Mary Ellen Kramp, DPT, CLT-LANA is a physical therapist and owner of Relief at Hand, LLC. She is also the president and co-founder of Pelvic Health Research Initiative, Inc, a non-profit developed to raise money for pelvic research. She has a doctorate in physical therapy from Boston University and is also a certified lymphedema therapist.
Fertility is complex. It involves a woman' s ability to ovulate (which includes a cycling of hormones), the egg to get into the uterine tube, sperm to find it and fertilize it, and the fertilized egg to implant into the uterine lining. In couples trying to conceive 57% will have success within 3 months, 75% at 6 months, and 85% at a year.
Couples who have been trying for one year without success to become pregnant are defined as infertile by the CDC. About 12% of couples fall into this category. Female infertility is the cause about 82% of the time and is due to ovarian issues, tubal problems, and uterine abnormalities.
Current treatments for infertility include hormone injections (such as Clomid), intrauterine insemination (IUI), and in vitro fertilization (IVF). These treatments tend to be invasive and expensive and do have risks.
A new theory currently being researched may prove to be of help to many women. Mechanical infertility is when infertility is due to mechanical issues which can be treated just like any orthopedic problem. If you injured your shoulder, a physical therapist would address the alignment of the bones, the ligaments, the muscles, the range of motion of the joint, and the swelling. Now let's consider the shoulder is a uterus instead.
1. The Bones
The bones of the pelvis help to protect the uterus, tubes and ovaries. The bones of the pelvis can become misaligned with traumas such as falls or car accidents. Therapists have multiple techniques to realign the bones of the pelvis.
The uterus is surrounded by connective tissue and suspended in the pelvis by ligaments. These ligaments attach to the sacrum (the triangular bone at the base of the spine) and the pubic bone in the front of the pelvis. Traumas to the pelvis such as falls (think about falling on ice, while roller skating, playing basketball, falling off a horse) can cause torsion through these ligaments and alter the position of the uterus. This can result in things like low back pain or painful periods. Just as physical therapy would work on someone with shoulder pain because of ligament strain, ligaments in the pelvis can be addressed the same way.
3. Blood Vessels
Blood vessels that feed the uterus travel through the connective tissue that surrounds and supports it in order to bring blood to it. If the ligaments surrounding the uterus are tight, then the blood supply to the uterus could be compromised. This could result in a less than optimal environment for a fertilized egg to implant or grow. By treating the ligaments and other connective tissue, the blood supply is improved to the uterus.
Lymphatics can become congested from prior infections (like STD's, bladder infections, and stomach flu). This congestion can create a back up of fluid and waste products within the pelvis. Women with this issue often note a chronic bloating. This can be treated with lymphatic drainage to decongest the lymph nodes and help to remove excess fluid from the pelvis.
Mary Ellen Kramp, DPT, CLT-LANA
Doctor of Physical Therapy
Co-Founder and President of Pelvic Health Research Initiative
Owner of Relief at Hand, LLC
1. Painful Intercourse
Sex should never be painful: not during foreplay, not during penetration, not with deep penetration, not during, and not afterwards. Pelvic pain can be treated. Pain can start for numerous reasons: vaginal birth, episiotomy, trauma, infections, hormone issues, falls onto the sacrum, and reasons unknown. Women are often told to do kegels in these cases, which for many of them cause more pain. Most women with pelvic pain tend to hold the pelvic floor too tight and need to learn how to relax the muscles. Therapists can work with women to release trigger points within the muscles and other issues creating pain as well as retraining the muscles to create a relaxed pelvic floor and eventually pain-free, pleasurable sex.
2. Stress Incontinence
Peeing when you cough, sneeze, run, jump, etc
Most women are told that peeing when you cough, sneeze, jump and run is a part of aging or is what happens after you have a baby. Yes, it is a common problem. NO, it is NOT what just happens when you have a baby or age! Stress on the pelvic floor and weakness of the pelvic floor muscles make it more difficult for women to be able to hold urine, but this can be treated by a therapist and pee-free coughing, sneezing, jumping and running can resume!
3. Pains During Pregnancy
Many women suffer from back pain, pelvic pain, round ligament pain and sciatic pain during pregnancy. All of these issues can be addressed with physical therapy. There is no need to stay in pain just because of the pregnancy.
4. Post Partum Issues
Pelvic floor pain, stress incontinence, and abdominal weakness (a separation of the muscles called diastasis recti) are the most common issues following birth. Scar tissue from either a c-section or vaginal birth can create significant pain. Physical therapists can work with women to help return the body to optimal function following pregnancy.
5. Women's Issues through the Lifespan
Physical Therapists can address such issues as painful periods, bowel, bladder and sexual dysfunction, osteoporosis, pelvic organ prolapse, and cancer care. Women may not be aware of the options available to them for treatment. For more information about women's health physical therapy, visit www.womenshealthapta.org .
Many women suffer from painful periods. The typical treatments are over the counter meds like ibuprofen or acetaminophen, or seeing a gyn and getting on The Pill. Very few women are aware that acupuncture and physical therapy are options. Acupuncture and herbal medicine can help normalize a woman's cycle and boost her system in order to improve her periods. Physical therapy can mobilize the ligaments surrounding the uterus in order to take pressure off of the uterus to alleviate pain. Why suffer every month?