Yesterday I went to a course about fucntional rehabilitation of the pelvic floor. For a long time, pelvic floor was associated solely with “female issues” and while urinary and fecal incontinence are the number one and number two reasons for admittance of the eldery to nursing homes, many people didn’t seem to be willing to look into options for treating the challenges.
I am happy to see that times are changing. Physical therapists (and hopefully doctors) are screening the genitourinary (so urinary, colo-rectal, reproductive systems) system just the way physical therapists screen all systems of the body. (For the record, this includes the integumentary(sking), neurological, musculoskeletal, cardiovascular, and respiratory systems for therapists plus gastrointestinal and genitourinary systems along with general constitution, eyes, ear/nose/throat, hematological, immune, endocrine, and pyschiatric systems).
The pelvic floor is a region with over 20 muscles in 3 distrinct layers, and yes, men have a pelvic floor as well. The pelvic floor provides support for the pelvic organs. Genitourinary and reproductive function includes excretion, urination, urinary sensations, sexual functions, menstruation, procreation, genital sensations. Many doctors seem to forget that men have a pelvic floor as well. The pelvic floor also provides sphincteric control for the bladder and bowels, supports sexual function, supports stabilty of the back as part of the core muscles of the body, and supports the lymph system.
Some of the main issues pelvic floor physical therapists work with include elimination disorders of the bowel (constipation, incomplete emptying, incontinence), pelvic organ prolapse (when the pelvic organs are no longer in the right place due to loss of muscle, fascia, or ligament support), pelvic pain, nerve pain. Incontinence also rises with diseases such as insulin-dependent diabetes, chronic pulmonary disease, and more. Low back pain is also associated with pelvic floor problems, and EVERY low back pain patient should be screened for pelvic floor problems. You would hate to have a back surgery when the real problem is something in your pelvic floor that a back surgery will not fix! Pre-existing incontinence, gastrointestinal problems, and breathing disorders are also associated with developing low back pain.
Incontinence is a big deal because it is a huge independent predictor for falls and injuries, depression, and nursing home placement. But you don’t need to be over 65 to have incontinence. There have been studies on elite athletes and incontinence. 17 percent of elite female athletes are noticing incontinence for the first time in JUNIOR HIGH and 40 percent of elite athletes are noticing incontinence in HIGH SCHOOL. You are actually 1.37 times to have urinary incontinence in middle age if your strenuous activity exceeded 7.5 hours per week during the teen years. Leakage of urine is failure of the tissue to handle the repeated load put upon it – if you keep straining the pelvic floor muscles repeatedly, the incontinence will just grow!
There are many ways to rehabilitate the muscles of the pelvic floor, and Kegel exercises (which most people do INCORRECTLY) are not the only way. Anyone having pelvic pain or leakage incontinence or suspiciion of prolapse should be evaluated by a therapist instead of just throwing a Kegel exercises at it. You will need more than one exercise to fix any of these situations, and “exercising” for pelvic pain might just make the pain worse. Pelvic physical therapists will work on posture (of the body and the posture/positioning of the pelvic organs), strength and endurance and coordination of the pelvic floor muscles in order to help challenges.
It was an interesting course, and nice to see physical therapy moving in the right direction in recognizing the pelvic floor as an integral part of core stability and as a body systems and a neuromuscular region that responds the way to rehabilitation as any other region of the body. There is hope!