Do you dribble when you laugh? or Sneeze?

Have you stopped doing things because of leakage?

Do you avoid sex because it’s uncomfortable?

Does your stomach feel weak after having a baby?

Do you have low back or pelvic pain?

How often have you heard that you should be doing your Kegels? Well if you are like most people and doing them ineffectively or have some pelvic issues they could be doing more harm then good. Hence a trip to your pelvic floor physiotherapy specialist is a great idea!

As awareness continues to grow around women’s health and specifically pelvic floor health we are finding more and more mixed messages out there about what we should be doing and what can help with some of the problems that can happen in and around the pelvic floor especially as it relates to pregnancy and childbirth.

As much of our journey through pregnancy and childbirth centres around our pelvis and the related muscles you would think that keeping this area healthy and happy would be a key part of building a pregnancy plan. Yet many women and their care providers are either not aware of the current condition of their pelvic health or dont know what to do with it.

If we were discussing a muscle like your arm or leg muscles it is common knowledge that we should do what we can to prevent injury and rehab it if it does sustain one. Yet often the pelvic floor is not included in this same ideology. And in some cases, medical staff intentionally injure the area as part of “routine procedures” and offer no advice or guidance on what to do to properly rehabilitate this vital muscle.

Unfortunately, many women don’t recognize that they have any pelvic floor symptoms that need treatment. And as such don’t seek medical attention or alter habits known to harm pelvic floor health.

According to the American Urogynecologic Society (AUGS), pelvic floor dysfunction is experienced by as many as one out of three women, and 80 to 90 percent of these note significant improvement if they seek help.

While I’m not an expert, I have personal experience working with a Pelvic Floor Physio Therapist as a client and I highly recommend finding one in your area if you experience any of the symptoms listed below.

What is Pelvic Floor PhysioTherapy

Pelvic Floor Physiotherapy specifically assesses and rehabilitates the musculature, ligaments, bones and fascia or the low back, hips, abdomen, and pelvic floor which comprises the low bowl of your core.

It can assess and support:

  • Bladder & Bowel Incontinence/leakage
  • Constipation
  • Bladder Pain & Interstitial Cystitis
  • Prenatal Preparation for Delivery
  • Pregnancy-Related Pelvic Girdle Pain
  • Postpartum Recovery of the Pelvic Floor
  • Postpartum Abdominal Separation Rehabilitation (Diastasis Recti)
  • Endometriosis Myofascial Release
  • Sexual Dysfunction & Discomfort
  • Dyspareunia and other painful vaginal conditions
  • Women (and Men) Pelvic Pain
  • Post Surgery/Cancer Treatment
  • Prolapse & Menopause Related Vaginal Discomfort
  • Releasing Scar tissue postpartum or post surgery

According to https://pelvichealthsolutions.ca/for-the-patient/what-is-pelvic-floor-physiotherapy/ The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate, and rectum. They also wrap around your urethra, rectum, and vagina. These muscles must be able to contract to maintain continence and relax to allow for urination, bowel movements and in women, sexual intercourse.

What to Expect in Your First Appointment

Your initial assessment appointment will often be around an hour, this will be primarily for your therapist to get an idea of your pelvic floor health history and assess what is going on. The assesment can include an external evaluation of the low back, pelivc girdle, and hips for range of motion. Following that, you will likely also receive an internal evaluation which the therapist will use a gloved hand and lubricant accessing your vagina and sometimes anal cavities.

Most offices will give you the chance to change out of your lower body clothing and lay down under a sheet prior to the internal exam. It feels similar to when your Doctor (or OBGYN) does an internal exam, but will likely last longer since there are more aspects of your pelvis the therapist is assesing.

Once the assessment is complete you and your therapist will plan a recovery schedule and map out your future appointments.

Follow up appointments

Follow up appointments will be spaced out based on your assessed needs, some times we need more tension release over a shorter period of time. Others we need to do our excersizes more frequently first.

However your follow up appointments may or may not include internal work. It all depends on where your body is at and what it needs. I’ve been doing pelvic floor work for over a year, and only the first 6 appointments did I require internal support. Now at 6 months pregnant and working through pre-labor preparations with my therapist, I’m mostly concentrating on exercises and work I can do at home with the occasional in an office visit.

Between appointments

Just a note, it is important to follow your therapist’s instructions on what work (if any) you should be doing at home. While the appointments themselves are beneficial and in some caess you may experience reliefe from some symptoms imediately not following your therapists instructions for excercizes, stretches or what not to be doing can put you at risk of the symptoms returning. This is not the type of therapy where you go for treatment and never do any of the work yourself.

