Is Your Suspension System Responsive?
Pelvic Floor Health is the topic today and this doesn’t just refer to the ability to control urine. There are many pelvic health concerns and discussing them continues to be uncomfortable for many. This is a topic that has been on my mind to discuss for awhile and thankfully my colleague Christina Carrick and I were able to reach out to three Physiotherapists to obtain content for this blog and radio show.
From Christina: “I caught a television commercial the other day which effectively had the message “you are a woman, you are of a certain age, it’s time to start thinking about which absorbent undergarment to choose”. The tone of the commercial struck me, as it suggested urinary incontinence is a normal part of aging and it happens to everyone once they have children, or reach some age. Although incontinence is common, it is by no means normal! Incontinence is a symptom of pelvic floor dysfunction, and should be addressed just as you would any other muscular dysfunction.”
We don’t talk about the pelvic floor nearly as much as we should, which can result in not thinking about it as much as we should. Both men and women can experience pelvic floor issues. With men it presents most commonly after trauma, or prostate pathology, but can be insidious, states Marnie Giblin, Pelvic Floor Re-education Certified Physiotherapist. Many women develop problems with just the aging process, childbirth, and surgeries.
What is the Pelvic Floor?
The Pelvic Floor is a sling of muscles that connects your genital area front to back. They work in concert with your lower back and abdominals. Without getting too specific on the names, picture the location and then turn you attention to the most important aspect: Function. Does your pelvic floor function as it should?
Both men and women suffer from pelvic floor dysfunction and it should be a consideration in those suffering from back pain. I think of the core as a cylinder or box that includes the shoulders, neck, and hips. At the lower end of this core box lies your pelvic floor, and in the middle lies your diaphragm. The importance of proper breathing mechanics makes sense when you think of the diaphragm having a piston action on your pelvic floor with each breath in and out. The diaphragm intersects your whole torso so it is very important in core stabilization and function of the pelvic floor health.
The muscles and connective tissue of the pelvic floor within the pelvis which serve many functions which we will call The 4 ‘S’s:
- Support for the internal organs
- Sphincters – constricting pelvic orifices including the urethra, vagina, and anus
- Sexual function
- Stability, including balance and responsiveness (did someone say CORE?!?).
If you are having problems with any of these functions, it could be time to start thinking about your pelvic floor!
Have you been drawing your belly button into your spine thinking that this could be helping your pelvic floor and core? We had a great coffee shop chat with Cheryl Leia, Certified Pelvic Health Physiotherapist that included some interesting visuals like this little chicken. It demonstrates that drawing that belly button in pushes the pelvic floor south which is not ideal!
What is Pelvic Floor Dysfunction?
Pelvic Floor Dysfunction occurs when the pelvic floor tissues are not functioning well enough to provide the 4 ‘S’s. The tissues might be weak and muscles unable to contract as strong as we would like or with the speed we would like. Or the tissues might be hypertonic – always contracted, and unable to let go. (In order for a muscle to function, it must be able to both contract and relax!) Or it could even be that muscles are not firing in a synchronized fashion.
Symptoms of pelvic floor dysfunction include:
- Urinary or bowel incontinence. This includes leaking during exercises (such as skipping, jumping, heavy lifting) as well as the inability to make it to the bathroom in time.
- A feeling of heaviness or protrusion during lifting. This could be an indication of pelvic organ prolapse – one of the internal organs has protruded or dropped through the pelvic floor’s support.
- Pain during sexual intercourse. Sex should not hurt.
- A difficulty maintaining core posture and transferring forces between limbs.
- Constipation. Even if you are pooping, you might still be constipated. Did you know you can poop around poop?! If your poop looks like deer droppings or toothpaste more often than not, you are probably experiencing constipation.
Side note: How often should bowel movements occur? Three answers for you:
- Former Nurse Sheila: If you don’t go every day or other day we have trouble.
- Physio Siobhan: Every day or so.
- Physio Cheryl: Three times a day to three times a week.
An important note on this topic includes the fact that constipation contributes to pelvic floor issues as well as being one. Start with water and fibre, and daily movement to improve frequency. (And movements!) The state of your gut health is currently a hot topic so I encourage you to look into this if you have chronic constipation issues.
Why is a personal trainer talking about this stuff?
Pelvic floor dysfunction could be hindering your workouts and your progress. Are there exercises you avoid because they cause you to leak or they give you a feeling of heaviness or protrusion? Or perhaps there are exercises which are more difficult than they should be, because the pelvic floor cannot maintain pelvic and core stability. The body is not just a bunch of adjoined compartments, working individually. It works as a whole, complex system, and if one piece is out of whack you can bet that everything else is being affected.
