Can Treating Your Pelvic Floor Beat the Bloat!?

time lapse photography of splash of water
Photo by Zoe Jane on Pexels.com

Fiona McMahon PT, DPT

Bloating is the worst. It hurts. It makes us feel uncomfortable in our clothes and can be super unpredictable. There is so much that can cause bloating and many times bloating can be caused by more than one thing: diet, gut flora balance (the ratio of good gut bacteria to bad), hormones, and your menstrual cycle/history, for those of us who menstruate. All these things can all play a part in bloating. Did you know the pelvic floor can contribute too? The truth is there are a lot of things that can contribute to bloating. In this blog we will give you a quick overview of where to start as well as explain how a tight pelvic floor can contribute to bloating.

Nothing fits and my belly really hurts! Help!

I’m so sorry! The first thing I would suggest at this point is get yourself an appointment with a trusted general practitioner. There really is a lot that can go into a rip roarin’ case of abdominal bloating, and having a good clinician to look through possible causes is worth their weight in gold. They are the first line to start sorting this stuff out. Go in prepared, if you notice any dietary contributors try and remember to tell your doc. Do you bloat at a specific time of day or after a specific activity? Does your bloating change based on your menstrual cycle, if you have one? Is there anything else amiss in your health, like fatigue, hair loss, overheating or feeling really cold? All of these details can be so helpful in the hands of the right clinician.

 

My Doctor did a bunch of tests, now what?

If your doctor found something on testing, hooray! You are closer than you were before, even if you have yet to see results. Samesies if your doctor didn’t find anything, because now you know the bloating isn’t caused by whatever they tested for. If you haven’t seen results OR didn’t receive a diagnosis at all, it’s time to look a bit deeper into your potential cause of bloating, the pelvic floor.

 

First of all, “The pelvic what?” and second of all, how can I tell if this is an avenue I want to go down?

Ah, the pelvic floor. If you are new to this blog, understand you are not alone if you have never heard of it. No one really talks about it, but it’s super important. The pelvic floor lives between the pubic bone in front and tail bone in back. No matter what anatomy you were born with, we all have one. The pelvic floor is a group of muscles that stabilizes the pelvis, regulates urination and defecation, and provides sexual function.

When people have pelvic floor dysfunction, many times the muscles are very tight and cannot move well to let stool out or keep urine in amongst other symptoms. A tight pelvic floor can affect your belly bloating by not moving down well to accommodate digestive gas. When we digest our food, the naturally occurring bacteria in our guts put off gas. In a healthy person, the pelvic floor will have some give to accommodate the bloat and allow you to expand like a balloon, up, down, side-to-side, and front to back. If you have a tight pelvic floor, much of the pressure is pushed out through your belly and you get that familiar and rather uncomfortable belly bulge. This is worsened if you have a weak transverse abdominis, which is the lovely little muscle that wraps around your belly and lies underneath to your six pack muscles. You may also find that you get heartburn along with the bloat which can be related to the pressure from the gas pushing up on your upper GI tract.

Signs the Pelvic Floor Could be Your Bloating Puzzle Missing Piece

Because the pelvic floor does so so so much for the body, we often see pelvic floor issues manifesting in many different aspects of our lives. Here are some symptoms that are caused by pelvic floor dysfunction. If you have these symptoms as well as bloating, pelvic floor physical therapy is very likely to be the right place to go.

  • Painful penetration
  • Painful orgasm/ejaculation
  • Painful sexual arousal
  • Urinary pain/burning
  • Urinary frequency (going to the bathroom more than once every 2 hours)
  • Urinary hesitancy
  • Urinary leakage
  • Urinary urgency
  • Bowel frequency (going more 3+ times a day)
  • Bowel urgency
  • Constipation
  • Bowel incontinence
  • Pelvic pain
  • Low back pain

How will Pelvic PT Help Me?

Pelvic floor physical therapy can help teach tight muscles contributing to bloating how to relax, normalize bowel movements, and strengthen the transversus abdominis, amongst many, many, other things. Learn more about how it can help, here.

There is so much that can be done to keep you from warring with your waistband and it may just start with pelvic floor PT.

Abraham S, Luscombe G, Kellow J. Pelvic floor dysfunction predicts abdominal bloating and distention in eating disorder patients. Scandinavian Journal of Gastroenterology. 2012. 12(6)

All About Testicles

tennis ball isolated

By Fiona McMahon, PT, DPT

Testicles have long held a special place in our society.  In fact, the word testis means “witness of virility” in Latin. They help produce the hormones that spark puberty. They are responsible for body hair, the growth of the penis, and sex drive.

