According to pelvic floor rehab specialist Dr Pauline Chiarelli, pelvic floor problems can effect as many as one in three women. If you came to see us for advice on rehabilitation and help with an injury you would quickly notice that weask questions that are not just related to your present concern but also questions about your health in general. We do this for a number of reasons; primarily we does this so that we can put your current concern into context but also it allows us to see if you have any other problems that you might have thought were “just normal”.
When we ask these questions our clients frequently mention some sort of pelvic floor dysfunction with which they have just learned to live.
Is pelvic floor dysfunction more of a female than a male problem? Scientists, Ireland and Ott, say the male pelvis is denser and the boney part of the pelvis is generally smaller in diameter allowing faster coordination between all the muscles. This denseness combined with the smaller area means that the male pelvic floor is less likely to become dysfunctional. Conversely, the female pelvis is less dense and wider, as the boney structure is designed to house and deliver a baby. This means that the female pelvic floor is more susceptible to decreased strength and coordination between the pelvic floor muscles.
How is your pelvis meant to work and why do people get pelvic floor problems e.g. incontinence?
In normal posture the pelvis should be anteriorly tilted allowing the bones of the pelvis to provide support to the internal organs, muscles, ligaments etc. In females the bladder is supported by the pubic bone at the front, which, in turn, creates support for the uterus. A large proportion of women with pelvic floor problems stand with a posterior pelvic tilt and decreased lumbar spinal curve. This puts more pressure on the pelvic floor by taking away the boney support from the bladder and uterus and creates pelvic floor problems. The good news is that this can be helped learning to correctly move your pelvis…. I will discuss a little later how to correct pelvic floor problems with exercises that are much more comprehensive than Kegels.
What is the Pelvic Core?
When looking at the muscular support of the pelvic floor it is useful to look at other muscles involved in its correct function: the abdominals, the spinal muscles, the hip and the respiratory diaphragm. These muscles work as a functional group, the pelvic core. For example, as the respiratory diaphragm contracts it lowers, drawing air into the lungs, as it lowers it causes the organs that are underneath it to move downwards. This increased pressure in the abdominal cavity gently puts pressure on the pelvic floor causing a harmonious movement between the diaphragm and the pelvic floor. The pelvic floor assists in lumbopelvic stability (Markwell 2001) along with the muscles of the lower back, hips and abdominals. Anatomically there are connections as well; one of the hip muscles, the obturator internus, and part of the pelvic floor, the levator ani, are connected by a common tendon, the arcuate tendon. This means that if there is restricted movement in one or both of the hips, perhaps from arthritis, tight muscles or even ankle injuries, part of the pelvic floor will also be affected.
Yes, due to the interconnected nature of the pelvic floor and the muscles of the low back, hips and abdominals we always look at the “pelvic core neuromuscular system” or PCNS for short. This term was originally coined by my friends and colleagues, Christina Christie and Rich Colossi, physiotherapists specializing in pelvic floor dysfunction. By taking this approach we can determine if the current pelvic floor problems are actually being maintained by other things like poor posture, faulty breathing patterns or even by some thing as far away as an old ankle injury!
Physiotherapist Gary Gray argues that in order to get the pelvic floor functioning optimally all the structures of the PCNS should be integrated subconsciously. For example, you don’t have to think about bracing your leg muscles to stop you from falling over, it just happens, and that should be the case for the pelvic floor as well. You shouldn’t have to consciously tense your pelvic floor to prevent leakage – it should just happen.
Pelvic floor dysfunction can take many forms, including but not limited to, pelvic pain, pelvic-organ prolapse, anal incontinence and urinary incontinence. Urinary incontinence can be subdivided into three categories:
•Stress incontinence – involuntary loss of urine with an increase in intra-abdominal pressure e.g. a sneeze or a hop causes a small leak of urine.
•Urge incontinence – the urge to empty your bladder with only a small production of urine.
