Pelvic PT and Painful Periods - Episode 15
In this episode, I discuss how Pelvic Physical Therapy can help women deal with painful periods. There are a variety of symptoms that Pelvic PT can help reduce directly (low back pain, low abdominal pain, thigh pain, and headaches) and indirectly (vomiting, diarrhea, and fatigue).
I referred to Johns Hopkins Medicine in preparation for this episode.
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Dr. Kari: Welcome to the Morone Pelvic Health Podcast. Hi, I'm your host, Dr. Kari Roberts. On this show, we will be discussing a variety of things regarding your pelvic health. These conversations will be a mix of education, personal experiences, and a blend of tips you can apply to have a healthier pelvis. The goal of this show is to normalize conversations around pelvic health and help women stop suffering in silence. Hello. Welcome back to the podcast. So I wanted to talk a little bit. We're going to switch gears and go into a series of episodes where we're talking about pelvic floor dysfunction that has to do with muscles and tension, and I'm just going to leave it high level like that. So today's episode, what I really wanted to get into is painful periods. Most women have had painful periods. Like so many other things, painful periods are common and mostly everybody has them, but it doesn't necessarily mean that they're normal. Some people can have just a little acre pain and it doesn't bother them. And then it can go the whole other end of the spectrum where it's actually a diagnosis of PMDD, which is an actual dysfunction with all kinds of other things. So we're not talking about PMDD, which is a very severe form of PMS, which actually stands for Premenopausal Dysphoric Disorder. We're not talking about that, and we're not talking about people that don't really feel anything. We're talking about that middle of the road, not necessarily a diagnosis, but you probably have some discomfort that interferes with you a couple of hours or a couple of days out of your cycle. So what comes with painful periods? Well, yes, people can have pain right at their abdomen where their uterus is, but so many other things can be associated with this pain. And I am a woman. I've been a woman my whole life. So a lot of this I know firsthand from what I've experienced or what I've heard other people experience. But I wanted to have a source. So I did reference the John Hopkins website and I'll be linking that in the show notes if you wanted to read up on it with a little bit more detail. But in a nutshell, symptoms that come with painful periods are lower back pain, lower abdominal pain, leg pain, headaches, vomiting, diarrhea, fatigue, and possibly passing out. Some of these things can be impacted directly through Pelvic physical therapy, and then the other list can be impacted indirectly through physical therapy with Pelvic floor physical therapy. So the Johns Hopkins University website said that there are several treatments that can be done to manage painful periods, and some of these include hormone therapy, like birth control, altering your diet, taking vitamins, taking medications over the counter like Tylenol, motrin, those kind of things. Acetaminophen, NSAIDs, exercise, heat and massage. So those are all things, they've been tested. It's a fact. These things can help reduce painful periods. What does that have to do with pelvic physical therapy because pelvic physical therapy can directly reduce your lower back pain, can directly reduce your lower abdominal pain, can directly reduce your leg pain and can directly reduce your headaches. And then on the indirect category, if we reduce pain in other areas, we can reduce vomiting if you change the way you are digesting food and we make sure that you have healthy bowel habits that can help you reduce the diarrhea and general light exercise can help reduce fatigue. That's the short version. Now let's dive a little bit deeper. With pelvic physical therapy. We are experts with understanding the muscles, the joints, the ligaments, the tendons in and around the pelvis. So what's in the pelvis? The uterus is inside the pelvis, the bladder is inside the pelvis and the bowels are inside the pelvis. So if you're having any type of uterine, vaginal pain or bowel discomfort, constipation, diarrhea or lower abdominal pain caused by the bladder, then what we do in pelvic physical therapy can help reduce those pains. What we do is we can help improve the function of the pelvic floor and improve the function of those organs inside of the pelvic floor. So that way we should be able to reduce some of your pain and discomfort. When we think specifically about that lower abdominal pain, there are some visceral mobilizations that we can do. There are some skin techniques. We can do gentle massage, skin rolling, cupping, things like that, that can really help reduce that abdominal pain, which can help you feel better. When we think about the lower back, we can do the same thing. We can do skin rolling and deep tissue massage, and soft tissue massage and even maybe some joint mobilizations to your spine if that's needed. We can also help you be more aware of your postures. Sometimes your pain can alter your posture, which can change your pain. And sometimes what you're going through during your cycle can impact how well your back is responding. Sometimes those lower back muscles will over respond, which can cause some sort of discomfort. And by looking at the whole person from top to bottom, from front to back, we can put some plans in place to help reduce that. Now when we think about the leg pain, usually generally it's inner thigh pain that kind of starts at the pubic bone and can radiate down towards the thighs. And so there are tendons that run that way, there are muscles that run that way. Fun fact, your adductor muscles which are on the inside of your thigh directly relate to your pelvic floor. So if we relax the tension in the pelvic floor, we can reduce the pain in your lower legs, excuse me, your upper legs. And at the same time, if we reduce the tension in those adductor muscles, we can therefore reduce the tension in your pelvic floor which impacts the period pain. So I hope you see how this is a continuous loop. Everything is connected. Everything can help each other. Now, when it comes with headaches, I put the headaches in the direct category as opposed to the indirect category because not if we pelvic physical therapists. We understand a