Happy New Year everyone, I hope you all had a safe and enjoyable holiday season! As we roll into January, I wanted to touch upon some current events and discuss an interesting article I read in the Journal of Women’s Health Physical Therapy.
The article is titled Pelvic Floor Considerations in COVID-19 and is written by Carina Siracusa and Amelia Gray. I found it very interesting, full of great information, and wanted to share a summary with all of my readers.
How does COVID-19 Impact Physical Therapy?
The conversation surrounding COVID-19 is all around us. Unfortunately, many of our questions currently do not have many answers, but what we are learning is that the after effects of this virus can be versatile and long standing. As a healthcare worker and pelvic floor physical therapist in NYC, I contemplated in the beginning of 2020 how I could provide help and relief to these COVID-19 patients.
My initial and fairly obvious answer to myself was to treat the visible symptoms of deconditioning, dysfunctional breathing, balance, mobility, and deficits in strength (just to name a few). This was particularly important and great for my orthopedic patients, but I wondered how could I tailor my treatment to better serve my pelvic floor patients?
Mechanics of Normal Breath
When people come to visit for for pelvic floor therapy, posture and breathing are frequently introduced as part of patient education due to the close relationship to pelvic floor function. Normal inhalation of breath involves the descent of the diaphragm and pelvic floor with simultaneous expansion of the abdomen.
Expiration is the opposite; the diaphragm returns to its normal resting position and pelvic floor gently contracts to push air out of the lungs. With more forced breath as in coughing or blowing out birthday candles, we feel our pelvic floor and abdomen working together (co-contraction) to rid the lungs of air.
What does COVID-19 do to the pelvic floor?
COVID-19 can affect the entire cardiovascular system causing dysfunctional breathing and regulation of blood pressure in our bodies. As we just reviewed, the simple mechanics of the system can easily be altered by the virus. In other words, we can see how dysfunctional descent of the diaphragm or regulation of forced breath can cause problems within the “piston” and create unwanted symptoms in our bodies.
Patients who come in for pelvic floor therapy can commonly be separated into underactive or overactive pelvic floor dysfunction. Those who are classified as underactive can have physical symptoms of pelvic organ prolapse or stress urinary/fecal incontinence. Overactive patients tend to have more pelvic pain or urinary frequency or urgence. It is important to note that defining this within our patients allows us to pick the proper treatment strategies.
Not all pelvic floor dysfunction requires strengthening (at least at first) and therefore kegels or strength training might cause more problems when not prescribed correctly from a pelvic floor specialist.
Symptoms of COVID-19 and Physical Therapy
COVID-19 can cause symptoms such as increased incidence of coughing, decreased capability to bring air into our lungs, increased anxiety, and decreased mobility. If COVID-19 is serious enough, someone might find themselves hospitalized or in the ICU for an extended amount of time.
In this case, symptoms might expand to increased psychiatric disorders, decreased cognitive function, and altered neuromuscular involvement. These symptoms can cause exacerbation in bowel or bladder symptoms such as incontinence or constipation, infection with prolonged catherization, sexual dysfunction such as ED, poor nutrition, and increased fall risk. All of these symptoms can impact our bodies and more importantly our pelvic floor.
Reach out About Your Pelvic Floor Questions
If you find yourself or a friend experiencing symptoms related to those we discussed, I urge you to seek out a pelvic floor physical therapist to be assessed properly and assigned a treatment plan. Remember that every pelvic floor case is different and must be treated as an individual case and many of these symptoms can be treated with simple exercises and treatment.
If you are uncertain about how COVID-19 could have impacted your pelvic floor, please reach out to our Flatiron clinic, The Center for Spine Care and Mobility for a free consult. If you know someone who might have been impacted, please share this information with them so together we can get people the help they need in these uncertain times. Wishing you all a safe and healthy 2021!
