This is the first post of a two-part spotlight on the pelvic floor. This post is geared more towards fitness professionals, while the next post will be addressed more to fitness and wellness clients.
I’m a mother of two so I’m well acquainted with my pelvic floor. It’s one of those areas that by the time you realize how important it is, it’s usually because something has gone awry and you’re in rehabilitation mode not prevention mode. Lots of fitness professionals remind you to “engage your pelvic floor” and make sure that pelvic floor is strong” but what does that even mean? As a fitness professional I know what it feels like and I’m sure personal trainers out there are familiar with the “pulling your elevator up to the next floor” analogy but do we even fully understand what’s truly going on in there?
I thought I understood until one of my sisters (also a mother of two) recently discovered her issues were exacerbated by the ever so popular kegel exercises. After hearing about her experiences I asked her to write down why she decided to seek treatment and what that treatment is like. Having a healthy pelvic floor is about more than kegels…so much more! Fitness professionals need to re-educate themselves on this deep issue that may be keeping potential clients away from fitness classes and working out. How fit pros are addressing this may even be making things worse!
*This portion was written by Jenn Richardson, BSN, RN
I became pregnant with my oldest daughter in December 2013, after a bout with anovulation and what we thought was infertility. My pregnancy was fairly healthy, though I suffered with bilateral separated SI joints (where your sacrum meets your hips-you have a joint on each side of your lower back). I had an induced labour which lasted just under eight hours and after having pushed for only 30 minutes, I delivered a beautiful, albeit wee, baby girl. I had no tears and no episiotomy. As soon as she was delivered, my back pain went away!
Fast forward to her first birthday, I was just a week pregnant with my second baby girl. This pregnancy was not so easy and I had hyperemesis gravidarum for the entire pregnancy, pretty major diastasis recti, as well as separated SI joints again. I went into labour at 39 weeks and barely made it to the hospital because she was in a hurry to get here. Again, I pushed for just 30 minutes, after just 3 hours of labour, and gave birth to a chubbier baby girl with no tears or episiotomies. This time, my back pain never went away.
I am now one year post partum (can I even call it that at this point?) and still suffering with pain. My lower back is in a constant state of cramping and I have pelvic pain that feels like menstrual cramps 2-3 days a week. I even had a couple days with pain so bad that it brought me to the floor. My pubic bone feels like it is constantly bruised (read: feels like I’ve been kicked in the crotch) and I have this hard-to-describe heaviness in my pelvis.
I have a runner friend who recently made a post about pelvic floor physiotherapy and how it has helped her after having two babies with even faster labours than I had. If it is helping her, maybe it could help me. I checked out a few clinics online and decided on Choice Health Centre in Bayers Lake and physiotherapist Stephanie Brown. She is specially trained in pelvic floor physiotherapy and has even used it as a patient herself.
I had my first visit to her clinic this week.
If you’re shy about professionals touching your lady bits, you’ll have a hard time with how hands on the assessment is. This part lasts a half hour or so and involves two fingers in your vagina the whole time. Ok, not the whole time. The first 4 minutes or so, she evaluates external pain trigger points and reflexes. Then the next 26 minutes involved an internal assessment, where she manually manipulates the muscles of your pelvic floor to find where your pain is coming from. I kid you not, at one point it felt like she had grabbed a hold of my pelvic floor and squeezed it as hard as she could. She told me she was just barely touching it. That is how injured my pelvic floor is. She continued this with all the muscles, finding wonderful pain trigger spots, sending shooting pain down my glutes and into my hips, with just the light touch of a finger. Hypertonic, she says. My pelvic floor is way too tight. She told me she could feel my muscles twitching and throbbing as she touched them. No wonder I have been having pelvic pain.
Part of this assessment is to evaluate for rectal prolapse (rectocele) and bladder prolapse (cystocele). She immediately caught my grade 1 cystocele just by having me cough. The anterior (top) wall of my vagina had weakened enough for my bladder to dip down just slightly. I had no idea I had a bladder prolapse! Thankfully, a grade 1 prolapse is nothing to worry about and it will likely not cause me any problems.
After a half hour of being internally massaged, for lack of a better description, Stephanie informed me that with a hypertonic pelvic floor, Kegels can make it worse (don’t tell her I really hadn’t been doing them anyway, like we are all told we should). My muscles were so tight that they were closing off my urethra (tube from bladder to outside of body), causing me to have to push to finish peeing. Many of them were spasming and twitching, causing cramp-like pain. It all makes sense!
Because my muscles are all so tight, I am working on reverse Kegels to relax those muscles. It is a hard as it sounds. I have to relax the pelvic floor without pushing it outwards….? It takes a lot of concentration and focus and I don’t even know if I am doing it right half the time. Stephanie has told me that she can do biofeedback, whereby they place a probe in your vagina and connect it to a computer. When you contract and relax your muscles, it presents as a graph on the screen (similar to cardiotocography, which monitors baby’s heart rate and mom’s contractions during labour) so you can learn how to effectively control those muscles. That sounds fun…
After having two children, one miscarriage ending in a dilatation and curettage and several visits to the emergency room during recovery, I’ve had enough hands up my vagina so I admire my sister for being willing to endure the discomfort and intrusion necessary to heal her lady bits. She’s a public health nurse who teaches sex ed to teenagers so nothing really phases her, but why is what she shared so important to fitness professionals?
Remember where she said the assessment revealed that her muscles were too tight and that “with a hypertonic pelvic floor, Kegels can make it worse”?Stop and think for a moment about how many times you’ve recited the “do your kegels!” to clients. Be honest…it’s probably a lot, right? Now, think about how many of those clients may be in the same situation as my sister. How many of you are feeling embarrassed right now? (As embarrassed as having a physiotherapist’s hands up your hoo haa?) When we know better, we do better, right?
I wonder how many women are avoiding running clubs, bootcamp classes, and fitness in general because of incontinence or discomfort? This is where potential clients are hiding! Knowing this presents a fantastic opportunity for you as a professional and for women in your area:
- get educated! Read up on the topic
- connect with a pelvic floor specialist in your area (I found several by typing “pelvic floor physiotherapist” into Google)
- if you’re a pelvic floor specialist, connect with some fitness professionals
- co-host an education seminar on the pelvic floor and educate women (and other fit pros! Remember the events you host don’t have to all be workout-related!)
- encourage your clients to seek the advice of a specialist
I’m glad my sister endured the discomforting hands-on (hands-in?) so that we could then share this information with you and hopefully improve the lives of many women.