Pelvic floor issues are on the rise. I am seeing that in my practice more than ever before and I
Female pelvic anatomy laying down (https://www.ncbi.nlm.nih.gov)
am surprised to hear so many people know the term.
This blog will address:
- The most commonly asked questions
- Myths about pelvic floor dysfunction
- A the one true solution to it all
While surgery and medication are 2 of the options for treatment of some symptoms of pelvic floor dysfunction, the focus here is on the non-medicine and non-surgical approach. While male incontinence and female incontinence are widely inflicting many, you are not doomed to live with pelvic floor dysfunction. In fact, regardless of urinary incontinence or fecal incontinence, it is more than likely that it is the pelvic floor that is weak.
But what is the pelvic floor? This blog will answer the most commonly asked and logical questions related to pelvic floor dysfunction.
Male pelvic anatomy standing up (https://teachmeanatomy.info/)
What Do the Pelvic Floor and Related structures Look Like?
In order to fully understand the pelvic floor, I am going to use a simple analogy and refer to it periodically! You will also need to understand other structures involved in pelvic floor dysfunction. ALL of these structures have to be addressed in order to fully resolve the issue. The issue we have is that we are NOT addressing all of these parts and are doing a half-hearted job taking care of the problem. Pelvic floor weakness and dysfunction affect people on many levels including social, psychological, physical, and emotional levels… and no, medicine is not the solution!
If your whole abdominal cavity was a paper bag with a cover:
- The top cover is the abdominal diaphragm
- The sides are the oblique muscles of the abdominal muscles
- The front is the rectus abdominus
- The back is the back muscles
- The bottom is the pelvic diaphragm which is just above the pelvic floor
Imagine the bottom of the bag is like a bowl with the inside lining of the bowl being the muscles of the pelvic floor. The outside are the muscles connecting the genitals to the anus and sphincters.
Pelvis Anatomy:
Now, let’s talk about your pelvis, the bottom of which is the pelvic floor or the bowl in our analogy. Your pelvis has 3 main parts to it:
- Two halves called ilium get connected to a triangular shaped bone called sacrum in the back (the end of the sacrum, away from the spine is the tail bone btw)
- And the front of these two halves form the pubic bone where the genitals are on the surface of.
When we walk, the sacrum and one half of the ilium move in opposite directions. That means when you put a foot forward, the ilium flexes on the right while the sacrum extends. Why am I talking about walking? Because you don’t have to have urinary or fecal incontinence to have a weak pelvic floor. And you need to be aware of it to fix it sooner than later.
You don’t have to be old to have pelvic floor weakness and dysfunction. Unfortunately, we are prematurely having issues with the pelvic floor because of sedentary lifestyles. Do you realize that people who are in their 40s now and younger have been sitting down, playing video games, and using computers almost all of their lives? That is many many years to get a weak pelvic floor.
Take the time to become familiar with the bony structure names of the pelvis AND pay close attention to the muscles that are involved in the pelvis region. Every single one of these muscles play a role in the health of the pelvic floor.
Pelvis bones (courtesy of https://orthoinfo.aaos.org/)
Pelvis ligaments (Back) impacting the floor
Pelvis ligaments (Front) impacting pelvic floor
Pelvic floor outside showing anus and bottom shaft of penis
Front of the abdomen= “front of the bag”
Oblique muscles of the abdomen= “side of the bag”
Lower back, pelvis and hip muscles are involved in pelvic floor integrity
Isn’t Incontinence the Inability to Hold Urine Correctly?
No, not necessarily. There is urinary incontinence that has to do with the urine. Then there is fecal incontinence that has to do with the fecal matter. Overall, it is a dysfunction of the emptying of the urine and/or fecal matter due to either the structures or nerves involved.
Types of Urinary Incontinence are:
1. Stress incontinence:
Pelvic floor muscle weakness is the cause, and the reason can be:
-
- sneezing
- exercise
- coughing
- pregnancy
- excess weight
- or medications
Pads, vaginal inserts, pelvic floor exercises, and biofeedback can be used to work on the brain recognizing the signals. Although, injections and surgery are the common approaches. Read below to see why I think they all serve their purpose but are only part of the answer. You will learn what I consider to be the most comprehensive approach to put an end to it.
2. Urge incontinence:
This can be because of nerve irritation or damage to the bladder area (such as multiple sclerosis, diabetes, and stroke). Nerve irritation or damage to other nerves in the body, just like pelvic floor weakness, or aging is more than likely just a decrease in the integrity of the muscles. While some medications can also lead to urge incontinence, I want you to remember that just because you are getting old, does not mean you are doomed. Look around and you will see there are plenty of older people that are active. Meanwhile, there is no shortage of those that just sit all day. Movement is SO important in overall health.
For Urge incontinence, timed avoiding and bladder training becomes the focus of the treatment which will help some. But again, as with Stress incontinence, to me, it is a partial solution.
3. Overflow incontinence:
When there is dribbling of the urine flow. This can be due to:
- Pelvic floor muscle weakness
- Nerve damage
- Enlarged prostate
- Tumors
- Constipation
- Medication
The chances of overflow incontinence leading to infection are high because the person with this issue has a hard time getting the full urine out. So UTI’s become common there.
4. Functional Incontinence:
Involving the hip and pelvic muscles of the pelvic floor: is when due to whatever reason, usually dementia or arthritis, the person can’t make it to the bathroom in time.
