Why bother finding out what’s REALLY going on down there? If you answer yes to ANY of the follow statements then your pelvic floor muscles are not doing their job and it’s worth finding out why…
- I leak when I cough/sneeze/exercise
- I leak when I don’t make it to the bathroom on time
- I often rush to get to the bathroom to avoid leaking
- I pee ‘just in case’
- I pee more than 10 times a day
- I feel pressure in my vagina/rectum
- I feel like my insides are falling out
- Things don’t feel right down there
- Sex is painful
- My back pain keeps re-occurring
- I’m constipated no matter how much fiber I eat/water I drink
- I still look pregnant (mummy tummy) even though I exercise and eat healthy
Your doctor may have told you “go home and do some kegels” to help with any or all of the above issues but did they ever explain where the muscles are or how to activate them? Most women I see in my physiotherapy practice say no one has ever shown them where these muscles are. It’s not surprising that a large percentage of women are doing kegels incorrectly! The pelvic floor muscles attach from your pubic bone to tail bone (front to back) and sitz bones (side to side). They act as a trampoline and have many jobs including supporting your bladder/uterus/rectum (and your baby when pregnant), stabilizing your low back/pelvis and closing the openings where urine and stool come out. In my opinion they are one of our most important sets of muscles our body has (men have them too) and are kind of a BIG DEAL!
Some common myths about your pelvic floor (a.k.a kegel) muscles:
1) If you are pregnant or have had children it’s normal to have incontinence/urine leakage….FALSE
A: It is common but NOT normal to leak urine at ANY time. If your pelvic floor muscles are doing their job and activating at the correct time, then you should never be leaking regardless of your age or how many children you have given birth to.
2) If you have had children your pelvic floor muscles must be stretched out and weak….FALSE
A: Your pelvic floor muscles can actually be tight even after having children. Just like any other muscle in the body, your pelvic floor muscles can have knots/trigger points. They can be tight for various reasons including; poor posture, stress, constant clenching, scarring from tearing during childbirth and/or pelvic surgeries. Try picturing doing a bicep curl…if your pelvic floor muscles are tight, it’s the same as only activating the top part of the bicep curl instead of a full contraction and relaxation which is required to prevent leaking and pelvic organs from descending as well as connecting with your core 4 to resolve an abdominal separation.
3) If you haven’t had children, your pelvic floor muscles must be doing their job….FALSE
A: Women who haven’t had children can experience all of the above symptoms including abdominal separation. Doing sits ups/crunches increases pressure in your abdomen which pushes out on your abdominal wall and can create/worsen a separation over time, pushes down on your organs and pelvic floor which can cause incontinence and pelvic organ prolapse. Also if you have tight pelvic floor muscles you may experience pain with sex and have incontinence for the same reasons mentioned above. Lastly, if you have had low back pain, pelvic pain, or sacroiliac joint pain and these muscles have not been re trained- they may not be working optimally. Basically, not having children doesn’t mean you get to steer clear of checking in with your pelvic floor.
So what is involved with a pelvic physiotherapy assessment?
We take a detailed history including your concerns, goals, medical / injury history and ask about your fluid intake, how often you void (both number 1 and number 2). This information is important in determining how your pelvic floor is currently functioning. We look at your posture, core stability, spine mobility and also check your external muscles that connect into your pelvis. For the internal portion of the assessment we talk you through the process and make sure you are comfortable at all times. It involves palpation of the muscles at the opening of your vagina and inside your pelvis. An internal assessment is the gold standard for assessing your pelvic floor muscle tone/tightness, strength, control and coordination/timing. We also assess any scarring/tearing (vaginal and c-section) you may have experienced with childbirth or other surgeries as this can contribute to pain and/or poor activation of your pelvic floor muscles.
I have many women ask – how did I get into the area of pelvic physiotherapy? Well, I began my career as an orthopaedic physiotherapist treating necks, backs, shoulders, ankles and still continue to do so. I use Pilates as a form of rehab for my clients so as you can guess, the core 4 (pelvic floor, transversus abdominis, diaphragm and multifidus) has always been a part of my treatment. In the past I would often refer to pelvic physiotherapists once I began to hear from my clients about their history that included leaking, prolapse and abdominal separation as I knew these issues would directly affect the progress and outcome of their rehabilitation. I then decided to learn how to assess and treat these muscles internally to better help my clients’ outcomes and increase my holistic understanding of the body. Since then I’ve never looked back! My passion is to help women pre-conception, during pregnancy and post-partum to prevent and resolve any issues which can affect the entire body. I treat incontinence, pelvic pain, pelvic organ prolapse, diastasis rectus abdominis (abdominal separation), back pain, hip pain and tail bone pain. I also enjoy educating women during pregnancy about ways to help with labour and delivery including positioning to help decrease the likelihood of tearing, how to properly push and what to do post-partum to help safely and effectively restore their core.
Remember…It is never too early or late to get your pelvic floor assessed and resolve any of the listed symptoms regardless if they have been occurring for 10 weeks or 10 years.