Understanding and Treating Pelvic Floor Dysfunction in Adolescents with Cystic Fibrosis

If you have ever leaked urine when coughing, you know that respiratory conditions can be linked to pelvic floor dysfunction. Adolescents with cystic fibrosis (CF) are particularly susceptible to issues like urinary incontinence and pelvic floor dysfunction due to the unique demands that chronic coughing places on their bodies. Despite the challenges, targeted physical therapy can be highly effective in addressing these issues and improving quality of life.

The Link Between Cystic Fibrosis and Pelvic Floor Dysfunction

Cystic fibrosis is a genetic condition that primarily affects the lungs and digestive system. One of its hallmark symptoms is chronic coughing, which leads to excessive pressure on the abdominal and pelvic regions. Over time, this repeated stress weakens the pelvic floor muscles, contributing to dysfunction.

Urinary incontinence, one of the most common pelvic floor issues in CF patients, is often overlooked in younger populations. However, studies suggest that up to 68% of females with CF experience some form of urinary incontinence, with stress incontinence being the most common. This occurs when weakened pelvic floor muscles and increased intra-abdominal pressure from coughing make it difficult to maintain bladder control. Adolescents with CF may also experience pelvic organ prolapse, bowel dysfunction, and chronic pelvic pain due to these mechanical stresses.

Symptoms of Pelvic Floor Dysfunction in Adolescents with CF

While urinary incontinence is the most frequently reported issue, pelvic floor dysfunction in CF can present with a range of symptoms, including:

  • Frequent urinary urgency
  • Difficulty fully emptying the bladder
  • Fecal incontinence or constipation
  • Pelvic pain or pressure
  • Pain with activities such as sitting, exercise, or even sexual activity in older adolescents and adults
  • A sensation of heaviness or bulging in the pelvic area

For many young patients, these symptoms can lead to embarrassment and avoidance of physical activity or social situations, negatively impacting their emotional well-being.

The Role of Pelvic Floor Therapy

Physical or occupational therapy plays a critical role in managing and improving pelvic floor dysfunction in adolescents with CF. As a pelvic floor PT, my goal is to educate, strengthen, and retrain the muscles involved in continence and support while also addressing respiratory function to prevent further strain on the pelvic floor.

Assessment

Each treatment plan begins with a thorough assessment, including:

  • A review of the patient’s medical history, including their CF-related respiratory function and any previous surgeries or interventions
  • A discussion about bladder and bowel habits
  • A postural and movement analysis to identify muscular imbalances or compensatory patterns
  • External and, if appropriate, internal examination of the pelvic floor muscles

Treatment Approaches

  1. Pelvic Floor Muscle Training
    • Strengthening exercises for the pelvic floor, tailored to counteract the excessive strain from coughing
    • Coordination training to ensure the pelvic floor muscles activate appropriately during activities like coughing and laughing
  2. Breathing and Coughing Strategies
    • Diaphragmatic breathing to reduce intra-abdominal pressure
    • Techniques like “the knack,” which involves engaging the pelvic floor before coughing to prevent leakage
    • Pursed-lip breathing to regulate pressure and reduce strain on the pelvic floor
  3. Postural Training and Core Stability
    • Addressing imbalances in the core muscles, including the diaphragm, abdominals, and pelvic floor
    • Teaching proper posture to reduce excessive downward pressure on the pelvic floor
  4. Bladder and Bowel Retraining
    • Establishing healthy voiding habits and addressing any constipation that may exacerbate symptoms
    • Dietary and hydration recommendations to support bladder and bowel health
  5. Biofeedback and Neuromuscular Re-education
    • Biofeedback techniques to help patients learn to properly contract and relax their pelvic floor muscles
    • Electrical stimulation in cases of severe muscle weakness or dysfunction

Encouraging a Holistic Approach

Beyond pelvic floor therapy, managing pelvic floor dysfunction in adolescents with CF requires a collaborative effort. Working closely with pulmonologists, gastroenterologists, and dietitians ensures a comprehensive treatment plan. Addressing nutritional factors that contribute to constipation and ensuring proper hydration are just as crucial as the physical therapy component.

Additionally, fostering open conversations about these issues can empower young patients to seek help without embarrassment. Many adolescents struggle in silence due to the stigma surrounding pelvic health, but normalizing these discussions can significantly improve their willingness to engage in therapy.

