HOLD TIGHT

CASEY MCPIKE talked to phys­io­ther­a­pist STACEY LAW and found not only do you need to give your pelvic floor area a whole lot of at­ten­tion, you need to give it the right kind of at­ten­tion

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We talk to a phys­io­ther­a­pist about pelvic floor health

How of­ten do you think about your pelvic floor? Once a day? Once a week? When­ever you sneeze or see a tram­po­line? Or are you fran­ti­cally do­ing the ex­er­cises you learned dur­ing an­te­na­tal classes right now be­cause you can’t re­mem­ber the last time you

did them? Don’t worry, you’re not alone. Around 46 per cent of New Zealand women will ex­pe­ri­ence pelvic floor dys­func­tion at some point in their lives. Many of these women will suf­fer some type of pelvic floor is­sue af­ter child­birth. Here, phys­io­ther­a­pist Stacey Law has come to the res­cue with a guide on every­thing you need to know about that area you pay the least at­ten­tion to.

WHAT EX­ACTLY IS THE PELVIC FLOOR?

“Your pelvic floor is a col­lec­tion of mus­cles, lig­a­ments and con­nec­tive tis­sue that form a ham­mock-like sling at the bot­tom of your pelvis. Its ma­jor role is to sup­port your pelvic or­gans (blad­der, bowel and uterus), and to con­trol the open­ings of your blad­der and bowel. The pelvic floor is also vi­tal to your sex­ual func­tion and has a huge part to play in pro­vid­ing sta­bil­ity for your spine, pelvis and hip joints. We like to get our pa­tients to re-de­fine their ‘core’, so that rather than fo­cus­ing just on ab­dom­i­nals, they also in­clude the pelvic floor, the deep mus­cles of the lower back, and the di­aphragm (your ma­jor res­pi­ra­tion mus­cle). In or­der to have a well-func­tion­ing core, all of these mus­cles need to be work­ing – and work­ing in sync with each other.”

WHAT ARE THE TELL­TALE SYMP­TOMS OF A WEAK PELVIC FLOOR?

“The most com­mon symp­tom is in­con­ti­nence (leak­age) from the blad­der or bowel. Other symp­toms in­clude: In­creased fre­quency and/or ur­gency to use the bath­room Con­sti­pa­tion Pelvic pain, lower back, hip or groin pain Pain dur­ing or af­ter sex – or an in­abil­ity to have sex Pro­lapse – a heavy, drag­ging feel­ing in your pelvis, a feel­ing that some­thing is fall­ing out or some­times you may ac­tu­ally be able to feel or see that some­thing has dropped down within your vag­i­nal canal Men are not ex­empt – erec­tile dys­func­tion is a com­mon in­di­ca­tion of pelvic floor is­sues.”

IS DUR­ING PREG­NANCY AND JUST AF­TER CHILD­BIRTH THE ONLY TIME WOMEN NEED TO BE THINK­ING ABOUT THEIR PELVIC FLOOR?

“No! Your pelvic floor is with you (hope­fully) for life. Preg­nancy and child­birth can place mas­sive stress on the pelvic floor and may cause trauma or dam­age, so it makes sense that women think about it more at this time. Our goal is for women (and men for that mat­ter) to think of the pelvic floor as an in­te­gral part of their core sta­bil­ity sup­port sys­tem at all stages of life. Later in life, hor­monal changes and the age­ing process place fur­ther stress on our pelvic floor mus­cles. We need to care for the pelvic floor prop­erly so it can work well for us as we age. It’s im­por­tant to note that women who have not had chil­dren can have is­sues with their pelvic floor as well. If it isn’t work­ing prop­erly it can still cause all of those symp­toms listed above – even with­out the stress of preg­nancy and child­birth put upon it.”

‘IT’S WHEN WOMEN HAVE RE­TURNED TO THEIR PRE-BABY EX­ER­CISE ROU­TINES TOO QUICKLY THAT WE SEE PROB­LEMS OC­CUR­RING. DO­ING SIT-UPS, LIFT­ING WEIGHTS AND GO­ING FOR LONG RUNS IN A QUEST FOR A FLAT TUMMY CAN DO MORE HARM THAN GOOD’

IS DAM­AGE MOST LIKELY TO OC­CUR DUR­ING PREG­NANCY AND CHILD­BIRTH?

