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Femina Physical Therapy blogThe Staff of Femina Physical Therapy Blogs About Vaginismus, Pregnancy and Postpartum Best Practices, Treatments for Incontinence, and More

Painful periods are common.

According to the American College of Obstetricians and Gynecologists, more than half of those who have periods suffer from “dysmenorrhea” (pain associated with their cycles) 1-2 days each month.

What causes the pain?

There are two main causes of the pain associated with menstruation:

  • Primary dysmenorrhea is pain caused by the related to menstruation and starts shortly before or after bleeding begins
  • Secondary dysmenorrhea is period pain that is tied to another condition, usually endometriosis or fibroids

Although period pain is a commonly shared experience, your pain shouldn’t be keeping you from doing things like resting comfortably, going to school, going to work, or being active.

Medical Treatment

When seeing a gynecologist or general practitioner for dysmenorrhea, a medical history review and a pelvic exam may be completed. Other exploratory procedures may be done to rule out any medical conditions that should be treated. and possibly an ultrasound or laparoscopy will be completed. Treatment may include medications like nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, other doctors may suggest birth control, or other procedures.

What Helps Painful Periods?

A 2014 review of literature aimed to see if physiotherapy (that’s the international equivalent to physical and occupational therapy) could help with painful periods. An earlier 2007 study also aimed to look at helpful treatments for painful periods.

The reviews found that a variety of interventions were indeed helpful. Here is a short summary:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, help with period pain, however these drugs may cause GI symptoms and ulcers. Please consult your doctor for correct dosage for your symptoms.
  • Topical heat helps ease pain with periods. Try hot water bottles or heating pads for home use. There are also over the counter heating pads that stick to the inside of your underwear for use outside of the house.
  • Transcutaneous electrical nerve stimulation (TENS) units can help reduce pain with periods, according to the study. A physical or occupational therapist can help you figure out the correct placement of the electrodes.
  • Acupuncture and acupressure can help reduce pain with periods. Discuss with your doctor if acupuncture is right for you.
  • Abdominal, myofascial, and connective tissue massage has been shown to reduce pelvic pain, including pain with menstruation. A trained therapist can give you treatment in the clinic as well as show you techniques you can do at home.
  • Therapeutic exercise including pilates and belly dance were shown to have clinical benefit for pain with periods.

Can Pelvic Floor Therapy Help?

A trained pelvic health therapist can help reduce discomfort with periods by teaching you pain management strategies that work for you.

What types of treatments you can expect with pelvic floor therapy:

  • Therapeutic Exercises
    • We will teach you exercises that increase range of motion, mobility, and lubrication in the low back and pelvic region, reducing stiffness and pain.
  • Neuromuscular Re-Education
    • We will conduct a thorough intake examination to help determine if you have pelvic floor dysfunction that is contributing to your pelvic pain and painful periods.
    • If dysfunction is present, we will help re-coordinate your brain and body to help the pelvic floor muscles rest in a more relaxed state, reducing pelvic cramps and muscle spasms in the area.
  • Abdominal massage
    • We will teach you techniques to help you relax the tissue restrictions in the abdominal and pelvic cavities that could be contributing to cramps and bloating.
  • Myofascial Release
    • Using manual therapy to address abdominal and pelvic girdle muscles that can be tight or in spasm, causing pain.

Give the therapists at Femina Physical Therapy a call today!

Resources

American College of Obstetricians and Gynecologists, ACOG. Dysmenorrhea: Painful Periods.
https://www.acog.org/-/media/For-Patients/faq046.pdf?dmc=1&ts=20150618T1901432825

Gerzson, Laís Rodrigues, Padilha, Juliana Falcão, Braz, Melissa Medeiros, & Gasparetto, Andriele. (2014). Physiotherapy in primary dysmenorrhea: literature review. Revista Dor15(4), 290-295. https://dx.doi.org/10.5935/1806-0013.20140063

Proctor, M. L., & Farquhar, C. M. (2007). Dysmenorrhoea. BMJ Clinical Evidence2007, 0813. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943779/#BMJ_0813_I10

 

**This information is for educational purposes only and is not intended to replace the advice of your doctor.

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Tightly Wound recently released on Iris!

Tightly Wound has been released, watch it today and share it with your loved ones and anyone else who may need more education on vaginismus and pain with sex.

