Pelvic Floor Exercise Program

I have been practicing as a physical therapist since 2005. In all of my years practicing in various settings, pelvic floor exercises and treatment have always mystified me. Yes, I took rigorous pelvic anatomy courses along with extensive anatomy and physiology during cadaver labs in school, but once I became an independent practitioner, I knew I was not equipped to properly help someone with pelvic floor dysfunction. I was not equipped to appropriately instruct my patients to treat pelvic floor dysfunction.

I quickly realized that in the field of physical therapy, a practitioner may choose various avenues that they wish to specialize in; orthopedics, acute hospital care, long-term rehabilitation, pediatrics, wound care just to name a few. I would be providing an injustice to attempt and treat an individual with pelvic floor dysfunction. Since this understanding as a new graduate, wherever I was working at the time, I would acquaint myself with practitioners around me understanding what they specialize in. This is vital to know when I am initially examining an individual, and know when they may have a condition that is outside my scope of specialization.

Unfortunately, with so few practitioners available in any given area, it can be difficult to locate a reputable pelvic floor specialist in your area. A good friend of mine, Dr. Alona Stein, who happens to be certified through the Pelvic Rehabilitation Practitioner Certification through the Herman & Wallace Pelvic Rehabilitation Institute, came up with an idea.

How about we get together and put together an amazing easy to follow pelvic floor dysfunction program that will be available to those that may not have insurance, reside in a rural or isolated environment without health services nearby, or those who would just like to be able to complete in the comfort of their own home.

After months of preparation, extensive research on development and understanding how long the program should be for optimal long-term benefits, Dr. Stein has developed the Desire Wellness Pelvic Floor exercise program for all to attain help with.

What exactly is the pelvic floor, and what dysfunctions may occur? A reputable website that I often point my patients, friends, and family to is WebMD. This is an article from their webpage, and it will provide you with a better understanding of the pelvic floor.

“Pelvic floor dysfunction is when you have difficulty coordinating your pelvic floor muscles, resulting in problems with urination, defecation (bowel movements), and having sex.

What Is Your Pelvic Floor?

The pelvic floor is a set of muscles that support many of your organs. In people with uteruses, it supports the uterus, bladder, and colon. In people with penises, it supports just the bladder and colon. The urethra, the vagina, and the anus are all openings in your pelvic floor.
Pelvic floor muscles are also known as PC muscles or pubococcygeus muscles.
You use these pelvic floor muscles to help control going to the bathroom and some sexual activity.

Symptoms of Pelvic Floor Dysfunction

The symptoms of pelvic floor dysfunction include:

• Difficulty urinating or having bowel movements
• Feeling like your bowel movements are not complete
• Leakage of urine or feces
• Frequently feeling the need to use the bathroom
• Feeling like you need to force out urine or feces
• Stopping and starting in the middle of urinating
• Long-term constipation
• Needing to change positions to get out a bowel movement
• Painful Urination
• Unexplained lower back pain
• Unexplained pain in your genitals, anus, or lower abdomen (pelvic region)

The symptoms can be different for people with penises and people with vaginas. In men, some cases of erectile dysfunction may be caused by pelvic floor problems. Additionally, the symptoms of this condition often mimic prostatitis, swelling of the prostate gland.

Causes of Pelvic Floor Dysfunction

Pelvic floor dysfunction can be genetic. Some people simply have weaker muscles and connective tissue.

However, it can also be caused by other things including:

• An injury to the pelvis
• Surgery in the pelvic area
• Aging
• Being overweight or obese
• Pregnancy and childbirth
• Using the bathroom too often or straining too hard when going to the bathroom

The most common causes of this condition in women are pregnancy, aging, and being overweight. If you were pregnant and did not deliver your baby vaginally, you can still get pelvic floor dysfunction. This is because pregnancy itself changes your pelvic area, regardless of how you give birth.

Since your nerves control your muscles, people with neurological disorders like Parkinson’s disease may also experience pelvic floor issues.

Diagnosis for Pelvic Floor Dysfunction

To diagnose pelvic floor dysfunction, your doctor will ask you questions about your health. This will include gathering information about your bowel movements, history of urinary tract infections, and any other conditions that can cause pelvic floor dysfunction. If you are a woman, your doctor may ask you if you have been pregnant, and if you have pain during sex.

Your doctor may perform an internal exam with their fingers, as well as an external exam to see how your muscles are functioning. There are other tests to determine how well your pelvic floor muscles are working. These include:

• Placing electrodes on the surface of your pelvic area to measure how well the muscles function.
• Performing an anal manometry to measure how well the anal sphincter is working. This is when a thin flexible catheter with an uninflated balloon on the end is inserted through your anus. It goes into your rectum and measures pressure movements as it is slowly withdrawn several times.
• Administering a defecating proctogram, a test that includes a thick enema that shows up in an x-ray so your doctor can see how your muscles work to push it out.
• A uroflow test to show how effectively your bladder empties each time you urinate.

Treatments for Pelvic Floor Dysfunction

The treatment your doctor may recommend for pelvic floor dysfunction depends on how the condition is for you and the symptoms you have.

Overactive Bladder . If it gives you an overactive bladder, your doctor may recommend Kegel exercises, topical estrogen cream, or prescription drugs to help.

Kegel exercises are when you tighten your pelvic muscles for five seconds and then release them. You can do 10 to 20 repetitions, three or four times a day. This can help strengthen your pubococcygeal muscles.

Fecal incontinence. Your pelvic floor dysfunction can also cause fecal incontinence. This is when the muscles that control your bowel movements don’t work properly, and there is leakage. For this, your doctor might recommend changing your diet, pelvic floor exercises, or surgery to stimulate nerves in the pelvis or tighten the sphincter muscle.

Prolapse. In some cases of pelvic floor dysfunction, prolapse occurs. This is when your rectum or vagina falls out of place because it is no longer properly supported by the pelvic floor muscles. Kegel exercises can help with this, but one of the primary treatments for prolapse is surgery.

General treatments. In general, treatments for pelvic floor dysfunction include:

• Muscle relaxers or other prescription medications
• Physical therapy to retrain and strengthen the muscles
• Behavior changes, like reminding yourself to avoid straining when using the bathroom
• Lifestyle changes, like doing yoga or taking baths to learn how to relax the pelvic floor muscles

You can do pelvic floor exercises to strengthen your muscles regardless of your age or gender. You can also do them whether or not you’ve given birth. If you are planning to become pregnant, or are pregnant now, doing pelvic floor exercises can help prevent dysfunction later.”

Warm regards,
Dr. Marty Sanchez

Sources:
Beaumont: “Pelvic Floor Dysfunction.”
Cleveland Clinic: “Pelvic Floor Dysfunction.”
Columbia Surgery: “Pelvic Floor Disorders: Frequently Asked Questions.”
Gynecology and Minimally Invasive Therapy: “Current Treatments for Female Pelvic Floor Dysfunctions.”
Mayo Clinic: “Fecal incontinence.”
MidMichegan Health University of Michigan Health System: “Uroflowmetry.”
NHS North Bristol: “Defecating Proctogram.”
Queensland Government: “How to find and exercise your pelvic floor muscles (for women and men).”
UC Davis Health: “Motility Diagnostic Services | UC Davis Health.”
UCLA Health: “Kegel Exercises for Men.”
Voices for PFD: “What are PFDs?”
You may locate this article published on the WebMD website here:
https://www.webmd.com/a-to-z-guides/what-to-know-about-pelvic-floor-dysfunction