Human Performance and Rehabilitation Centers, Inc.

The Things We Take for Granted

Dr. Oz brought women’s health into the limelight in April 2014 with an episode about Pelvic Floor Dysfunction (PFD). His segment introduced a very well-known pelvic floor physical therapist, Amy Stein MPT, from Manhattan. If you viewed or missed his segment you might be asking, “I need a physical therapist for my what?” Don’t fret, let me explain. The pelvic floor is a group of muscles, nerves, and soft tissue that attach from the pubic bone in the front of your body to the tailbone behind, similar to a hammock.

Physical therapists are well known and effective in treating all types of muscle problems. We treat muscle strain, spasm, weakness, and tightness. We treat muscles after injury and especially after surgery to regain their best function. Are you still asking, “Do I need a pelvic floor physical therapist?” The answer may very well be yes. The Massachusetts General Hospital website states one in three women will develop a pelvic disorder in her lifetime.

Physical therapists are teaming with doctors to effectively and conservatively treat many types of pelvic floor disorders.

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The muscles of the pelvic floor serve the important function of supporting the organs in the pelvis, and assist in stabilizing and supporting the spine. They also play a role in sexual function and pleasure, indeed important muscles! It is these muscles that help keep us dry or continent and must relax in order for us to empty the bladder or rectum, and stretch to deliver a baby. We take for granted that these muscles will function throughout our lifetime, but sometimes they just need help.

In May 2014, Moore Magazine had an article highlighting all the treatment options for one type of PFD, stress incontinence. A physical stress from above the bladder pushes down on the organs in the pelvis and the muscles just do not have enough oomph to push back. This is a muscle problem. The pelvic organs are not well supported due to muscle weakness. Does your bladder leak with sneezing, coughing, laughing or lifting things? Think again about that physical therapist.

In 1948 Dr. Arnold Kegel developed exercises for women to reduce bladder leakage, assist in vaginal laxity, and support mild pelvic organ prolapse. Pelvic floor muscles can be strengthened just like any other muscle with properly prescribed Kegel exercises. But, one size does not fit all! So, if you were ever told to practice Kegel exercises, you were on the beginning of the right path…possibly. I hear many women state, “Oh, I tried Kegel exercise and they didn’t work for me.” Unfortunately, up to 51% of women are not able to perform Kegel exercises through verbal instruction alone (Bump et all 1991). Properly prescribed, instructed (squeeze and lift) and practiced (repetitions determined by your ability to produce and hold a contraction) Kegel exercises do work. You don’t have to squeeze your thighs or hold your breath or clench your buttocks, but you do need to learn to isolate the hammock of muscles in your pelvic floor. You can learn to exercise these muscles with your regular gym workout, and no one will know the difference, except you. You will be more comfortable, dry and less anxious about finding a bathroom. Take a look at www.totalcontrolprogram.com or www.nafc.org for more info.

Kegel exercises are NOT all we do. Not all women or men need or should even try to do Kegel exercises. For various reasons, pelvic floor muscles can also become short and tight, and lose their ability to relax. Symptoms of tight muscles might be pelvic and low back pain, constipation, finding it hard to empty the bladder or bowel, or experiencing pain with intercourse. Physical therapy can help with that too. Manual techniques to soften and lengthen muscle tissue and reverse Kegel exercises help to restore function and reduce pain.

The muscles of the pelvic floor are especially vulnerable in women due to pregnancy and delivery, but are important in men’s health as well. Dysfunction has multiple causes and affects all ages. The National Association for Continence (NAFC) website reports it takes an average of 7 years before a woman will discuss her bladder problems with her physician. Ignorance is not bliss. Your doctor can guide your treatment. The GOOD news is pelvic floor dysfunction is treatable, and a physical therapist that specializes in the pelvic floor can offer conservative options.

In September 2014, The American College of Physicians released guidelines for non-surgical solutions for uncomplicated stress incontinence. These guidelines include pelvic floor muscle exercises, bladder training and weight loss as effective options, and recommended conservative options as a first choice of treatment.

A pelvic floor physical therapist specializes in understanding and treating the multiple problems of the pelvic floor muscles. We can help you find your muscles in your pelvis and learn to control them. We can help that got-to-go feeling with a bladder training program. A pelvic therapist will complete a comprehensive pelvic floor muscle exam, digitally examine the pelvic floor muscles, evaluate posture and examine the joints of the low back and pelvis and prescribe appropriate treatment options.

There is HELP and HOPE for your pelvic health problems! You will be grateful for those hidden muscles once they are no longer hiding from you!

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