Pelvic Health Rehabilitation: A Mission Critical Resource that Enables Military Readiness

Courtesy Photo | Lieutenant Colonel Leigh Anne Lechanski, Doctor of Physical Therapy and Department Chief of Rehabilitation at Eisenhower Army Medical Center, guides a patient through a pelvic floor muscle exercise training session using a surface electromyography biofeedback system. This intervention gives patients a visual aid and objective information about muscle activation in the pelvic floor structures.  

FORT GORDON, GEORGIA, UNITED STATES

05.30.2023

Courtesy Story

Dwight D. Eisenhower Army Medical Center

Pelvic Health Rehabilitation: A Mission Critical Resource that Enables Military Readiness
Written by: Lieutenant Colonel Leigh Anne Lechanski, DPT and Major Stephanie Fournier, DPT

Military women have proven resilient since their service in the United States Armed Forces first began in 1901. The percentage of female service members has grown from just 2.3% in 1945 to 16.2% of the total force in 2020. Since the inception of female integration into combat job series in 2016, military women now serve in a diverse array of demanding positions to fight and win the nation’s wars. They are graduating from advanced military schools—once only open to men—in record numbers. Yet, amidst the plethora of performance optimization programming in the military with specialized services and support that cover a wide range of readiness domains, pelvic health is often an overlooked and under-reported aspect of readiness. A silent struggle exists that affects the overall well-being of many women in uniform—pelvic floor muscle dysfunction.
Pelvic floor muscle dysfunction can present with symptoms such as pelvic pain, incontinence, constipation, abdominal weakness, and pelvic organ prolapse. These conditions can significantly impact female service members' physical and emotional health. The physical demands of military life—including rigorous training, high load carriage demands, and prolonged combat deployments and field training exercises in austere environments—can profoundly impact women's pelvic health. Fortunately, pelvic health rehabilitation is an available resource through the military health system. It has emerged as a transformative solution, offering a range of benefits that alleviate symptoms, restore functionality, and enhance the overall quality of life in patients.
A Policy Revolution:
The month of May marks National Women’s Health Month and this year there is much to celebrate. Recent monumental policy changes improving service members’ quality of life are now being implemented. These changes directly support optimal family readiness, retention rates, and overall well-being. A critical piece of this is enhancing access to specialized health care resources. The military’s support of women’s unique healthcare needs for retention has come a long way since the 1950s when women were once mandated to separate from military service due to pregnancy.
Senior leaders and Soldiers alike can celebrate the significant progress the Department of Defense, Army Medicine, and the Defense Health Agency have made in updating policy and programming directly supporting family readiness. These changes include the establishment of the service-specific Women’s Initiative Teams, same-day access to contraceptive medications, standardized postpartum physical recovery timelines regardless of pregnancy outcome, lactation accommodations, testing and development of maternity uniform items, increased parental leave, and administrative absence authorizations for non-covered reproductive health care services.
Senior government officials also recognize the United States military requires access to specialized services that promote readiness. Section 707 of the Fiscal Year 2022 National Defense Authorization Act directed enhanced postpartum care that resulted in the publication of four recent clinical practice recommendations on the following topics: (1) optimizing postpartum care; (2) behavioral health screening and referral in pregnancy and postpartum; (3) pelvic health evaluation, treatment, and referral for women; and (4) pelvic health pregnancy and postpartum rehabilitation services.

