Pelvic Health Archives - Page 2 of 2 - Elevation Physiotherapy & Wellness

Not Only Women Should Pay Attention to Their Pelvic Floor

It’s fair to say that most people never give their pelvic floor muscles any thought at all until they have a problem. The pelvic floor group of muscles work like every other muscle in the body, but because they are inside the body, they are easily ignored.

Of course both men and women have the same pelvic floor muscles—mostly. The superficial layer is a little different, but the deeper layers of muscles, bladder and rectum are all the same, and men can have the same issues with urinary incontinence or pelvic pain as women.

Recent studies show that many men undergoing a radical prostatectomy (having the prostate removed due to cancer)will be incontinent as a result of the surgery, and having a pre-operative program of Kegels (pelvic floor muscle exercises) can help after surgery for men to use fewer pads for a shorter period of time. These studies demonstrated that men who work to strengthen their pelvic floor muscles prior to surgery do better than the “controls”—the group who does Kegels leak less urine, and score better on the Incontinence Assessment Scale (ICIQ-SF).

At Elevation Physiotherapy & Wellness, we have physiotherapists who specialize in pelvic health, and can ensure that any man is performing Kegels properly, start a program of exercises to be done daily, and progress through more difficult variations of exercises as each man is able. Studies show that these treatments are inexpensive, and have zero side effects. Don’t buy pads forever—get to work strengthening the pelvic floor. It can help you get better, faster.

https://elevation-physio.com/services/pelvic-health-physiotherapy/

Aylin Aydın Sayılan and Ayfer Özbaş. The Effect of Pelvic Floor Muscle Training On Incontinence Problems After Radical Prostatectomy. 2018: American Journal of Men’s Health, Vol. 12(4): 1007-1015

Li-Hui Pan et al. Improvement of Urinary Incontinence, Life Impact, and Depression and Anxiety With Modified Pelvic Floor Muscle Training After Radical Prostatectomy. 2019: American Journal of Men’s Health, Vol. 13(2): 1-10

Weight Lifting For The Vagina

The pelvic floor group of muscles work like every other muscle in the body, but they are generally fairly ignored until someone has a problem. The muscles sling underneath from the pubic bone at the front of the pelvic to the tailbone at the back, and also wrap around the vagina, urethra and rectum.

Since these muscles are at the base of the core and attach onto the spine and pelvis, they can help support the pelvic structures, and are involved in control of botht the bladder and the bowel.

If these muscles are weak, and they are in most people due to the above-mentioned fact that people generally ignore them, some people can experience stress urinary incontinence (SUI), which is when urine leaks occur with exertion, like coughing, sneezing, and jumping. Pelvic organ prolapse (POP) can occur when the weakness of the pelvic floor muscles and other supporting structures causes the bladder or uterus to descend down into the vaginal canal.

So what can be done? Since the pelvic floor muscles are just like other muscles, there are strength-training exercises called “Kegels” that can be very effective in helping SUI and the symptoms of POP. Kegels can be done with short pulses (contraction and release of the pelvic floor muscles that takes 1-2 seconds, repeat 10x) or longer holds (squeezing the pelvic floor muscles and holding them engaged for 5-10 seconds, relaxing completely between repetitions).

Pelvic floor weights (vaginal cones) involve inserting a weight inside the vagina for the time that you would do the Kegel exercises—they are not meant to be worn through the day. The series of weights start out bigger and lighter so they are easier to hold inside, and get smaller and heavier as you improve.

A review of the data tells us that pelvic floor weights are no more effective that simply doing Kegel exercises for strengthening the pelvic floor muscles. If the idea of weight-training for the pelvic floor appeals to you (some women love tools and devices), then they are fine to try. Be sure to use a medical grade set that can be cleaned appropriately.

Making sure that you are doing a proper Kegel is most important. At Elevation Physiotherapy & Wellness, we assess each person to ensure they are performing Kegels properly and get you started on a program to help build strength, endurance and control through the pelvic floor. If you are experiencing urinary incontinence or a prolapse of the pelvic organs, we can help!

The ProSTATE Of Affairs

Do Men Need to Work Their Pelvic Floor Too?