great deal how the nerves are connected with our body and our muscles. And one of the most important nerves that we speak a lot about is the vagus nerve. And we know stimulating the vagus nerve can reduce headaches and migraines and digestive issues and so many other things. And yes, you can stimulate the vagus nerve in a lot of indirect ways. But I put this in the direct way because when we work on your breathing and when we really get you to hone in on the mechanics that you're doing when you're doing proper breathing, it does stimulate the vagus nerve directly that inhaling and exhaling helps calm your nervous system. But the inhaling and exhaling, the moving, the contracting and relaxing of those breathing muscles, the contracting and relaxing of your diaphragm directly stimulate the vagus nerve which reduces headaches. So that's why I put headaches in the direct category because so much of what we do in pelvic physical therapy, at least here at moron pelvic health is working on really honing in your dynamic breathing. And once we get not your dynamic breathing, I'm sorry, honing in the mechanics of your breathing. And when the mechanics of your breathing are good, so many other things fall into place. Now let's move over to the indirect section of the vomiting, the diarrhea and the fatigue. The fatigue is another one. It could be direct. Well, technically it's indirect, but improving exercise which while you're on your cycle that may not look like doing a whole full CrossFit workout or a total body strength routine. The exercise might look like some mobility work or some stretch work or bar or Pilates, something gentle, something that's going to increase that blood flow and reduce the tension in your body. It could look like doing a short casual walk around your neighborhood or at your local park. But just a little bit of exercise can reduce your fatigue feeling that you have while you're on your cycle. Another one of the indirect symptoms that we can help with is diarrhea. If we can get your bowels healthy, which might look like using a squatty potty or having some healthier habits while you're having your bowel movements, like refraining from straining or staying away from foods that don't agree with your body. That is an indirect way that we can reduce your diarrhea during your period, something that we cannot control. A lot of times there's talk out there about period poops. Yes, it's a real thing. We have changes in our hormones, prostaglandins particularly and that alters the way that our body absorbs food in our intestines. It makes the food run through your intestines a little bit quicker. So then therefore you get those period poops that people talk about a way to slow things down, just general is just to increase fiber, because fiber generally decreases the way how fast food moves through your bowels, which can help reduce your diarrhea. So that's another indirect way that pelvic physical therapy can help. And then the last one, the vomiting. I believe that we can indirectly reduce the vomiting because if we do the other things to directly reduce the pain, reducing the pain will therefore indirectly reduce your vomiting. Now, if your vomiting is truly from the fluctuation of your hormones, no, we can't do anything about that, but we can reduce it if your vomiting is related to your pain specifically. Now, I know I went through it once, but I just want to go through it again. John Hopkins recommends doing several things to manage your pain, which we don't do directly in pelvic physical therapy, which is prescribing medication or prescribing hormones. Now, giving you general information about your diet, yes, we can do that. Like I just did. Sometimes increasing your water intake or increasing your fiber can help with reducing your constipation or diarrhea issues. So that's just an example of a way that we can educate you. And then vitamins. Some of us have taken some extra educational work training to be able to prescribe vitamins that might work for you. I'm not in that category, so I'm just going to leave that out there. I have a personal interest in vitamins, but I'm not like, for example, magnesium. It's been shown that magnesium can help with side effects of PMS, such as tender breasts and some painful periods. But I don't know a ton about it, so I can't give you any more specific information than that. But what I can give you information on is three other things that is recommended to reduce your period pain, which is exercising, applying heat, and massage. So physical therapists, we can do a lot of hands on work, such as joint mobilizations, soft tissue work, deep tissue work, which can go under that massage window. We apply tens units, electric stimulation units, and hot packs and cold packs, which helps with that one recommended thing, which was heat. Heat is recommended. That's something that most of us can apply in the clinic, or we can educate you on how to apply that at home. And then, of course, exercise. I think everybody thinks about physical therapists when we're thinking about exercising, both in a more advanced way, but also in a more gentle way, such as increasing your mobility, increasing your range of motion, increasing your tissue. Yeah, that's it. I was going to say something else that didn't make any sense. So that, in a nutshell, is how pelvic physical therapy can help with your painful periods. And if you're having painful periods that are impacting you a couple of days a week out of sorry, a couple of days a month out of your cycle. It's probably going to be worth it to check out a Pelvic physical therapist so you can get some treatment to help you during those months, but also get some techniques that you can do ongoing in the future. So as review, there are four symptoms of painful periods that we can directly impact, which is lower back pain, thigh pain, lower abdominal pain, and headaches. There are three symptoms that we can help reduce indirectly, which are vomiting, nausea and fatigue, and the ways that we can do that is through exercise, hands on techniques such as mobilizations and massage, and applying modalities such as hot packs. Thank you for checking out the podcast and I will be back next week to talk all about vaginismus. Thank you for listening to this episode of The Moron Pelvic Health podcast. Please do me a favor and leave a review so that more people can find this content and make sure you like and subscribe yourself so you never miss another episode.