Journal Club! COVID-19 and the Pelvic Floor

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There is an increase in pelvic floor dysfunction during and after a COVID-19 infection

Is this surprising? Or Not? Let’s Learn Together!

From the Oct-Dec 2020 issue of Journal of Women’s Health Physical Therapy, by Syracusa and Gray. Official Citation and link:

Siracusa C, Gray A. Pelvic Floor Considerations in COVID-19. J Womens Health Phys Therap. 2020;44(4):144-151. doi:10.1097/JWH.0000000000000180

This article has a great overview of present physiological mechanisms that can contribute to common, but not normal, symptoms post COVID infection.  Having one of these symptoms doesn’t mean you did something wrong, or that you are less worthy or a failure.  It means that your body fought a tough virus, and has a few side effects that need some attention.  We’re here to help. 

Guess who has an increased incidence of urinary incontinence and pelvic organ pressure complaints? Not to mention constipation and sexual dysfunction if they were in the ICU??

Post-COVID patients!!!

So medicial providers and loved ones, be sure to ASK PEOPLE ABOUT THIS, even if you don’t have the specific technical skills to treat them. Asking, and listening, lets them know that these complaints can be treated, and they are not alone.

Send them to a pelvic floor PT who can help them get this important part of their life back!! 

But I don’t get it. WHY and HOW
does COVID-19 affect the pelvic floor?

I am SO glad you asked 🙂

  • Pelvic Floor Muscles are “accessory” muscles of breathing.  Meaning in normal relaxed breathing, they shouldn’t do much. But, in active-forced breathing, they are recruited to help.  And, with COVID, or shortness of breath associated with it, we are doing a lot of active-forced breathing all the time. Now, these pelvic floor muscles aren’t made to be used all the time for breathing, so they are going to fatigue.  Frown face. 
    Fatigue in pelvic floor muscles → reduced upward force to keep pee inside your body → increased leakage and pelvic pressure
COVID-19 and the pelvic floor. COVID-19 causes exacerbation of many pelvic floor dysfunctions. 
 Here is an illustration of a person sneezing, and drops of urine coming from their pelvic region.
Leaking urine or feces with sneezing is one type of stress incontinence, and is more common during and after a COVID-19 infection. It occurs because the downward forces on the bladder are greater than the upward supportive forces of abdomen, gluteals and pelvic floor muscles.

Crap. So my bladder is yelling louder, and my pelvic floor can’t resist it?  

But wait…there’s more…

  • Add frequent coughing or sneezing to the mix.  Now you have a series of MANY, rapid, forceful downward movements exerted upon irritated, weak pelvic floor muscles.  No wonder we see increased complaints of urinary urgency, leakage, frequency and pelvic pressure. 

I have a penis. I’m not leaking.
This doesn’t apply to me.

  • “Oh really”?  COVID-19 specifically affect Leydig cells in the testicles.  This can cause inflammation, which can lead to erectile dysfunction.  Not to freak you out, but rather to empower you to know that this is a thing.  And if you’ve had COVID-19, and now you’re having erectile issues, you’re not alone, and there is a medical explanation for this.  Talk to your general practitioner, urologist, or pelvic floor PT about next steps.  

I was on a ventilator. Did that affect me differently?

I’m glad you’re here…because it means you’re still alive, and many others who were on a ventilator can’t say the same thing right now.  So start out with that gratitude.  Next off, high five for being proactive in reading this. 

Being on a ventilator for 6 days more than doubles your risk of constipation.  

Illustration of person sitting on toilet, with red coloring, indicating irritation and pain, in their lower abdomen.  Behind them, a large, red, jagged, background indicates discomfort, and the person is frowning.
Conspitation is a major contributor to many types of incontinence and pelvic pain. It is more common in people post COVID-19 infection.

Constipation? No big deal, you say.  BIG DEAL, I say. 

Conspitation is a major player in many types of incontinence, pelvic organ prolapse and pain, due to how it stresses (literally) the pelvic floor muscles. You need to be hydrating well (see hydration post), taking in good fiber, and working on diaphragmatic breathing and bearing down, to help get that pelvic floor out of the way of that rock hard poop.  Unsure of how?  Check out the pelvic floor muscle self exam on my Signature Series.  You’ll thank me later.  

To summarize, the medical community’s understanding of the global health effects of COVID-19 are deepening daily.  From cognitive changes to systemic inflammation, it is so much more than ‘just a respiratory disease’.   

Thanks for reading! Remember to join my mailing list to be kept up to date on other AMAZING blog posts with practical tips for all ages, anatomy and stages of life, for improving your pelvic (and overall) health!  Mailing list subscribers also get exclusive discounts to Pelvic Floored products, and access to subscriber only events!  Don’t miss out!  Sign Up Today!

Thanks for reading!

xoxo, Dr. Kelly

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Journal Club! COVID-19 and the Pelvic Floor
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