So….the COVID-19 pandemic has been going on for almost 18 months! And I don’t know about you, but the past year-and-a-half has been a time warp. Almost every aspect of our daily lives has been drastically affected in some way. From our mental health to our physical health, it can be easy to feel alone and isolated in this pandemic-fueled world. 

Today, I want to talk about pelvic health -- and how the pandemic has affected it, whether or not you have had COVID 19.

In broad terms, the pandemic has decreased ability to address our pelvic floor issues in a clinic and has significantly affected the quality of life for many women and men (Brusicano et al., 2020; Sacco et al., 2021; Carlin et al., 2021). This is due to resources are being divided elsewhere- and why we see our clients in their homes.

If you have had COVID-19, the extent to which your pelvic health may be affected depends on the severity of the symptoms you experienced, pre-existing pelvic floor dysfunction, whether or not you were hospitalized, and for how long (Siracusa & Grey, 2020).

So lets dive into COVID and your pelvic floor more deeply.

Intro to COVID

First, let’s take a quick run down of COVID-19. At its very basic (most serious) level, the virus is spread by respiratory droplets and attacks our respiratory system first (Yuki et al., 2020). The immune system creates an inflammatory response to fight the virus.

Symptoms can range from mild (coughing, fever, fatigue, nausea) to moderate (pneumonia) to severe (pneumonia with decreased oxygen in our blood stream <90%) (Yuki et al., 2020). 

If things get severe enough -- chronic inflammation in the blood occurs (sepsis), which can lead to multi-organ failure. Particularly in the critical stage, COVID-19 can lead to something called acute respiratory distress syndrome (ARDS), which can then cause chronic scarring of the lungs. (We will talk more about this later). 

COVID and My Pelvic Floor

So how does this affect my pelvic floor? Well, our pelvic floor muscles (PFM) -- along with our diaphragm -- form a pressure system in our abdomen and they work as a team. The pelvic floor muscles move in the same direction as the diaphragm and they do their jobs together.

When we inhale, our diaphragm and pelvic floor both move downwards. The opposite happens when we exhale- they both move upwards.

Check out the GIF below to see all of your CORE muscles (which includes your diaphragm and pelvic floor) move on a NORMAL breath.

Mild COVID-19 Symptoms:

If you are thinking, “Well, I didn’t go into the hospital. I only had mild symptoms, like a cough, then I am okay!”

This could be incorrect.

A persistent cough (even for short periods of time) can cause tiny tears in the pelvic floor muscles, leading to progressive weakness. This can cause (or increase) issues with pee leakage, poo leakage, pain with intercourse, trouble peeing/pooping, and even pelvic organ prolapse. 

Difficulties with breathing also puts our Fight/Flight response into overdrive, which leaves our “down there” muscles in a constant state of stress. This means that your pelvic floor won’t be able to handle daily/functional movements (like lifting and squatting) like normal and may lead to the above listed symptoms. 

Moderate to Severe COVID-19:

So...going back to that acute respiratory distress syndrome (ARDS)-

Permanent scarring of our lungs means we can’t take a full breath and our diaphragm can’t move as well -- which means our pelvic floor can’t either! Remember the GIF from above, the pelvic floor and diaphragm work together. If one is hurt, the other one can’t work as well.

Something else that can happen with respiratory distress is that the diaphragm becomes weak and the pelvic floor may be recruited to help you breathe. That means that the muscles are in a constant state of work and can’t relax -- which can cause (or worsen) pee leakage, pain with intercourse, lower back pain, pelvic organ prolapse symptoms, or poo leakage. (Siracusa & Gray, 2020).

Treating the Pelvic Floor After COVID-19

“Okay, I had COVID.  I am having issues with my pelvic floor. So what do I do?” 

1: Be kind to yourself.  Take a look at your activity levels. A stroll around the neighborhood might feel like a marathon for a while post-COVID. Between our body putting work into fighting the virus, the coughing, and increased couch/bed use (which you needed!), you may feel weaker than normal. This is perfectly normal. Just be understanding of your body and know that you will build your strength back up in time. This goes for your Diaphragm and Pelvic Floor Muscles too.

 

2: Look at your diet and water intake. We tend to lose our appetites when we feel unwell and eat anything that sounds good. Constipation is normal after being sick, particularly if you were in the hospital. Consider increasing your daily fiber intake. And make sure you drink lots of water.

 

3: Hit up your pelvic floor physical therapist! We can perform a thorough examination, history-taking, and develop a treatment plan specifically for your needs! If you don’t feel comfortable with us coming to you, we can still treat you virtually (like Zoom). And no- no Lady Bits will EVER be on camera.

Research has shown that virtual Pelvic Floor PT can treat pelvic floor symptoms/function effectively and significantly improve your quality of life (de Mata et al., 2021). 

 

You have lots of options. The important thing is that you do not have to live with pelvic floor dysfunction. We all have had highs and lows the past 18 months. But you are not alone. Every area of our lives has been examined and tested -- and we’ve adapted. And we will come out all the stronger for it -- together!

<3 The Recharged Performance Therapy Team

(321) 802-1630

Paige@RechargedPerformanceTherapy.com

Sources:

https://aptapelvichealth.org/course/covid-19-and-possible-effects-on-bowel-bladder-pelvic-floor/

Brusciano, L., Gualtieri, G., Gambardella, C., Tolone, S., Lucido, F. S., Del Genio, G., ... & Docimo, L. (2020). When preserving life becomes imperative, quality of life is eclipsed! COVID-19 outbreak impacting patients with pelvic floor disorders undergoing pelvic floor rehabilitation. The British journal of surgery, 107(8), e242.

Sacco, E., Gandi, C., Li Marzi, V., Lamberti, G., Serati, M., Agro', E. F., ... & Italian Society of Urodynamics (SIUD). (2021). Extensive impact of COVID‐19 pandemic on pelvic floor dysfunctions care: A nationwide interdisciplinary survey. Neurourology and Urodynamics, 40(2), 695-704.

Ferreira, C. H. J., Driusso, P., Haddad, J. M., Pereira, S. B., Fernandes, A. C. N. L., Porto, D., ... & Ferreira, E. A. G. (2021). A guide to physiotherapy in urogynecology for patient care during the COVID-19 pandemic. International urogynecology journal, 32(1), 203-210.

Carlin, G. L., Kimberger, O., Morgenbesser, R., Umek, W., Kölbl, H., Bodner, K., & Bodner-Adler, B. (2021). Female Pelvic Floor Dysfunction Continues to Negatively Impact Quality-of-Life during the COVID-19 Lockdown. Journal of clinical medicine, 10(5), 1075.

da Mata, K. R. U., Costa, R. C. M., Carbone, É. D. S. M., Gimenez, M. M., Bortolini, M. A. T., Castro, R. A., & Fitz, F. F. (2021). Telehealth in the rehabilitation of female pelvic floor dysfunction: a systematic literature review. International urogynecology journal, 32(2), 249-259.

Yuki, K., Fujiogi, M., & Koutsogiannaki, S. (2020). COVID-19 pathophysiology: A review. Clinical immunology, 215, 108427.