Strengthening weak pelvic floor muscles often helps a person gain better bowel and bladder control. A physical therapist can help you be sure you are doing a Kegel correctly and prescribe a home program to meet your individual needs. Diet modifications can also reduce urinary and fecal incontinence. Bladder re-training can decrease urinary frequency and help you regain control of your bladder.
There are various procedures used to address prolapse. Cystoceles are treated with a surgical procedure known as a Burch colposuspension, with the goal of suspending the prolapsed urethra so that the urethrovesical junction and proximal urethra are replaced in the pelvic cavity. Uteroceles are treated with hysterectomy and uterosacral suspension. With enteroceles, the prolapsed small bowel is elevated into the pelvis cavity and the rectovaginal fascia is reapproximated. Rectoceles, in which the anterior wall of the rectum protrudes into the posterior wall of the vagina, require posterior colporrhaphy.
Develop your core. You can develop your core muscles (between your pubic bone and lower rib cage) by doing the following: Take in a deep breath while keeping your shoulders down and pulling your abdomen toward the back of your spine. Notice how this feels like engaging a corset. Hold for the count of 10—keeping all those corset muscles pulled in. Aim for doing this 10-20 times per day. This will pull up and strengthen your abdominals and take pressure off your pelvis. This is not the same as sucking in your gut unconsciously. This is consciously developing your core strength. Esther Gokhale of the Gokhale Method teaches this as part of ideal posture: Sit with a towel folded lengthwise under your sitz bones. This will automatically tilt your pelvic bowl forward so that your pubic bone is where it should be—under your pelvic contents. Think of your pelvis as a bowl—you want it tilted so water spills out the front. When you sit, make sure your tailbone is out behind you.
During the internal exam, your physical therapist will place a gloved finger into your vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues. Internal exams and internal treatment are invaluable tools that are taught to pelvic floor physical therapists. It can tell us if there are trigger points (painful spots, with a referral pattern or local); muscle/tissue shortening; nerve irritation and/or bony malalignment that could be causing your pain directly or inhibiting the full function of your pelvic floor muscles. We can also determine if your pelvic floor has good coordination during the exam. A pelvic floor without good coordination, may not open and close appropriately for activities such as going to the bathroom, supporting our pelvis and trunk, sexual activity, and keeping us continent.
The contents of this website are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, dietary supplement, exercise, or other health program.
Pain can emerge because of lifestyle factors and underlying medical problems. Sitting all day can affect the nerves in your saddle, which may translate into a burning pain in your vulva, explains Rhonda K. Kotarinos, DPT, a specialist in pelvic floor dysfunction in the Chicago area. The discomfort of chronic vaginal infections or holding urine all day long can also lead someone to “walk around with their pelvic floor clinched to their ears. It can make your pelvic floor very angry,” she says.
Try Biofeedback. Biofeedback can help you learn how to strengthen or relax your pelvic floor muscles. Using special sensors that track your pelvic floor muscle function, you can learn how to activate the correct muscles to keep your pelvic floor toned. This is typically done in an office setting by a nurse or trained therapist. The sessions are usually about an hour. You sit in a comfortable chair with your clothes on after the sensors have been put in place – usually one on your abdomen and the other in your anal canal. The sensors measure the electrical activity of your pelvic floor muscles – especially the ones that control bladder and bowel function – while you contract and release the muscles. There are also home biofeedback devices you can purchase, but you should still have a pelvic floor assessment by a professional before using.
It is essential that we, as pelvic floor physical therapists, also include other assessments when we are examining our patients for the very first time. We employ the tried and true physical therapy exam practices to determine if there is an underlying condition elsewhere in your body, such as a strength deficit or alignment issue that could be affecting your pelvic floor. It’s wild to think of it, but something as seemingly unrelated as a flat foot or a hip injury can be enough to set off pelvic and abdominal pain!
Scars are almost always a fact of life. From surgeries, to accidents, to conditions like endometriosis, or certain STI’s, almost everybody has one. What doesn’t have to be a fact of life are the muscle, nerve and skin restrictions and overactivity that they can cause. By releasing scar tissue in physical therapy, it has been shown that the surrounding restrictions also decrease their resistance and adherence to the deeper tissues and surrounding organs.
Try squatting. Biomechanical specialist Katy Bowman points out that the gluteal muscles are the ones that are most important for pelvic floor function. Doing regular squats elongates your pelvic floor muscles and makes them more functional. Squats also help re-position your pelvis by balancing out the anterior pull of your sacrum. When you have a flat butt and no curve in the small of your back, that’s a sign that your pelvic floor is starting to weaken. Humans used to squat to eliminate urine and feces. Some cultures still use squat toilets. And, many cultures use the squat as a sitting position instead of using chairs. To do a deep squat (called malasana, or garland pose, in yoga), you may want to start with a towel or yoga mat rolled up under your heels, then lower yourself slowly until your tailbone is as close to the floor as possible with your heels still flat on the floor or your towel. You can practice deep squatting at home, at the gym, or at the yoga studio. You can also practice deep squats while playing with small children (notice how they do this!), gardening, and while using the toilet with the help of a Squatty Potty or something to lift your feet. In addition to strengthening your pelvic floor, you may notice fewer problems with your gut function, and may even avoid hemorrhoids. Note: many Westerners cannot do the deep squats that other cultures are brought up doing. We tend to lose this ability after childhood. Don’t worry about it. Just squat as low as you can while keeping your knees in alignment with your toes. I personally can’t do anywhere near the kind of squat that my 3-year-old granddaughter can do.
Surface electrodes (self-adhesive pads placed on your skin) can test your pelvic muscle control. This might be an option if you don’t want an internal exam. The electrodes are placed on the perineum (the area between the vagina and rectum in women, and between the testicles and rectum in men) or on the sacrum (the triangular bone at the base of your spine). This test is not painful.