Pelvic Floor Function and Dysfunction

My name is Miriam.  Like Janet, I work in the Health Promotion department at Positive Women’s Network.  It’s an honour to be blogging for her today, while she’s out of the office.  I have to confess right off the bat that I’m not yet in my middle years, but I’ve been looking forward to this opportunity to write about a topic that affects women of all ages but becomes more common as we age.

Like many women, I have experienced what I would have called “reduced bladder control” since the birth of my son two years ago.  When it started, I didn’t even think to call it incontinence, let alone pelvic floor dysfunction.  In fact, I think I told the doctor something along the lines of “I’ve been pissing myself”.  For many women, urinary incontinence expresses itself in small leaks when they sneeze or cough or exercise.  I guess this is what I had in mind when I thought about post-partum bladder issues, but it wasn’t like that for me.  I didn’t normally have leaks and I could even go out for a jog without any problems.  Mine was more of a “once-in-a-while-got-some-exciting-news-jump-up-and-down-OMG-I’m-peeing-and-I-can’t-make-it-stop” kind of problem … It turns out that both frequent little leaks and less frequent big leaks are signs that the pelvic floor muscles are not functioning as they should.

In my journey from my family doctor to the urologist and eventually to the pelvic floor physiotherapist, I’ve become a bit more knowledgeable about the subject.  The pelvic floor muscles are a group of muscles that connect the front of the pubic bone to the tailbone at the back.  They support (literally hold in) the bladder and reproductive organs, while the urethra, vagina and rectum pass through them and depend on them for for proper functioning.  To work properly, they also must cooperate with the abdominal muscles (transversus abdominis and multifidis).  Pain, poor alignment and/or movement patterns (wearing high heels all the time, for example), surgery and childbirth can all result in using this group of muscles in an unbalanced way.  It can cause lower back, pelvis or hip pain, as well as urinary or fecal incontinence.  Unfortunately, once the pain or trauma has passed, they don’t “snap back” to healthy function on their own.  Like any other muscle that’s been ignored or misused, they need to be worked and retrained.

About one in four women aged 40 to 59 are living with some kind of pelvic floor disorder.  Wow, like so many women’s health issues, that’s a lot of women experiencing something that many consider taboo to talk about!  What we do hear more and more about is kegel exercises and their importance for women.  These are the exercises that, if done correctly, can help prevent or reverse incontinence.  Unfortunately, 65% of people who think they know how to do kegels are doing them incorrectly.

I’m currently in the middle of the slow, humbling, and sometimes frustrating process of learning to do them correctly, so I’m definitely no expert.  I find the first page of this brochure from White Rock based Diane Lee & associates quite useful for learning to isolate and retrain the pelvic floor.  Venturing off in a completely different direction, I’ve just discovered biomedical scientist Katy Bowman who advocates against kegels.  Instead she recommends working on alignment and retraining ourselves to stop pulling our pelvis forward in the “tummy suck” that make us think we’re using our abdominal muscles …  She also advocates doing lots of squats and strengthening the glutes (butt muscles).  I have to do some more reading and consulting before I commit, but her argument is very compelling.

Wherever you decide to focus your energies, it is all about retraining this group of muscles to function properly.  It takes some research, if possible some professional support, and lots of patient, precise work.  Happy kegelling!

-Miriam
 

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