Since we have been in the COVID-19 pandemic, I have noticed an uptick in patients in my outpatient physical therapy clinic who are seeking pelvic floor physical therapy after a bout of COVID. Typically, these patients have had mild/moderate COVID and were not hospitalized. Patients have reported symptoms of new or worsening urinary incontinence or pelvic heaviness since contracting COVID. This has most frequently been related to the increase in coughing that comes along with the respiratory virus. I have also had patients who report the fatigue caused by COVID has exacerbated the pelvic conditions they were already experiencing. My small sample size got me thinking this has to be a widespread effect of a COVID infection, and yet another complication that may cause issues down the road. Two PTs authored a clinic commentary on this very topic, detailing the many effects COVID can have on the pelvic floor (Siracusa and Gray, 2020).
So why would breathing impact your pelvic floor? The pelvic floor works closely with the respiratory diaphragm. When you inhale, your lungs fill up with air, the diaphragm moves downward, and the pelvic floor moves downward. When you exhale, the air leaves your lungs, the diaphragm moves upward, and the pelvic floor moves upward.
Here is my very basic Paint drawing on how the two work together 🙂
We know that COVID is affecting the way patients breathe, and therefore can affect the way the pelvic floor functions. If you can’t take a big breath in, your diaphragm will not move the same, and the pelvic floor may not fully drop and relax. This can be associated with pelvic pain and urinary/bowel dysfunction.1 Coughing also increases the pressure in your abdomen and causes strain on the pelvic floor. We are seeing patients who have “underactive” or weakened/fatigued pelvic floors due to repeated coughing. A weakened pelvic floor may lead to worsening leakage or other pelvic floor conditions.
If you have noticed an increase in urinary incontinence or pelvic heaviness after recovering from COVID, know that you are not alone, and pelvic floor physical therapy may be able to help. Reach out to Renew Physical Therapy at 479-440-4147 or firstname.lastname@example.org to get scheduled for an evaluation.
- Siracusa, Carina PT, DPT; Gray, Amelia PT, DPT Pelvic Floor Considerations in COVID-19, Journal of Women’s Health Physical Therapy: October/December 2020 – Volume 44 – Issue 4 – p 144-151 doi: 10.1097/JWH.0000000000000180