Testicles are gonads. Gonads are sex organs that produce sex cells.  People with male anatomy produce sperm and  people with female anatomy produce ova (eggs). Testicles also produce the hormone testosterone, which as stated earlier is responsible for people with male anatomy’s secondary sex characteristics, like body hair, muscle bulk, and sex drive.

Testicles are housed in the scrotum, a sack of skin just behind the penis. Within the scrotum, the testicles are covered by a fibrous sheath called the tunica vaginalis and tunica albuginea. The testicles are composed of many tightly bound tubules called the seminiferous tubules. These tubules give the testicles their uneven feel. Each testicle is held in the scrotum by the spermatic cord, which is composed of the vas deferens, blood vessels, and lymph vessels.

Anyone who has watched an Adam Sandler movie knows that testicles are delicate and sensitive creatures. Even just a jostle can be enough to double one over in pain. But sometimes your testicles may hurt for no apparent reason.  Acute scrotum is the technical name given to sudden onset testicular pain without swelling. There are many medical reasons your testicles may hurt.  Testicular pain can be a serious condition and should not be ignored.

Testicular torsion is a medical emergency that requires immediate treatment in order to save the testicle.  Testicular torsion is most common in people with male anatomy under the age of 25. It occurs when the spermatic cord twists cutting off blood supply to the testes. Usually testicular torsion is spontaneous and cause pain great enough to wake a one out of sleep and induce vomiting.

In some people testicular torsion is contributed to by what is known as a bell clapper deformity. A bell clapper deformity occurs when there is a lack of fixation in the tunica vaginalis. Because of this lack of fixation, the testis is free to rotate around on itself and obstruct blood flow. Bell clapper deformities are present in 12% of males and in males with bell clapper deformity 40% have bilateral derformity. In neonates, extravaginal torsion can occur when the tunica vaginalis and the testes both twist in the inguinal canal. Any case of sudden and severe testicular pain should be considered testicular torsion until proven otherwise and treated as a medical emergency.

Testicular cancer is usually painless but in 20% of cases pain can be a symptom. The pain caused by testicular cancer is typically due to hemorrhage. In the overall population testicular cancer is relatively rare, however it is the most common form of cancer in young males between the ages of 15 and 35. Signs of testicular cancer include a dull ache in the abdomen and groin, heaviness in the scrotum, lump in the testicle, enlargement of the breast tissue, or back pain. Any of these symptoms warrant a visit to your general practitioner.

So what about testicular pain that is not cancer or testicular torsion? Testicular pain can also be caused by other medical conditions like epididymitis, orchitis, urinary reflux, urinary tract infection, or sexually transmitted infection. Again as stated before, any acute testicular pain that occurs out of the blue warrants immediate medical attention.

There are some people however who suffer from acute and recurrent testicular pain for which a medical cause has not been established. For these people, not having concrete answers for what is going on can be especially distressing. In a paper by Anderson and colleagues, trigger points elsewhere in the body have been found to cause pain in the testicles, shaft of the penis, and other areas in the genital region.

Trigger points are defined as areas of hypersensitive and painful spots within the muscle that can be felt as a tough or tight band. In their study, Anderson and colleagues found that testicular pain could be elicited in 80% of men with testicular pain with no other medical cause, when trigger points in the external obliques were palpated. The study also found other trigger points referring to the shaft of the penis, and the perineum (the bicycle seat area of the body). Myofascial restrictions can refer pain to testicles as well as reduce blood flow to the genitals, making erections difficult or painful.

Irritated nerves can also be the cause of testicular and penile pain. The pudendal nerve is most commonly associated with male pelvic pain. The pudendal nerve supplies sensation to many of the pelvic structures including the penis, scrotum, and anorecatal region. This nerve can become inflamed or strained for a variety of different reasons. Straining with constipation, boney alignment that stresses the nerve, as well as tight ligaments and muscles that surround the area can all stress the pudendal nerve and cause scrotal, anal, or penile pain.

Other nerves such as the Iliohypogastric can cause suprapubic and gluteal pain. The inguinal nerve can cause pain in the inner thigh, and lateral scrotal skin. The genital femoral is also associated with the skin of the scrotum and thigh.

