Your Pelvic floor; what all women need to know!

 

You may be wondering about pelvic floor exercises after childbirth… Or you may have no idea. Have you even heard of Kegel contractions? It sounds a bit like a chip brand to me! Like grainwaves or twistys, but let me assure you it’s certainly NOT a chip brand! Kegels are pelvic floor exercises designed by Doctor Kegel.

Most women have heard they should be doing pelvic floor/kegel contraction exercises to strengthen their pelvic floor muscles, especially after having a baby in order to reduce urinary leakage and even pelvic organ prolapse risks.  However if you’ve been given instructions by your GP, obstetrician or gyno the advice may actually be too vague or not specific enough to educate you on how to perform these properly. If you have pelvic pain or you’re still suffering with incontinence, performing certain types of exercise may be be making it worse.  Seeing a women’s health physio who specialises in the pelvis may be hugely beneficial at learning how to actually perform Kegel contractions before you jump back into exercising again!

How do I know if I am doing them correctly?  How many should I do?  What position should I be in?  Are you supposed to do them when you’re weeing or not? Will it help with my urinary leakage?  What about with my sex life? Yes you read right, your pelvic floor relates to ALL of these!

 

Here is a little anatomy lesson on the pelvic floor

A group of over 20 separate muscles that lie underneath the pelvic organs (the bladder and the bowels, the uterus and vagina in women, and the prostate in men), the pelvic floor acts to support the organs and gives us voluntary bowel and bladder control. Most people think their bowel, bladder, or genital troubles are due to problems in the organs themselves.  Your bladder problem may really be a muscle problem.

You might be thinking, “What could a  physio, or a personal trainer of all people, do about my bladder or bowel problem or my pelvic pain?” A lot, actually.

The pelvic floor muscles are skeletal muscles, which mean they are under your command.  They are controlled by your brain, just like the muscles in your arms and legs, which means they can have the same type of problems as any other muscle.  Weakness, poor endurance, poor coordination, and even painful tender points and scar tissue adhesions can occur in the pelvic floor muscles after birth.  Instead of causing difficulty with walking or lifting, pelvic floor muscle dysfunction can cause incontinence, pelvic organ prolapse, and even pain during sex. Horrified yet?

A bit like pinching a garden hose, the pelvic floor muscles contract around the urethra (your bladder tube) to give us bladder control.  When you have the urge to urinate and “hold it”, your pelvic floor muscles are doing the holding.

If your pelvic floor muscles don’t have adequate strength, they can’t pinch the urethra tight enough to hold urine inside the bladder.  If you have poor endurance in your pelvic floor, you might have trouble making it to the bathroom on time.  If you have poor coordination, your pelvic floor muscles might not squeeze fast enough to counteract that cough or sneeze, which is quite common.  The same can be said for bowel control, too.

However, your average Kegel contractions may be too simple to address these muscle complexities. Bladder and bowel control is dependent on the pelvic floor muscles working in harmony, not just being “strong”. In fact many women nowadays are becoming quite vigilant about ‘switching on’ their pelvic floors and can actually create an overactive pelvic floor, and dysfunctional recruitment patterns throughout the deep abdominal muscles. This can lead to major problems if you plan to have a baby!

Think about it, does it make sense that just doing biceps curls would fix every arm problem?  No, it doesn’t.  Kegels can’t fix every pelvic problem either.  There are many  types of pelvic exercises. Kegels are just one type of exercise a women’s health physio may prescribe.

 

A women’s health physio understands more and therefore so do we!

To put it simply, pain inhibits normal muscle function.  When we hurt, we don’t move normally.

It is easy to see if someone has pain in their knee or ankle – they limp!  The pelvic floor is an inside muscle, which makes seeing its dysfunction more difficult.

If your pelvic floor muscles are painful due to an episiotomy scar or other birth trauma, repetitiously contracting the muscles may make your pain worse.  You may need exercises that stretch rather than strengthen your pelvic floor.  Only a trained pelvic floor physical therapist can evaluate your pelvic muscle function and then prescribe the right type of pelvic floor exercise program for you.

 

We will individualize your program

A Women’s Health Physio and personal trainers use movement to treat the body the same way a doctor uses medicine.  Exercises are prescribed and individualized to the client.  A triathlete or cross-fitter will have a different program compared to a Mum who has just given birth!

In a recent study, 52% of people with low back pain also reported having some form of pelvic floor dysfunction (voiding dysfunction, urinary incontinence, sexual dysfunction and/or constipation). Over 80% of those with pain said their pelvic floor symptoms began about the same time as their low back or pelvic pain did.

If you have pelvic pain, back pain, tailbone pain, or genital pain, it is very likely your pelvic floor is part of the problem. Seeking professional help who can tailor a program for you can be a part of your solution.

 

Womens Health experts know a lot about Kegel exercises.

A short history lesson

There was a Dr. Kegel.  He was a Mayo-trained surgeon who became interested in finding non-surgical treatment options for incontinence in post-partum women in the 1930’s.  He did not “invent” the exercises. Therapists in England had been teaching pelvic and pelvic floor exercises since the late 1800’s to new mothers in the maternity wards.  He was, however, the first to apply the scientific method to prove pelvic exercises actually worked to reduce urinary incontinence.  After decades of research on the best methods on how to teach the exercises, he published his results in 1948. His approach was 84% effective in curing incontinence symptoms.

So what happened?  

The methods Dr. Kegel developed in the lab just didn’t translate well into modern medical practice unfortunately, in today’s post-partum healthcare world, Dr. Kegel’s methods of teaching pelvic exercises have been replaced with a brochure that new mums are handed as they leave the obstetrician’s office.  Most well-meaning doctors didn’t have the time or resources to duplicate Dr. Kegel’s methods in their clinics. Over the years, the verbal or written description of how to “squeeze down there” started to replace the individualized approach Dr. Kegel was able to take in his research.  

Dr. Kegel advocated that without one-on-one physical instruction by a trained professional, most women would not be able identify the right muscle, therefore making the exercises ineffective.  Decades after this assertion was published, multiple studies now support Dr. Kegel’s early observations.  One study found that in women who were given only verbal and written instructions on Kegel exercises in an obstetrician’s office, less than half could demonstrate a correct pelvic floor contraction.

How would Dr. Kegel teach you how to do Kegel exercises?  

First, he would look at and palpate your pelvic floor to make sure you were using the right muscle group.  He would then use an internal vaginal pressure sensor called a perineometer, an early type of biofeedback, allowing you to “see” your internal pelvic floor muscles working.  He would progress your exercises as you became stronger.  You would be instructed several times over the course of weeks or even months.

If you have tried Kegels on your own and not gotten the results you wanted, maybe you need a “Kegel coach” – a Women’s Health Physio who has the time, the equipment, and the knowledge to evaluate your Kegel skills and then develop an exercise plan especially for you.

If you live in Sydney, Australia and you would like the details of a Womens Health Physio or you would like to know more about what we do for women who have recently had a baby please contact us so we can have a chat or so we can connect you with a professional who can help 🙂  

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