What is Pelvic Floor Muscle Weakness?
PLEASE NOTE: following information and associated clinical care relates to female patients only. We are not offering pelvic health care to male patients at this time.
Hypotonicity, or weak pelvic floor muscles, can contribute to urinary and fecal incontinence, as well as pelvic organ prolapse. When the pelvic floor muscles are weak, they need to undergo a properly designed and structured strengthening program. Basic instructions to “do Kegels” are often the only instructions that both women and men get from their medical doctors. On the extreme opposite end of the spectrum, other patients might be told to perform up to 1000 repetitions per day! This has no basis in science! One can easily look online for a description of how to perform Kegel exercises for either man or woman. It is important however, to know that most people cannot find these internal muscles without at least one consultation with a pelvic health physiotherapist specially trained in internal palpation. Not all physiotherapists know how to do this, it requires advanced training.
In 2010, the Cochrane Collaboration, the global independent network of researchers, health professionals, patients, carers, and people passionate about improving health outcomes for everyone, everywhere, concluded that physiotherapists properly trained in pelvic health and pelvic floor rehabilitation should be the first intervention sought for urge, stress and mixed incontinence in women, before seeking surgical consultation. Upon review of the research, The Cochrane Group concluded that pelvic floor rehabilitation is 80% in resolving pelvic floor dysfunction and related health conditions without needing to progress to surgery. For every ten patients with these problems, eight are able to successfully treat with conservative care and only two need to proceed towards surgery. As in most European countries, Great Britain’s National Institute of Health requires a trial of conservative care for pelvic health conditions before considering surgical consultation and correction. This approach is warranted, especially considering the potential risks and negative side effects of surgery in general, and in particular those associated with the sling repair procedure.
Self-care is an important part of treatment. Avoid pushing or straining when urinating and ask your health care provider about how to treat constipation. Relaxing the muscles in the pelvic floor area is important, and doing reverse kegels may be one way to help lengthen and relax these muscles. Regular deep breathing is an important part of learning to relax tension in all of your muscles, but particularly the pelvic floor. Using methods such as warm baths twice daily can also be helpful.
Medication such as compounded vaginal or rectal diazepam can be quite helpful and may be prescribed by your doctor. These medications can be used as local muscles relaxants in the vagina or rectum. Good posture to keep pressure off your bladder and pelvic organs, and other stretching techniques such as yoga, can be helpful to avoid tightening and spasms in the pelvic floor muscles as well.
Persistent pain education is an important part of treating pelvic floor muscle problems since the pelvic area is an area that we often hold our stress. Anxiety, stress and our thoughts, attitudes and beliefs can perpetuate the pain in our pelvis; understanding how our pain system works has shown to be an effective way of reducing the threat of ongoing pelvic floor problems.