Pelvic Floor Dysfunction
What is it?
What is the pelvic floor?
The pelvic floor is a group of muscles and ligaments which support the bladder, uterus (womb) and bowel. The openings from these organs, the urethra from the bladder, the vagina from the uterus and the anus from the bowel pass through the pelvic floor. The pelvic floor muscles attach to your pubic bone at the front and the tail bone at the back and form the base of your pelvis.
What do the pelvic floor muscles do?
When the pelvic floor is strong, it supports your pelvic organs to prevent problems such as:
Incontinence (the involuntary loss of urine or faeces)
Prolapse (lack of support) of the bladder, uterus and bowel.
The pelvic floor muscles also help you to control bladder and bowel function, such as allowing you to ‘hold on’ until an appropriate time and place.
Mechanism of Injury
Some of the common causes of pelvic floor muscle weakness are:
Pregnancy
Childbirth – particularly following delivery of a large baby or prolonged pushing during delivery
Being overweight
Constipation (excessive straining to empty your bowel)
Persistent heavy lifting
Excessive coughing
Changes in hormonal levels at menopause
Growing older
What can I do to prevent damage?
To prevent damage to your pelvic floor muscles, avoid:
Constipation and/or straining with a bowel motion
Persistent heavy lifting
Repetitive coughing and straining
Putting on too much weight.
Make training part of your life by:
Tightening your pelvic floor muscles every time you cough, sneeze or lift
Doing some regular exercise, such as walking
Progressing your exercises by doing them in different positions e.g. on your hands and knees, standing or sitting.
Common Management Techniques
Make an appointment with the Physiotherapists at Palms Physiotherapy to get taught some Pelvic Floor Exercises!
Good Bladder Habits
A well-trained bladder will significantly help your pelvic floor and its ability to hold when you have the urge to run to the toilet.
Remembering to drink enough water throughout the day is very important for your bladder and general health. This means drinking enough water throughout the day to replenish any fluid lost through metabolism, bodily functions, daily activities and exercise. The daily recommended intake for an adult is 1.5-2 litres of water, just water, and should increase with hot weather or activity such as exercise.
However, it’s not just about how much but the quality of your fluid intake. Although it’s not what you want to hear, caffeine and alcohol are bladder stimulants. What this means is your bladder is told to empty before it should causing increased frequency in urination. What’s the problem here, you ask? Increased frequency means your bladder is unable to fill and stretch and this decreases the overall hold capacity of the bladder overtime and ultimately increasing your frequency.
One of the first things I look at with all pelvic floor clients experiencing incontinence is fluid intake and output. How much and what fluid is going in and when and how much fluid is coming out. On average your bladder should empty up to 7 times a day and 0-1 times during the night with a volume of 300-600ml. If a client comes back saying they empty their bladder 8-10 times a day then fluids need to be adjusted or they need coaching on how to hold on.
A bad habit that has developed over the years is going ‘just in case’. Going to the toilet before you leave the house or because you happen to be near a toilet is common, but not a great method to help your bladder. This will also lead to the increased frequency cycle. So instead of creating this bad habit, use strategies that will help you train your bladder and pelvic floor to hold on. Deferment strategies include: crossing your legs, sitting on the corner of the chair to apply pressure, contracting your pelvic floor muscles or if in standing then drop one hip. If none of those are working then distraction is always a good option. Defer for as long as you can to gradually train your bladder and pelvic floor to hold on.
Good Bowel Habits
Not only do you need to train your pelvic floor muscles, but you also need to train your bladder and bowel. Quite frankly, pushing on the toilet or running to the toilet due to loose stools will continue to stress your pelvic floor and are very uncomfortable to deal with on a daily basis.
Having a healthy bowel consists of easily passing soft well-formed bowel movements regularly. However, regular can mean different things to different people so anywhere from 3 times a day to 3 times a week. You should also be able to hold your bowel movement until you get to a toilet and the bowel movement should occur within one minute of sitting down. Bowels love routine, so find your ‘regular’ and make it a habit!
Constipation is bad for your pelvic floor. If you are struggling with constipation, you should try and get to the root of the problem. Make a diary of what foods you eat and any symptoms you have after each meal, documenting what kind of bowel movements and when they occur. You can use the Bristol Stool Chart for this (see below).
You may notice in your meal diary that you are lacking fibre, both soluble and insoluble. Soluble fibre can be found in oats, nuts and apples and insoluble fibre can be found in seeds, whole-wheat bread and brown rice. In combination with adequate water intake, they play a huge roll in keeping things regular on the journey through your digestive tract.
Another factor in constipation is the position you sit on the toilet. We were designed to squat in order to open our bowels and toilets don’t fit into that. So use a step stool to get your knees above your hips, lean forward with your elbows resting on your knees and let your belly relax. Your bowel will open as it was designed and straining your pelvic floor will not be necessary.
Prognosis
The Physiotherapists at Palms Physiotherapy are skilled in treating common pelvic floor issues and can effectively assist with relief and rapid recovery.