If you find yourself with testicular or penile pain that has not been resolved with medical intervention, it may be time to find your way to a licensed pelvic floor physical therapist. Physical therapists can work with you to break up your trigger points, provide postural education to correct alignment, reduce constipation with bowel training, and incorporate relaxation and postural changes to prevent your pain from coming back. At Beyond Basics, we have a great team of therapists who treat pelvic floor disorders who can help treat your testicular pain.

Sources:
Anatomy and physiology of the testicle. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/anatomy-and-physiology/?region=on. Accessed June 10, 2015
Anderson R, Sawyer T, Wise D, Morey A. Painful myofascial trigger points and pain sites in men with chronic prostatitis/ chronic pelvis pain syndrome. The Journal of Urology, 182;6 2753-58
Jefferies M, Cox A, Gupta A et al. The management of acute testicular pain in children and adolescents. BMJ. 2015
Mayo Clinic Staff. Testicle Pain. Accessed June 8, 2015. http://www.mayoclinic.org/symptoms/testicle-pain/basics/causes/sym-20050942
Mayo Clinic Staff. Testicular Cancer. http://www.mayoclinic.org/diseases-conditions/testicular-cancer/basics/definition/con-20043068. Accessed June 10, 2015

What’s Neater Than Your Peter? Burning Urination

#3MalePelvicFloor_Nolabel_copyright
 copyright Amy Stein 2008

Fiona McMahon PT, DPT

It’s been a while since we’ve done a “What’s Neater than Your Peter” series so it’s definitely time for another addition! Today we will cover urethral burning. For people with penises, this can be an alarming symptom. By itself it can be a pretty non- specific symptom. Thus, for anyone experiencing urethral burning, it is important to visit your healthcare provider right away, to find out what is causing your symptoms. In this blog we review potential causes of urethral burning, which is by no means an exhaustive list, and discuss what can be done for urethral burning caused by musculoskeletal conditions as well as some food items that can irritate the urethra.

If you are saying “ureth- what?” you are not alone. Both people with male and female anatomy have a urethra. The urethra, or the “pee hole” as it is colloquially known, the passageway from the bladder to the outside of the body. In people with male anatomy, the urethra also transports ejaculate out during ejaculation. Nifty. For people with penises, your urethra is longer than those of us with female anatomy, which is somewhat protective against urinary tract infections(UTIs), you lucky duck, you.

Pain and stinging in your urethra could indicate a lot of things. Things that you definitely don’t want to wait on treating include; sexually transmitted infection (i.e herpes, chlamydia, and gonorrhea), bladder infection, which untreated can progress to kidney infection, reaction to personal care products, prostatitis, and pelvic floor dysfunction, which can cause non- bacterial prostatitis), amongst other conditions.

The thought of potentially having an STI can keep people away from the doctor secondary to embarrassment, cost barriers, etc. According to an up to date article cited in the sources, more than half of the United States population who is eligible for screening fails to do so. Don’t let it be you. The complications of untreated STIs can be much worse than the initial infection, not to mention the risk of harming your future partners. Also know that STI’s are fairly common and having one does not make you a “dirty” or “bad” person. It’s so common! Nearly 1 in 2 people will acquire an STI in their lifetime, so if you do have one, you aren’t alone and you deserve to feel better.

So what happens if you’ve ruled out STI, bladder infection, prostate infection, and reactions to personal care products? What in the actual heck could be causing your urethral discomfort? At this point it is important to look at your pelvic floor and your diet.

Let’s talk about diet first. There are some substances that can irritate the bladder and urethra, and give the feeling of burning in the urethra as well as increased urinary frequency and urgency. I write about bladder irritants in my recent blog and you can check out a list of bladder irritants here. (INSERT BOTH BLOG AND bladder irritant list). But if you are too busy to read the whole blog, the long and short of it is, not every irritant on this list will bother your symptoms. Be mindful when eating foods with these irritants. If your symptoms flare 2-3 hours following eating an irritant, consider eliminating it from your diet and see how you do. The most common irritants we see at BBPT are caffeine, citrus, alcohol and spicy food.