“Preg­nancy cer­tainly places strain on the pelvic floor as the mus­cles need to sup­port ex­tra weight from the baby, pla­centa, en­larged uterus and breasts, and in­creased blood vol­ume. Child­birth can cause trauma. Risk fac­tors for pelvic floor dys­func­tion are def­i­nitely in­creased if there is a long push­ing phase, tear­ing, an in­ter­ven­tional birth (for­ceps, ven­touse), and de­liv­er­ing a large baby (over 4kg). Re­turn­ing to high in­ten­sity ex­er­cise af­ter child­birth ei­ther too soon or with poor tech­nique can also cause a lot of dam­age to the pelvic floor. We of­ten see women who be­lieve they’ve come through preg­nancy and birth with no pelvic floor dys­func­tion, but months or even years later dam­age can start to cause symp­toms. In many cases it’s when women have re­turned to their pre-baby ex­er­cise rou­tines too quickly that we see prob­lems oc­cur­ring. Do­ing sit-ups, lift­ing weights and go­ing for long runs in a quest for a flat tummy can do more harm than good. We are not anti-ex­er­cise – far from it! The

stronger a woman is the bet­ter, re­ally, as mother­hood is such a phys­i­cally de­mand­ing job. But we do want to make sure that women are do­ing the right ex­er­cise for their body, while keep­ing their pelvic floor safe.”

ARE WOMEN BE­COM­ING MORE AWARE OF THE IM­POR­TANCE OF A STRONG PELVIC FLOOR?

“We love that we have women proac­tively com­ing in for post­na­tal as­sess­ments to see how their body has come through preg­nancy and birth, and to en­sure that they get their re­hab and re­cov­ery right. It is so awe­some to see women in that early post­na­tal phase, and to help en­sure they don’t do any dam­age to them­selves. While the mes­sage is get­ting out there, the cor­rect way to care for the pelvic floor is still a new con­cept for many of the ladies we see. A big is­sue we face is that even if a woman is aware of her pelvic floor and thinks she’s do­ing all the right things to take care of it, it’s not al­ways the case. We know that a good per­cent­age of women who think they’re con­tract­ing their pelvic floor cor­rectly can ac­tu­ally be do­ing the com­plete op­po­site. They of­ten end up “bear­ing down” on the pelvic floor mus­cles in­stead of lift­ing them, or they may be tight­en­ing other mus­cles in their abs, glutes and hips – and not be get­ting the pelvic floor mus­cles work­ing at all. Another com­mon is­sue we see is a hy­per­tonic pelvic floor – where the pelvic floor mus­cles are too tight to re­lax. This con­di­tion can cause just as many prob­lems as a weak pelvic floor. A su­per strong pelvic floor is not al­ways a func­tional one! For these rea­sons, we rec­om­mend women have a check with a Women’s Health Phys­io­ther­a­pist (phys­io­ther­apy.org.nz and continence.org.nz – both have lists of where to find one). Firstly, we make sure that their pelvic floor mus­cles are ac­ti­vat­ing cor­rectly, and then en­sure they have a pro­gramme tai­lored specif­i­cally to them. For ex­am­ple, there is no point in a woman with a hy­per­tonic pelvic floor do­ing hun­dreds of ‘kegels’ as it will only ex­ac­er­bate her prob­lems. The ear­lier we know about our pelvic floor, how it works and how we can best care for it, the bet­ter.” PELVIC FLOOR EX­ER­CISES ARE EASY — YOU JUST NEED TO IMAG­INE YOU’RE HOLD­ING ON TO URINE AND WIND

Many women think they’re do­ing their ex­er­cises cor­rectly, but are ac­tu­ally bear­ing down on the pelvic floor and caus­ing more dam­age. Pelvic floor ex­er­cises are not a “one size fits all” sce­nario as there might be other is­sues go­ing on. Talk to a women’s health phys­io­ther­a­pist, your doc­tor or mid­wife to make sure you’re on the right track.

WHEN WOULD SURGERY BE REC­OM­MENDED TO RE­PAIR PELVIC FLOOR DAM­AGE?

“Be­cause ev­ery case is dif­fer­ent, we work in con­junc­tion with doc­tors and spe­cial­ists who ad­vise when surgery is the best course of ac­tion. If sur­gi­cal re­pair is the best op­tion for a woman, learn­ing how to ac­ti­vate pelvic floor mus­cles prop­erly and do­ing post­sur­gi­cal re­hab with a phys­io­ther­a­pist is so im­por­tant to aid re­cov­ery and help keep them prob­lem-free. Guide­lines rec­om­mend a min­i­mum of six months su­per­vised pelvic floor train­ing be­fore any surgery is rec­om­mended for stress uri­nary in­con­ti­nence (SUI). In up to 80 per cent of cases, strength­en­ing the pelvic floor is suf­fi­cient to al­le­vi­ate SUI symp­toms. The stats are slightly lower (but still more than 50 per cent) for mild to mod­er­ate pro­lapse.” 

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