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26 Jan, Thursday
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Montreal Families

Find relief with pelvic floor therapy

Other than performing the occasional Kegel exercise, many of us barely give our pelvic health a thought. Even during routine appointments or post-labour checkups, the pelvic floor is rarely talked about. But while leaking bladders (when sneezing) and lower back pain are laughed off as part of the “joys” of being pregnant or growing older, it doesn’t mean that they’re normal or something that women need to put up with.

The pelvic floor, which is actually more similar to a bowl, is central to a wide variety of disorders — painful sex, bowel problems, chronic pelvic or back pain, heaviness into the vagina, pregnancy-related conditions, and bladder issues. According to a 2014 study published in Obstetrics & Gynecology, 25 per cent of U.S. women as young as 20 reported experiencing at least one disorder.

A complex structure

Although many women experience these issues, they can be sensitive to talk about. But whether pelvic problems have come on suddenly, or have hung around for years, there are therapies that may help or alleviate symptoms.

Marie-Josée Lord, pelvic health physiotherapist and owner of Kinatex Centre de Santé Pelvienne in Pointe-Claire, has been treating patients in the West Island for the past 31 years. She also owns Uro-Santé, a teaching company founded in 1994 by herself and Claudia Brown, a fellow expert in the field.

Lord notes that when she first started her career, most patients who she treated came in for urinary incontinence. But, she explains, pelvic floor health is much more than a single condition that comes with a one-size-fits-all set of exercises. “The muscles are at the base of the pelvis and are like any other muscles of the body; they need to work properly,” she says. “They need to be able to contract, and to relax.” Lord explains that while the pelvic floor muscles take care of the urinary system, they are also crucial to the ano-rectal system and sexual function — penetration and pleasure for women and erections in men.

These muscles also play a big role in the abdominal cavity (the abdominal muscles, the spine in the back, and the diaphragm at the top). “A lot of people have a pelvic floor that may not be functioning adequately and they might end up having back pain,” Lord says. “Or their muscles or fascia are not contracting or relaxing when they’re supposed to. [Doing] core exercises is huge right now, but that starts with the pelvic floor muscles. So if people are not aware of how to adequately recruit their pelvic floor, they’re not going to be doing good core exercises and they may cause other problems.”

Even breathing, something we don’t generally think about, can have negative effects on the pelvic floor if the diaphragm is not properly engaged. “It will exert a certain pressure on the pelvic floor and could cause dysfunction like urinary incontinence, a tight pelvic floor, pain with intercourse, organ prolapse, or chronic pelvic pain.”

As with anything that’s not talked about openly, misinformation often comes from internet searches or from well-meaning, but inexperienced sources. One incorrect assumption is that Kegels are the cure-all for these types of issues and that women have chronically weak pelvic floor (when it may be an overactive one).  “Sometimes people will be doing these exercises and they’re supposed to be doing the opposite, they should be relaxing their pelvic floor because it’s too tight.”

Lord says that painful intercourse — which affects 16-20 percent of women, many in their late teens and twenties — is one example of a condition that can be due to tight pelvic floor muscles. Because of their location and how they function, knowing that these muscles are tight is very difficult unless you’re being taught how to relax them. “You can have someone that has difficulties starting the flow of the urine, a hyperactive bladder, or an overactive bladder, which means that the person has increased frequency or urgency. If they’re doing contraction exercises, like Kegels, they’re just going to make the problem worse. We need to work on the opposite,” Lord says. “Sometimes a hypertonic pelvic floor — so a tight muscle — does not mean that it’s strong. It actually gets tired very quickly.”

Pregnancy and a healthy pelvis

If you are pregnant, learning to release or relax the contraction of the pelvic floor muscles is important for optimal function and to ease delivery. “We also give exercises that they can do with their partner to start elongating the pelvic floor and have that feeling of stretching,” Lord says.

Therapy during pregnancy can also help those suffering from pelvic girdle pain — pain in the back, hips, pubic bone, and groin — and issues such as pain in the sacroiliac joints or pain during sex and intimacy. Post-birth, it may help with vaginal scarring and pain, contraction or relaxation of pelvic floor muscles, and gentle exercises can be given to work the inner core like the transversus abdominis muscle.

Lord says an important part of recovery from a cesarean birth is working the surgical scar and the abdominal cavity. “If the C-section scar is not mobilized and there’s scar tissue pulling, there can be pain with intercourse because of the pulling of the fascia that goes into the pelvic floor,” Lord said.

Whether problems arise during, right after childbirth, or much later, Lord says that it is never too late to seek help.

What to expect

The complexity of pelvic health means that sessions are in-depth and longer than a standard physio session. During the first appointment, Lord will take the person’s history and ask detailed questions followed by a physical evaluation that respects each person’s level of comfort. An internal exam similar to a gynecological exam will be performed at the first or a subsequent appointment to determine how the muscles of the pelvic floor are working. 

Based on the findings and whether there are painful points or weaknesses, manual techniques, bio-feedback, or electrical stimulation may be used and people will be taught how to recruit or relax their muscles and given exercises to try at home.

Not only for women

It’s not just women who have had babies or people of a certain age who experience issues. Though this set of muscles is most often associated with women, prioritizing the pelvic floor is an important part of everyone’s overall health. Therapists can also address pelvic-related concerns for men, children, and the trans population through a variety of treatment options. A free 20-minute call can be scheduled to assess your needs.

For more information visit kinatex.com/centres/sante-pelvienne


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