Throughout the last several years, pelvic floor physical therapy has started to get some of the attention that it deserves. It has become more commonplace to hear about pelvic floor strengthening in commercials, magazines, and throughout social media. We are hearing more and more about diagnoses such as incontinence, diastasis recti, and prolapse than we used to in the past and it’s great that the word is starting to get out there! However, many of the treatment techniques seen in the news for pelvic floor conditions include statements such as “Tighten your tummy,” “Strengthen your abs,” or “Do your kegels!” Unfortunately, for some individuals, these activities can be detrimental to the healing process.
We often assume that if we are having a problem with our pelvic floor, it is because the tissues are weak or lax and we need to strengthen or tighten them. However, sometimes we can experience dysfunction of the pelvic floor due to overactive, tight muscles. This is why it is especially important to see a trained professional before starting an exercise program you find in a magazine! If your muscles are already overworking, why would you want to increase the load placed on them?
You are probably thinking, “Why would I be having symptoms of urinary leakage if my pelvic floor is too tight? Surely mine is weak!” I often use the analogy of holding a stack of books. You can think of your bicep muscles in this case. Let’s say you are holding a stack of 6 large textbooks ALL day. Around the middle of the afternoon, someone walks up to you and places one more large book at the top of the stack. Your arms are done. You have been carrying around this stack of books all day and that last book added on top was the last straw for your biceps. You drop the whole stack! Now let’s equate this to your pelvic floor. Your pelvic floor is tense and tight all day, supporting a full bladder or increased pressure from above (similar to the stack of books). All of a the sudden, you feel the urge to sneeze or cough (that extra book placed on top) and your pelvic floor is not able to withstand any more pressure from above. Your pelvic floor fails and you experience a leakage of urine. Can you see why additional kegels or tightening of the pelvic floor may be detrimental now?
If your pelvic floor is hypertonic (overly tight or contracted), you may benefit from some of the methods used in therapy to relax or decrease the tone of your pelvic floor first. Most likely your muscles are also weak, but we MUST teach them to relax first. This will keep them from fatiguing and also place them in the best position possible to generate force and power. If our muscles are always in a shortened position, then we are not able to utilize their full strength.
Increased tone can often be found in those individuals with pelvic or hip pain, those with increased stress and anxiety, elite athletes, those with a history of surgery or other trauma in the abdominal or pelvic region, as well as several other populations. If you have tried some of the exercises you’ve seen promoted and have noticed your symptoms getting worse, or not changing, this may be the reason why!
See a women’s health physical therapist for guidance in determining what exercise plan is best for you and get assistance in progressing your exercises in the most beneficial way for the needs of your body!