Both men and women have biceps, quads, and most other muscles, so why would working this very important group of muscles be important only to women? Think of the pelvic floor as a group of muscles that act as support and stability for the base of the core—these muscles attach to the spine, hips and around the pelvis, and they blend very directly with the lower abs, oblique abdominals, and deep back muscles. If you are working your pelvic floor muscles with your other core training, you will build a better, stronger core!

Breathing very much influences how these muscles move. When we inhale, our diaphragm lowers and the pelvic floor descends and relaxes. With exhalation, the pelvic floor contracts and raises with the diaphragm, and the lower abdominal and deep back muscles contract to squeeze around the spine and pelvis. If exercising lower abdominal muscles, there is a better and more efficient contraction if we exhale and engage pelvic floor muscles at the same time!

Let’s Talk Prostate!

We can’t talk about the male pelvic floor without mentioning the prostate. The prostate gland sits right below the bladder wraps around the urethra, which is the tube that drains urine from the bladder. If the prostate is enlarged, it can squeeze around the urethra and limit the flow of urine.

If the prostate has to be removed or have other treatments to manage issues at the prostate, many men will be incontinent for a time. Working the pelvic floor muscles will help to build more external support around the urethra, along with proper “core“ breathing and strengthening other parts of the core, will help to restore continence in men faster than if men do nothing. There is much that can be done for men to improve or fix their continence issues after prostate surgery, and it all begins with the pelvic floor!

Prostate Issues are Not Just for your Grandpa

Prostate cancer is often diagnosed in men in their 50s and 60s, but younger men can experience this as well. About 40% of men diagnosed with cancer are low-risk, and will have “active surveillance” over time, but it should start with a blood test to see the PSA (prostate-specific antigen) level. If this is at all concerning, then it can be followed up with an MRI to see if a biopsy is even needed.

Often men will first have their PSA tested at age 50, but it is now recommended that a man has his first test in his mid-40s. If the PSA level is low, then it needs to be repeated only every 5 years until about age 60. Doctors are suggesting that healthy lifestyle choices might help to lessen the chance of developing prostate cancer—regular exercise, maintain a healthy weight and eating less animal fat.

For those who develop prostate cancer, it needs to be treated aggressively. If a man has to have the prostate removed, better surgical techniques have been developed that allow sparing of the nerves that control the bladder for urination, as well as erection and ejaculation. For several months after the surgery, almost every man will experience urinary incontinence and erectile dysfunction, but pelvic floor physiotherapy can be helpful to return to a much better quality of life.

The pelvic floor is a group of muscles that sling under the pelvis, and act as support and stability, as well as assisting as a sphincter. These muscles work collectively, and are generally ignored by all until there is a problem with leaking urine. Your pelvic physiotherapist can help you to make sure that you are engaging these muscles correctly and effectively, as well as teaching you how to manage the abdominal pressure changes that come with coughing, sneezing laughing or moving around.

There is much that can be done, and seeing a physiotherapist who practices pelvic health can get you back on the road to full function quickly.

Pelvic Organ Prolapse—What Can Be Done?

It is really common for women to have some descent in their bladder, uterus or bowel, and it is not just women who have had babies—this condition can be an issue for women who have never had kids as well. Research supports physiotherapy as a first-line treatment for pelvic organ prolapse (POP). A 2016 Cochrane review of the physiotherapy studies for POP found that pelvic floor muscle training significantly decreased symptoms and improved the stage of prolapse when compared to control groups (Dumoulin et al., 2016).

Many women diagnosed with POP had no idea it was even possible for prolapse of the pelvic structures to occur, had no idea where to seek treatment (or that treatment even existed!), and were scared to discuss their concerns with their friends or healthcare providers. Additionally, many people’s concerns are written off as a “normal” part of aging by their practitioners; this leads to people living with potentially modifiable symptoms because they simply don’t know where to go or who to see.

Sometimes the advice given to a woman to help a prolapse is not very practical. For example, a young mother being told not to lift anything heavier than 5 or 10 pounds and to stop all exercise beyond swimming and those performed in lying down positions. While this might be important in the early stages of healing, the exercises and movements would have to progress to the point that this woman could comfortable lift and carry her baby, and get back to the activities that she finds meaningful and fulfilling. No two pelvic floors are the same and everyone experiencing POP has different goals and abilities.

