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You asked. Pelvic Floor Physiotherapist Lisa answered.

A few weeks ago, I was at the weekend birthday get together of a friend of mine with a bunch of other women, most of whom I hadn't met before. My friend introduced me as the person to talk to about pelvic floor stuff and I was more than happy to talk about pelvic floor restorative action that anyone can take right away. Like considering a change of foot wear, sitting and especially slouching less, walking much more, doing hip and butt strengthening work, learning to breathe properly and, of course, to seek out a local pelvic floor physiotherapist (besides working with a Restorative Exercise Specialist, because those peeps can be a rather valuable resource, hint, hint!). 

So while everybody knows what Nutritious Movement aka Restorative Exercise is (OF COURSE!), it turns out that not every woman knows that pelvic floor physiotherapists exist and that pelvic floor issues don't have to be endured and accepted BUT that dysfunctional pelvic floors CAN PERFORM AGAIN!

Turns out that there are women out there who are too shy to talk to their friends about their pelvic floor issues. 

And it turns out that if they talked to their friends about their pelvic floor issues, they'll discover that at least one of them has the same problem and that at least another one of them can recommend a pelvic floor physiotherapist. (Maybe not if you live in a small town.) 

So, I figured that there are a bunch of women out there who are too shy to ask questions and I collected some of those questions via an anonymous online questionnaire. I then asked Ottawa Pelvic Floor Physiotherapist Lisa Flanders to answer them. And she did. Because she is just awesome.

You'll find the Qs and As below. At the end, you'll find additional resources to help you get a healthy pelvic floor. 

Q: I was diagnosed with a rectocele after my second baby.   Sometimes when I need to poop I will get sharp pains in my anus.  Is this due to the rectocele? And what can I do to prevent this?

Also recently I've been getting a heavy cramping in my anus.  It feels like period cramps, but not at all related to it.  It's only been early in the mornings while lying in bed.  Again is this the rectocele? Thank you!

A: A rectocoele is the bowel (rectum) either collapsing into the posterior vaginal wall or distending outward through the anus.

The sharp pains can be caused by a variety of factors. When the rectum is collapsing into the vagina, it can create a hollow where the bowel movement can store, over time this can become hard making evacuation difficult, creating pain on evacuation. Other avenues to explore include rectal fissures (small cracks in the tissue surrounding the anal verge) due to constipation, hard/dry bowel movements and difficult bowel movements.

The cramping feeling in the mornings may be related to constipation or dietary factors. With a rectocoele, sometimes-complete bowel emptying is interrupted. Another explanation is increased muscle tension in the posterior pelvic floor, creating constipation and difficulty with complete emptying. I would recommend an internal exam by a pelvic floor physiotherapist as well as exploring dietary factors with a naturopathic doctor or holistic nutritionist.

Q:  I have intermittent pee control since giving birth 3 years ago, i.e. fine for a few months and then I can just make it to a bathroom on time.  Aside from kegels what can I do?

This is called urge incontinence (urgent need to urinate and leakage while trying to make it to the washroom). This can be related to pelvic more muscles that are too weak, however kegels may not be the solution. Most women do not do kegels correctly. Kegels are also typically done in a static manner (lying down or sitting at a stop light). The muscles must be retrained in a functional manner.

Often urgency is circumstantial, related to running water or getting home from work and putting the key in the door. It can be as easy as changing your self-talk. If you feel the urge to urinate, tell yourself “I will go when I have my pants pulled down and I am sitting on the toilet.

Q: Does having sex make my uterine or bladder prolapse worse? 

Pelvic organ prolapse means the bladder, uterus, or rectum are falling into the vagina. Symptoms are often worse with increased intraabdominal pressure (breathing holding or valsalva).

Having penetrative vaginal intercourse with a prolapse will not make the prolapse worse (actually penetrative vaginal intercourse will provide some support for the prolapse during). It is important to use a natural personal lubricant, as the vaginal wall is usually a bit thinner with prolapse.

My favorite lubricants
1. Yes Oil-based: Organic, made with almond oil (watch for allergies) but not condom compatible
2. Sliquid: Natural, Water-based, and compatible with condoms.

Q:  In your opinion, what effect does wearing heeled shoes have on pelvic floor function?

High heels can be great for a special occasion or night on the town but should not be worn daily, especially if you have an active profession or lifestyle. I have one pair of heels that I just love, but I call them my “sitting shoes” because I will only wear them if I am going to be sitting most of the evening.

Wearing high heels too often can affect and shorten your posterior chain meaning the muscles found on the posterior part of the body. What does this do to your pelvis and pelvic floor? It will cause an under or over rotation to the pelvis (depending on compensation patterns) meaning the muscles attached will work in a non-optimal pattern. The tailbone will either tuck under (shortening the sling) or over extend (over-stretching the sling). Either way it will affect the pelvic floor, tense muscles are involved in painful intercourse, constipation and incontinence, a tense muscle is not a functional muscle, muscles must be able to relax fully and contract fully to be functional. The tailbone is the base of the spine so how it moves will affect the spine all the way up to the neck and will create dysfunction.

If you are going to wear high heels, even just one evening, it is necessary to stretch and mobilize the posterior tissue following.

When choosing a pair of heels for a special occasion, choose supportive heels. This means a thicker heel or wedge, a soft gel insole and a wide toe box so your toes aren’t squished.

Q: After delivering my 3rd child naturally, I find it hard to fully empty my bladder at one sitting. I pee, and I can feel that there's more, but it seems stuck no matter how long I try to "relax" and wait, and as soon as I give up and get up, I feel that I'm able to go. Is this a pelvic floor dysfunction? (FYI, I have a deep diastasis and have occasional leakage issues).

Great question as I hear this often. This may be related to the position of your bladder following delivery especially if it is prolapsing into the vagina (even slightly). The position of the bladder can mean that there may be a ‘kink’ in the line between the bladder and urethra similar to how you can ‘kink’ a garden hose to stop the water flow. Positioning on the toilet can be beneficial leaning the belly button forward toward the knees. Also have an evaluation of the bladder position with a pelvic floor physiotherapist.

Q: As a dancer and pilates teacher I spend a lot of time engaging my pelvic floor.  What exercises/release techniques can you recommend to help make sure that the muscles get some 'down time'?

My number one exercise for relaxing the pelvic floor and giving downtime is diaphragmatic breathing.

Lie on back, knees bent and inhale through the nose. Breathe out through pursed lips (like you are whistling) as this slows the oxygen exchange. Focus on long, slow, smooth breaths.

Q: Why do I feel the urge to go with only a small amount of urine. Not always, just at certain times?

Urgency can be triggered by certain events or routines. Often hearing running water can trigger the need to urinate. Another common trigger is coming home and putting the key in the door, often called “latch-key” urgency. This is often a miscommunication between the bladder and the brain. Start by trying to pinpoint what is triggering you and using self talk (to reassure yourself that you do not have to urinate) and relaxing exercises such as diaphragmatic breathing.

 

RESOURCES

Find a Physio
Find a Pelvic Floor Physiotherapist in Ontario (just type in your city and click pelvic floor and search)
Find a Pelvic Floor Physiotherapist in Canada and the USA

Find a Nutritious Movement certfied Restorative Exercise Specialist
Find a Teacher

Katy Bowman's Nutritious Movement For A Healthy Pelvis: Digital Download (US19,95) click on the image

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Alignment Snacks
are 20-30minute downloadable classes with Katy Bowman, each focusing on a certain area of the body. They are $5. Here are two of them that address the pelvis and the muscles that surround it:

All Fo The Pelvic Floor (click on the image)
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Balance Using Lateral Hips (click on the image)
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