To Kegel or Not to Kegel: Demystifying the Pelvic Floor | Element Physio

The Pelvic Floor muscles are a small group muscles located at the bottom of the pelvis. They start at the tailbone and run forward to attach on the pubic bone. The two hip bones make the sides of the “bowl” and the pelvic floor is the bottom of the bowl.

1 in 3 women experience some form of Pelvic Floor dysfunction, however many of these issues can be treated with pelvic floor physiotherapy!  Below, we explore some of the most common myths surrounding the pelvic floor. The Myths were “borrowed” from the Canadian Physiotherapy Association and adapted by our physiotherapist from clinical experience, course notes and textbooks.

1. Incontinence is normal after childbirth.

FALSE. Incontinence is not normal at any time or with any activity.  75% of basic urinary incontinence can be improved with pelvic floor physiotherapy.

2. Pelvic pain and pain with sexual intercourse are normal following a vaginal delivery.

FALSE. 10-15% of North American woman suffer from dyspareunia, which is pain (or discomfort) during sexual activity.  It is not normal to have persisting pain with sexual intercourse or pain that prevents sexual intercourse.  Scars from episiotomy or tearing may be sensitive or the inability to fully relax your pelvic floor muscles. Many women (especially breastfeeding moms) find vaginal dryness to be a major factor as well.

3. If you have a C-Section your pelvic floor is safe.

FALSE.  The pelvic floor works with our deep abdominal muscles and low back muscles, as well as the diaphragm to form a “tube” or canister.  These muscles all need to work together to have a strong core and pelvic floor.  Sometimes a disruption in one part of the canister (abdominal incision with c-section) can lead to disruption in another part (low back or pelvic girdle pain, pelvic floor symptoms).

4. Only women experience pelvic floor dysfunction.

FALSE.  Although the anatomy and organization of muscles is different, we have the same group of pelvic floor muscles.  Men can experience difficulty with incontinence (especially after prostate surgery), problems with sexual dysfunction and pelvic girdle or low back pain.  Children can have pelvic floor problems as well such as bed wetting, incontinence and constipation.  Paediatric Pelvic Floor physiotherapy is quite different than in adults. We are excited to offer this service as our physiotherapist has recently been certified to work with children!

5. Pelvic floor dysfunction occurs due to weakness.

FALSE.  It can occur because muscles are too tight, too weak, or are not functioning properly as a group.  Or perhaps you have no idea where they are or how to use them. An internal examination of the muscles helps to locate them and properly use them.

6. Kegels will fix your pelvic floor.

NOT ALWAYS.  Some conditions may require surgery or medication, as well as physiotherapy. There is about only a 40% success rate with many of these surgeries depending on when you have them in life and physio can help keep the muscles working properly. We work with your doctor or specialist to ensure the best care for you.  It is also equally as important to learn to relax your pelvic floor, as well as having a strong pelvic floor.

7. All dysfunction of the pelvic floor is caused by the pelvic floor.

FALSE.  Consider the answer to the c-section question above.  Sometimes the way you breath, move and lift can cause pelvic floor problems.  Weak or tight abdominals and/or performing abdominal exercises incorrectly may contribute.  The thoracic spine, pelvis, hip and low back may be another source. Neurological diseases/disorders such as Multiple Sclerosis or a spinal cord injury can also cause pelvic floor problems.

8. Your vagina needs to be “cleaned” with soap or wipes.

FALSE.  The skin around the vagina, the vulva, is fairly sensitive, especially to scented products.  Clean water in the shower or bath will do!

These are a few things that our physiotherapist can help with:

  • Urinary/bowel incontinence
  • Urinary frequency
  • Pelvic girdle and low back pain
  • Pain from episiotomies and tearing
  • Post c-section
  • Pain with sexual intercourse
  • Pre and post hysterectomies
  • Pre and Post prolapse repair surgeries (bladder lifts etc.)
  • Children (bed wetting, urine leakage and constipation).

References

Canadian Physiotherapy Association: http://physiocanhelp.ca/the-top-eight-myths-about-your-pelvic-floor/
Course notes form Uro-Sante: Perineal Re-education Courses Level I, II and III
Course notes from Diane Lee:”New Perspectives from the ISM for Treating Women’s Health”
Wallace, Kathe. “Reviving Your Sex Life After Childbirth”