Research has supported that different people manage intra-abdominal pressure during activity differently, and each woman needs to understand how their own body will respond to the exercises and activities that they are interested in returning to. Some women who are looking to resolve or manage their symptoms tend to do well with the help of physiotherapy and lifestyle modification/education. A physiotherapist who works in this area will have advanced training to help pelvic floor issues, and will likely do an internal assessment to gauge the strength, endurance and control of the pelvic floor, and address the pelvic floor engagement with proper breathing to manage pressure changes.

If you’re noticing pressure or heaviness in the vaginal area, or you can feel a bulge in your vagina in the shower, get checked by your doctor or a pelvic health physiotherapist—there is much that you can do to help this problem!

Kegels are your Friend—Get to Know Them!

If you’re leaking urine when you cough, sneeze or laugh, it’s no laughing matter—but there is a lot that you can do to help it. It is not normal to leak even if you’ve had kids, nor is it an inevitable part of aging.

The muscles of the pelvic floor work like every other muscle in your body, they are just tucked up inside, so people don’t given them much thought. Due to this weakness, they often don’t work to squeeze effectively around the urethra, and leaking can happen. They also work to hold up organs like the bladder, uterus and colon, and need to be kept strong to keep these organs from sinking down.

It’s not just women who have had kids that have problems with their pelvic floor—it can happen to any woman. A decrease in hormone levels with menopause can cause irritability in the bladder and pelvic floor muscles, and gravity can help things descend if there is poor external support.

The good news is there is so much that can be done before and after you notice any problems. It is important to get to work on strengthening your pelvic floor muscles, and of course, it is necessary to make sure you’re doing them correctly. A proper pelvic floor contraction is a lift—for example, imagine a ping pong ball sitting outside your vagina and you want to lift it inside. Once you have the lift movement down, try to do 10 contractions in a row. Keep practicing—you will get better strength and control as you practice.

It is worth seeing a physiotherapist who works in pelvic health who will do an internal assessment to make sure that you are engaging the muscles properly, and then give feedback on the strength, endurance and control. A pelvic physiotherapist can also give you exercises to work your other core muscles along with your pelvic floor and proper breathing—breath is very important to train with your pelvic floor muscles. Working the pelvic floor regularly –and properly—can help you get to the point where you can cough or laugh without leaking, and that is nothing to sneeze at!

Where are the Pelvic Floor Muscles?

The group of muscles that make up the base of your core are collectively called the pelvic floor. They are muscles like every other muscle in your body, they are just inside, so most people don’t give them any thought until they start to have a problem, like leaking(incontinence) or when the bladder or uterus starts to descend (pelvic organ prolapse).

People often hear that they should strengthen the pelvic floor, but either don’t even know what muscles are involved, or if they are able to work them properly. Let’s break it down:

This is the view of the pelvic floor muscles if looking from below; at the top, there is the urethra (the hole where urine comes out), then the vagina, and at the bottom, the anus. The pelvic floor muscles sling from the pubic bone on the front to the tailbone at the back, and also can wrap around the vagina and anus. Together they act as support for the base of the core and trunk, and stability as they attach to the bones of the pelvis, spine and hips. When the muscles contract, they behave like a sphincter to affect the vagina or anus, and can also help pump lymph through the system to prevent pooling at the pelvis.

So now that you know where they are anatomically, how do you locate these muscles? Both men and women can do this in the same way.

Sit or lie down and keep all of your muscles relaxed. It is often easier for people to identify these muscles if they are lying down to start.
Squeeze the muscles around the back aspect of your pelvic floor as if you are trying to stop passing wind, then relax them. Try this several times until you are sure that you are contracting the right muscles, and don’t squeeze your buttock muscles—they should stay relaxed.
When sitting on the toilet to urinate, try to stop the stream, then start it again. You can try this to learn the right muscles to engage, but do not train this way or do it often, as it can mess with the reflexes between your bladder and pelvic floor muscles. It’s a good technique to understand the proper contraction of the pelvic floor (it should feel like a lift in your vagina or scrotum), but continue to practice this Kegel exercise while not urinating!
If you don’t feel a distinct “squeeze and lift” through your pelvic floor muscles, it’s time to contact your doctor, or better yet, a physiotherapist who is specially trained in working with your pelvic floor