1) What is the Pelvic Floor?
The pelvic floor is like a hammock of muscles in the lower part of the pelvis, a muscular “cradle” that extends from the pubic symphysis to the coccyx and supports the pelvic viscera: the bladder, the uterus and the rectum.
The pelvic floor contributes to:
- The support of the pelvic viscera (bladder, uterus and rectum)
- Bladder and bowel continence
- Core stability
- Normal sexual intercourse
- Pregnancy and childbirth
- Breathing
2) Pelvic Floor Dysfunctions and their symptoms
Pelvic floor dysfunctions refer to the inability to contract, relax, or coordinate the pelvic floor muscles.
- Urinary incontinence
Any unwanted loss of urine is considered incontinence and can be effectively treated with the help of a qualified physical therapist.
It is distinguished into incontinence by effort, urge incontinence and mixed type, where both forms coexist.
Stress incontinence is characterized by loss of urine during normal activities that increase the intra-abdominal pressure (coughing, laughing, running).
Urge incontinence is characterized by a strong and frequent urge to urinate, a feeling that the person does not have the time to find the right place, at which point urine loss occurs.
- Urination disorders
The need to “push” when urinating, the need to visit the toilet frequently as a precaution, interrupting the flow of urine, are all signs of pelvic floor dysfunction.
- Bowel disorders
Constipation, incomplete bowel movements, pushing during bowel movements, having to change positions or use one’s hand during bowel movements, and passing gas during movements such as bending over and lifting weights, all indicate pelvic floor muscle dysfunction.
- Pelvic organ prolapse
The descent and bulge of the pelvic viscera into the vaginal canal, usually due to the relaxation of the muscles and ligaments that hold them in their normal position.
- Sexual dysfunctions
An overactive pelvic floor (tight and inflexible muscles) can lead to painful intercourse (dyspareunia), while an underactive pelvic floor (weak muscles, lack of coordination) can contribute to difficulty in pleasure and orgasm.
- Chronic pelvic pain
Discomfort or pain in the pelvic and/or low back area lasting more than 6 months is usually associated with an overactive pelvic floor.
3) Risk Factors
- Multiple pregnancies
- Childbirth
- Obesity
- Chronic cough (chronic respiratory disease, smoking)
- Professions with frequent heavy lifting
- Surgical procedures (hysterectomy)
- Hormonal changes (drop in estrogen, menopause)
- Loss of normal lumbopelvic rhythm
- Dysfunctions of the lumbar spine
- Chronic poor posture
- Chronic constipation
4) Why Kegel exercises are not enough
The advice “do Kegel exercises” or “go Pilates” is often heard, given especially to women after childbirth, but it is not always correct.
It has been shown that 33% of women, when asked to activate their pelvic floor, push down and lengthen their muscles, instead of pulling them up, cranially.
Furthermore, there are many dysfunctions of the pelvic floor that do not require strengthening the muscles but relaxing them or retraining their coordination as a whole.
So, Kegel exercises are not always the solution, and they may even worsen the existing problem.
The Pilates method has very good results in general strengthening and especially of the cpre, but the muscles of the pelvic floor do not work individually.
This means that when there is dysfunction in the pelvic floor, it is important to first see a qualified physiotherapist, focus on rehabilitation and re-education of the pelvic area and gradually return to any activity.
5) The Physical Therapy session
A pelvic floor rehabilitation program usually lasts 12 weeks and requires the active participation of the patient, as well as her consistency.
Our first meeting includes the documentation of the patient’s health record, educating her on pelvic floor anatomy (with models, videos, pictures), helping her become aware of these muscles in her own body (through guided meditation, visualization, self-awareness), giving her thorough information about the assessment method (external, intravaginal, via biofeedback) and having her written consent that she is aware and receptive to the procedure.
After evaluating all structures involved in thedysfunction of the pelvic floor, we proceed with the rehabilitation program, the retraining of the pelvic floor muscles and their gradual integration into daily activities.
6) My personal Holistic approach
In conjunction with the pelvic floor rehabilitation and re-education program, there is an opportunity to look at other aspects of the lifestyle that affect overall health and well-being and work on gradual changes in a holistic way. Changes in diet, sleep and rest, exercise, general body posture, contact with nature, interpersonal relationships, etc., can be achieved through tools such as such as yoga, meditation and mindfulness, Craniosacral therapy, holistic nutrition, therapeutic massage, women’s circles and others healing modalities.