Tightly Wound is a 15-minute animated short by Shelby Hadden. Our very own Heather Jeffcoat, DPT is one of the producers of film.

The film follows Shelby’s journey with vaginismus; a condition characterized by involuntary contractions of the pelvic floor muscles including the muscles at the opening of the vagina. These contractions cause pain, problems with penetration, and make intercourse very painful and seemingly impossible.

The film has earned an Honorable Mention at the Nashville Film Festival and has been accepted into numerous film festivals in the US and Europe, including the prestigious Annecy International Animated Film Festival in France.

We love this film! It is one step towards destigmatizing women’s sexual health disorders. Share this film with your medical providers, partners, friends, family, and anyone else who needs more education about vaginismus.

Do you have sexual pain? Pelvic floor therapy can help. 

If you have pain with sex, tampon use, gynecological exams, or another form of penetration, give the therapists at Femina Physical Therapy a call today. 

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Pilates Can Strengthen the Pelvic Floor


A modified Pilates program can be a fantastic way to improve the strength of the pelvic floor muscles. A 2018 study by Lausen et al.  had clients attend weekly one-hour Pilates classes over the course of six weeks. These classes used a type of Modified Pilates which consisted of Pilates exercises which had been modified and led by a physical therapist to specifically target the pelvic floor for the management of urinary incontinence. Those who attended the Pilates classes reported less leakage, improved self-esteem, decreased social embarrassment and lower impact of incontinence. Some of the women also reported improvement in their personal relationships after attending the classes.

In another 2011 study by Phrompaet et al., researchers found Pilates to be an effective treatment for instability in the low back and

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Yoga can help manage pelvic organ prolapse, but there are also some poses, movements and breathing methods that could make the condition worse.

What is a Pelvic Organ Prolapse?

"Prolapse" refers to a descending or drooping of organs. Pelvic organ prolapse (POP) refers to the prolapse or drooping of any of the pelvic floor organs, including:  the bladder, uterus, vagina, small bowel, or rectum. These organs are said to prolapse if they descend into or outside of the vaginal canal or anus.

Read our previous blog for more information on prolapse and how pelvic floor therapy can help.

Which yoga poses will help and which poses will make it worse?

Yoga has been found to help women with urinary incontinence, but will it help with prolapse?

There are hundreds of yoga poses as well as breathing exercises in the practice of yoga. Some of these poses can help manage or reduce the negative sensation felt with organ prolapse. Other poses and breathwork, however, may make the condition worse. This is due to the role of intra-abdominal pressure (IAP) on the organs and the pelvic floor. Prolapse occurs when pressure in the abdomen is greater than the strength of the pelvic floor, the connective tissue, and deep core muscles that help keep organs in their place.

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Happy Pride Month! Femina Physical Therapy is proud to be a supportive and inclusive orthopaedic and pelvic health center. Earlier this month, I had the privilege to attend the first ever physical therapist-specific course for LGBTQ in the US, with an emphasis on transgender care. The course covered, amongst many things, pre-operative, intra-operative and postoperative recovery guidelines. While this is the second course I have taken on transgender care (with a third coming up in a few months), it was the first that was held primarily for the benefit of training physical therapists.

This course was led by Holly Herman, and supported by other physical therapists, nurses and physicians.

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Rectal Prolapse or Hemorrhoids?

We continue Pelvic Organ Prolapse Awareness Month by talking about Rectal Prolapse and hemorrhoids, two conditions that are commonly mistaken for one another. 

Rectal prolapse and hemorrhoids can both cause irritation, discomfort, and pain in the anal region. However the causes and treatment can be different for both conditions.

Hemorrhoids

Hemorrhoids are veins in the lower rectum that become swollen or stretched. They are similar to varicose veins in the lower legs. There are two types of hemorrhoids: internal and external.

Internal hemorrhoids are swollen veins inside the rectum. Sometimes these swollen veins begin to descend and come out through the anal sphincter.

External hemorrhoids: are swollen veins that can be seen and often felt under the skin outside around the anal sphincter. Usually they look like a small bulge and are the same color as the skin.

Hemorrhoid Symptoms

The most common signs of hemorrhoids are:

  • Bright red blood on toilet paper
  • Drops of blood in the stool
  • Pain at the anus
  • Burning, pressure, or intense itchiness at the anus

About 75% of adults in America will have hemorrhoids at some point in their lives.

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