Kegels are not: “One size fits all”
Who has ever been told to do a kegel? And when you do it, how many of you squeeze your buttocks or legs together and hold your breath??? Kegels are not for everyone, and even when needed are often not done properly!
Pelvic floor rehabilitation is usually indicated for stress, urge and mixed incontinence as well as pelvic pain in women and believe it or not, men.
Pelvic floor physiotherapy should be the first line of defence, before surgical consultation, and is becoming more established in the literature as a first-line of defence against incontinence and pelvic pain.
The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around your urethra, rectum, and vagina (in women).
These muscles must be able to contract to maintain continence and relax to allow for urination, bowel movements, and in women, sexual intercourse.
Pelvic Floor Dysfunction can be caused by:
HYPOTONICITY (Weak pelvic floor muscles):
Contributing to stress incontinence and urge incontinence
Pelvic organ prolapse.
Incontinence is NOT a normal part of aging.
HYPERTONICITY (Tight pelvic floor muscles):
Urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying
Constipation, straining, pain with bowel movements
Unexplained pain in your low back, pelvic region, hips, genital area, or rectum
Pain during or after intercourse, orgasm, or sexual stimulation
Uncoordinated muscle contractions causing the pelvic floor muscles to spasm
Many people with pelvic pain have pelvic floor dysfunction, but specifically hypertonic muscles, or muscles that are too tight. When these muscles have too much tension (hypertonic) they will often cause pelvic pain or urgency and frequency of the bladder and bowels. When they are low-tone (hypotonic) they will contribute to stress incontinence and organ prolapse. You can also have a combination of muscles that are too tense and too relaxed.
Pelvic floor dysfunction is diagnosed by specially trained doctors and physiotherapists by using internal and external “hands-on” or manual techniques to evaluate the function of the pelvic floor muscles. They will also assess your ability to contract and relax these muscles. Your bones and muscles of your lower back, hips and sacro-iliac joints will need to be assessed as well since these joints can stress your pelvic floor muscles.
Therefore, kegels are NOT always indicated for pelvic floor problems and sometimes they do more harm than good. When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Pelvic Health Physiotherapists perform a number of different muscular release techniques internally to relax these muscles as they would an external muscle with stretching, trigger point and myofascial release. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and strengthening exercises are prescribed, if appropriate. A key reason why a pelvic floor assessment is critical prior to exercise prescription.
Pelvic floor training is more difficult than it seems. Kegels are often not performed correctly, with compensation occurring by holding your breath or squeezing the buttocks and legs together. Pelvic floor physiotherapy is very useful in teaching women how to effectively contract the pelvic floor; know how long they are holding the contraction and increase strength in the muscles.
All of the conditions listed above are common and should be spoken about. There is a level of shame associated with incontinence and/or pelvic pain. Hopefully, with increased education and awareness, shame will be replaced with treatment.
For more information on whether or not you require Pelvic Floor Physiotherapy please contact East York Massage and Physiotherapy Studio at 416.285.1777 or email www.eastyorktherapy.com. Follow us on Instagram @eastyorktherapy or on Face
book at East York Massage and Physiotherapy Studio.
Fanaye Whyte, PT
East York Therapy