. Often, women are told by doctors that symptoms are normal and to be expected - so issues are unaddressed.
Male patients that experience pain, urinary urgency, urinary frequency, constipation, or sexual dysfunction come for treatment immediately. Female patients can have issues for as long as 20 years before addressing them.
Teachers and nurses are groups that often have pelvic floor issues. They may have bladder issues because of their restrictive work schedules and the over-giving Type C nature of these jobs. They may not be going to the bathroom frequently enough which over time can result in dysfunction of the pelvic musculature. Routine is the key here, it’s less about exercises.
People usually don’t associate constipation with pelvic floor dysfunction, but it can be a result of too-tight muscles. Type C people might suppress the sensation and not answer the call. Over time the pelvic floor muscles can be impacted.
Painful sex can be another issue for Type C. For people who have experienced any type of sexual trauma, the pelvic floor muscles have a memory. The body might stay in a state of tension. It might not be sexual trauma - it can also be tight muscles because of chronic stress. When it comes to pain, often we don’t want our partner to feel bad. Women will typically express these feelings, whereas men are different. Type C people might put all emphasis of pleasure on their partner instead of themselves.
Being stuck in a fight or flight response can impact breathing. The response is meant to be like an on/off switch. If we are stuck, breathing is shortened and the diaphragm is not going through a full range of motion - which means the pelvic floor is not going through a full range of motion. Developing a breathing routine can be very valuable to pelvic health.
Postpartum patients can have a difficult time addressing pelvic health if they don’t have a robust village to support them. New moms need people to take some of the workload. It can be difficult to carve out time for PT appointments and homework exercises.
Childbirth can cause prolapse. The pelvic floor can stretch 3-4 times its normal length. Interestingly, the symptoms are not always correlated with the grade of the prolapse. People have different perceptions of the discomfort. It may have less to do with pelvic floor muscle strength but more of an overloading of the bucket - stress, changes to estrogen levels, other physical issues, hydration, parenting stress. The cup can runneth over and then we notice the symptoms more.
When providers care for Type C people, they have to think about the whole picture, they have to think holistically and explore the patient’s lifestyle and available resources/support. Many providers are trying to get away from a strict anatomical model - but our healthcare system is not set up for this. Appointments may be only 15 minutes and providers can’t get the full picture. Results are always better when providers can get the full picture and get to the root cause of the problem.