Painful Internal Examinations…

A number of people I know don’t like internal exams, and I can totally understand why. Especially when they tell me that it hurts. While I haven’t had an exam that I would call excruciating, I can say that it hasn’t always been comfortable to get my annual pap smear done.

This increased pain/discomfort is usually a sign of the connective tissue in your abdomen, thighs, groin and low back being very tight.

You should check with your assessing therapist if they think that this would continue after treatment or not. In most cases I belive you will find reliefe and the treatment will help you, in the long run, enjoy things like sex more.

A note of Caution

If you are a sexual assault survivor the internal exam could feel like a new violation. PLEASE talk to your therapist about what you can and can not do with out it if you need to.

Also any trauma survivor should be aware that as humans we store memories in our muscles. This type of work can cause some of those memories to release and it can be helpful for your therapist to know in advance that this is possible. I say this becuase I had some come up and I needed to seek out professional assistance for my Mental Health at the same time I was having my pelvic floor treated. It is worth the work in my experience, but you need to be ready for it as the emotions can be intense and overwhelming and your PhysioTherapist may see them.

Treatments can include

Manual therapy to soften tight muscles and ligaments
(think massage but very light touch)

Specific exercises of the pelvic floor to strengthen weak muscles
(could include kegels, but may include other types of muscle strengthening as well)

Strategies to help support pelvic organs
(Posture correction, and stretches for example)

Mobilizations to lumbar and pelvic joints to reduce pain and improve mobility
(Posture work, stretches, muscle strengtheners etc)

Myofascial release techniques in the pelvis and abdomen to loosen tight fascia
(this is a very specific type of massage that feels absolutely amazing in my opinion, it’s a light touch and can do wonders)

visceral mobilization to assist with core function and abdominal activation.
(includes manually stretching the muscles among other things)

If your pelvic floor is tight and weak at the same time it is likely that the tightness will be treated first. Once the muscles have the ability to relax as needed then the process of assessing and strengthening will begin if appropriate.

Physiotherapists really do have a cool set of skills at their disposal to help us heal a lot of different concerns we may be dealing with.

What is a Dysfunctional Pelvic Floor?

In a 2008 study done in the Netherlands it was found that the pelvic floor muscle was dysfunctional in 77% or more of patients who already had bladder, bowel or sexual dysfunction.

The thought was that in changing the behaviour to compensate for the dysfunction of one pelvic organ often lead to either an injury or other factor that impacted the function of the pelvic floor muscle.

As such it was determined that Pelvic Floor Dysfunction (AKA PFD) was a low functioning muscle that supports our pelvis and related organs.

Symptoms of a dysfunctional Pelvic Floor

The symptoms of a dysfunctional pelvic floor can range from annoying to downright debilitating and can involve any or all of the pelvic organs.

There are two main types of issues within the pelvic floor, muscles that are too tight or muscles that are too loose. Both situations can cause a number of symptoms and concerns.

  • peeing more often, with urgency, hesitancy, stopping and starting, painful, not able to empty completely
  • constipation, straining, pain with bowel movements
  • low back pain
  • pelvic pain
  • hip pain
  • genital pain
  • rectum pain
  • pain during or after sex, orgasm, or just being stimulated
  • pelvic floor spasms due to uncoordinated muscle contractions
  • leakage of the bladder or bowel

Hypertonic (too tight)

If your pelvic girdle is too tight it’s likely your are experienceing an extra urgency when you pee or need to poo, their could be some pee leakage (think dribbles when you sneeze or laugh) and a whole host of other issues.

I myself experience this one as some intense low back pain and issues with my left leg cramping up and not working fully.

Hypertonicity (Weak muscles)

If your muscles have a low level of tone you could be experiencing more of the incontinence, and organ prolapse (bladder or uterus). And no incontinence is NOT a normal thing after having a baby, or growing older either!

It is worth it to note that if you are experiencing one of these symptoms your chances of experiencing others increases.

The causes of Pelvic Floor Dysfunction

There are too many to list really, but it basically boils down to if something in your abdomen has an issue and your body starts to try and compensate for it, chances are the pelvic floor muscles will suffer and sustain either an injury or get overly tight.

This can mean things like constipation and the straining to push a bowel movement out could damage the muscle if done regularly.

Having a baby, and all the changes that happen during pregnancy places a lot of stress on this muscle. It is after all supporting the new life and your regular organs.

Childbirth, especially tearing can directly injur the pelvic muscles.

And it could also be connected to things like cycsts, or painful conditions like endometriosis which impact a whole lot more then just your uterus.

