The pelvic floor is a group of muscles located deep within the abdomen and pelvis that are integral parts of proper bowel, bladder, and sexual function for both men and women. As they are a group of muscles, they can be treated by a specialized physical therapist. Below are five common signs of pelvic floor dysfunction that can be treated or managed by a trained physical therapist as well as five tips from Jessica Russell PT, DPT, a pelvic floor therapist within the Kennebunk community.
1. You have leakage
If you have leakage of urine, bowel, or gas, you may have a poor functioning pelvic floor. Contrary to popular belief, incontinence as you age or following labor and delivery is not a part of normal function. Leaking a few drips or losing the entire contents of the bladder during physical activity, sneezing, coughing, or laughing are all indicators of a dysfunctional pelvic floor. A pelvic floor should function appropriately at any age and in any capacity. This means that no matter the situation, it should be able to stop hold back urine, bowel, or gas. Leakage can be caused by weakness but is also linked to muscle tension or misfiring/dyscoordination of the muscles and before you go straight to kegels, you should figure out what treatment approach will most cater to your individual needs.
2. You go to the bathroom all the time
On average, you should empty your bladder every 2-4 hours. This means anything more frequent than that may be considered bladder frequency. This occurs if the stretch reflex of the bladder becomes hypersensitive, causing it to perceive being full faster than it actually is. If prolonged, this can alter the function of the bladder and the musculature of the bladder resulting in the need to empty the bladder more frequently due to a smaller threshold for holding urine.
3. You have sudden, severe urges to use the bathroom that are hard to control
Have you ever got home from work and the entire drive home you had no sense of your bladder filling or being full but as soon as you walk up your front steps to the house you have to go to the bathroom, and you have to go right NOW? This is called Key in the Lock and it’s indicative of bladder urgency. This means throughout our day to day routine we have conditioned ourselves to go to the bathroom at certain times, in certain locations, or during certain activities. This can negatively affect your overall bladder health as you become conditioned to using the bathroom at specific times resulting in the dire need to use the restroom.
4. Intercourse is painful
This is the most sensitive of topics, but intercourse should be a comfortable and enjoyable experience for those involved and if it’s not it can affect one’s self-esteem, emotions, and relationships. The pelvic floor must function, for both men and women, appropriately to have enjoyable sexual health and function. A part of dysfunction is muscle tension, tenderness, or spasm, can all result in discomfort with intercourse.
5. You are pregnant or have delivered children
During pregnancy the body goes through many changes. Muscles, ligaments, and joints have to become stretched and relaxed by release and production of Relaxin as the baby grows as well as to create space for improved ease of delivery. This can create issues such as low back pain, sciatica, SI joint dysfunction, and pubic symphysis separation. Symptoms stemming from these issues can be lessened through proper strengthening of the deep abdominals and the pelvic floor musculature. Following pregnancy, if the pelvic floor does not return to proper strength or length, issues related to incontinence, low back pain, or pelvic pain may continue.
What you can do to manage your own symptoms...
The most important aspect of proper bowel and bladder health is to stay properly hydrated. As we become dehydrated, the concentration of urine becomes higher which becomes a bladder irritant and you will need to go to the bathroom more frequently. The new recommendation for proper water intake is to take your body weight (in pounds) and divide it by two. This number is the amount of ounces of water you should consume in one day. If this seems like a lot, it is! But it is individual and specific to your body size. Keep in mind that increasing your water intake suddenly may make incontinence, frequency, and urgency symptoms worse until your body is able to filter the water appropriately, so slowly increase your water intake until you reach your goal.
2. Limit intake of bladder irritants
Bladder irritants cause increased urination due to the fact that the bladder will want to dispel these as fast as you will let it. Common bladder irritants include coffee (including decaf!), caffeine, carbonated beverages, alcoholic beverages, artificial sweeteners, and foods high in acidity. If you consume these types of beverages or foods and do not want to eliminate or ration the intake of them all, you may want to supplement with water or find different options that are available to you.
3. Try a voiding schedule
If you find you are going to the bathroom many times in an hour or frequently throughout the day, challenge yourself to make a voiding schedule. Start by voiding every hour and as that becomes easy, increase by 15-30 minute increments up to 4 hours. This will slowly stretch the bladder allowing it to tolerate more volume without need to urinate.
4. Use lubricant
If you are having discomfort with intercourse, lubricant is a good first line of defense to help minimize these symptoms. Either natural or artificial, lubricant can help decrease friction and irritation that may cause discomfort.
5. Focus on the core!
The core is made up of three different muscle groups—the pelvic floor, the transverse abdominus, and the multifidi. These muscle groups have to work as a unit to provide good stability and strength of the low back, pelvis, and hips. For good mobility at the extremities, you must have good stability from the core. Proper core strengthening will help strengthen and improve function of the pelvic floor due to the co-contraction of the pelvic floor with the transverse abdominus and the multifidi.
Jessica Russell PT, DPT is a pelvic floor therapist practicing at of Saco Bay Orthopaedic and Sports Physical Therapy. She has been treating general orthopedic conditions at Saco Bay for over 2 years and has 1 year experience evaluating and treating patients with pelvic floor dysfunction. This includes bladder retraining, myofascial release, soft tissue mobilization, exercises, and functional training. If you are interested in more information about the pelvic floor, bladder health, or core strengthening, be on the lookout for an upcoming seminar at Spurling Fitness.