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!
Blessings,
Carrie
The Parenting Passageway 
Hi Carrie!
I’m curious if you’re familiar with Katy Bowman’s work and what you think of it. She has written many books including Move Your DNA, Diastasis Recti, and many more. She includes various stretches and exercises for pelvic floor issues as well as lifestyle changes. I would love to hear your thoughts on her different approach.
As a (student, almost done!) midwife, I have seen how pelvic floor dysfunction can impact the way a baby is aligned in the pelvis during birth and feel like this can lead to cesarean. This is often speculative as the woman may not have known of any dysfunction. We have seen it happen more often in woman who are highly athletic. If a woman comes to us for a second baby after having a c section for the previous baby due to an asynclitic head or a failure to progress after everything has been tried, we usually ask her to work with at PT who specializes in the pelvic floor. And in our town of 14,000 we have two practices (4-5 PT’s) who specifically specialize in pelvic floor dysfunction. So cool!! I feel we are just at the beginning of understanding how the pelvic floor affects birth and how our sedentary lives (even those that exercise daily) affects our pelvic floor.
Would love your thoughts! Thanks for all the many posts I have loved through the years!
Kristen
On Thu, Oct 4, 2018 at 8:55 AM The Parenting Passageway wrote:
> Carrie posted: “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 ” >
Hi there Kristen! I am not familiar with Katy Bowman’s work but I have just started delving into this area. That is amazing that your town has two practices of pelvic floor therapy! We have numerous practices here, but I have to be honest and say when I talk to therapists, there are only several practitioners that really seem to stand out. I think we are just beginning to understand a lot of things – how visceral manipulation can affect infertility and PCOS, how to best treat diastasis recti, and more. Many blessings, Carrie
Dear Carrie,
*Thank you!* for this post!!! It is so timely for me as I have just begun to look into physical therapy to help me with low back and side aches. I’ve had a consultation with a PT and also with a DO (for osteopathic manipulation) and neither of them mentioned that it might be a pelvic floor issue! I have had no obvious back injuries and I even went to try Arvigo (Mayan abdominal) massage thinking perhaps I had some issues with prolapse. This post is SO interesting to me. How do I go about finding a physical therapist knowledgeable in pelvic floor issues? Do I simply call up various offices and ask? Is there some sort of national certification/organization that lists therapists trained in these issues? And do you have a resource for how to do Kegels correctly? (I’m thinking to our Bradley childbirth class and now I’m wondering if we learned them correctly!?) Thank you so much for sharing your knowledge with the rest of us!
Kate
Hi Kate! I think you could try the list from Herman & Wallace, which is a provider of continuing education classes and certification in the pelvic floor: https://pelvicrehab.com/?utm_source=hwdotcom&utm_medium=mainmenu
or through the Women’s Health Section of the American Physical Therapy Association: https://www.womenshealthapta.org/
I would start there! Hope you find a knowledgeable P.T. I think all orthopedic physical therapist’s should be cross trained at least to screen for pelvic floor dysfunction. I hope you find exactly what you need. ❤ Blessings and love, Carrie
Thank you for this, Carrie! Diastasis recti separation is so closely related to pelvic floor function. Doctors and physical therapists are grossly under-educated about diastasis recti. Most postpartum women with diastasis recti separation are either told to do more sit ups (the worst thing!) or told that surgery is their only option.
Many of us are told to just accept our postpartum bodies and that we’re being vain if we don’t. But this is a matter of health! Diastasis recti separation can affect your overall energy level, as well as contribute to back pain.
My young daughter has mild DR, and we’re told by her pediatric PT to do plank/wheelbarrow walks and twisting sit ups (again, the worst thing for DR!!!). All health care providers mean well, but the health care profession needs mass education about the “mummy tummy” for women and the “beer belly” for men, as well as how to prevent umbilical hernias through proper core strengthening.
I’m just a mom with severe DR (not a physical therapist or any kind of medical professional), but with much personal experience and trial and error, I have worked with multiple physical therapists and haven’t been fortunate enough to find one who could help me progress. I have learned a lot from The Tupler Technique and even more from Carrie Harper of CarrieFit.
Information about DR and pelvic floor function has increased over the past few years, and I hope that solid information and good standards of practice will one day become widespread in the medical profession.
Thank you for spreading the word, Carrie!
Planks and wheelbarrow walks and situps — UGH! So glad that you know better and can also help spread the word. I too am hoping that solid information gets out there! Blessings, Carrie
Very informative post! I have Interstitial Cystitis (IC), also known as Painful Bladder Syndrome. Pelvic floor issues are common with IC patients. I had dry needling to help. I started a blog to share my story and hopefully encourage and support others with IC and pelvic floor issues. https://treatinginterstitialcystitis.wordpress.com Please visit my blog. I, along with my readers, would benefit from your knowledge! Again, thanks for a great post.