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The Pelvic Floor Dysfunction: one of the most common, yet undiscussed, dysfunctions in women.

Did you know that around 50% of the population suffers from urinary incontinency, or the bladder leakage? And did you know that some studies suggest that upwards of 75% of women will suffer from pelvic floor dysfunction? Though not often discussed in the open, incontinence and pelvic floor dysfunction, along side their resulting morbidity, negatively affect millions of people every year. In fact, urinary incontinence is one of few chronic conditions, along with stroke and arthritis, that has been shown to have a severe impact on health-related quality of life in both men and women, across all age groups. Urinary incontinence can often get overlooked as a health condition, perhaps attributed to the stigma resulting in its undiscussed nature or its normalization as an ‘unavoidable part of life’. But, what was at one time considered a “hush-hush” topic is now the center of much discussion as an increasing amount of evidence is submerging to support the fact that bladder leakage is in fact a preventable and treatable problem.

Common myths about urinary incontinence:

– Urinary incontinence is normal: This is not true. It is very common, but it is not normal. A similar example would be considering a twisted ankle “ normal” in a soccer player. Though ankle injuries may be common in this group of people, the ankle is meant to strong and stable, not lax and painful. Yes, there are factors, such as age and gender, that cannot be modified and may increase the risk of incontinence. But, not all women over the age of 45 experience incontinence. This means that there are other factors, modifiable factors, at play that may determine whether or not you experience bladder leakage, namely: your pelvic health. Pelvic health, or the state much of bladder, bowel, and reproductive organs, is perhaps the most modifiable factor concerning urinary incontinence (as well as sexual dysfunction, pelvic pain, and pelvic organ prolapse). Pelvic health is determined by factors such as weight, smoking, inactivity, pregnancy and perhaps most importantly: the function of the muscles and tissues of your lower pelvic, also known as your pelvic floor.

– All bladder leaks are caused by “weak” pelvic floor muscles that needs to be “tightened up”. In fact, many times the muscles of the pelvic floor are too tight. Though they have an underlying weakness, they may first need to be stretched and relaxed before they can be strengthened.

– Kegals will cause all of my troubles to go away. Kegals, or “squeezing” your pelvic floor, can be an important part of pelvic rehabilitation, but they will not benefit those individuals with tight pelvic musculature. A similar comparison would be like strengthen a bicep muscle with bicep curls if your biceps is “stuck” in a bent position. You would probably want to stretch your arm out first, and then progress to the bicep curls once your arm is able to move more. Furthermore; back, hip, abdominal, and breathing problems can play a big role in pelvic pain and dysfunction. In such a case, performing kegals may only be addressing one piece of a very dynamic and complex puzzle.

So what can be done about Urinary Incontinence?

Believe it or not the bladder is a muscle. Your bladder works closely with the muscles of the pelvic floor to control the flow of urine. The pelvic floor works as a sort of trampoline, able to lift up and down to support the contents above it. Any kind of dysfunction in the “trampoline”, say the springs get loose or become stiff, will alter its mechanics and change its ability to function. Dysfunction of the pelvic floor can lead to incontinence, sexual dysfunction, pain, and pelvic organ prolapse. The good news is that since the bladder and pelvic floor are muscles, they respond to muscle training the same as any other muscles does. Proper training, including strength and endurance components, paired with education, manual therapy, and stretching, can rehabilitative these muscles back to optimal function.

The idea that the principles of physiotherapy can be applied to urinary incontinence is gaining popularity worldwide. In the UK, physiotherapy is the required first line of treatment for urinary incontinence. This means that individuals are sent to physiotherapy for “pelvic floor training” before surgery will even be considered. Studies have shown such good results that the International Olympic Committee invited a team of pelvic floor physiotherapist to the 2016 Rio Olympics. These therapists worked with the high level athletes who experienced pelvic pain and bladder leakage during their sport (just another fact that shows the prevalence of urinary incontinence across all demographics).

Here are a few tips to get you started:

Engage your core: The pelvic floor is part one of the four main components of your core. The diaphragm, transverse abdominals, and spinal extensors, make up the remaining three. These muscles work together to maintain the orientation of your torso, and the function of the organs inside them. Simple exercises such as “bridging” or planking can engage the core and spinal extensors and support your pelvic floor. Do not forget to keep breathing! Remember: the diaphragm works as part of the core, if you are holding your breath during exercise, the four components will not be working together effectively.

· Speaking of breathing, take a breath: Speaking of breathing…a good way to start moving the pelvic floor, regardless of if it is tight or weak, is by adding deep breathing to your daily routine. The diaphragm and pelvic floor work opposite of each other. A healthy pelvic floor stretches as we breathe in and contracts slightly as we breathe out. Start by finding a comfortable position and relaxing your shoulders. Breathe in slowly through your nose and try to make the air “reach your bellybutton”, hold for 1-2 seconds and slowly release.

· Modify the modifiable: As mentioned previously, there are factors that you can modify which can improve the health of the pelvic floor. These factors are: maintaining a healthy weight to reduce the downwards pressure on the pelvic floor, quitting smoking to improve circulation and lung function (remember the link between breathing and the pelvic floor?), and increasing physical activity by engaging in mild-moderate exercise (try 20-30 minutes of walking a few times a week).

A pelvic floor physiotherapist is trained and authorized to complete thorough assessments of the pelvic musculature. Their objective and subjective findings will allow your physiotherapist to create a treatment plan that is individualized to your lifestyle, based on your specific goals.

By Jenny Lee

Pelvic Health Physiotherapist

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