Now let’s talk about urethral burning and its relationship to the pelvic floor, shall we? The pelvic floor is the area of muscles that live between the pubic bone in front and the tailbone in back. Like an onion, the pelvic floor has layers: three to be precise. The outermost layer contains a muscle called the bulbospongiosus (bulbo), along with its buddy the ischiocavernosus, and the superficial transverse perineum. The bulbo surrounds the urethra and is at the base of the penis. If it is tight, it can make it harder to pee and also cause urethral burning with urination and ejaculation. In addition, the layer below: the urogenital diaphragm and the layer below that, which consist of a whole bunch of muscles called the levator ani, can contribute to these symptoms as well. In fact, dysfunction in these muscles causes almost 95% of non bacterial prostatitis cases. Wowzah, no? I discuss prostatitis in much more detail in this blog (INSERT). How can you tell if your muscles are tight? The best way to tell is getting yourself to a skilled pelvic floor physical therapist, who can accurately diagnose issues with the pelvic floor as well as provide you with a plan to start feeling better.

Sources:

American Sexual Health Association. Statistics. http://www.ashasexualhealth.org/stdsstis/statistics/ [ Accessed January 14, 2020]

Ghanem K, Tuddenham S. Screening for sexually transmitted infections. Up to Date. October 11, 2019

Mayo Clinic. Painful urination (dysuria). https://www.mayoclinic.org/symptoms/painful-urination/basics/causes/sym-20050772. [Accessed January 14, 2020]

Publications. Harvard Medical School. 2007. http://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome. Accessed December 11, 2016

Prostatitis What it is and What to do About it

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Fiona McMahon DPT

Introduction

Prostatitis is a common diagnosis we see at Beyond Basics Physical Therapy. If I have a new evaluation on my schedule, who is male and between the ages of 18-40, we can place a pretty good bet that they are coming to see me for issues pertaining to non-bacterial prostatitis. It is estimated that 35-50% of men are reported to have prostatitis symptoms  in their lifetime (Rees). Prostatitis can be classified into different types based on their causes and response to treatment. Prostatitis is a vexing condition for many patients. In cases of non-bacterial prostatitis, which makes up 95% of all prostatitis, it’s often very difficult to determine what brought it on, and often times our patients have been bouncing from practitioner to practitioner trying to find answers and effective treatment. Let’s dive into the causes, symptoms, and treatment in order to help shed light on this condition.

 

Prostatitis Symptoms,

Although there are different types of prostatitis, the symptoms of prostatitis are mostly the same between types. That isn’t to suggest that every man with prostatitis experiences the same symptoms, quite on the contrary. Men with prostatitis may experience almost all of the symptoms listed below or they may only notice one or two. This melange of symptom possibilities can add to the confusion of having prostatitis and getting down to an effective cure.

 

Symptoms:

  • The sensation of having a golf ball stuck in the rectum
  • Hesitant urinary stream (having trouble getting the urine to start flowing)
  • Post void dribble (spotting of urine on underwear following voiding)
  • Pain that radiates into the abdomen (this is one of the differences from symptoms of benign prostatic hyperplasia)
  • Erectile dysfunction and decreased libido
  • Painful ejaculation
  • Painful or burning urination
  • Genital pain: penile, testicular, groin and perineal pain

 

Types of prostatitis:

Here’s where it gets a little more complicated. There isn’t one type of prostatitis. There are four. Each type of prostatitis is a little different in terms of etiology (how it developed) and how it’s treated.

Type 1: Acute bacterial prostatitis

This type of prostatitis is caused by an infection by a microbe. It is relatively rare. In addition to the symptoms above, a person with this type of prostatitis will feel the symptoms of an ongoing infection, including pain in the body, fever, and chills. This type of prostatitis generally response well to antibiotic treatment.

Type 2: Chronic bacterial prostatitis

Chronic bacterial prostatitis can occur after multiple infection or when there is an ongoing low grade infection. The symptoms, particularly those of infection are dampened in this form of prostatitis than those of type 1. Type 2 is often more tricky to treat and may require multiple courses of antibiotics

Type 3: Chronic Prostatitis/ Chronic pelvic pain syndrome (the most common making up 90-95% of all prostatitis and WHAT WE TREAT!)

This type of prostatitis occurs with no evident infectious cause and makes up the majority of cases. This is the classification that is one of the more frustrating for patients to deal with because the causal agent is much harder to ascertain; however the majority have musculoskeletal dysfunction, which we now know can be treated effectively through expert pelvic floor physical therapy.  Type III prostatitis can be further categorized based on the presence or absence of white blood cells in the urine or prostatic fluid, inflammatory and noninflammatory respectively.

Type 4: Asymptomatic inflammatory prostatitis

As the name implies, this type of prostatitis is usually not noticed unless semen or urine analysis is being performed to diagnose another condition. Typically this type is left untreated.

