Category: General Health and Wellness

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“No One Told Me I Would Be Coming Home in Diapers Too”

New Mom Chrissy Teigen Discusses her Pelvic Floor Issues
 

While today’s blog title could have been stated by a number of my patients, it has been quoted, in fact, by none other than supermodel Chrissy Teigen.  On April 20, 2016, she boldly tweeted about her post-partum urinary incontinence to her thousands of Twitter followers.  Teigen isn’t the only one to publically discuss her postpartum problems on social media.  In October 2015, Kim Kardashian West blogged on her website “Do you know you basically have to wear a diaper for two months afterwards?! LOL! No one told me that!”  Stars truly are just like us, and even celebrities are susceptible to the musculoskeletal changes that occur during and after pregnancy.

The running theme that emerges from these celebrities, who are likely receiving top notch medical care and guidance, is “NO ONE TOLD ME.”  Many women can probably relate to the frustration of incomplete patient education.  After all, forewarned is forearmed, and it is understandable that women want to know what to expect when (and after) expecting!  This blog is a response to the aforementioned complaint, and it will hopefully help women prepare in advance.

Both women who deliver vaginally and women who deliver via Caesarian section are subject to significant pelvic floor changes.  The pelvic floor muscles, the muscles responsible for maintaining urinary and fecal continence, are subject to triple the amount of pressure compared to the non-pregnant state.  Furthermore, increased amounts of the hormone relaxin, a hormone which loosens ligaments, circulate throughout the body to enable the pelvic expansion necessary for labor and delivery.  When this occurs, the pelvic floor muscles can become overstretched and weak, thus impairing their ability to maintain continence.

While Kardashian West may believe that two months of diapers is par for the course for postpartum women, as a pelvic floor physical therapist I strongly disagree.  Pelvic floor physical therapy is an excellent approach to address pregnancy related incontinence.  Upon arrival to physical therapy, many women inform me that they have tried doing Kegel exercises but it has not made a difference.  The truth of the matter is that approximately 50% of women who attempt to perform pelvic floor muscle exercises do so incorrectly.  The most effective way to teach women how to utilize the proper muscles is via internal manual digital facilitation.  One of my favorite moments as a clinician is sharing that “Aha!” moment with patients, i.e. when a patient experiences what it feels like to correctly contract their pelvic floor muscles for the first time (as opposed to the improper technique they had previously employed).  Once a patient has properly identified the pelvic floor and how to engage it, biofeedback is another useful tool that physical therapists can use to train and strengthen the pelvic floor muscles.

 

Consider yourself educated, and please share this knowledge with other women.  Let’s eliminate the “No one told me” component that frustrates so many new mothers and decrease the stress as much as possible.  Not knowing what is happening within one’s own body adds to the other stressors experienced by postpartum women.  Therefore, I encourage you to share this information with those who stand to benefit from it.  Kudos to Teigen and Kardashian West for opening this conversation and normalizing previously tabooed topics.

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A Tailbone of Two Injuries

 

The Coccyx (Tailbone)

The coccyx, colloquially referred to as the tailbone, is a small, often overlooked anatomical landmark that sits below the lumbar spine and sacrum.  Despite it’s tiny size, it is extremely clinically significant.  Think of it as the Grand Central Station of your pelvic floor, so to speak.  The coccyx serves as the attachment site of the gluteus maximus and levator ani muscles (which include the coccygeus, iliococcygeus, and pubococcygeus muscles) and ligaments (including the anterior, posterior, and lateral sacrococcygeal, sacrotuberous, and sacrospinous ligaments).  Injury to the coccyx can affect the aforementioned muscles and/or ligaments.  Conversely, injury to the muscles and/or ligaments can affect coccyx alignment.  Symptoms of coccyx dysfunction include coccyx pain (referred to as coccydynia), pain with defecation, pain with intercourse, pain with prolonged sitting, pain with transitional movements (such as sit to stand), coccyx pain, low back pain, and even neck pain.

As per the title of this blog, the tailbone is often injured in one of two ways.  It can either involve a traumatic onset, which involves a sudden and easily identifiable injury (ex. a sharp or painful fall), or an insidious onset, which is harder to pin point and often due to cumulative repetitive trauma.  These traumas may include a history of chronic pelvic floor muscle tightness which can pull the coccyx out of alignment, or it may be related to a history of multiple minor falls or sports injuries (even during childhood) which seemingly “healed on their own over time.”  As I often tell my patients, our musculoskeletal systems have a better memory than our brains, and what seemed at the time to be insignificant may in fact have a large impact down years later.  My goal in stating this is NOT to produce fear or nervousness over waking up tomorrow with symptoms of tailbone pain due to unresolved previous injuries.  Rather, my goal in sharing this information is to raise awareness and broaden your thinking; if you already DO experience any of the aforementioned symptoms, please consider that it may be due to the often overlooked coccyx.

Now that we have identified the importance of the coccyx and how it can become injured, let’s move onto the fun part…the part where physical therapists enter the scene…treatment and fixing the pain.  The most common direction of coccyx injury is a “flexed” coccyx, or the coccyx becoming stuck in an anterior/forward position.  Treatment of the coccyx involves external and internal mobilization of the coccyx to move it back into the proper position.  Internal work can be accomplished through vaginal or rectal approach, depending on the patient’s comfort level and preferences.  If the coccyx is deviated to either the right or left (in addition to or instead of a flexed coccyx), appropriate directional mobilizations are also indicated.  In addition, the therapist may choose to tape the coccyx into the newly corrected position after treatment to help maintain the correction.  Furthermore, as mentioned previously, the coccyx is attached to other structures, and therefore should not be treated in isolation.  Any muscle or ligament tightness needs to be addressed in order to maintain the improved alignment.  The final component of treatment is patient education about proper sitting posture, appropriate rest breaks to avoid prolonged sitting, and possible use of a donut or a different cushion initially for decreased pain.

If you or someone you know may benefit from pelvic floor physical therapy to treat an injured coccyx, please contact Revitalize Physical Therapy.  I would love to have the opportunity to help you along your healing journey!