Final Thoughts

While pelvic floor dysfunction in adolescents with cystic fibrosis presents unique challenges, pelvic floor therapy offers effective, evidence-based solutions. By strengthening the pelvic floor, improving breathing mechanics, and addressing overall postural and core function, we can help these young individuals regain control and confidence in their bodies.

If you or someone you know is dealing with incontinence or pelvic pain related to CF, seeking care from a pelvic floor physical or occupational therapist can be life-changing. Early intervention is key in managing symptoms and improving overall quality of life, so don’t hesitate to reach out for support.

 

 

The Hidden Link Between the Pelvic Floor and the Airway: How Breathing Affects Bladder and Bowel Function in Children

As pediatric pelvic floor therapists, we often see children struggling with bedwetting, constipation, or urinary urgency. Parents diligently follow toileting schedules and dietary recommendations, yet progress sometimes stalls. What if the missing piece of the puzzle isn’t in the bladder or bowel, but in the way a child breathes?

It may seem surprising, but research and clinical experience show a deep connection between airway function and the pelvic floor. Poor breathing mechanics, often tied to conditions like mouth breathing, tongue ties, or sleep-disordered breathing, can disrupt core stability, bladder control, and proper elimination. Understanding this relationship can be a game-changer for families seeking lasting solutions to common pelvic floor concerns in children.

The Airway-Pelvic Floor Connection

The pelvic floor is part of a dynamic system that includes the diaphragm (our main breathing muscle) and deep core muscles. These structures work together to maintain intra-abdominal pressure, support the spine, and regulate functions like urination and defecation.

When a child breathes well—primarily through their nose with their tongue resting on the roof of the mouth—the diaphragm moves efficiently with each breath. This natural movement promotes core stability and encourages healthy pelvic floor function.

However, if a child habitually breathes through their mouth, the diaphragm’s function is altered. Mouth breathing is often linked to low tongue posture, which can lead to improper craniofacial development, sleep disturbances, and even postural changes affecting the entire body—including the pelvic floor.

How Airway Issues Contribute to Pelvic Floor Dysfunction

  1. Mouth Breathing and Core Weakness Mouth breathers tend to develop compensatory breathing patterns, using their neck and chest muscles rather than their diaphragm. This can lead to poor core activation, affecting the pelvic floor’s ability to contract and relax appropriately. Children with weak core muscles may have difficulty with bladder and bowel control, leading to issues like incontinence or constipation.
  2. Sleep-Disordered Breathing and Nighttime Accidents Obstructive sleep apnea (OSA) and other forms of sleep-disordered breathing (SDB) are increasingly recognized in children. These conditions cause fragmented sleep, preventing the body from fully relaxing and achieving proper hormonal regulation. One key hormone, antidiuretic hormone (ADH), is responsible for reducing urine production at night. Children with SDB often have lower ADH levels, leading to increased nighttime urination and bedwetting.
  3. Tongue-Tie and Dysfunctional Swallowing A restricted tongue (due to ankyloglossia, or tongue-tie) may prevent a child from properly resting their tongue on the palate. This can affect oral development, swallowing patterns, and airway function, leading to mouth breathing and inefficient core engagement. Over time, this can impact the pelvic floor’s ability to coordinate with the diaphragm, potentially contributing to dysfunctions like urinary urgency, constipation, or pelvic pain.
  4. Postural Changes and Pelvic Floor Imbalance Children with persistent airway issues often exhibit characteristic postural changes—forward head posture, open-mouth resting position, or excessive lumbar curvature. These postural shifts can place unnecessary strain on the pelvic floor, leading to tightness or weakness that disrupts normal toileting function.

What Parents Can Do

If your child struggles with pelvic floor dysfunction and traditional strategies haven’t resolved the issue, consider evaluating their airway health. Here are a few steps to take:

  • Observe Their Breathing: Watch your child at rest and during sleep. Do they breathe through their mouth? Snore? Frequently wake up tired?
  • Check for Oral Restrictions: A pediatric dentist, myofunctional therapist, or speech-language pathologist can assess for tongue-tie or other oral dysfunctions that might impact breathing.
  • Address Sleep Concerns: If sleep-disordered breathing is suspected, a consultation with an ENT (ear, nose, and throat specialist) or sleep specialist can provide further insight.
  • Incorporate Breathing Exercises: Encourage nasal breathing through techniques like diaphragmatic breathing or guided breathing exercises, which can enhance core and pelvic floor function.
  • Seek Pediatric Pelvic Floor Therapy: A trained therapist can assess both the pelvic floor and breathing patterns, providing targeted interventions that address the root causes of dysfunction.

