Pelvic Organ Prolapse CAN be Helped!

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when a pelvic organ—such as your bladder or uterus—drops (prolapses) from its normal place in your lower belly and pushes against the walls of your vagina. This can happen when the muscles that hold your pelvic organs in place become weak or stretched.

Many women will have some kind of pelvic organ prolapse. It can be uncomfortable or painful, but is not typically a serious health problem.  It doesn’t always get worse, and it has been shown that with work it can get better!

More than one pelvic organ can prolapse at the same time. Organs that can be involved when you have pelvic prolapse include the bladder, rectum, uterus, urethra or small intestine.

A bladder prolapse (cystocele) is most common, and occurs when the tissues that hold the bladder in place are stretched or weakened. This causes the bladder to move from its normal position and press against the front wall of the vagina, forming a bulge.

A uterine prolapse occurs when a woman’s pelvic muscles and ligaments become weak, allowing the uterus to drop from its normal position and the cervix to bulge into the vagina.

A rectocele occurs when the tissues and muscles holding the end of the large intestine (rectum) are stretched or weakened, allowing the rectum to move from its regular position and press against the back wall of the vagina.

There is much that can be done to improve your prolapse!

You will need to work with a physiotherapist who works in pelvic health to make a program of exercises and other healthy habits that is specific to you and your situation and lifestyle.

Some things you can do to help:

  • Pelvic floor strengthening exercises (called Kegel exercises) can help to build support at the bottom of your core
  • Reach and stay at a healthy weight
  • Avoid lifting things that are too heavy for you, as it can put stress on your pelvic muscles
  • Caution with higher impact exercise and activity, and possibly switch to lower impact exercise
  • Avoid straining with bowel movements, and increase fibre intake
  • Try “the Knack”, which is a technique of engaging your pelvic floor muscles just before you cough, sneeze or lift in order to better manage the pressure increase

Is your Bladder Running Your Life?

Urinary frequency and urgency are very common issues. If you’re usually going more often than that, or are always needing to know where the toilet is wherever you go, it is possible to train your bladder to be a better reservoir by using your pelvic floor muscles.

What is “overactive” bladder?

The bladder can become irritable or “overactive”, making you pee more often.  This could be due to habit, if you often empty the bladder before it is full. If your bladder never fills up, it doesn’t ever expand and can become smaller over time.  But this can be reversed! You can use your pelvic floor muscles to train your bladder to hold more urine before you need to pee.

It is important that you first get checked by your family doctor, and assuming there is no infection or other medical reason, you can get some help from a pelvic health physiotherapist, who has advanced training in working with pelvic floor muscles and other structures in that area.

What to do?

If you feel you need to urinate more than every 2 hours, try not to go with the first urge you feel.

When you do feel the urge to pee:

  • be still (standing or sitting) and tighten up through your pelvic floor muscles
  • try to distract your brain at the same time with something else

Doing this can help settle down the urge to urinate. If after a minute or two you still need to go, try to walk to the toilet slowly. If the urge to pee has settled down, try to delay going until you feel an urge again. Over time you are trying to lengthen the time between visits to the toilet.

A physiotherapist trained in pelvic health can help to improve these issues further, by listening to your own experience and making a plan forward that is individual to you. If you continue to struggle with urinary frequency or urgency, speak with your physio about this.

The Pelvic Floor in 3D: Here’s why working the pelvic floor matters

It is fair to say that the pelvic floor group of muscles is pretty much ignored by most people until they have an issue like urinary incontinence or urgency. Think of this group as any other mucle in your body, that needs to know how to turn on and off easily, and be coordinated with other parts of the core. This “One Minute Wellness” video explains all about the pelvic floor, and how engaging these muscles can help improve strength and control at the base of your core.

Peeing all the time? Physiotherapy can help!

Symptoms of urinary urgency or frequency are very common and can be incredibly disruptive to your life. It is not a good feeling to have to run your life by where your next bathroom is.

A physiotherapist with advanced training to treat pelvic floor dysfunction can help! There are several factors that you need to look at:

1. Consider your pelvic floor: the pelvic floor muscles work like every other muscle in the body, they’re just inside. It is important to make sure you can properly engage those muscles and also relax the muscles easily. These muscles can be  involved with issues with urinary urgency and frequency or pelvic-area pain.