 

Causes

Here’s one of the universal questions that patients with prostatitis have: “why do I have this?”  Sometimes patients may find themselves blaming their prostatitis on something they have done in the past, like masturbating or poor hygiene habits as children. The fact is, prostatitis can occur for a multitude of reasons, and it’s usually something one has no control over like a fall on the bottom or an infection. It’s unfortunately something that happens, and as noted in the introduction of this blog, it is quite common. Here are some possible causes:

 

  • In chronic nonbacterial prostatitis/ chronic pelvic pain syndrome 90-95% of cases- no definitive cause ( or very difficult to ascertain); however pelvic floor dysfunction is a prevalent contributor.  
  • Bacterial infection, which can have good results with antibiotics
  • Chronic bacterial prostatitis, recurrent infection
  • Inflammation to the pelvic area
  • Central and peripheral sensitization- meaning a past injury in the area caused your pelvic nerves to perceive non painful stimuli as painful
  • Trigger points (irritable points of muscle) in the pelvic floor and abdomen

 

Treatment

Treatment is evolving in prostatitis. Increasing evidence supports a multimodal approach to treating prostatitis and its symptoms, meaning that not only is medical intervention used, but psychological, nutritional, and physical therapy.

From a medical perspective the first line of treatment for prostatitis is the “3 A’s”, antibiotics (especially the quinolone class), anti-inflammatories, and alpha blockers. Antibiotics obviously clear up any infection that might be causing your symptoms, anti-inflammatories to bring down the pain and discomfort, and alpha blockers to improve urine flow. Sometimes this is just what the doctor ordered (literally), especially in individuals with type 1 prostatitis and they are on their way with no further treatment needed. Since the vast majority of people with chronic prostatitis fall outside of the type one category and into more difficult to treat types, their recovery may require a more involved intervention to effectively treat their symptoms and the 3 A’s may not be the answer, or the complete answer for these patients.

 

Physical Therapy: Anderson and his colleagues described the relationship between the presence of myofascial trigger points and symptomatic prostatitis. They also showed that physical therapy intervention, including manual release of these trigger points was effective in reducing symptoms of prostatitis. The benefit of physical therapy was shown again to be more effective than placebo in a 2011 paper by Nickel. In addition to treating the trigger points themselves, PT’s work to determine what lead up to the formation of the trigger points in the first place, whether that be poor habitual posture, poor strength, or tight muscles in other parts of the body. They also teach patients how to avoid clenching their pelvic floor to prevent exacerbating symptoms.  This type of therapeutic approach was found to be effective in reducing pain in 72% of participants in a study conducted by Anderson and colleagues in 2005. The therapists at Beyond Basics Physical Therapy work to go beyond simple treatment of the trigger points themselves.  We develop plans and treatments to prevent their recurrence in the future.   Some other effective physical therapy techniques that we use include but are not limited to, joint mobilization to assist proper structural alignment, therapeutic exercise, postural and neuromuscular re-education and a detailed and individualized home exercise program.

 

Dietary Modifications:

Avoiding irritants to the bladder and gastrointestinal system is another simple and effective place to start. In some men, avoiding spicy foods, alcohol and caffeine can work wonders in making symptoms more manageable.   

 

Phytotherapy:

Preliminary data shows that there is evidence to support the use of saw palmetto, quercetin and bee pollen extract in reducing the pain of prostatitis. If supplementation interests you, consult with your general practitioner or urologist.

 

Stress Reduction

As clinicians who have seen a lot of cases of prostatitis, high stress is a contributor that we see with the vast majority of our patients. Studies have shown that high levels of stress are correlated with higher pain and disability scores in individuals with prostatitis. Stress can also perpetuate unhealthy holding or clenching in the pelvic floor, which causes or contributes to trigger points discussed earlier in this section. Stress reduction is a key component to expediting your recovery and is something we recommend to nearly all of our patients.

 

Final Thoughts

  • Prostatitis is a common and aggravating condition to be living with, and the fact is, every case of prostatitis is different. You may fall into the category were a course of antibiotics does the trick or you may fall into the category where you require physical therapy alongside medical intervention which can be much more slow going. Regardless of where you fall, be patient, there usually is a lot that can be done to help the more complex cases of prostatitis clear up. If you are suffering with this condition, make an appointment with an expert pelvic floor physical therapist today. There is so much we can do.