The Bigger Picture

Children’s bodies are beautifully interconnected, and dysfunction in one area—such as the airway—can have ripple effects throughout the entire system. By recognizing the profound link between breathing and pelvic floor function, we can offer more holistic and effective treatment strategies for common childhood concerns like bedwetting, constipation, and urinary urgency.

If your child is struggling with these issues, don’t just focus on one thing—take a deep breath and look at the bigger picture. Sometimes, the key to dry nights and happy tummies lies in something as simple as proper nasal breathing.

 

Recognizing Pelvic Floor Symptoms After Breast Cancer Treatment

As a pelvic floor and lymphedema therapist, I often see patients who have completed breast cancer treatment and are experiencing unexpected pelvic floor dysfunction. While much attention is given to the physical and emotional challenges of cancer recovery, many women are unaware that their pelvic health may also be affected.

Breast cancer treatments—such as chemotherapy, radiation, hormone therapy, and surgery—can impact the body in ways that contribute to pelvic floor dysfunction, urinary issues, and sexual health concerns. Recognizing these symptoms early can help survivors seek appropriate care and improve their quality of life.

How Breast Cancer Treatment Affects the Pelvic Floor

  1. Hormonal Changes & Vaginal Dryness
    Many breast cancer treatments, particularly hormone-blocking therapies (such as tamoxifen or aromatase inhibitors), reduce estrogen levels. This can lead to vaginal dryness, thinning tissues (vaginal atrophy), and pain with intercourse. The pelvic floor muscles may also become less elastic, contributing to discomfort and dysfunction.
  2. Pelvic Pain & Muscle Tension
    Cancer-related stress, changes in posture after mastectomy or reconstructive surgery, and scar tissue formation can all contribute to increased muscle tension in the pelvic floor. Some women experience pelvic pain, painful urination, or discomfort with sitting due to these muscular imbalances.
  3. Bladder & Bowel Dysfunction
    Chemotherapy and radiation can affect the nerves controlling bladder and bowel function, leading to symptoms such as:

    • Urinary urgency and frequency
    • Stress or urge incontinence (leaking urine with movement or sudden urges)
    • Constipation or difficulty emptying the bowels
      These issues often go undiscussed, but they can be significantly improved with pelvic floor therapy.
  4. Lymphedema in the Trunk & Pelvic Region
    While lymphedema is commonly associated with arm swelling after lymph node removal, it can also develop in the chest, abdomen, and even the genitals. If lymphatic drainage is compromised, fluid buildup can lead to discomfort, heaviness, and swelling in the lower abdomen, pelvis, or thighs.
  5. Core Weakness & Postural Changes
    Breast cancer surgeries (mastectomy, lumpectomy, or reconstructive procedures) can alter posture and core stability, indirectly affecting the pelvic floor. Scar tissue and protective postural habits may lead to core muscle imbalances, which can result in low back pain, hip discomfort, or reduced pelvic support.

How Pelvic Floor & Lymphedema Therapy Can Help

The good news is that specialized therapy can significantly improve these symptoms. A pelvic floor and lymphedema therapist can help by:

  • Teaching gentle pelvic floor exercises to restore function without increasing pain.
  • Using manual therapy techniques to release scar tissue and reduce pelvic tension.
  • Providing lymphatic drainage therapy to improve circulation and decrease swelling.
  • Addressing postural and core stability concerns to support long-term recovery.
  • Offering strategies for bladder and bowel health, including dietary and behavioral modifications.

You Don’t Have to Suffer in Silence

If you’re a breast cancer survivor experiencing pelvic pain, urinary leakage, vaginal dryness, or unexplained swelling, you’re not alone. These symptoms are common, but they are treatable. Seeking care from a pelvic floor and lymphedema therapist can help restore comfort, confidence, and overall well-being.

Have questions or want to learn more? Reach out for a consultation—we’re here to support you on your healing journey.