2. Measure things: sometimes certain tools can be used to get a big-picture sense of what is going on, and can help your Physio design the plan that will help you fastest. These can include tests like:

  • Bladder diary- provides a picture of your bladder and bowel habits, how much and what you drink to figure out any patterns. Constipation is important to address as it can impact bladder function as well as pelvic pain.
  • DASS (Depression, Anxiety and Stress Scale)
  • PCS (Pain Catastrophization Scale)

4. Look at everything:  a thorough physiotherapy assessment includes looking at how you breathe, your posture, how you move, your lower back, and overall strength—not just the pelvic floor itself. The pelvic floor muscles are very important with urinating, having a bowel movement, and sexual function.  There are many reasons for the onset of overactive pelvic floor muscles, and it is important to get to the driver or source of this in order to move symptoms forward.

5. Diet modification– caffeine, alcohol, carbonated beverages, tomato products, citrus fruits and juices and cranberry juice are several irritants that can contribute to intense discomfort. Sometimes they need to be stopped for a period of time to help symptoms.

6. Breathing– HOW you are breathing matters! Purposeful deep breathing can calm your nervous system, and can be one of the easiest, yet most effective, interventions to learn.

7. Help improve sleep– three out of four people who have ongoing pelvic pain have difficulty staying asleep, and that is worse if you have to get up in the night to pee. Going to sleep at the same time every day, staying warm, and no screens right before bed can all be helpful.

8. Manual therapy– different treatment techniques will be helpful for different people—one thing does not work for everyone, of course! Your Physio will likely want to work with stretching or strengthening different muscles (pelvic floor and others), and techniques for your nerves and connective tissue With the pelvic floor, it is possible to be both too tight and too weak, and lengthening must be addressed first.

9. Exercise: exercises that are fun, non-irritating and novel will help to change the brain to look at pain differently.

All of these things can help change pain, frequency or urgency issues to help get better, faster!

The ProSTATE Of Affairs

Prostate

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!

How To Do A Proper Plank

There has been plenty of conversation lately around doing plank exercises after age 50—is it safe?  What is the effect of estrogen depletion of skeletal muscles? Can doing planks to strengthen the core actually cause a prolapse of the pelvic organs?

The answer is a resounding NO—planks can continue to be a great strengthening exercise, but there is more to it than that.

  1. Like any other exercise you would ever do, your form really matters.  Don’t start planking at a level that is beyond where you are. Start on your knees or a modified version and progress onto your toes as your strength improves.
  2. Make sure that you are engaging your pelvic floor muscles while you are holding your plank—meaning that you have to know that you are engaging them properly, and remember to breathe as well
  3. You have not become fragile when you reach age 50, or beyond for that matter! Decreasing levels of estrogen in your body has been shown to reduce the strength in our skeletal muscle.  Let’s not forget that general inactivity, at any age, will also decrease strength in our skeletal muscle. There is also evidence to show that we can still build muscle when we age, and everybody should do this!
  4. When you stop challenging your body physically, you WILL get weaker over time.  That is the same for all muscles.  Many people have weak pelvic floor muscles because they don’t work them specifically unless they have developed a problem! So if you are starting to plank (at any age), you should have a pelvic health physiotherapist assess you if:
    1. You leak urine while holding a plank
    1. You feel a heaviness or pressure in your pelvic floor after planking
    1. You can’t hold good form
    1. You are experiencing back or hip pain to do a plank

HOW TO DO A PROPER PLANK:

  • Keep your body in a straight line, whether you are on your knees or your toes
  • Tuck your pelvis under
  • Stack your elbows under your shoulders
  • Think about pushing away the floor with your elbows
  • Squeeze your glutes hard!
  • Keep your hips level: don’t let them sag or rise up
  • Remember to breathe

Prostate Issues are Not Just for your Grandpa

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.

Kegels are your Friend—Get to Know Them!

Elevation Physiotherapy & Wellness :: 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.

  1. 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.
  2. 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.
  3. 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!
  4. 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