Anything that irritates the bladder, bowel, or uterus or injures the pelvic floor muscle can produce or compound the symptoms of a pelvic floor dysfunction.

Common Risk Factors for Pelvic Floor Dysfunction

  • Smoking
  • Dehydration
  • Poor diet full of bowel-irritating foods/beverages
  • Some Medications
  • Radiation & Chemotherapy
  • Chemicals/dyes or friction that irritates the perineum
  • Family history of PFD
  • Childhood bed wetting
  • Some medical conditions like diabetes
  • Hormonal changes
  • Increased weight/BMI
  • Chronic urinary tract or yeast infections
  • Pregnancy
  • Perineal Tearing during Childbirth/Episiotomies
  • Vaginal Delivery during Childbirth
  • Forceps Delivery during childbirth

Myths

MYTH 1: Urinary incontinence is normal after childbirth

FACT: it’s common, that doesn’t make it normal

Beliving that this is “Normal” means to some extent that we think it is inevitable and nothing can be done to correct it.

That’s like saying having sex once will get you pregnant… it happens, sometimes with a frequency, we wish it wouldn’t. But that doesn’t mean it can’t be prevented with something like birth control.

Approximately 3+ million people in Canada experience urinary leakage in some form or another.

MYTH 2: Sex has to hurt after delivering a child vaginally

FACT: While it is common after birthing, PAIN IS NEVER NORMAL

The birthing process is amazing and can be very empowering for women. But it is also intense and can be very hard on your body. Things like tearing and episiotomies, as well as the natural (or forced) stretching of the muscles during the pushing process, can lead to pain and dysfunction.

MYTH 3: A C-Section prevents pelvic floor dysfunction

FACT: NO, it doesn’t

A c-section is major abdominal surgery, and like any surgery it can cause dysfunction. By cutting through the abdominal muscles and uterus the process affects the deep core which plays an important part in pelvic floor function.

MYTH 4: All Pelvic health concerns are related to weakness in the pelvic floor… so just do your kegels

FACT: there are 2 types of pelvic floor issues that cause dysfunction.

Too tight or hypertonic, and low tone or hypotonic. For a muscle to be functional it must be able to both contract and relax, just like any other muscle in your body.

MYTH 5: Doing kegels will fix all pelvic floor function

FACT: kegels help with low tone, not too tight issues which are more prevalant. Exercising too tight muscles makes the problem worse not better.

Add to that many people don’t know how to do a Kegel correctly and you get other muscles doing the work instead of the one you are trying to exercise… how well would it work if you went to the gym for an arm day and ended up doing leg presses because you didn’t know the difference?

Also, Kegels are usually done sitting in a chair at your desk or in a car. While helpful for these situations they are not always the most effective as they need to be done as part of an active system.

MYTH 6: Pelvic health dysfunction is caused by a problem in the pelvic floor

FACT: the body is an interconnected system and functions that way. Any shift in one aspect of that system can affect the pelvic floor

For example, a mother may experience shortness of breath (say due to a baby who used to kick her in the lungs). After the birth she could be assessed and noted that the pelvic floor is contracting and relaxing well but her upper abdomen is tight from the muscles used to breathing repeatedly being kicked. This causes additional pressure in the abdomen and can lead to pelvic floor dysfunction like bladder leakage, or muscle separation like Diastasis Recti.

MYTH 7: Clean your vagina with soap for optimal health.

FACT: the vagina and surrounding vulva are self-cleaning and should never have to deal with soap

Cleaning your vagina with soap actually stops your vagina from working correctly. Messes with the natural pH balance and vaginal flora necessary for a healthy vagina. It can also make you more likely to get yeast infections, urinary tract infections and pain around the vulva.

Questions to ask yourself

Do you stop yourself from laughing because you worry about the loss of bladder control?

Do you use the bathroom more than 9 times a day?

Do you feel like you need to poop with a strong urgency unexpectedly?

Do you worry about not being able to get to the bathroom in time regularly?

Do you use the washroom “just in case” ?

Do you strain when trying to poop or pee?

Do you feel a heaviness at the bottom of your pelvis near the end of the day? Especially after standing or lifting a lot?

Having pelvic floor dysfunction does not need to be the end of the world. It can actually lead to a healthier and more satisfying life if you seek the right treatment for you! Things like bladder leakage, or pelvic pain should not be seen as part of the “growing older” aspect of life, nor as a consequence of having children either. These are old and outdated ideas that need to go, so I would encourage you to talk to your local Pelvic Floor Physio Therapists about your options.