Caroline Knox is a Clinical Specialist Physiotherapist in Musculoskeletal Physiotherapy. Caroline is also a women's health physiotherapist and has done an Advanced Urogynaecology Course for Physiotherapists and has extensive experience in treating pelvic pain in the public and private settings.
How do I know I have a pelvic floor problem?
Do you recognise -
Needing to go to the toilet in a hurry or not making it in time
Feeling you constantly need to go to the toilet
Losing control of your bladder accidentally
A prolapse-in women felt as a bulge in the vagina, feeling dragging, dropping, discomfort or heaviness
Painful sex or pain in the pelvic area
How do Problems of the pelvic floor occur?
The Pelvic floor muscles may be too weak , stretched or too tight. In some people this can occur from an early age while others develop problems later with:
Pregnancy, childbirth and with menopause
Pelvic floor fitness is affected by a history of low back pain and poor posture
Heavy lifting at work and in the gym
A chronic cough/sneeze linked to asthma smoking and hayfever.
A previous injury to the pelvic region eg a fall surgery or radiotherapy
The Pelvic Floor & The Core
’30-40% of women are bothered by exercise induced urinary incontinence this is greater in higher impact sport’
The pelvic floor forms the base of the group of muscles called the core these muscles work with the abdominal muscles , back muscles and the diaphragm to support the spine,
If any of the muscles of the core including the pelvic floor muscles are weakened their coordinated muscle action is altered – when this occurs there is potential to overload the pelvic floor causing depression of structures at the base of the pelvis ( see diagram below)
when this occurs many times during an exercise session this may strain pelvic floor organs resulting in loss of bladder and bowel control and possible pelvic organ prolapse. If there is already a problem the pelvic floor symptoms can be worsened.
Pelvic floor muscles needs to be strong but also flexible to work as part of the core- the Pelvic floor muscle need to let go and relax as well as lift and hold
Common Mistakes Made When Exercising
Commonly people brace their core muscles constantly during exercise thinking they are helping to support their spine but constantly bracing these muscles can lead to them becoming too tight and stiff- this stiffness can occur in an already weak pelvic floor muscle aggravating problems such as urinary urge incontinence and leakage.
I f the pelvic floor muscles are too tight you can develop pain in the pelvic region leading to pain with sexual intercourse and problems emptying the bladder. (Herman H 2014)
Common Pelvic Floor Myths
One common myth is that you only need to follow a few written instructions to do these exercises properly. There is research that shows up to 50% of women using written instruction only use an incorrect technique-this will not help and can make things worse. (Continence Foundation of Australia)
Another myth is the damage is already done when you have had your baby- post natal pelvic floor exercises have been shown to assist recovery of the pelvic floor muscle function and help prevent the development of long term urinary incontinence.
Another myth is that I am too old for pelvic floor exercises Older people are as likely to benefit from doing pelvic floor exercises as younger people
Another myth is that Pelvic floor exercises don’t work. There is plenty of research (IUGA2013) to show that Pelvic floor exercises are effective when done correctly and when taught and supervised by a Physiotherapist who specialises and has a special interest in Women’s Health and incontinence such as our Senior Physiotherapist Caroline Knox who practices in our Baggot Street Clinic in Dublin City Centre.
Caroline can confirm your technique is correct and develop an individualised program specifically for your problem and the condition of your pelvic floor. If extra methods are required such as biofeedback or electrical stimulation this can also be carried out and supervised by Caroline as part of your pelvic floor retraining programme. Caroline can also assess and treat spinal and pelvic pain and postural issues that can be contributing to your incontinence.
Continence Foundation of Australia www.pelvicfloor.org.au
Hollis Herman Female and Male Sexual Medicine A Rehabilitation Perspective Evaluation and Treatment. Blackrock Clinic 2014
IUGA Conference 38th Annual meeting . Dublin 2013
Cusack C Assessment and Treatment of Female Urinary Incontinence Lecture Beaumont Hospital 1st and 2nd March 2014