As trainers we fill the training plans with load to achieve other goals such a muscle gain and bone density. Program planning must consider pelvic floor cuing and I am here to state it hasn’t been in my experience. We must change this folks so get comfortable talking about it and incorporate the cues shared here into your training and practice.
What cues should we be using to ensure we train safely and minimize risk?
We have to be careful that the cuing we use with our clients is not causing more issues cautions Cheryl Leia, Certified Pelvic Floor Physiotherapist. We do need to pick up and support the floor prior to an imposed demand. The controversy lies in what that means exactly. The pelvic floor muscles do respond to sets and repetitions with the same principles of adaptation as the rest of the body. It seems to me that intensity of the exercises in the pelvic area are what one should be careful with.
If too many Kegels are being done with the wrong intensity (too much squeeze) or the breathing isn’t right it can make matters worse. Many are at a loss as what to do.
Siobhan O’Connell of Trimetrics Physiotherapy states we are moving away from squeeze words and gives us some updated terminology:
- Draw in a little
- Activate gently
- Engage lightly
- Gently pick up a “blueberry” without crushing it.
For the Men:
- Pull the testicles gently to the body.
- Bring the boys back home.
Can proper breathing help the pelvic floor?
Yes, and in fact learning about the piston action of the diaphragm and pelvic floor can go a long way to helping improve the function and responsiveness of this area.
If you suspect a problem….what can you do?
If you are experiencing any of the above symptoms, you should mention it to your doctor or trainer. Both should suggest a referral to a Pelvic Health Physiotherapist who is qualified to make a thorough examination and assessment with follow-up exercises. The Pelvic Health Physiotherapist and the Trainer can then work together to ensure you are getting the most out of your workouts while strengthening the pelvic floor. Often this will involve special attention to breathing mechanics and postural alignment during exercise.
Poor postural alignment can also lead to shortened and weakened pelvic floor muscles. Standing with the hips tucked under all day can lead to some of the pelvic muscles always being in a shortened, contracted state. When the body then looks for pelvic stability, the muscles can misfire or are unable to fire in a synchronized fashion. With the pelvic floor compromised this way, symptoms such as incontinence can occur. Adjusting posture so that feet, hips, shoulders and head are aligned to the task can help balance out muscular contraction and aid in responsiveness of the pelvic floor.
Marnie Giblin another Pelvic Floor Physitherapist we consulted (Myodetox/Pivotal Physiotherapy) states “Many people with pelvic health concerns stop exercising, but this is more damaging long term. Development of core strength, postural awareness, and control of the diaphragm and pelvic floor muscles are key.”
In the first picture above, notice how tucking the hips under moves them forward of the feet and shoulders. In the second picture, the shoulders and hips stack evenly above the feet.
Just where is your weight going with jumping jacks and skipping? If this is you, try getting your hips over your shoelaces instead of your toes.
What about Kegels?
Kegels are a highly debated topic among health and fitness professionals, with some universally prescribing kegels as the exercise to prevent or treat pelvic floor dysfunction and others saying they are a waste of time or even counter-productive. As usual, the truth probably lies somewhere in between the two extremes.
A Kegel is a pelvic floor contraction – an exercise meant to strengthen the pelvic floor. One common cue for performing a Kegel is to “stop the pee”. Some physiotherapists have found that this cue results in over-gripping, however, so a better cue might be to “imagine picking up a blueberry with your vagina”. If you are a man, a more appropriate cue would be to “bring the boys home”. (See above for more notes on cuing.)
Some experts have pointed out that Kegels might not be the exercise a person needs, however. Biomechanist Katy Bowman points out that Kegels will pull the sacrum inward, and for someone with weak gluteal muscles which cannot balance out the Kegel, this will result in excessive gripping of the pelvic floor and an inability to contract properly. According to Katy, the best way to GET pelvic floor dysfunction would be to do too many Kegels while having weak glutes! Katy instead prescribes exercises which strengthen the glutes and surrounding muscles, and encouraging a more central posture with the bum not tucked under.
If you are doing kegels and not sure if you are doing them correctly, or if you have been doing them but not getting results, consult a Pelvic Floor Physiotherapist. The therapist will be able to do an internal and external examination and get you on the path to a stronger pelvic floor! Some therapists have real time ultrasound so they can see what is really going on (or not) which can be helpful in making the treatment plan.
Written by: Sheila Hamilton and Christina Carrick
Copyright Jan 2019
Thank you to these three Physiotherapists for contributing to the content of this blog:
Certified Pelvic Health Physiotherapists
Trimetrics Physiotherapy: Siobhan O’Connell
Canopy Health: Cheryl Leia
Myodetox/Pivotal Health: Marnie Giblin
From the web:
Copyright: <a href=”https://www.123rf.com/profile_rastudio”>rastudio / 123RF Stock Photo</a>