And should we kegel or not?
These are some of the questions that our patients post to us, some are not even aware these are questions that women should raise up especially during and after childbirth.
In a nutshell, kegels are not for everyone...plus, even when they're prescribed, they're often not done properly, which can be either non-useful or even causing pain.
Pelvic Floor Dysfunctions can be caused or aggravated by the following:
Please take note that kegel exercises are not always the one and only solution to pelvic floor problems; they can exarcebate the problem and often they are not done properly.
a study called the Cochrane Collaboration 2010, the conclusion was that
physiotherapists with training in pelvic floor physiotherapy and
rehabilitation should be the first line of defence for pelvic floor
abnormalities, before surgical consultation in women.
Many women with pelvic pains have pelvic floor dysfunctions, but usually it's very specific to either over-tight (hypertonic) muscles.
You see, the pelvic floor muscles are a group of muscles that attach to the front, back and sides of your pelvic bone and sacrum (see picture). They behave somehwat like a sling or a hammock, and it serves to support your bladder, uterus, prostate and rectum. The same muscles also wrap around your urethra, rectum, and vagina (in women).
These muscles must be able to contract (tighten) and relax properly to ensure continence, allowing for normal functioning of urination, bowels, and in women, for sexual intercourse.
What happens when these muscles have too much tightness (hypertonic), they will cause pelvic pains or urgency/frequency of the bladder and bowels. When the same muscles are lax (termed as hypotonic), it will cause stress incontinence and even organ prolapse.
You can also have a combination of both too tight and too laxed pelvic muscles at the same time.
Pelvic floor dysfunction is diagnosed by specialist doctors and physiotherapists using internal and external manual techniques to evaluate the function of your pelvic floor muscles (for your comfort, we only practice external manual techniques)
They will also assess your ability to contract and relax these muscles. At the same time, your bones, muscles and joints of your lower back, hips and sacro-iliac joints will need to be assessed as well, as they can also strain your pelvic floor muscles.
If/when your pelvic floor muscles are too tight, causing weakness, then pelvic floor physiotherapy will begin with treating the tension first before treating the weaknesses - only once the muscles have reached a normal resting tone, and able to contract and relax normally, then the strength is assessed and strengthening exercises are prescribed.
Education for the purpose of self care is a very important part of pelvic floor physiotherapy.
You have to avoid pushing or straining when urinating, and do ask your health care provider how you can manage constipation.
Being able to actively relax the pelvic floor muscles is important, and doing reverse kegels may be one of the solutions that will help you lengthen these muscles.
Having warm baths twice daily can also help to relax the muscles, as heat therapy does encourage muscle relaxation and blood flow.
In some situations, medications such as compounded vaginal or rectal diazepam can be quite useful and they may be prescribed by your doctor - they help as muscle relaxants in your vagina or rectum.
You will also need to have good posture to keep unnecessary pressure off your bladder and organs, as well as employ other stretching methods such as yoga to help prevent tightening and spasms in your pelvic floor muscles.
Educating on managing persistent pain is a very important part of treating and managing pelvic floor dysfunction, as the pelvis/pelvic area is an area where we often hold our stress.
Stress, anxiety, negative thoughts and beliefs can actually aggravate the pain in our pelvis, which is why understanding how our pain system works has been proven to be an effective method to reduce the problem of pelvic floor dysfunction.