 

Squats: A Foundation for Pelvic Floor Health

When we think of squats, many of us picture a gym-goer lifting heavy weights or a fitness class instructor guiding participants through reps. However, squats are far more than a tool for building strong thighs and glutes. They’re a fundamental movement deeply connected to your body’s core strength, posture, and, perhaps surprisingly, the health of your pelvic floor.

As a pelvic floor therapist, I often recommend squats not only as a general exercise but as a targeted tool to improve pelvic floor function. Whether you’re postpartum, navigating menopause, or experiencing pelvic floor dysfunction such as incontinence or prolapse, squats can be transformative when done correctly. Let’s dive into why squats are so effective, how they support your pelvic floor, and what to consider for safe and effective practice.

Why Squats Are Essential for Pelvic Floor Health

  1. Engagement of Core and Pelvic Floor Muscles

The squat is a compound movement that recruits multiple muscle groups, including the quadriceps, hamstrings, glutes, and the core. What many people don’t realize is that the pelvic floor is an integral part of the core. It works in concert with the diaphragm, deep abdominal muscles, and spinal stabilizers to provide stability and support.

During a properly performed squat, the pelvic floor is naturally engaged. As you lower into the squat, the pelvic floor lengthens and relaxes slightly. On the ascent, it contracts, much like a trampoline being gently pushed and then springing back. This dynamic movement mirrors the natural functioning of the pelvic floor during everyday activities like walking or lifting.

  1. Improved Blood Flow and Flexibility

Squats encourage better circulation to the pelvic region, which can help support healing and prevent stiffness. For individuals recovering from childbirth or surgery, this increased blood flow aids tissue repair and reduces inflammation. Additionally, squats help maintain the flexibility of the pelvic floor, preventing tightness that can lead to discomfort or dysfunction.

  1. Promoting Functional Strength

Your pelvic floor doesn’t exist in isolation; it interacts with your entire body. Functional movements like squats train your body to work as a whole. Whether you’re picking up your child, carrying groceries, or simply standing from a chair, a strong and responsive pelvic floor contributes to these everyday movements. Squats mimic these natural actions, making them a practical exercise to incorporate into your routine.

Squats Done Right: Key Considerations for Pelvic Floor Safety

To maximize the benefits of squats while protecting your pelvic floor, proper form is essential. Here are some guidelines:

  1. Start with Bodyweight

If you’re new to squats or dealing with pelvic floor issues, avoid adding weights initially. Focus on mastering the basic movement and ensuring proper form.

  1. Alignment Matters

Stand with your feet hip-width apart, toes pointing slightly outward. As you lower into the squat, keep your knees aligned with your toes and your back neutral. Avoid tucking or overly arching your pelvis, as this can strain the pelvic floor.

  1. Breathe Intentionally

Breathing plays a vital role in pelvic floor activation. Inhale as you lower into the squat, allowing your diaphragm and pelvic floor to relax. Exhale as you rise, engaging your deep core and pelvic floor muscles.

  1. Listen to Your Body

If you feel downward pressure, bulging, or discomfort in your pelvic floor during squats, stop and reassess your form. These sensations may indicate overloading or improper technique. A pelvic floor therapist can guide you in modifying the exercise.

Modifications for Different Needs

Postpartum

Postpartum individuals often benefit from starting with shallow squats and gradually increasing depth as strength returns. Incorporating a pelvic floor squeeze (kegel) on the ascent can enhance recovery.

Pelvic Organ Prolapse

For those with prolapse, avoid deep or weighted squats initially. Instead, focus on half squats with an emphasis on core engagement.

Advanced Practitioners

Once strength and control are established, adding weights or combining squats with other movements (e.g., a squat-to-overhead-press) can further challenge the pelvic floor and improve overall fitness.

Incorporating Squats into Your Routine

Start small, aiming for 8–10 squats daily, and gradually increase the number as your strength improves. You can incorporate squats into everyday activities, such as sitting and standing from a chair without using your hands. These “functional squats” are a simple way to build pelvic floor strength without setting aside extra time.

Conclusion

Squats are more than an exercise for toned legs—they’re a powerhouse move for pelvic floor health. By integrating squats into your routine with attention to form and progression, you can strengthen your core, improve pelvic floor function, and enhance overall well-being. As always, consult a pelvic floor therapist if you’re unsure where to start or if you need tailored advice. Your pelvic floor will thank you for it!