Expert Answers to Common Women’s Health Questions
Expert advice from Lavinia Creswa, PTA, LMT
I’ve spent the last eight years in women’s health physical therapy. As a physical therapist assistant with a background in massage therapy, I have dedicated my career to helping women, especially with their pelvic, bladder and bowel health. Since I’m pretty outspoken—I’m the girl who explained exactly WHY a Squatty Potty helps you poop during Thanksgiving dinner—a lot of people have asked me questions over the years. I regularly receive DMs from people who want my opinion on some of these “taboo” topics. I’m here to answer a few of the ones I get most frequently.
“I have no idea what to expect after I deliver my baby … will I really pee every time I laugh?”
There are so, so many factors in terms of what to expect in your postpartum body, it really makes a general answer to this question impossible, Everything plays a part: How complicated was your delivery? Were forceps used? How was your labor? Did you tear or have an episiotomy? The list of what can affect your pelvic floor goes on and on. Your body has gone through a big change, and sometimes new issues arise. These are perfectly normal, and some problems can take time to resolve. A lot of women say they don’t feel “normal” again for months, sometimes even up to a year after they finish breastfeeding.
Some postpartum women leak urine with coughing, sneezing, laughing or exercise. This is called Stress Urinary Incontinence (SUI). It just means your pelvic floor muscles are a little weaker. This can happen whether you have a cesarean or vaginal delivery. Luckily, there are trained pelvic floor therapists available who can help you strengthen and use these muscles functionally again. In France, women get 10 visits of pelvic floor PT prescribed after every pregnancy; I’d love for this to be the norm in the U.S. as well. Usually at about six weeks postpartum, you can start an exercise program targeted to fix your specific troubles. Talking to your doctor and requesting a referral is a great way to get these muscles back into shape.
“Menopause sounds terrible. What should I expect?”
Another one that really depends on the individual in question. However, menopause itself—not so bad. That’s when you’ve had a year of no cycles and your ovaries have stopped producing hormones.
It’s the perimenopause that will kick your butt! We’ve all heard about the hot flashes, but did you know you can expect heavy, irregular periods, vaginal dryness, weight gain, mood swings and being *ahem* erotically charged? And you can still get pregnant! Continue to take precautions if you don’t want a “bonus baby.” There are several pharmaceutical options available which can ease these symptoms, including hormonal creams, pills, injections or pellets. If you decide to go through the process naturally, there are over-the-counter remedies such as vaginal moisturizers and evening primrose supplements that can take the edge off of these symptoms. Just remember: This too shall pass, and once you’re in the post-menopausal stage, the majority of these issues will resolve on their own.
“I have pain with ____”
Talk to your doctor if you have pain! As a pelvic floor therapist, I treat pain occurring between the rib cage and knees. This includes, but is not limited to, pain with bowel movements, pain with urination, pain with intercourse, pain with orgasm, pubic symphysis pain, pain with sitting, pelvic pain or pressure with exercise and painful periods (more than just cramps).
All of these problems are legitimate. None of these are normal. You should not have to live with or suffer from any of these issues. If your doctor tells you it’s normal or discredits you by saying you just need to relax, lose weight or that it’s “in your head,” FIND A NEW DOCTOR.
It takes some women years for a doctor to take their pain seriously and refer them to an appropriate clinic to begin proper treatment. I would suggest seeing a urogynecologist.
Urogynecology is a fellowship-trained specialty solely working in women’s pelvic and bladder health. And the best news? Oklahoma City has at least one urogyn in all of the major hospital networks. Should you require additional treatment or surgery, urogynecologists are trained in minimally invasive techniques and procedures. All of these doctors work directly with pelvic floor therapists to best treat your symptoms on an individualized basis. For a lot of women, the musculoskeletal aspect of pain is just as important as any physiological diagnoses. Having a multidisciplinary team is so beneficial. Chronic pain can be tricky to treat, so it’s important to keep an open mind that just because the “problem” is gone, the pain may linger. Be your own advocate, and continue to seek treatment until you have an answer.