If you're experiencing pelvic floor problems such as involuntary loss
of urine or pain in your delicate areas, you're not alone.
Women don't want to talk about incontinence or pain, but if you've
worked up the courage to talk to someone about it, the odds are you've
probably heard the phrase, “Just do your Kegels.”
Although a Kegel is an indispensable exercise in improving pelvic floor
problems, I've found that women need a lot of assistance to correctly
perform this exercise. In my experience as a women's health physical
therapist, I have also seen countless women whose pain or incontinence
can be worsened by doing Kegels.
The truth is, there are myriad things that can go wrong in the pelvic area,
everything from incontinence to pain to dropped organs. We've seen
patients ranging from teenage girls to elderly women experiencing tissue
changes from aging, injury, organ pathology, or the demands of life such
as caring for a newborn.
We see patients experiencing bladder or bowel problems and also treat women
suffering from pelvic pain which make things like using female hygiene
products, intercourse, urination, bowel movements, sitting or even wearing
Pelvic muscle problems can be a major contributing factor to these issues.
Although pelvic floor muscle weakness can lead to incontinence and provide
poor organ support, these muscles are not always weak and in need of strengthening.
They can also be too tight or uncoordinated.
Muscles need to contract and relax at the right time during your daily
activities. If your muscles are excessively tight and hold trigger points,
strengthening them now can do more harm than good. Tight muscles can compress
neighboring nerves and create more pain.
Instead of blindly strengthening your pelvic floor muscles, it is wise
to consult your doctor if you have pelvic floor problems. Your physician
will assess your condition and create a plan of care which may include
physical therapy. At times you may need a combination of treatment approaches
or even surgery.
If physical therapy is appropriate, a pelvic floor physical therapist,
as part of your healthcare team, looks at the quality of your muscle contraction,
relaxation and coordination. A therapist looks at pelvic floor muscle
tone, tender points, trigger points and peripheral nerve irritability.
We also look at connective tissue integrity from the trunk down to the knees.
You may need muscle lengthening, strengthening, coordination training,
connective tissue manipulation, or nerve and joint mobilization. You may
need advice on better habits to improve your ability to empty your bladder
and bowels, as well as improved posture and movement patterns to decrease
pain. I hope you now see that “just doing Kegels” may not
necessarily solve your pelvic problems.
Pelvic floor issues can be embarrassing to talk about. While part of the
problem is the lack of awareness about the variety of treatment options
for these issues, sometimes the barrier to women seeking help is actually
too much awareness. Some women do not discuss their pelvic floor problems
because they think, “These issues are common, so why bring them
Just because a problem like incontinence is common doesn't mean you
have to endure it. Just because pelvic pain is difficult to talk about
doesn't mean you have to live life suffering from it.
I hope that women will feel empowered enough to seek help from physicians
and physical therapists so we can guide you towards the right treatment
to achieve a confident and pain-free life.
– Kathleen Lombardo is a physical therapist at Hoag Hospital.