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Pelvic Floor: To Kegel or Not to Kegel

From W dish

Every time I cue my clients to engage their pelvic floors, I find myself doing it along with them. I’ve been engaging my pelvic floor like mad since my daughter was born over ten years ago, but I
recently discovered that all those kegels were doing nothing for what I lovingly refer to as ‘leaky lady syndrome’ AKA stress incontinence.

Then last month, I had the good fortune of meeting Michelle Fraser (referred to as Fraser in her circles), Orthopaedic and Pelvic Health Physiotherapist, certified yoga instructor and Rehabilitation Director at Synergy Sports Medicine. We were discussing treatment protocol regarding one of her patients, (one of my clients) and in that conversation I realized I had a lot to learn about the ins and outs of the pelvic floor and, more specifically, I had a lot to learn about my own.

So I booked an appointment. What better way to help my clients then to learn through my own body? She performed an internal exam to assess my pelvic floor muscular imbalances and within
a few minutes, I found out why I was suffering from stress incontinence even though I had a relatively strong pelvic floor. I was given a set of very specific and finely tuned exercises including
a breathing exercise that taught me how to fully relax my pelvic floor, something I clearly had forgotten how to do in all my manic kegelling.

What blew my mind is how ultimately simple my issue was and yet, so many women like me don’t get the help we need. In fact, I even trained one male gynaecologist who insisted pelvic floor
exercises were a waste of time and only surgery could really fix stress incontinence. What!?

I interviewed Fraser to share a bit of what I learned. This is what she had to say:

What's your biggest pet peeve about how kegels or pelvic floor exercises are coached?
What makes me most sad is that so many men and women's quality of life could be significantly changed with relatively simple treatment...so my pet peeve is that so few people know about pelvic
health physiotherapy! Doctors, obstetricians, gynaecologists, urologists midwives -- their patients could benefit so much from pelvic health physiotherapy. Our responsibility is to continue to educate these health care professionals, as well as the general population, about this type of work. The most understanding seems to be anecdotal reports from patients/ clients/ friends...so spreading the word in the manner that we are doing (an article based upon a personal experience) is perfect!

Can people do more harm than good in doing a kegel/pelvic floor exercise the wrong way?
Yes. When I assess muscle function of the pelvic floor, I am checking to see whether muscles are working optimally, and if they are not, whether they are weak, too tense, too short, or not working
in a coordinated fashion with other muscles. Let's say that, in one's pelvic floor, one muscle is overused while an adjacent muscle is weak. If a general pelvic floor exercise is performed, such as a general kegel, the muscle that is already overused will come in, while the muscle that is weak may not. Therefore, the muscle that is overused may become painful because it is being overused even more, while the weak muscle may not catch up. This may lead to the difference in strength between the two becoming even more significant, worsening the patient's condition. Ideally, overused muscles would be taught to relax, and pelvic floor strengthening exercises designed specifically for the weak muscles would be performed.

What types of major issues have you seen corrected for people who sought proper treatment with you?

  •  Urinary incontinence (stress urinary incontinence, urge urinary incontinence)
  • other urinary symptoms (nocturia (getting up at night to urinate)
  • Hesitancy (unable to start the stream)
  • Pelvic, hip and low back pain
  • Sexual dysfunction due to pain that is not being able to participate in sexual activity due to pain
  • Rectus diastasis: separation of the abdominal wall, usually due to pregnancy
  • constipation
  • Mild bladder prolapse

Why do you think so many women are dealing with pelvic floor issues nowadays?

Our society teaches women to multi-task, to be "super-mom"and that "stronger is better." Many of my patients benefit from the opposite of this -- they benefit from softening, stopping and taking a breath, listening to their bodies, and not pushing through discomfort in order to reach unattainable goals. The conditions listed above are often due to too much tension in the body, rather than a
need to strengthen.

Also, there is a false notion in our society that it is "normal" to have symptoms such as urinary incontinence after childbirth -- perhaps it is common, but it is not "normal" -- and a pelvic health
physiotherapist can help to resolve these symptoms.

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