 

Sources

Anderson R, Sawyer T, Wise D. Painful myofascial trigger points and pain site in men with chronic prostatitis/ Chronic Pelvic Pain Syndrome. J Urol. 2009;182(6): 2753-8

Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

Chronic nonbacterial prostatitis (chronic pelvic pain syndrome). Harvard Health Publications. Harvard Medical School. 2007. http://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome. Accessed December 11, 2016

Duclos A, Lee C, Shoskes D. Current treatment options in the management of chronic prostatitis. Ther Clin Risk Manag. 2007; 3(4):507-12

 

Rees J, Abrahams M, Doble A et al. Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015; 116(4):509-25

 

Nickel J. Prostatitis. Can Urol Assoc J. 2011; 5(5): 306-15

Pilates with Kiertsin! The Saw

Kierstin Elliott, Pilates Rehab Specialist

Exercise: Saw

Set Up: Seated with legs extended mat distance apart and arms extended out to the side.

Execution: Inhale to prep, exhale to rotate torso right as you flex forward (nose toward knee) reaching your left hand toward the outside of the right foot. Reach the pinky finger to the pinky toe a little further 3 times (creating a saw like action) before rolling up through the spine. Inhale as you pass through center and rotate left as you repeat the same actions on the left side. Complete 3 rounds.

Focus: Focus on anchoring the opposite hip to the mat while reaching toward the foot. Be sure to keep a flexed spine versus an extended spine while folding forward over the leg. Lastly, keep shoulders out of the ears (IE. Relax your shoulders) while reaching toward foot.

Importance: Spinal rotation and hamstring length! It’s so easy to track improvement with this one 🙂

Modifications: For extra tight hamstrings or hip flexors, sit on a bolster or a couple yoga blocks to elevate the pelvis.

Pilates with Kierstin! Thoracic Mobility

Kierstin Elliott

Exercise: Thoracic Mobility

Set Up: Set up your foam roller vertically (so it runs up and down your spine). Sit on a mat with the end of the foam roller placed right between the bottom tips of your shoulder blades. Lean back into the roller with arms stretched back so hands are gently placed on either side of roller. Place feet flat on the mat, parallel.

Execution: Inhale to prep, exhale to lift hips off the mat, finding extension through the psoas. Inhale to lower hips down. After about 3-5 hip lifts, reposition the roller a couple inches further up the back, mid shoulder blades. Repeat hip lifts. Pause here with hips on the mat and take a few lateral bends right and left, allowing the roller to become an extension of your spine. After about 4-6 reps on each side, reposition the roller one more time towards the top of your thoracic spine (upper shoulder blades), being careful not to place it on the neck. Repeat the hip lifts.

Focus: Focus on stabilizing your pelvis during lateral flexion and connecting to breath during the hip lifts.

Importance: Mobilizing the thoracic spine! This alone comes with so many benefits: deeper, expansive breath, more accessible spinal rotation, mobile shoulders, greater spinal extension and flexion, better connection to core, etc.

Modifications: Place a small pillow or towel roll under head if neck support is needed. Take a few moments after the lateral flexion for some snow angels to stretch the pecs and open the chest.

How to Start an Exercise Routine When You Have Pelvic Floor Issues

woman running with white backgorund
Photo by Tim Savage on Pexels.com

Fiona McMahon PT, DPT

New Year New You! It’s all well and good, but if you are dealing with pelvic pain or dysfunction this can be an especially tough time of year when you want to get fit, but the gym can feel like it is off limits. Do you have to stay on the sidelines until you get better? Or is there a way to integrate a workout routine into your recovery from pelvic dysfunction?

The first thing I would suggest is to get a good pelvic floor physical therapist. Before we become pelvic floor physical therapists, we receive broad based education in sports physical therapy. What that means, is we have the ability to think about and treat the pelvic floor as it relates to sports and exercise. We also can take a close look at the health of the pelvic floor and assess if there are any exercises you probably shouldn’t be doing right now. If you do try something and you symptoms flare, it is an excellent opportunity for you and your physical therapist to determine why and help correct the issue so it doesn’t happen again.

The tricky thing with writing this blog, is there are no hard and fast rules, no “don’t do that” or yes “definitely do this” in terms of exercise. The literature out there is really varied. There are many studies that sing the benefits of exercise for the pelvic floor, while others caution against it. Before we get into some exercise guidelines, let’s look at what the data say.

