Friday, February 24, 2023

Guest Post : What is Pelvic Floor?

I am pleased to share this article about Pelvic Floor by Theresa Wilk Feeley, PT, DPT, PRPC, NCMP, RYT, Pelvic Health & Wellness Center Director at Atlantic Pelvic and and Wellness Center / Physical Therapy.  It compliments my post on Have You Considered Pelvic Floor Therapy


Theresa Wilk Feeley
 The pelvic floor is a group of muscles that span the base of the pelvis, with the hip girdle at either side,

the pubic bone in the front and the tailbone in the back. These muscles play a critical role in bowel,
bladder and sexual function. The deeper layer works to stabilize the hip girdle and also helps to support
the organs that sit in the pelvis (bladder, rectum, uterus). They work especially hard during pregnancy
when they need to support the growing uterus while also stabilizing the pelvis.
The deep layer contracts and relaxes rhythmically with your breathing. As you breath in, air fills the lungs and the guts descend creating a gentle stretch to the pelvic floor muscles. As you exhale, the muscles naturally contract to lift back up and help to push the air out. When these muscles don’t work with your breathing, you might have symptoms of stress incontinence with forced exhalation (sneezing, coughing, laughing). This rhythmic up and down motion also creates a sump pump effect for the gastrointestinal system to aide with digestion and lymphatic drainage.
There is also a superficial layer of muscles that work for sphincter control to close the urethral, vaginal and anal openings. Both this layer and the deeper layer need a balance of strength and flexibility. They need to contract to lift up for support, and to close the opening to hold things in (urine, gas, stool). They also need to relax to allow for your bowel and bladder to empty. In a female pelvis, the relaxation is also important to allow for tampon use, gynecological exams and intercourse. There is more awareness around weakness in the pelvic floor muscles in relation to incontinence but tightness is also extremely common. Short and tight muscles lead to bowel, bladder and sexual dysfunction, as well as pain in the pubic bone, tailbone, hips and lower back.
Looking for your pelvic floor muscles? In sitting, use your hand to find your tailbone and then moving a little further down and towards one side. Next, contract your pelvic floor muscles by creating the motion of stopping the flow or urine or trying to hold in gas. You should feel a small movement under your fingers as these muscles activate. You can do the reverse motion by gentle pushing down like you would to have a bowel movement. A healthy pelvic floor should be able to do both motions!

There are many reasons why Kegels aren’t helping your pelvic pain or dysfunction.  And the biggest one is that you don’t need to be doing them.

But if you do have weakness in your pelvic floor that is causing dysfunction, doing Kegels correctly will strengthen these muscles.  Some of the biggest reasons they don’t work is that they are done incorrectly, not frequently or long enough or they are only performed lying down. If you have pelvic floor dysfunction that isn’t responding to Kegels - see a pelvic floor practitioner!!! They can assess your quality of contraction, dose repetitions in what positions or what movements- or discover that you don’t need to do them and get you the right treatment and exercise program!
Every Day is a Blessing! 

Tuesday, February 21, 2023

Have You Considered Pelvic Floor Therapy?

In 2018, the #gyncsm community chatted about Pelvic Health After a Gyn Cancer Diagnosis. We discussed how treatments for gynecologic cancers affect pelvic health. We also talked about pelvic floor physical therapy and how it can help alleviate many of the pelvic issues including pain and dysfunction such as urine leakage. 

"Pelvic heath involves the entire area of the bony pelvis, lower abdomen, genitals, reproductive organs, muscles, bowel/bladder/sexual function, nerves...and more." "GYN survivors often have bladder/bowel issues after radiotherapy & surgical treatment." (#gyncsm chat 12/12/18 transcript) 

When the muscles in the pelvic floor are weak or don't function properly then pelvic dysfunction may happen. In addition to surgery, radiation such as brachytherapy ( internal radiation used to treat cervical, endometrial and other cancers ) can also effect the pelvic floor muscles as well as issues due to aging, being overweight, injury and pregnancy.

Pelvic floor therapy is a specialized therapy for those with pelvic floor dysfunction. Exercises can help strengthen muscles, increase range of motion and help restore the function and eventually get you back to a normal routine. 

The Mayo Clinic , when discussing physical therapy states:

"Stretching exercises, massage and other relaxation techniques may improve your chronic pelvic pain. A physical therapist can assist you with these therapies and help you develop coping strategies for the pain. Sometimes physical therapists target specific points of pain using a medical instrument called transcutaneous electrical nerve stimulation (TENS). TENS delivers electrical impulses to nearby nerve pathways. Physical therapists may also use a psychology technique called biofeedback, which helps you identify areas of tight muscles so that you can learn to relax those areas."

When I saw my advanced practice nurse last year I discussed some issues I was having. She thought it was a good idea to try physical therapy and gave me info on a physical therapists in North Jersey. 

When I got home I remembered a zoom workshop I watched during Covid on Menopause and Pelvic Health given by the same physical therapy group I had used when I had issues with my knee. So I reached out. 

In December, I started the pelvic floor therapy with Theresa Feeley, DPT from Atlantic Physical Therapy. I had thought I had been doing the Keegal exercise correctly but I had not. The physical therapist went over the correct way to do it as well as  breathing techniques while laying down and standing. She also asked me to keep a diary of what I ate and what I was doing when issues occurred. I found that I would use the restroom before I left the house even if I might have gone 15 minutes before. It didn't matter if I was going to be out for a few hours or a quick run to the post office I would go. In effect I had programmed myself to go and of course my bladder worked accordingly. So I was "going" more that I really needed to.  I had to consciously tell myself that in most cases I did not need that extra trip to the rest room. 

Using the diary I found that I had more issues when I had caffeinated beverages. So I have cut back on caffeinated tea, soda and coffees.

Between visits I perform the exercises and follow the breathing techniques especially when bending over during yoga and Jazzercise.  Here I am, a few months later, and I have seen a significant improvement.  

 I urge other women who have issues with leaking etc to speak to their health care provider and ask for a referral for pelvic floor therapy. I'm happy I did!



Every Day is a Blessing.