Pelvic Health: You’re Going To Put Your Hand Where Now?

By Gwen Dawkins

Part 1

Before my hysterectomy, the doctor told my husband and I that my vagina would be off-limits for about a month or so. I’m paraphrasing of course, but that was the gist. And, I was supposed to “take it easy” for a few weeks and no exercise for two or three months.

But I felt surprisingly well right after surgery. I wasn’t particularly in pain and my energy was good, so I got cocky. I saw no reason to lie around on the couch when I felt fine. Soon after, I went for walks, had a meeting at my kids’ school, and went to the grocery store with my sister. I’d had the hysterectomy on Tuesday and by Friday night, I was back in the hospital for emergency surgery. 

I hadn’t gone to the bathroom in two days and couldn’t consume one more morsel. I felt filled to the brim when I walked gingerly into the hospital, afraid that one false move would trigger a vomit spray gun.

“Somehow,” my intestines got a kink and began pushing against the stitches, eventually popping through the fascia. I was about to burst. Luckily, the exposure had not been long enough to cause decay and the surgeon simply pushed my intestines back into place and stitched me up again. But my less than careful behavior made me paranoid, so I avoided exercise and sex for four months. And then guess what happened? I couldn’t have sex because I was too tight! My doctor referred me to Denise Alberto, a physical therapist who specializes in pelvic floor rehabilitation as well as chronic pain issues. I didn’t even know this profession existed and neither did many of my friends. So, I asked Denise to talk about her work:

What are the most common reasons patients come to you? 

Mostly for issues revolving around pelvic pain as well as poor function, which could be an inability to have intercourse, or to urinate effectively, leaking urine, and defecation problems. I see a lot of postpartum and peri-menopausal women.

Is there a typical age range among your patients? 

Most are women in their 30s and 40s who have either just had babies or are not going to have any more children and want to restore their pelvic health. But I have male and female patients ranging from 16 – 83 years old. My oldest patient is a man who became “de-conditioned” during the pandemic. Before Covid-19, he exercised regularly at the gym and walked frequently. Shelter-In-Place orders caused a change in his habits and subsequently, leaking or “fecal urgency.” He only needed two visits with me. I gave him specific at-home exercises, including Kegels, which made all of the difference for him. 

Do specific conditions occur within certain age groups? 

Yes, these are some of the common conditions I treat and educate my patients about:

• Teens: many have so much anxiety and vaginal/bladder pain, they aren’t able to insert a tampon. 
• 20s – 30s: There’s a challenge for some young women who have difficulty consummating intercourse –– it took one couple 10 years to successfully engage. Also, women in their childbearing years commonly seek treatment to overcome urination and defecation leaks due to the strain of pregnancy and childbirth on the perineum. 
• 40s: Cumulative trauma effects begin appearing in this decade. Weakness of the abdominal wall, pelvic floor, and body injuries or scar tissue can cause dysfunction. Falls during activities such as snowboarding, skiing and other high-velocity sports often result in tailbone injuries. The tailbone is attached to the pelvic floor. For example, I have a patient in her late 40s with endometriosis as her official diagnosis; but I discovered injuries in her musculoskeletal system stemming from her high school cheerleading days, in which her specialty was doing the splits. More than twenty years later, those injuries are just now affecting her.
• 50s: Changes in hormones alter the soft tissue in the body, while decreased estrogen leads to muscle loss. The drop in estrogen in peri-menopausal women may cause restrictions of the pelvic floor, weaknesses, and affect the fascia within the vaginal canal. 
• 60s, 70s & 80s: I see patients with stiffness and pain. This is also when flexibility and balance training is needed to maintain the integrity of the spine, pelvic girdle and lower extremities. Ankles get tight during these years, and as a result, we become unbalanced and many people begin to fall. Breaking a hip is common in this age range, which stems from the imbalance. I tell people to remember the first time they tripped. That’s a wake-up call to work on improving ankle strategies, stretching and improving reaction times. 

Do people without trauma, injuries or surgeries benefit from pelvic therapy? If so, how? 

Yes! Kegel exercises are for everyone and I educate people about how to do them properly. Using Kegel exercises can control incontinence issues and help prevent them later in life. They are also great for improving sexual pleasure and satisfaction for both men and women. I teach people how to utilize those muscles more effectively.  

What’s the most surprising condition you’ve come across? 

A “short pelvic floor,” in which the vaginal opening is smaller than average. These women suffer from the inability to have intercourse and are not able to consummate. I spend time stretching them and showing them how to use dilators as well as teaching their partners how to self-massage. This condition can be helped but takes time and consistency. 

How did you end up specializing in pelvic health? 

My first job as an orthopedic outpatient physical therapist was in an extremely busy practice in which I had 22 patients per day. I literally had to ask permission to go to the bathroom. Therefore, I was constantly gripping and squeezing because of stress and poor toiletry habits. I would tell my patients that I’d be right back, then I would run to the restroom, push it out, stand up and start leaking after going to the bathroom. I needed help but couldn’t find anyone locally who specialized in pelvic health. I had to go to Portland to find a pelvic floor health course. I found it so interesting that by my early 30s, I had decided to specialize in this part of the body.

Many people don’t know pelvic physical therapy is a thing? How do people react to treatment? 

People are very reticent to come in and are not sure what to expect but once they meet me and see that I am truly listening to them and evaluating them fully; they feel very comfortable and are excited to be there so their condition can improve.

Contact Denise Alberto Physical Therapy, Inc. for more information about pelvic pain and pelvic floor rehabilitation. 

Check back soon for Part 2 of our interview with Denise Alberto