50 Shades of Aging

1. 50 Shades of Aging Kathleen Lindaman Aebischer PT

2. What is the pelvic floor and what does it have to do with my quality of life? Much more than you think!

3. Statistics • 2010 • 40 million adults over the age of 65 (12.9% of the population) • 53,364 adults are greater than 100 yrs old (.13% of the population) • 2030 • Estimated 72 million over the age of 65 (19% of the population)

4. Life Expectancy • Adults over the age of 65 have an average lift expectancy of 78.2 yrs with women living 20 yrs more on average and men only 17 yrs on average

5. Who do The Seniors Live with? • 72% of older men and 42% of older women live with spouses at home • Widows account for 8.7 million of the population and widowers 2.1 million • 29% over the age of 65 live alone

6. Nursing Homes • Only 1.5 million (4.1% of the population) live in nursing facilities

7. 2009 Seniors Living Outside Nursing Facilities • 40% rate their health as excellent or very good despite having at least one chronic medical condition • 37% of those over 65 categorize themselves as having a disability vs. being disabled

8. A Much Larger Segment of Seniors • 17.4% over the age of 65 are working or seeking work (6.7 million)

9. Views on Retirement • 59% view retirement as a time to be active and involved • Only 24% see retirement as a time to relax and enjoy leisure

10. Older Volunteers • 46.6% of seniors from 65 to 74 volunteer in their communities • 43% of those 75+ yrs old also volunteer

11. The next generation retirees will be the healthiest and longest lived with 40% of the population expected to reach 90 by 2050

12. How Do We Get To That Healthy Vigorous Life of Possibilities ?

13. General Changes as We Age • Loss of Muscle Mass • Weight gain • Decreased skin elasticity • Loss of height • Loss of bladder capacity • Stiffening of the joints and ligaments

14. General Changes with Aging • Decreased circulation • Glucose tolerance deteriorates • Bones become more brittle • There is a decrease in the immune response effectiveness

15. Many of these conditions can be improved or slowed by remaining active • Regular exercise • Stretching, aerobics, and strengthening

16. Dietary Changes Slow Aging

17. Sexuality and Aging • Interest and pleasure in sex does not decrease in healthy aging adults but sexual behavior does decline • Sex remains a way to communicate love, affection, warmth, sharing and bonding

18. Benefits of Sex • Sex burns fat • Boosts the immune system • Releases brain endorphins • Relieves stress • Slows the pronounced changes that occurs with aging • Improves flexibility of the tissues • Improves body image

19. Aging Changes Specific To Women • Low sexual desire/sex drive • Pain due to illness • Lack of mobility • Medications • Poor body Image • Depression • Fatigue and stress • Slower sexual arousal • Low testosterone

20. Menopause • The largest change in aging for women • Symptoms • Hot flashes • Worsening of organ prolapse • Incontinence, urgency, frequency • Frequent urinary tract infections • Vaginal dryness

21. Lack of Estrogen • Causes a cascade of physical changes in the body • Lean fit women are at more risk for post menopausal problems associated with lack of estrogen

22. Atrophic Vaginitis • The vagina shortens and becomes more narrow • The tissue is thinner with loss of elasticity • Vaginal dryness • Intercourse is painful for 25 to 45% of post menopausal women

23. Treatments • Vaginal moisturizers • Replens • Dilators • Purchased sets / Candles • Vibrator use • Lubricants

24. Local estrogen treatment • Vaginal estrogen creams such as Estrace and Premarin • Vaginal tablets such as Vagifem • Vaginal estrogen rings such as Estring • Vaginal suppositories

25. Systemic estrogen treatments • Estrogen is absorbed into the blood stream and reaches all the tissues • Estrogen patches • Hormonal Replacement Therapy or HRT oral estrogen replacements • Homeopathic remedies

26. Side Effects Vary • Headache • Stomach upset, bloating, nausea • Weight changes • Breast tenderness • Back and abdominal pain • Respiratory infections • Vaginal itching or yeast infections • Change in sexual interest

27. Vaginal Irritants • Soaps and laundry detergents with dyes and perfumes • Lotions • Douches • Condom use • Smoking

28. Preventative Measures • Use natural oils to hydrate the tissue in the vulva (area between the inner vaginal lips) • Exercise regularly including stretching, aerobics, and strengthening • Maintain a healthy diet • Work on loving the body you are in

29. AND Use It Or Lose It!

30. Pelvic Floor Function • Supports the internal organs • Assists the round sphincter muscles in clamping tubes so we don’t loose urine or feces • Assists with sexual function

31. Pelvic Floor Muscles • 3 muscle layers • Superficial External Genital Muscles • Urogenital layer (Perineal Membrane) • Pelvic layer

33. Supportive Dysfunctions • Incontinence • Stress • Urge • Mixed • Overflow • Treatment • Physical Therapy • Medication • Botox and other injections • Surgery

34. Supportive Dysfunctions • Organ Prolapse • Uterine prolapse • Bladder prolapse • Rectal prolapse • Vaginal vault prolapse • Treatment • Physical Therapy • Pessary use • Surgery

35. Signs and Symptoms of Supportive Pelvic Dysfunctions • Painful intercourse (dyspareunia) • Pressure against the vaginal wall • Full feeling in the lower belly • Groin stretching pain • Feeling like something is falling out of the vagina • Incontinence

39. Contributing Factors to Supportive Pelvic Dysfunctions • Obesity • Long lasting coughing bouts • Frequent constipation • Pelvic Organ tumors • Difficult vaginal delivery

40. Hypertonus Pain Dysfunction • Signs and Symptoms • Pain • Dyspareunia/sexual dysfunction • Difficulty with defection/urination • Difficulty with sitting

41. Hypertonus Treatments • Relaxation and biofeedback • Physical Therapy • Trigger point injections • Epidurals • Anti-depressant medication • Pain medications and regular muscle relaxants do not work well on the pelvic floor

42. Hypertonus Contributing Factors • History of rape, abuse or incest • Post surgical pain • Scar tissue restrictions • Fractures of the coccyx (tailbone) • Pain due to hemorrhoids or severe constipation • Unknown

44. Incoordination (Muscle Dys-synergy) • Inappropriate use of muscles of the pelvic floor and core

45. S & S of Muscle Incoordination • Val salva • Improper tissue contractility • Neurologic disorders • Adhesions • CNS disorders • Disuse

46. Contributing Factors Incoordination/Disuse Dysfunction • Lack of awareness: • Weakness, lack of coordination of muscles • Muscle disuse atrophy • Muscle imbalances: post-op reconstruction, • Lack of training • Neurological diseases

47. Incoordination Treatment • Physical Therapy • Muscle re-education • Muscle coordination • Relaxation • Postural education • Electric stimulation • Biofeedback

48. Visceral Pelvic Dysfunction • Abnormal mobility of the pelvic organs • Endometriosis is the most common cause • Adhesions, trauma, surgery and childbirth • Congenital muscle imbalances

49. S & S of Visceral Dysfunction • Weakness • Decreased sensation • Constipation or diarrhea, or both • Flatulence • Pain in the back, abdomen, thigh and leg

50. Visceral Dysfunction Treatment • Physical Therapy • Acupuncture • Surgery • Hormonal Treatment