Many conditions that we treat are, to some extent, preventable. We highly recommend an appropriate “pelvic muscle and function” evaluation to individuals who are concerned about maximizing comfort and function of their pelvic structures. This differs from a gynecological or urological evaluation, as those examinations are geared towards identifying tissue pathologies (such as infections or diseases), rather than assessing the system as a whole.

Our pelvic wellness and prevention program includes an evaluation of trunk and pelvic muscle firing patterns and pelvic organ position, and training to properly recruit your trunk musculature as well as teach you which behaviors to avoid in order to best preserve the integrity and function of your pelvic organs.


The hormonal changes associated with pre-menopause and menopause begins before the last menstrual period or the “official” start of menopause (1 year after your last menstrual period). When a woman’s hormone levels begin to change, which may be several years before her last period (as early as their early 40s), she may experience urinary urgency or frequency, vulvar or vaginal burning, vaginal dryness, sleep changes, and changes in muscle strength (including pelvic muscles). This may result in pain with intercourse/sexual activity, urinary incontinence, or general discomfort even with clothing contact to the vulva. These symptoms may set in motion a chain of events that further deteriorate her genital and sexual health. Pain or discomfort may cause a cycle of muscle spasm. Fighting to maintain continence may also cause vaginal muscle spasm and pain.

These will manifest themselves in several ways:

  • Pain with intercourse
  • Tearing or bleeding of vulvar and/or vaginal tissues
  • Infection
  • Urinary frequency and/or urgency

These conditions are part of a vicious cycle, which can be interrupted with appropriate treatment.

What to do:
It is a good idea to schedule a physical therapy session at the first signs of hormonal changes (or even before the early signs) to evaluate the health of your pelvic tissues and organs, and pelvic floor muscle function. In this session we will teach you to properly recruit your pelvic musculature as well as teach you which behaviors will promote ongoing health of your pelvic organs and tissues.

Prolapse Prevention

Pelvic organ prolapse is the protrusion of any of your pelvic organs (bladder, uterus, rectum/bowel) outside of the vaginal or rectal openings (similar to a hernia).

This can be caused by:

  • Weakened pelvic floor muscles
  • Genetic makeup of your connective tissue, or Excessive bearing down during lifting
  • exercise
  • child birth
  • bowel/bladder elimination

This happens because of too much downward pressure from above, which occurs when exercises/activities are performed without proper preparation and/or stabilization. All of our clients are taught to correctly recruit the appropriate muscles at the right time for the purpose at hand to properly modulate intra-abdominal pressure. Too often, our clients have been taught improper muscle recruitment patterns from lesser-trained professionals, who are not familiar with current neuromuscular research. Learning proper pressure modulation in advance can help to prevent this problem.

What to do:

It is a good idea to schedule a preventative physical therapy session to evaluate your own muscle firing patterns and pelvic organ position. In this session we will teach you to properly recruit your trunk musculature as well as teach you which behaviors to avoid in order to best preserve support for your pelvic organs.

Maintaining Continence

There are several causes of incontinence that are related to changes associated with aging, and some that are related to behavior or habit. A behavior that emerges due to behavioral or age-related changes may actually result in further challenges to a woman remaining continent.

  • Weakened muscles associated with hormonal changes
  • Frequent urination that results in decreased bladder capacity
  • Frequent bearing down associated with exercise form or lifting
  • Constipation that results in straining and excessive downward pressure on the bladder, or that reduces bladder capacity due to a full rectum which sits behind the bladder

For example, many women begin new exercise programs such as pilates or core strengthening programs to maintain their health or their figure, but are not taught to recruit their muscles properly. They actually perform the exercises incorrectly, and use a strategy that involves “bearing down” and pushing on the bladder which challenges their continence. They then end up “clenching” their pelvic floor muscles in an attempt to maintain continence while performing exercises that challenge their bladder’s capacity to hold urine, which in turn can result in urinary frequency or urgency symptoms. Proper instruction in muscle recruitment strategies and correct “form” in performing your exercise routine can prevent this outcome.

Another example is that one’s muscles may weaken as their hormone levels change, which may result in some urine leakage with exercise. This may result in premature emptying of the bladder, in order to avoid filling to a level that is a challenge to hold, which, in turn, may result in decreased bladder filling capacity and an increase in urinary frequency. Or, she may respond in excessive “clenching” of her vaginal muscles in an attempt to prevent the leakage, which can, in turn, cause muscle irritation which results in urinary frequency and urgency. In our evaluation we investigate the root cause of your symptoms, and devise strategies to deal with your specific presentation.

What to do:

it is a good idea to schedule a preventative physical therapy session before any major changes in habit, such as a change in your exercise routine, to make sure that you implement your program in a way that will not challenge your capacity to remain continent down the road. In this session we will evaluate your muscle firing patterns and teach you to properly recruit your trunk musculature as well as teach you which behaviors to implement in order to best preserve your ability to maintain continence over a lifetime of exercising, including through transitions through lifespan phase changes (e.g. childbirth, menopause).

Sexual Participation

Many girls and women experience some difficulty initially with penetration. Their first attempt at tampon insertion is not successful, or their first pelvic examination is painful. This is very different from ongoing difficulties with penetration, for example never being able to insert a tampon, pain with subsequent attempts at penetration or vaginal examinations. The entry point to the vagina is covered with the hymen in many girls or women who have not experienced penetration. In cases where the hymen is intact, penetration may be painful due to tissue tearing. This should heal fairly quickly (within a few days), and tissue should stretch and accommodate with successive episodes of penetration.

Some women experience ongoing pain with penetration, for a variety of reasons (e.g. repeated catheterizations in childhood). This may occur from her first attempt at penetration, or may begin after a period of painless penetration. Often the reason for this is unknown. These individuals are often led to believe that this is a result of an anatomical challenge- they are simply “too small.” Anatomical abnormalities, however, are rare, and one must consider that these tissues are designed to stretch to accommodate the passage of a full-term baby through them (albeit with hormones present that help relax the tissues further).

In the vast majority of cases, women must learn to consciously relax their pelvic floor muscles to allow for easy penetration. Most of our clients learn quickly to relax and stretch their vaginal muscles to allow for easy, painless penetration.

What to do:

If you are having trouble with penetration of any kind, it is a good idea to schedule a preventative physical therapy session, rather than to continue painful penetration or avoid it altogether. We will evaluate the status of your vaginal muscles, and teach you to relax and stretch them as appropriate.