Of course remember, you can have more than one type of incontinence. And it is easy to start with one but as a result of its chronicity, other factors causing more incontinence to occur.
While medications, electrical stimulation, surgery, and even catheters are used for incontinence, the question is the long-term efficacy of them. While in some cases there is no choice but surgery. Even in surgical cases, post-surgical rehab is very similar to pre-surgical therapy. What is missed the most and certainly not done to the extent that it should be is the biomechanical contribution to pelvic floor dysfunction.
How Does Movement Affect the Pelvic Floor?
What I want you to pay attention to is that not every movement is based on the ‘factory designed’ patterns we are born with. I don’t want to digress from the subject of the pelvic floor, and pelvic floor dysfunction. So I urge you to read my page on Functional Movement and watch the video below on postural neurology.
Both of these are the core to the concept of movement and its impact on the pelvic floor. Anything that impacts your movement and pushes it from the biological (factory designed way) of movement to the pathological patterns of movement leads you to first weakness then full-blown dysfunction of the pelvic floor. If the bottom of the ‘bag’ is not strong, it does not matter how strong the sides are, all will be unstable and subject to falling apart.
Does Pelvic Floor Manual Therapy Work?
As I explained before, there are muscles on the inside of the pelvic girdle that are weak. When a trained physical therapist specialized in pelvic floor treatment manually addresses those areas, there is certainly an increased benefit in most cases. The problem is how long it lasts. Additionally, most people feel uncomfortable as this procedure is addressing the anus and genitals.
Manual therapy of the pelvic floor in most cases is to be repeated over time and used in conjunction with biofeedback and other devices. It is a great way to address the inside of the pelvis after surgery just as massage helps with tense muscles. BUT expecting massage to get rid of lower back issues powered by other causes is not a good solution as you may have suspected.
Why Are Kegel Exercises Not Enough?
Have you ever seen a tree trunk that was cut off, but the following year, new shoots came off of its cut off trunk? That is the story with kegel exercises. If you think doing kegels is going to make your pelvic floor dysfunction go away by itself, you are mistaken. Plus, how many of those can you do a day? Do you do them every day? Do you do them 50 times a day? I am sure the answer is no. If you do them, how strong are the ‘holds’?
Those with pelvic floor dysfunction not only don’t do the kegel exercises often, but the power behind their ‘hold’ is not much. The only true machine I have seen that does a great job of stimulating the action of kegel muscles is the Emsella. At 400 kegels a minute, no-one can match its performance; there is no intrusion of privacy BUT Emsella by itself does not take care of the job either.
Pelvic Floor Dysfunction and Emsella Chair
What is the Best Solution to Pelvic Floor Dysfunction?
What if, you were educated on the basics of the pelvic floor, similar to having the manual for the operation of any machine? Then learn about biological breathing because with it comes safeguarding the integrity of the lower back, torso, and hips in movement (watch this video), use Emsella to strengthen the actual floor of the ‘bag’ (see the top of the page in bold), start movement poses that allow the whole body to move based on the concepts of Developmental movements (make sure you don’t skip this), assure proper brain-body connection in posture and balance based on the concepts of postural neurology, and then address the proper nutrition to strengthen your muscles and nerves, choose a lifestyle that incorporates this routine, move throughout the day, use proper ergonomics, and establish eating habits to assure the problem does not come back. Does this seem too involved and unattainable?
…and the answer is
NOT at all. While the 400-kegel-a-min Emsella machine is not covered by any insurance plans (they pay for the surgery but not this machine and in most cases, pelvic floor therapists don’t accept insurance), It does an amazing job strengthening the actual bottom of the ‘bag’ portion in the case of pelvic floor dysfunction. A quick search shows there are not too many places that have the machine and while the price tag more than likely plays a role, they are owned by urogynecologists, and a few med-spas (pelvic floor strength plays a role in sexual pleasures too). These doctors are medical doctors that are trained in their specialty to either prescribe meds, do surgery or refer out for therapy. Their actual expertise is not in movement and biomechanics.
What kind of doctor treats pelvic floor dysfunction?
Being a licensed doctor of chiropractic with a specialty in Postural Neurology and Functional Movement, I look at what it takes to move and balance correctly with all of my patients and not just the ones with extreme pelvic floor dysfunction, such as incontinence. As said before, while in most incontinence cases pelvic floor issues are heavy contributors, not every pelvic floor issue comes with incontinence!
Any doctor specializing in biomechanics using the concepts of developmental kinesiology with an Emsella machine should be able to help you with your weak pelvic floor and its associated symptoms.
If you think kegel exercises to the level of fixing the weak pelvic floor are easy to do, if you think you are too old for pelvic floor muscle work, if you think you had a baby and the damage is done, if you think you don’t have incontinence so you don’t have a pelvic floor issue, if you are a man and think you don’t have a pelvic floor, if you think your insurance does not pay so you can’t afford the proper care, if you think you have to be rich to have the effective care, you are mistaken!
The effective treatment does not break the bank, it does require your commitment, your determination, your cooperation with what you need to do and avoid doing, and not giving up. But then again, this is what it takes to effectively address anything in life and not just a stronger pelvic floor; you deserve to enjoy life instead of being defined by your limitations. Every time a partial treatment is done, only a partial solution is achieved and as such, it won’t last long.
If despite your efforts you still experience pelvic floor dysfunction, I am here to help.
Dr. Shakib