Unique Military Women’s Health Challenges:
Increased rates of musculoskeletal injuries, urinary tract infections, unintended pregnancy, sexually transmitted infections, lower breastfeeding and lactation rates, eating disorders, behavioral health conditions, and sexual trauma all impact readiness. The required physical demands and rigors of military service can lead to various pelvic health challenges. Prolonged periods of living in austere environments, intense physical activity, and wear of heavy gear can disrupt pelvic floor muscle function. The resulting pelvic floor muscle dysfunction can present as pelvic pain, urinary leakage, difficulty with bowel movements, sexual dysfunction, and postpartum recovery challenges. These symptoms not only affect physical performance, but also a person’s body image perception that can undermine the mental and emotional resilience of women in the military.
Pelvic Health Rehabilitation Resources:
The United States Army and the Defense Health Agency maintain a robust inventory of Physical and Occupational Therapists. These clinicians are considered subject matter experts in evaluating and treating neuromusculoskeletal conditions and support the physical and cognitive domains of the Army’s Health and Holistic Fitness (H2F) program. Specialized therapists in the United States are addressing this challenge by evaluating and treating pelvic floor muscle dysfunction through pelvic health rehabilitation programs. This treatment is considered a first-line, low-cost, conservative treatment option for managing urinary incontinence, fecal incontinence, urinary urgency or frequency, bowel dysfunction, and/or pain in the pelvic region for all genders and identities. Pelvic health rehabilitation can also treat pain or dysfunction in the abdominals and pelvic girdle. Pelvic health rehabilitation offers targeted interventions, exercises, and techniques to alleviate pain, enhance pelvic floor muscle strength, improve bladder and bowel control, and enhance sexual function. Early recognition and treatment of pelvic floor muscle dysfunction symptoms followed by appropriate diagnosis and treatment are essential for maintaining readiness, minimizing limited duty time, and retaining service members.
Pelvic health rehabilitation services are available at several major Defense Health Agency military treatment facilities, including but not limited to: Eisenhower Army Medical Center, Walter Reed National Military Medical Center, Madigan Army Medical Center, Landstuhl Army Medical Center, William Beaumont Army Medical Center, Tripler Army Medical Center, San Antonio Military Medical Center, and Augusta Military Medical Center (formerly Belvoir Army Community Hospital). Health-care providers can also refer all beneficiaries to an authorized TRICARE network provider for evaluation and treatment if pelvic health rehabilitation services are not available at the local military treatment center.
Pelvic health rehabilitation is an invaluable resource for service members struggling with pelvic floor muscle dysfunction. This specialized therapy targets physical symptoms and aims to restore function and enhance performance by restoring strength, coordination, and mobility in the pelvic floor muscles. Through personalized treatment plans, therapists employ techniques such as therapeutic exercise, biofeedback training, and manual therapy to alleviate pain, improve muscle control, and optimize function. This restoration of function translates into enhanced physical performance, improved confidence, and increased readiness for the demands of military service.
Pelvic health rehabilitation also emphasizes preventive care by aiming to address pelvic floor muscle dysfunction early to prevent the progression of symptoms and future complications. By promoting proper body mechanics, optimizing muscle function, and providing education on self-care strategies, service members can take proactive steps to safeguard their pelvic health and prevent long-term symptoms outside of the clinical setting that cultivates long-term well-being and resilience.
The benefits of pelvic health rehabilitation extend beyond physical impairments. Pelvic health rehabilitation provides a safe and supportive space for service members to address the emotional and psychological impacts of pelvic floor muscle dysfunction. Providers empower service members to navigate their health challenges with resilience and confidence by offering education, guidance, and support. This holistic approach recognizes the interconnected nature of physical and mental well-being, thereby fostering an improved overall quality of life and performance.
Pelvic floor muscle dysfunction poses significant challenges for military service members. Women are especially prone to these unique health care conditions, which can greatly impact their physical and emotional well-being. By recognizing the importance of pelvic health and understanding the benefits of pelvic health rehabilitation, the military can effectively support service members' readiness and overall well-being. It is critical that leaders and clinicians both promote the utilization of comprehensive pelvic health rehabilitation resources and provide access to this readiness-enabling care to foster optimal physical and cognitive performance.

• Date Taken: 05.30.2023
• Date Posted: 05.30.2023 08:58
• Story ID: 445733
• Location: FORT GORDON, GEORGIA, US