•Frequency incontinence – urinating more than eight times in twenty four hours.
So what is normal for a healthy pelvic floor? Generally you should be urinating every two to four hours during the day and zero to once during the night (although pregnancy does temporarily increase the incidence of urinary incontinence).
When we are talking about urinary incontinence it is worth noting that the loss of control and coordination of the pelvic muscles puts strain on other structures in the body. Many people do not realize that their back pain, sacroiliac dysfunction, sciatica, knee pain and ankle sprains could all be coming from dysfunction of their PCNS, and visa-versa.
Due to the pelvic floor’s highly integrated nature with the rest of the body it doesn’t make sense to continually isolate it and rely on exercises like Kegels. That would be like treating a sore knee that was caused by limping due to a sprained ankle. The ankle should be treated first, otherwise the knee pain will just keep coming back. Having said that, there are circumstances where specific pelvic floor work such as Kegel’s are useful, but if you are able to, it is more beneficial to strengthen the pelvic floor in an integrated way.
In order to create an environment where the pelvic floor and it’s functionally related muscle groups (diaphragm, low back, hips and abdominals) are working subconsciously we need to exercise the body in all three planes of motion using both the arms and legs to ‘drive’ or move the body to create a specific load to the whole complex of functionally related muscles.
Introducing the Pelvicore Exercise Ball… This simple device was developed by Christie and Colossi to help their patients get faster and better results from exercises they were doing. It consists of a small inflatable ball that fits between the knees and an elastic strap that goes round the thighs holding the ball in place. Strengthening the hip muscles becomes easy when wearing the pelvicore ball because if you step out to the side all the lateral hip muscles have to work against the resistance of the elastic strap and when you step back all the medial/adductor muscles work against the pressure of the ball. Depending on your level of ability exercises with the pelvicore ball can vary from simply sitting and slowly moving your legs apart and then back together to exercises that involve squats, lunges and alternate hand drivers. These are whole body exercises that involve all aspects of the PNCS right from the ankle up to the neck.
If you thought you were resigned to doing Kegels for the rest of your life you now know there are alternatives that may work better for you. Buy a ball from the founders or make all and follow these exercises where you learn how to use a pelvicore ball so that you can do exercises at home to help prevent problems with your pelvic floor from returning. We know that for the one in three women who suffer from pelvic floor problems this offers a chance for them to get stronger and more flexible. What a relief to not be in fear of the familiar accidental leak that can happen all too easily when the pelvic floor is not working properly!
Follow along Videos
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Chiarelli, P. 2002. Women’s Waterworks: Curing Incontinence. Wallsend, NSW; George Parry.
Christie, C., & Colossi, R,.2010. Paving the way for a healthy pelvic floor: Turn on the Pelvic Core Neuromuscular System with triplanar movement and functional education. Idea Fitness Journal.
Gary, G., & Tiberio, D. 2010. Seminar. Chain reaction transformation. The Gray institute.
Ireland, M.L., & Ott, S.M. 2004. Special concerns of the female athlete. Clinics in Sports Medicine, 23 (2), 281-98.
Markwell, S.J. 2001. Physical therapy management of pelvic/perineal and perianal pain syndromes. World Journal of Urology, 19 (3), 194-99.
Over the last 10 years Ed has been building a YouTube library to help people manage their own pain or movement limitations and increase performance through exercise. He regularly adds videos so be sure to subscribe and visit regularly
"Oh My Gosh- I am ALREADY feeling relief after a few days! I used to wake up 2-3 times a night with shooting pain that anti inflammatories couldn't touch. Now I have been waking up just because I want to notice what it feels like to lay in bed pain free- THANK YOU!."
"When I first started with your program I was experience a lot of pain. Walking was difficult. I had to stop and catch my breath every few minutes and lean against a wall for support. Now when I walk with my husband we go for over an hour. I never had to sit down and stop...and, hardly any pain!!! 😊😊 I can’t thank you enough."
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