Patient Info |
Pelvic Health & The Pelvic FloorIntroductionThe muscles of the pelvic floor play a key role in core stability, breathing and posture, as well as the support of the pelvic organs. Pelvic floor muscles work alongside other key muscles to enable proper support of the lower back, pelvis, bladder and bowel.
What is the Pelvic Floor?The pelvic floor is made up of a number of layers of muscle tissue and associated ligaments that are anchored within the ‘bowl’ of the pelvis. These are connected to the pubic bone in the front, the tailbone in the back, between the sitting bones as well as to the hip muscles deep inside the pelvis. The muscular tissue and ligaments support all of the organs located in your pelvic region, including the bladder, small intestine, rectum, and, in women, the uterus and vagina. Causes of Pelvic Floor DysfunctionPelvic floor dysfunction can be caused by:
The most common causes of injury to the pelvic floor muscles, nerves and fascia are pregnancy and childbirth. During pregnancy the growing baby puts extra pressure on the mother's pelvic floor, especially if she is expecting twins, triplets or other multiples. In preparation for delivery, the mother’s body produces hormones which soften the ligaments and muscles to allow for the pelvic joints and soft tissue to widen, allowing the baby to descend through the birth canal.
Since you can't see your pelvic floor structures, you might not even realize that they have become stretched, weakened or injured until you notice other changes in your body or health. There are four categories of pelvic floor issues that may develop, which are outlined below. Please note that although treatment options are discussed in this article, your physiotherapist at River East Physiotherapy will work with you in a supportive and caring way to address your questions, concerns, and treatment options. Urinary IncontinenceUrinary incontinence affects approximately 200 million people around the world – mostly women. In fact, 26% of women between the ages of 30 and 59 have problems with urine leakage [1]. Urinary urgency or urge incontinence can be caused by common triggers such as certain foods, drinks, and medications. It can also be caused by medical issues as common as a bladder infection, or due to more serious causes such as bladder or pelvic cancer. The symptoms of urinary incontinence can range from leaking urine when you laugh, cough, sneeze or run to having a sudden need to urinate that is so overwhelming that you don't always make it to the bathroom in time. Some people find that they dribble urine, while others feel like they never really empty their bladder. Many people with urinary incontinence tend to suffer in silence because they are too afraid or embarrassed to talk to their doctor. Many women with this problem also wrongly assume that the loss of bladder control is a normal part of aging or motherhood because it is so common. More than half of first-time moms and one in three women who have already had a baby experience some urinary leakage [2]. If urinary incontinence is affecting your daily life, you should definitely talk to a medical professional. Further specialized testing may be needed to provide more detailed information. One potential, non-pharmaceutical intervention for urinary incontinence is physiotherapy. River East Physiotherapy can work with you to design a customized program that will help address weakness and spasm, regular bowel and bladder emptying as well as exercises to prevent further injury. Three common techniques that River East Physiotherapy uses to help improve bladder control are: Exercises – Many people simply need to strengthen and re-educate their pelvic floor muscles to dramatically improve their symptoms. Gaining greater control over the muscles deep in your lower abdominals can also help improve pelvic floor muscle function. Rigid contractions of both the abdominal and pelvic floor muscles can actually make leaking or pain worse. Behavioral modifications are lifestyle and dietary changes that can significantly reduce your symptoms and improve your overall health. Combining behavioral modifications with pelvic floor strengthening techniques improves the effectiveness of your program. Your physiotherapist at River East Physiotherapy may include one or all of the following to help improve your control over your bladder: Bladder Training – People with incontinence often get into the habit of going to the bathroom too often. There are a number of techniques you can use to gradually increase the amount of time between bathroom trips, including learning how to control the urge to urinate and learning how to empty your bladder more completely. A licensed physiotherapist can also give you advice on how to modify your daily habits to help you regain control of your bladder. Monitoring what and how much you drink, losing weight and doing regular exercise may also help reduce or eliminate your symptoms. Relaxation Techniques – Stress, anxiety and tension only make bladder problems worse. Physiotherapists at River East Physiotherapy can instruct you in breathing, postural and relaxation techniques that can help put you back in control. Many people with urinary incontinence tend to suffer in silence because they are too afraid or embarrassed to talk to their doctor. Many women with this problem also wrongly assume that the loss of bladder control is a normal part of aging or motherhood because it is so common. More than half of first-time moms and one in three women who have already had a baby experience some urinary leakage [2]. If urinary incontinence is affecting your daily life, you should definitely talk to a medical professional. Further specialized testing may be needed to provide more detailed information. Bowel IncontinenceSome people with pelvic floor injuries experience bowel incontinence which results in the inability to control the release of gas or feces. Like those with bladder problems, many people living with bowel or fecal incontinence (FI) never tell anyone, including their doctor. However, there are treatments available that are specifically designed to treat incontinence of gas or feces.
Pelvic Organ ProlapseIn women, if the pelvic floor muscles and ligaments become stretched and injured, the bladder, rectum or uterus may drop down into the vaginal walls. This is called pelvic organ prolapse. Depending on how bad the prolapse is, the uterus may just bulge into the top part of the vagina or it could stick all of the way out of the opening.
Some women find that their symptoms are worse when they are standing up, straining or coughing and tend to disappear when they are lying down or relaxing. Very mild cases of uterine prolapse may cause no symptoms at all until the woman gets older.
In severe cases, pelvic floor exercises may not be enough to pull your uterus back into its normal location. As a result, your doctor may recommend that you use a vaginal pessary. This doughnut-shaped device is inserted into the vagina to help prop up the cervix and uterus. This is only a short-term solution though, and surgery may be needed to completely repair the damage. Sexual DysfunctionThe pelvic floor muscles play an important role in sexual pleasure in all genders. Females For females, purposely squeezing pelvic floor muscles can contribute to sexual sensation and arousal. Also, weak pelvic floor muscles can have a devastating affect on libido. One study that looked at 301 females over the age of 40 linked pelvic floor symptoms to low sexual arousal, infrequent orgasms and painful intercourse [4]. Weakened or damaged pelvic floor muscles can also reduce vaginal sensation. SummaryIf you are dealing with any of these pelvic health conditions or hope to prevent them from ever occurring, the professional physiotherapists at River East Physiotherapy would be happy to talk to you. They will also be able to answer any questions you might have about whether physiotherapy is right for you. ReferencesMuller N. What Americans understand and how they are affected by bladder control problems: highlights of recent nationwide consumer research. Urologic Nursing. 2005:25(2):109-115. Ege E, Akin B, Altuntuğ K, Benli S, Arioz A. Prevalence of urinary incontinence in the 12-month postpartum period and related risk factors in Turkey. Urol Int. 2008;80(4):355-61. Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991;165:322-27. Barber MD, Visco AG, Wyman JF, Fantl JA, Bump RC. Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 2002;99(2),281-289. |