This week I would like to talk about pelvic floor dysfunction. I have been reading some great literature lately, and think it’s a great addition to the work that I do, and also a very important topic to mention.
The pelvic floor is a very complex structure. The pelvic floor is all the muscles, plus the nerves controlling the muscles, plus the tissues called fascia that connect everything together, plus the ligaments that link bone to bone and bone to organ that are attached to the front, back and sides of the pelvis, from the pubic bone in the front of the body all the way back to the tailbone. These structures are the floor of the pelvis, and act like a sling or hammock to support the urinary tract, digestive tract, and reproductive organs.
All the muscles work together to support the organs, but each muscle also has its individual role. These muscles are voluntary, meaning we control them consciously. These are different from muscles in the lungs, intestines, blood vessels, ect which are involuntary and operate automatically.
These muscles are also skeletal muscles, which means they are attached to bone. When we contract the pelvic floor muscles, it applies force on the tailbone. The muscles come in two speeds.
70% is slow twitch or slow contraction(supportive muscles), the other are fast twitch (bladder/bowel/sexual function)
-These muscles do lose strength as the body ages, although the slow twitch tend to keep their power and function longer. That’s why it’s important to stay as fit as we can for as long as we can!
Even with it being SO complex, there are four root causes of pelvic floor dysfunction.
1. Inflammation– Any kind of chronic inflammation in any of the pelvic organs can originate a disorder
2. Infection– Any kind of infection: UTI, yeast, bacterial, hormonal issues as well!
3. Trauma– Injury from an accident or fall, cesearan, hysterectomy, prostatectomy, physical/sexual abuse, childbirth
4. Mechanical-weakness in trunk and pelvic stabilizers, misalignments in the pelvis, ** What I see most common-sacroiliac joint sprains., poor posture, heavy lifting, wearing clothing that is too tight, sitting on a concrete stadium bench during a rock concert….(yes even this)
Any or all of these can lead to a spasm or weakness or impairment of these muscles, producing dysfunctions ranging from debilitating pain to irritable bowel syndrome to skin disorders to erectile dysfunction and/or lowered libido.
* HUGE point here. because the pelvic floor muscles are so closely interconnected, any kind of disorder anywhere in the pelvic floor can have an impact on any or all of the pelvic floor’s other functions. You might strain a muscle during a gym workout and find that you are having a hard time fighting a urinary urgency, or bowel dysfunction. One pelvic floor dysfunction may lead to another, and another. It can also affect the upper and lower body! Maybe foot or leg pain.
This is why so many people who suffer from this disorder feel a combination of symptoms, and its rarely the first thing we think of for the range of symptoms the disorder can prompt. A case of diarrhea may send us to pepto bismul (i hope not) or gastroenterologist. Many are diagnosed as a problem with the organ. However the pain is just radiating from muscle, tissue, nerve, ligament, or all.
Its a system of strengthening, stretching, relaxation exercises, modifications to diet and lifestyle behavior, deep massage, hot and cold, and more modalities if needed.
I don’t have time to teach these in my office, so I usually refer out for different parts, however reading this literature, I may be posting a video soon to help patients be able to do some of this work at home. I mostly refer out to amazing pilates instructors, who I still will no doubt, but I didn’t also realize the important of stretching and relaxing some of these structures as well, which you would have to do at home.
The first steps are relaxing and stretching. The reason is that tensing our muscles may be an automatic reaction. We do it so often, so spontaneously, for so long that the tension settles into our bodies and the tightness becomes the norm. This is like when someone comes and massages our shoulders and they are like ROCKS. You didn’t know you had been tensing so much.
It’s important to let go an elongate the pelvic floor muscles and then strengthen the muscles around them. This provides support so the pelvic floor muscles don’t have to work so hard! it’s also important to massage certain muscles daily.
If you go in first just trying to strengthen everything, like by say, just doing kegels, it won’t work. If the muscles are already spasmed and you try to contract doing kegels, it will spasm even more or just won’t work. You must do the relaxation/stretching as well as getting regular sacral occipital work (what i do), beforehand. You don’t want to just go full out stretching something if there is an injury involved, so make sure you are getting some chiropractic care. There also might be a ton of scar tissue, so you must do relaxation and perhaps some scar tissue bodywork beforehand.
I will mentioned here two of the 11 steps in the first part of the program. They involve breathing.
Step 1. Breathe.
Deep-Breathe. Inhale- expand your belly outward and your ribs to the sides, and “open” your pelvic floor, without lifting your chest. Feel the air filling the “receiving areas of the lungs” making one big chamber.
Exhale- Obviously you’ll do the reverse as you exhale. Start from the top. Let the air out of your upper lungs, then relax your ribs, your belly, and your pelvic floor, so that the air just gradually flows out of you.
Step 2. Drop.
Stand, sit or lie down- whatever works for you. You may need to try varying positions before you find the one that suits you. Relax your body as much as possible. Close your eyes. Do a conscious deep breathing inhalation, for five seconds. Start your exhale. As you do, visualize your breath descending the chambers of your lungs and being pressed downward and out from your pelvis as you simply drop those pelvic floor muscles and let go. Breathe out for 4-6 seconds. Do five repetitions throughout the day.
If this visualization doesn’t work, the drop feeling is the feel you feel after you urinate. Thats the feeling you want to recall and reproduce for this exercise.
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After a few weeks/months of doing this, the strengthening part comes into play. This is why you want to keep charts of your symptoms to tell what is getting better/worse.
Strengthening isn’t about getting hard muscles either. Strong muscles improve your posture, and as you know a body better aligned, works better! It also assists in circulation, including your digestive system.
Strengthening includes core work, glute work, incorporating kegels and other exercises into the routines, and then moving into advances exercises. I cannot put all these exercises into this blog, but I perhaps will make a video or handout for those that need it.
And of course! I have a great referral system either Amie Wang at Play fit now, or Ariel at Pilates sante locally are amazing for the strengthening portions. If you want more information please let me know! They are rockstars in their realm. Amie also has amazing post partum care routines.
Of course depending on the symptoms you have with the pelvic instability, maybe its constipation, incontinence, diarrhea. You will need some nutritional variations, to decrease the inflammation and allow healing.
I hope this was informational and helpful to you all! I might start for myself this program as it is beneficial to everyone!.