Women on TikTok have been sharing their experiences with pelvic pain. While some admit they have problems because of conditions, such as endometriosis, others report the pain starting more recently. Some have felt sharp pains radiating from their pelvis, making it impossible to walk or sit comfortably for long periods of time. Others have noticed that sex has become painful. Some might not even realize that urinary incontinence or constipation might be related to their pelvic floor.
Doctors and pelvic floor physical therapists are seeing increasing numbers of people seeking help for pelvic floor pain and dysfunction and believe the ongoing COVID-19 pandemic is likely contributing to some of it.
How stress can impact the pelvic floor
“It’s more stress related rather than a mechanical issue, such as sitting longer,” Sara Reardon, a physical therapist at Nola Pelvic Health, who’s known online as The Vagina Whisperer, told TODAY. “We had so many patients who were just having an increase in pain, pelvic pain, bladder symptoms, constipation symptoms and painful intercourse after stressful periods.”
While some suspect that working from a makeshift home office might be to blame, Reardon doesn’t think a lack of exercise or bad office furniture is at fault. It’s likely all the other complexities that have flourished since the start of pandemic.
“A lot of the social isolation that people have from not going into the office, from not having that commute to and from work to decompress a little. They’re working at home with a partner. They may be juggling kids,” she said. “That’s a really stressful environment.”
Dr. Staci Tanouye also said she’s seeing increasing numbers of patients experiencing pelvic floor problems. While experts have long known a relationship between stress and pelvic floor pain (or any pain for that matter), the length of the pandemic and how people access — or cannot access — medical care could be creating more pain and dysfunction.
“A lot of even general preventative health care got pushed to the back burner, which then obviously is going to further exacerbate any sort of underlying issues,” Tanouye, an OB-GYN, told TODAY. “Then things just slowly get worse.”
Excessive coughing can also make symptoms worse
While turmoil plays a role in worsening pelvic floor health, experts also know that coughing too much can intensify pain and stress incontinence.
“So the symptoms of that is leakage with a cough, laugh, sneeze or a bulge,” Dr. Jill Rabin, professor at the Feinstein Institutes for Medical Research in New York, and author of the book, “Mind Over Bladder,” told TODAY. “If you experience that, it’s important to do things that are going to help the pelvic floor get stronger.”
Coughing is one of the primary symptoms of COVID-19 and can linger patients with long-hauler symptoms. All this coughing could put more strain on a pelvic floor that could be weakened from childbirth, gravity or aging.
“Respiratory function and pelvic floor dysfunction go hand in hand because the respiratory function of the diaphragm is really important and connected to the relaxation and the contraction of the pelvic floor,” Tanouye said. “If you have COVID … you’re going to exacerbate those pelvic floor symptoms even more.”
The postpartum population may be suffering
Another group of people experiencing pelvic floor dysfunction include those who had babies in the pandemic. Many people felt unsafe going for follow-up care prior to vaccines or weren’t aware of all the support available to them.
“There was really limited access to health care providers, postpartum support, family support and childcare,” Reardon said. “Those new moms and individuals have really struggled to rehabilitate.”
At first, she worried that people wouldn’t seek out pelvic floor physical therapy, but she is experiencing an influx of patients. Some are even pregnant again and are hoping to have a better pregnancy and postpartum outcome than the last time.
“They’re coming in for their second baby and they’re feeling like ‘I felt really unprepared. I wasn’t able to have my doula. I wasn’t able to have my family there and I want a better experience,’” Reardon said. “They’re saying, ‘Hey, we want a different experience and we want pelvic floor therapy to help us navigate this better.’”
Help is available
Many people believe it’s normal to leak while coughing or laughing, or experience pelvic pain, but experts stress that while it occurs often, it shouldn’t be considered normal.
“Issues that have to do with the vagina and the uterus, there is a stigma against it,” Tanouye said. “People with vaginas in general have just been taught that ‘Oh that’s just something that happens after you have kids and that’s just something that happens as you get older. So we’re just going to have to put up with that.’”
People experiencing pelvic pain, urinary or fecal incontinence or any sort of bulge from the vagina — also known as pelvic organ prolapse — should speak with their OB-GYNs. They might recommend they visit a pelvic floor physical therapist and a specialist, such as a urogynecologist. Pelvic floor physical therapy helps people strengthen their pelvic floor and reduce many of the problems from pelvic organ prolapse, pain and incontinence.
“It’s important to do things that are going to help the pelvic floor get stronger, which are basically pelvic floor muscle exercises on your own or with a physical therapist,” Rabin said. “You can actually thicken your pelvic floor muscles and the muscles in the urethra.”
While pelvic organ prolapse can require surgery or devices to fix it, working with a pelvic floor physical therapist can help many people to have less pain and fewer problems.
“Pelvic floor physical therapy includes external work. It includes internal, sometimes vagina work, and breathing techniques, a technique called diaphragmatic breathing,” Tanouye said. “Diaphragmatic relaxation is connected to the relaxation and contraction of the pelvic floor. So it’s teaching that connection and how to control that.”
Social media is increasing awareness of pelvic floor physical therapy and Reardon said she’s had patients find her without going through a doctor.
“They end up coming in and getting an assessment and we’re able to evaluate them if they do need help,” she said. “People now feel like they have a resources for those symptoms, whether it is bladder health or childbirth preparation or pelvic pain or painful intercourse. They feel like they don’t have to suffer.”