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The Femina Physical Therapy Blog
Featuring original articles by our staff about current events and trends
Explore our insightful blog articles on pelvic health, where we delve into essential topics that empower and educate. From understanding pelvic floor disorders to strategies for conquering infertility, our content is designed for those seeking knowledge and support. We discuss the latest research, expert advice, and practical tips to enhance your well-being and foster a deeper connection to your body.
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Exploring the clinical consequences of Levator Ani Muscle Avulsion
Including its risk factors and current management strategies, including the role of pelvic floor physical therapy
Levator ani muscle (LAM) avulsion is a significant concern in obstetric care, particularly for women undergoing vaginal delivery. This condition involves a tear in the levator ani muscle, which plays a crucial role in pelvic support and function. Avulsion of the levator ani muscle from its insertions has a significant impact on the function of the pelvic floor, often leading to symptoms such as pelvic organ prolapse, urinary and bowel incontinence, and sexual dysfunction.
The Clinical Consequences of Levator Ani Muscle Avulsion
According to Dietz (2012), levator ani avulsion can lead to a range of adverse outcomes, impacting a woman's quality of life. The levator ani muscle supports pelvic organs and maintains continence. When avulsion occurs, this support is compromised, increasing the risk of pelvic organ prolapse, urinary incontinence, and other functional disorders. The severity of these outcomes can vary, but they often necessitate further medical intervention.
Read more: Understanding Birth Injuries: Levator Ani Muscle Avulsion
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The pelvic floor is a crucial yet often overlooked part of our anatomy. It is a group of muscles akin to a hammock, starting from the pubic bone to the tailbone, which help to support our pelvic organs and contribute to overall core strength and stability. These muscles also act to control the opening and closing of our urethra and anus to allow urine and feces to eliminate, and stay continent (Raizada 2008). Last but certainly not least, the pelvic floor also plays a role in sexual function. For women, the pelvic floor assists with arousal and orgasm as it is in close proximity with the clitoris (Rosenbaum 2007). The pelvic floor undergoes remarkable changes during and after pregnancy, impacting both physical health and daily life.
Pelvic Floor Changes During Pregnancy
During pregnancy, the pelvic floor undergoes several significant changes:
- Increased Pressure: As the baby grows, it exerts additional pressure on the pelvic floor muscles. This pressure can lead to stretching and potential weakening of the muscles.
- Hormonal Effects: Pregnancy hormones, such as relaxin, help loosen the ligaments and muscles in preparation for childbirth, which includes the muscles of the pelvic floor (Aldabe 2012)
- Weight Gain: The added weight from the baby and amniotic fluid increases the load on the pelvic floor, requiring it to work harder to maintain support.
Read more: What is the Pelvic Floor and What Happens After Giving...
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Negotiating Physical Activity for Perinatal Mental Health
Exercise is commonly prescribed as one method to help improve one’s mental health (Ekkekakis 2013, Hu et al 2020, Heissel et al., 2023, Stubbs et al 2018, Vella et al 2023). However, a major barrier to begin an exercise routine can often be lack of motivation and fatigue, which is experienced by those suffering from depression (Faulkner and Biddle 2004, Glowacki et al 2017). Postpartum depression and other mental health illness is quite common, with research suggesting a prevalence of up to 20% in new mothers (Bauer et al 2014). Many new moms are told by health care providers to exercise during pregnancy and postpartum. However, advice and guidance on how to overcome barriers to exercising, including mental health barriers, is not addressed often enough.
Most research is focused on the benefits of exercise for mental health support in the general population and postpartum, but rarely addresses the barriers the postpartum population experiences related to mental health. An online survey by Goncalves et al recently set out to fill this gap in knowledge, exploring how women negotiate physical activity for their mental health and the barriers to participating in physical activity associated with mental health illness. 186 mothers were included in the study, from 6 weeks postpartum up until 4 years postpartum, three main themes were found in this qualitative study: barriers to physical activity associated with mental illness, strategies to negotiate being active for perinatal mental health, and guilt associated with not being active enough.
Read more: Negotiating Physical Activity for Perinatal Mental Health
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What are the “deep core muscles”?
The “deep core” is a muscle group that acts to stabilize your spine. This muscle group consists of the diaphragm, the pelvic floor muscles, the transverse abdominis and the multifidi muscles. When properly engaged, your intra-abdominal pressure increases and improves stability in the core. Due to the connection to your diaphragm, breath control is essential to core stability.
How are your deep core muscles affected by pregnancy?
These muscles are essential to stabilize your spine and create a solid foundation in order for you to move well and efficiently. During pregnancy, as your baby bump grows, the pressure in your abdomen increases. This means that the deep core structures have to work overtime in order to maintain core stability. The abdominal wall stretches to create space for a growing baby and this can affect the integrity and strength of the transverse abdominis. The increased weight of a growing baby can also put increased pressure on the pelvic floor and may cause pain or other pelvic health symptoms such as urinary leakage.
Read more: What are deep core muscles and how does pregnancy affect...
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What is symphysis pubis dysfunction (Lightning Crotch)?
Symphysis pubis dysfunction (SPD), also known as pubic symphysis dysfunction, anterior pelvic girdle pain, or lightning crotch, is a common musculoskeletal condition that is experienced by pregnant women and can vary from minor discomfort to severely debilitating pain. It is typically characterized by discomfort in the front pelvic area that can radiate to the inner thighs and perineum (think where your pubic bone is).
Read more: Lightning Crotch in Pregnancy: How You Can Start...
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What is Edema, and what causes swelling during pregnancy?
During pregnancy, extra water and salt retention is one of the most common complaints and symptoms that occur during pregnancy– this is called edema. Edema happens as a result of a few different changes that occur in pregnancy: the growth of the baby as they put greater pressure on one of the major blood vessels of the body called the vena cava which is located in the abdomen; hormonal changes that happen during pregnancy such as changes in progesterone, estrogen HCG (human chorionic gonadotropin), and prolactin which can cause increased swelling in the body; increased blood volume (by up to 50% more in pregnancy). Additionally, varicose veins may occur in up to 60% of females, with an increased risk depending on increased age and increased number of pregnancies.1 Edema can cause stiffness in joints, heaviness, and a sensation of warmth in the area that is swollen.
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Dr. Debbie Dy, PT, DPT
Orthopedic Clinical Specialist/Pelvic Health Physical Therapist
Once the exciting news of a new pregnancy is shared, it is common to get flooded with misinformation and “advice” from concerned family members regarding the safety of exercise during their pregnancy. Historically, it is common for people to be told to “take it easy” during their pregnancy or spend more time in bed. What we know is that exercise during pregnancy is safe and beneficial for both birthing parent and baby.
ACOG Updated Guidelines on Exercise During Pregnancy
The American College of Obstetrics and Gynecology (ACOG) in 2020 released updated guidelines regarding exercise in pregnancy which states that “exercise is both safe and desirable for birthing people in the absence of obstetric or medical complications or contraindications.” Not only is regular exercise safe for most pregnancies, exercising has immense physical and mental health benefits for not only the birthing person, but for the growing fetus as well. Birthing people who engage in regular exercise during their pregnancies have been shown to have decreased rates of gestational diabetes, hypertension, cesarean births, operative vaginal births and postpartum recovery time. It can also be preventative for the development of depressive disorders in the postpartum period.
Read more: Safe Exercise During Pregnancy: ACOG Backed Guidelines
