DROOPY PELVIC FLOOR 

“MAY YOUR COFFEE, PELVIC FLOOR, INTUITION AND SELF-APPRECIATION BE STRONG”

INTRODUCTION

The pelvic floor is a funnel- shaped structure which is made up of a layer of muscles covering the bottom of the pelvis that support the bladder and bowel in men and bladder, bowel and womb in women. These structures that sit on top of the pelvic floor are known as our pelvic organs. The muscles run like a hammock from the front of the pelvis to the tailbone (coccyx) at the back, and side-to-side from one sitting bone to another.

It is similar to trampoline, as they have the ability to move up and down.

The pelvic floor consists of two main muscles, the leavtor ani, and the coccygeus.

The leavtor ani muscle is a broad thin muscle made up of 3 muscles – pubococcygeus, puborectalis and iliococcygeus. The muscle join in the middle of pelvis except at the prostrate in males and vagina and urethra in females.

The coccygeus is also known as ischiococcygeus muscle. It is a small muscle that makes up the posterior portion of the pelvic floor.

FUNCTION OF PELVIC FLOOR MUSCLES

PELVIC ORGAN SUPPORT - Support internal pelvic organs in the correct positions (Bladder, bowel and womb).

BLADDER AND BOWEL CONTROL - Allows self-control of bladder and bowel habits using the sphincter muscles. This allows us to control the release of urine (wee), faeces  and gas. 

PASSING OF URINE AND FAECES - When relaxed, they allow the passage of urine and faeces out of the body.

SEXUAL FUNCTION - Sexual function in males the pelvic floor muscles are important in maintaining an erection during sex and preventing early ejaculation. In females awareness of the tightening of the pelvic floor muscles can contribute to sexual sensation 

BREATHING - The pelvic floor muscles play a role in breathing by relaxing and increasing the space the lungs have to expand.

PREGNANCY AND CHILD BIRTH - During pregnancy, the pelvic floor offers support to the baby and also assists in childbirth 

Pelvic floor dysfunction is an umbrella term for a variety of disorders that occur when pelvic floor muscles and ligaments are impaired Tissues surrounding the pelvic organs may have increased or decreased sensitivity or irritation resulting in pelvic pain. Pelvic floor dysfunction may include any of a group of clinical conditions that includes urinary incontinence, fecal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and several chronic pain syndromes, including vulvodynia. The three most common and definable conditions encountered clinically are urinary incontinence, anal incontinence and pelvic organ prolapse.

                                                   

                                                                      

                                                            

                            

                                                          

SIGNS AND SYMPTOMS

Constipation or bowel strains

Ongoing pain in the  pelvic region, genitals or rectum.

A prolapse – may feel as though there is a bulge/ pressure in the rectum or a feeling of needing to use your bowels without actually needing to go.

Accidentally leaking urine when you exercise, laugh, cough or sneeze.

                                                    

Ongoing pain in the  pelvic region, genitals or rectum.

A prolapse – may be felt as a bulge in the vagina (feeling or seeing a bulge or lump in or coming out of your vagina) or a feeling of heaviness, discomfort, pulling, dragging or dropping sensation.

Accidentally leaking urine when you exercise, laugh, cough or sneeze (stress incontinence).

Feelings of urgency in needing to the bathroom, or not making it there in time.

CLASSIFICATION OF PELVIC FLOOR DYSFUNCTION

1. Pelvic pain and hypertonus

2. Urinary incontinence

3. Prolapse

FACTORS THAT AFFECT THE PELVIC FLOOR

1. ANATOMICAL

2. PSYCHOLOGICAL

3. HORMONAL

4. MECHANICAL

ROLE OF PHYSIOTHERAPY IN PELVIC FLOOR CARE

1. CORE  STABILIZATION

2. KEGEL’S EXERCISE

3. ELECTRICAL STIMULATION

4. BIOFEEDBACK

5. EDUCATION

6. CONE - THERAPY

POINTS TO CONSIDER 

Holds, repetitions and frequency – Pelvic floor exercises are divided up into short hold contractions and long hold contractions. 

SHORT HOLDS – Ask the patient to hold pelvic floor contraction, this is an on/off contraction, for example, squeeze- release squeeze- release squeeze- release. 8-10 repetitions are advised, to begin with, encourage the patients to increase the number of repetitions each week to continuously challenge the pelvic floor muscles. It will train fast-twitch fibers within pelvic floor muscles to react quickly to those spontaneous movements.

LONG HOLDS - This type of training strategy is to aimed at the slow twitch fibers within the pelvic floor muscles, which are responsible for strength and endurance.

FREQUENCY -  Pelvic floor muscle training should be done as many times a possible daily. However, due to silent and hidden nature of this exercise, it can be difficult to remember ! Try to help the patient establish a routine that is specific and suitable to their lifestyle.

THE KNACK TECHNIQUE 

The knack technique can help o support pelvic floor health! Pressure builds up in the abdomen when doing spontaneous movement, this creates a downward pressure on the pelvic floor muscles when can lead to our beloved internal “trampoline” becoming stretched . the knack technique involves contracting the pelvic floor muscles before lifting, bending, sneezing, coughing or any movement which can increase the abdominal pressure.

LIFESTYLE ADVICE

• Keeping a fluid diary
• Bladder training
• Distraction
• Eat less and move more !

NOW-A-DAYS PILATES IS ALSO USED TO STRENGTHEN THE PELVIC FLOOR MUSCLES