Embarrassed to ask? Here are some answers. A lot of women feel too embarrassed to ask questions about their pelvic health. They either feel like they'll be judged for not already knowing the answer or they feel uncomfortable talking about the subject altogether. Well, no judgment here! We're taking the topic of pelvic health out from under the rug. Hopefully, knowing the answers to a few questions will give you the confidence to ask a few of your own. inguinal (through the inner groin - aka sports hernia), umbilical (through the belly button), and incisional (through a surgical scar). Like a prolapse, severe cases may require surgery, but because there is always a layer of muscle involved, physical therapy can be an effective form of treatment. Additionally, physical therapy is important in preventing hernias from occurring or reoccurring by ensuring that the core muscles that hold tissues in place are strong and activated.
Q: How often should I be peeing? A: Usually people who ask this question are concerned about an increase in number of trips to the bathroom rather than a decrease. Frequent urination can be due to a variety of factors and is classified as peeing more than 8 times per day. The healthy number of trips to the bathroom is 4-5 times per day. The bladder has a capacity of 300-400 mL and you should be peeing every 3-4 hours, though no more than once at night. In order to achieve this frequency of urination, you need to consume 25-30 mL of fluid per kg of body weight per day. If you're otherwise healthy but experiencing frequent urination despite normal fluid consumption, an over-consumption of bladder irritants could be to blame. Strawberries,alcohol,spicy foods,chocolate,andcarbonatedbeveragesare just a few things the bladder wants to get rid of quickly. On the flip side, decreased urination is considered an output of less than 400 mL of urine per day. This could be due to dehydration in women but is more commonly seen with prostate problems in men. If you're not sure whether the number of trips to the bathroom you're taking is something to be concerned about, ask to speak with one of our physical therapists about how to keep a bladder diary. Lukacz, E. S., et al. "A healthy bladder: a consensus statement." International journal of clinical practice 65.10 (2011): 1026-1036. Q: Should I expect to start leaking as I age or after having a baby? A: It is VERY common for leaking to occur during these times, but that doesn't mean ithas tohappenand itdoesn'thave tobeyournewnormal.Leaking ismost often due to weakness in the pelvic floor muscles; the muscles you would use to stop the flow of urine that can weaken with age and get stretched while giving birth. Coughing, sneezing, and jumping all challenge the pelvic floor muscles even more than gravity and is often when leaking occurs. This type of leaking is referred to as stress incontinence, whereas urge incontinence is leaking when the bladder gets too full. Those with urge incontinence will often experience frequent urination, sometimes by choice, to avoid any leaks. In this case, bladder retraining in addition to pelvic floor muscle exercises will be part of physical therapy treatment. Just like any other muscle, you can regain strength and control through exercise, which makes most cases of leaking 100% treatable with physical therapy. Dumoulin, C., and J. Hay-Smith. "Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review." (2008): 47-63. Q: Are prolapses and hernias the same thing? Are they as serious as they sound? A: No, these are different diagnoses but with sometimes similar causes. Prolapsesoccur inthevaginaorrectumsiteswhileherniasoccur intheabdominal or groin regions. There are different severities of both prolapses and hernias, but don't be scared because there is treatment available for every level! Prolapse refers to when organs lose their support and begin to fall, usually forward or down. Pelvic organ prolapse is the most common form and more of an issue after childbirth. Weakness in the pelvic floor muscles due to being stretched reduces their ability to hold the organs in the body, which means the bladder or uterus drops down against the vagina. Surgery may be required in severe cases, but because pelvic floor muscle strengthening and retraining is such an effective treatment, conservative management should be attempted first. Hernias refer to soft tissue pushing through a weak spot in the surrounding tissue that holds it in place. There are several different types of hernias such as
Bø, Kari. "Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction." World journal of urology 30.4 (2012): 437-443.
® Q: Is it normal to have pain during sex? A: No.There might be moments of discomfort which are normal, but significant or constant pain during intercourse is not normal. For women, vestibulodynia refers to pain at the entrance of the vagina and this can be generalized/constant or provoked/when touched. For a lot of women, the issue is overactivity of the pelvic floor muscles with difficulty relaxing them. It might seem counterintuitive, but these women might also struggle with incontinence because even though the muscles are very much on, they can't react well to changes in pressure from sneezing or a full bladder. In this case, physical therapy might include, biofeedback, dilators, and internal pelvic floor manual therapy in addition to pelvic floor exercises that emphasize both activation and relaxation. Additionally, some women experience postpartum pain with intercourse from a painful scar after an episiotomy or vaginal tearing. Physical therapy can help with a painful scar by mobilizing the scar tissue, and then re-training your scar to move with the tissues around it so that it is less painful during intimacy. Morin,Mélanie,Marie-SoleilCarroll,andSophieBergeron. "Systematic reviewof theeffectiveness ofphysical therapymodalities inwomenwithprovokedvestibulodynia."Sexualmedicine reviews 5.3 (2017): 295-322. If you’d like answers to your own questions, you can find at least one qualified Women’s Health Therapist at each of our 8 clinics.
Exercise of theMonth Try this movement if you're having trouble with leaking.
Super Kegal
Pelvic Floor Muscle Activation: Usea foam rollorafirmcushion toblock your pelvis and allow your back to curve slightly towards the floor. Being in this position will give your pelvic floor muscles an assist from gravity and your other core muscles. Perform a kegal contraction the same way you would stop the flow of urine. You should feel the muscles tighten together and draw up towards your head. Practice holding your kegal, working up to 30-second holds. Once you've mastered that, you can alternate marching your legs for 30 seconds ensuring no movement occurs above your hips (you might need to reset your kegal before lowering your leg back down).
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