30th Apr 2019 No Comments Carmen De Lange Physio wisdom, Uncategorised , , ,

This month we celebrate Mothers Day by teaching you about the Pelvic Floor. But men, don’t stop reading, you may also benefit from this information.

Over the next few blogs, Candice Langford, our very own Pelvic Health Physiotherapist, will be teaching you about the the pelvic floor, pelvic health and pelvic physiotherapy. The first will cover some basics and dysfunction. Then later we will take a more in depth look at what to expect from a pelvic health physio, what is rectus diastases and lastly what is the hype about kegels?

It may seem like an unusual topic but we all have a pelvic floor and I doubt many of us know much about this very important part of our anatomy. So without further ado, let us begin…

Pelvic Floor and Control

Your pelvic floor (male or female) sits at the base of your pelvis, here it forms a bowl like structure comprised of muscle, ligaments, tendons and fascia. This bowl, otherwise thought of as a hammock or trampoline, has holes in it (2 for males and 3 for females) to allow for ‘pee, poo, pleasure’. Just like any bodily function there is an element of voluntary and involuntary control over these holes. Think of the simple function of bending an elbow. If you want to lift your glass you voluntarily bend to bring a cup to your mouth, if you touch a hot stove you bend your elbow involuntarily as a reflex to avoid being burnt.

Your pelvic floor is partly responsible for the fact that you can eat and drink without everything passing straight through you (involuntary control). You may also now understand that sometimes we need to voluntarily generate tension to close off these holes and ‘keep things in’ (urine, faeces) or you may need to consciously relax and let go in order to ‘let things out’ (faeces) or even ‘allow things in’ (intercourse)?

Relating back to your arm and biceps. If you would like to lift that glass well and without difficulty, you would need to ensure that your biceps is flexible enough to allow for your arm to reach for the glass and strong enough to overcome the weight of the glass, you will also need to control that movement to ensure you do not drop the glass and of course make sure you are able to aim for your mouth. In the same sense, you require flexibility, strength, control and awareness of your pelvic floor in your daily life.

What happens if something goes wrong with this balanced system of control? Pregnancy, child birth, a cesarean section, rectus diastases, hysterectomy, menopause, endometriosis, laparotomy, laparoscope, prostatectomy, radiation, any lumbo-pelvic procedure or even injury to the surrounding areas (lower back pain, groin strain, sciatica, muscle spasm) can all lead to an imbalance resulting in dysfunction. Note that some of these aren’t exclusively experienced by women and therefore men can also develop problems with their pelvic floor.

Too Much or Too Little

Once you understand the functions of the pelvic floor you will be able to identify ‘dysfunction’ a little easier.

Allow passage of urine and faecal matter

You need to have the ability to ‘let go’ and allow waste to flow without pushing to pass urine or fecal matter.

Dysfunction:

Inability to relax leading to; Urinary retention, incomplete emptying, constipation, pelvic pain, muscle spasm

Maintain continence (urinary or faecal)

You need to have adequate strength and tone to maintain continence (leak free) between toilet breaks.

Dysfunction:

Weak Pelvic floor (hypotonic), Muscle tear leading to;

  • Urge Urinary Incontinence (UUI) – leaking when you have the urge to urinate.
  • Stress Urinary Incontinence (SUI) – Leaking with an increase in intra abdominal pressure (when you cough, sneeze, laugh, jump.)

Support the pelvic organs (Bladder, Bowel, Uterus)

Pelvic connective tissue and musculature prevent the descent of pelvic organs into the vaginal canal.

Dysfunction:

Weak Pelvic floor (hypotonic), Muscle tear, ligament rupture leading to;

  •  Pelvic Organ Prolapse (POP) of the bladder, urethra, bowel, uterus or a combination.

Sexual function

Ability to relax the pelvic muscles to allow for pain-free penetration.

Strength to contribute to reaching orgasm (rhythmical contraction of the pelvic floor and uterus)

Dysfunction:

Tight (hypertonic) pelvic floor leading to; Dyspareunia (pain during intercourse), Vulvodynia (vulvar pain), Vaginismus (inability to achieve penetration).

Is there help?

The above mentioned symptoms are unfortunately often left untreated as a result of the fear of stigma or embarrassment during discussion. You can rest assured that you are not alone! These symptoms are very common, but that does not make them normal and it is never too late to seek assistance. If you are experiencing any of the symptoms mentioned above, you may not have known that there was a conservative management option available for you. Spark a conversation with your physio and she/he will refer you to a pelvic physio to further investigate.