Megan's Pelvic Floor Story

Megan, a 24-year-old mom of 3, was experiencing symptoms of pelvic organ prolapse including pressure and heaviness in the vagina. She started to experience these symptoms during the 2nd trimester of her 3rd pregnancy after feeling a vaginal bulge in the shower. At 7 weeks postpartum, she made an initial evaluation appointment at Pelvic Balance Physical Therapy because the symptoms were not going away. In fact, the feeling of heaviness would typically get worse as the day went on. By 6-7 pm at night, she would notice a lot of heaviness and pressure after she had been on her feet all day and would notice increased heaviness after walking for 45 minutes. This made it difficult to care for her 3 children and perform her job as a waitress.

Heaviness and pressure are very common symptoms when experiencing a prolapse. Women will usually feel better earlier in the day because their body is more rested after spending the night in laying down positions as compared to upright positions. Upright positions, such as sitting and standing, require more effort from our body, including the pelvic floor muscles, as compared to laying down. 

During Megan’s evaluation, she noted small amounts of leakage with coughing, sneezing, and jumping. This is called stress urinary incontinence, or SUI, and occurs when the body has increased activity or pressure and is not able to keep the urine in the bladder. 

Megan’s examination showed that her spine range of motion was overall normal except for some limitation with being able to rotate (twist) her spine. She also had tightness in her hip flexors (muscles at the front of the hips), her IT band on the outside of her hip to her knee, and hamstrings. In terms of strength, Megan had some weakness in her leg muscles, specifically her hip rotators, glutes, and adductors (inner thigh muscles). Megan, like many moms with multiple pregnancies, had diastasis recti, or DR, which means a stretching of the connective tissue down the middle of the belly. This connective tissue connects the two sides of the rectus abdominis, or 6 pack muscle. 

Based on Megan’s prolapse symptoms, hip tightness and weakness, core weakness, and stress urinary incontinence, she was seen for 5 treatment sessions over 8 weeks. Her treatment sessions and home program included the following:

• Discussed optimal toilet positions to reduce straining/pushing with peeing and pooping.
• Small, but more frequent rest breaks during the day where she would lay down with pillows underneath her hips to help reduce prolapse symptoms.
• Making sure to exhale with position changes and with exercise.
• Pelvic floor strengthening using biofeedback. Biofeedback allows us to see the pelvic floor contractions on the computer and can be especially helpful for those of use who are visual learners.
• Core strengthening that included the transverse abdominis or lower abdominal muscle. This muscle has a very close relationship with the pelvic floor and is extremely helpful to reduce prolapse symptoms, urinary leakage, and DR. 
• Full body strength training that included upper body, core, and lower body with breath and pelvic floor coordination. 

By her 3rd appointment, Megan was no longer feeling pressure at the end of her work shift. By the 4th appointment, she did not have any heaviness in her pelvic region after workouts and noticed tolerable soreness in her muscles for 24-48 hours, which is normal. There was one day when she noticed pelvic heaviness when out of town family came to visit because she was spending a lot more time on her feet and walking while they were visiting. By her 5th appointment, Megan was no longer experiencing any pressure or heaviness in the pelvic region or urinary incontinence. Her abdominal muscles were also able to coordinate correctly to prevent further stretching of the diastasis recti. She felt that “everything is coming together”.

Megan was encouraged to continue with her 2-3 times per week of strengthening with appropriate breathing coordination to ensure continued strength improvements and prevent the return of prolapse or urinary symptoms.

If you are experiencing pelvic organ prolapse symptoms, such as heaviness/pressure in the pelvic region or feeling a tampon type sensation in the vaginal canal, please reach out to your local pelvic floor therapist and get an individualized assessment and treatment plan tailored to you. You do not have to live with those symptoms! 

Written by Jordan Schmidt, PT, DPT