Pelvic floor therapy: strengthen and relax muscles
THE coronavirus pandemic has been blamed for a rise in mental health conditions, weight gain, broken toes, skin picking and dental issues. But, according to physical therapists and urologists, it also may be responsible for problems in an often-overlooked part of our bodies: the pelvic floor.
Located at the base of the pelvis, the pelvic floor consists of a group of muscles that provide support for internal organs, including the bladder, rectum, uterus and prostate. The muscles are also involved in posture, urination, bowel movements and sex.
Anecdotally, some pelvic floor experts say they have seen an influx of patients during the pandemic with new or worsening pelvic floor problems related to working from home and heightened levels of stress and anxiety.
“The combination of stress and then just sitting and not getting up to go to do those different activities throughout your workday definitely seem to have contributed to people’s symptoms,” said Alicia Jeffreythomas, a pelvic floor physical therapist at Greater Boston Urology.
“The need for pelvic [physical therapy] has kind of exploded in the last year,” said Jeffrey-thomas, who started posting informative videos about pelvic health on Tiktok (@ scrambledjam) during the pandemic, many of which have gone viral.
Many people experiencing pelvic floor dysfunction are embarrassed to openly discuss their symptoms, which can include incontinence, constipation and pain during sex.
Think of your pelvis as a large cereal bowl, said Susie Gronski, a pelvic floor expert specialising in men’s pelvic health and sexual pain. The pelvic floor muscles are the bottom of the bowl, stretching from the pubic bone to tailbone and extending between your sit bones, she said. Inside that bowl are the pelvic organs.
Beyond supporting these organs, the muscles work with your core and act as a postural stabiliser, said Mary Austin, director of the Pelvic Health Physical Therapy Residency at Johns Hopkins Hospital.
To locate the muscles, Gronski recommends sitting and sliding your hands underneath your sit bones (or the ischial tuberosity, the bones in the lower part of your pelvis that support your weight when you sit).
Then, she said, cough, laugh or sing a song. “The change in intracavitary pressure will translate down into the trampoline-like pelvic floor,” she said. “Your pelvic floor will adjust to the tissue demands placed on it, and you might notice some movement in your hand.”
The most widely known cause of pelvic floor dysfunction is pregnancy and delivery, Austin said, noting that both vaginal and Caesarean delivery can result in muscle trauma.
Other factors that can increase your chances of developing problems are aging; trauma to the pelvic area, including sexual abuse; surgeries, such as prostatectomies or genderaffirming procedures; and overusing the pelvic muscles by, for example, going to the bathroom too often or straining too hard.
Overactive muscles are often responsible for pain symptoms and can also complicate urination and make it harder to have a bowel movement. Although people often associate underactive – longer and overstretched – muscles with urinary incontinence, experts emphasised that the overactive muscles, which are also weak and not co-ordinated, could be to blame.
Although pelvic floor problems are common, Jeffcoat urged people not to dismiss their symptoms as “normal”. Anything that bypasses the typical mechanisms of your pelvic floor could cause or worsen problems in that area, Jeffrey-thomas said.
When you use the bathroom don’t hover over the toilet, she added. Instead, assume a squat-like position on the toilet, with your knees supported a little higher than your hips, which is particularly helpful when dealing with bowel movement issues.
“It actually causes more length in those muscles and lets you relax and lets you evacuate your bowels more easily,” Austin said.
Additionally, be mindful of what and how you're drinking, and how often you're using the bathroom, Jeffrey-thomas said. Sip water instead of chugging it, and try to minimise drinking caffeinated or carbonated beverages.
She urged people to not make it habit to go to the bathroom as soon as they get home or to urinate in the shower, because they can train their body to have an intense urge to urinate when they put their key in their front door or hear the sound of running water.
For those with desk jobs or those still working from home, avoid sitting in one position for hours on end.
“It might not be a very high load on the muscle, but a little bit of a low strain that happens every single day for several months is cumulatively going to build up,” Austin said.
To relax the muscles, experts suggest diaphragmatic breathing exercises, stretching and what are known as “reverse kegels”, which require pushing down through the pelvic floor and lengthening the muscles.