The Research

I read a few studies about the impact of exercise on the pelvic floor and thought the data are mixed, I did come away with some important takeaways. The first of these takeaways is that pelvic floor dysfunction is exceedingly common with a prevalence of 1 in 4, which most of us in the field would feel is on the low side, given how personal the subject is and that many people may not want to talk about it. Because pelvic floor dysfunction is so common, it is something all fitness professionals should at least think about when recommending exercise programs.

The next consideration that honestly I did not need to read a study for, nor do you need to read to in this blog to learn is that exercise is overwhelmingly good for you! Exercise can improve health in a multitude of different ways from heart health, bone health, even mental health. There are huge potential benefits to be gained from starting an exercise program.

What was unclear are the risks. One hypothesis is that exercise can strengthen the pelvic floor and leave it nice and healthy well into your old age. The next hypothesis is that exercise can increase the burden on the pelvic floor which may be rough on the pelvic floor. SO WHAT DO I DO?!

Freak out. No don’t do that. Let’s just put on our critical thinking hat and dissect the second hypothesis a bit more, shall we? “Exercise may increase intra-abdominal pressure (IAP), which may be harmful to the pelvic floor.” Okay so what does that mean? There are certain but not all exercises that increase the pressure from your abdomen down on your pelvic floor. A good example is a person in the upper echelons of powerlifting holding their breath to make their core stiffer to lift up a massive weight. Can you imagine the grunt? That breath holding serves a purpose to allow the weightlifter to crush her competitors and put up the most weight, but also creates a heck of a lot of downward pressure on the pelvic floor (increased IAP). We also see increases in IAP in sports that involve jumping, think running (which is essentially a hop from one foot to the next), basketball, or trampoline training. These increases in IAP may actually worsen pre-existing pelvic conditions for a number of reasons. If you are already suffering from prolapse the pressure coming down on your pelvic organs may worsen it. If your pelvic floor is weak from being either too tight or too loose, you will likely experience as loss of urine with your workout. It may worsen pelvic floor tightness and make pain worse.

Total bummer right? Seems like it, but all is not lost. Not all exercises dramatically increase IAP and they are really lovely places to start when returning to fitness. One study found that the mean IAP increase with Pilates exercises was less than that of getting up out of a chair (seems like a safe activity to do!) I would suggest going to a 1 on 1 session (Pilates Rehab, ideally), a few times before jumping into a group class so you can explore how your body likes to work with Pilates. We offer Pilates at Beyond Basics with special focus on pelvic floor patients. Other exercises that are pretty gentle are the elliptical machine, walking (especially on a slight incline if you want to get your sweat on), and swimming.

I can hear some of you yawning in the back. For the high intensity people who do like running and crushing weights at the gym, I hear you! There are ways in physical therapy where we can train your body to both absorb more of the ground impact force and thus decrease IAP as well as improve your pelvic floor’s response to increased IAP. A good pelvic floor physical therapist can help you develop better pelvic floor mobility, length and strength to deal with IAP appropriately, as well as strengthening other muscles in your body to share more of the burden. This ultimately results in a decrease in load on your pelvic floor. The caveat being is sometimes you do have to be patient and work on some of the fundamentals before you can really let it rip with more intense exercise. But as a previously injured athlete, I can assure you the wait is worth it.

 

Start Slow

When adopting a new exercise it can be really easy to go all in. But I highly advise you to go slow. This allows for a few things. One for your body to get used to the increased activity, and two for you to develop a sustainable routine. I would strongly encourage those of you with pain and dysfunction in your pelvic floor to consult with your local pelvic floor PT to help guide you to safely returning to exercise.

Stretch

Don’t skip it! I am so guilty of this and have paid the price more than once. Stretching after a workout is so helpful. Amy, the founder of BBPT has some excellent stretches in her book, Heal Pelvic Pain.

Last Thoughts

There is a way to make exercise work for you if you are suffering with pain or dysfunction. Reach out to your PT to help guide you and have fun out there.

Sources:

Dias N, Peng Y, Khavari R. Pelvic floor dynamics during high-impact athletic activities: a computational modeling study. Clin Biomech. 2017;41: 20-27

Gephart L, Doersch K, Reyes M, et al. Intraabdominal pressure in women during Crossfit exercises and the effect of age and parity. Baylor University Medical Proceedings. 2018; 31(3) 289-93

Karmakar D, Dwyer P. High Impact exercise may cause pelvic floor dysfunction FOR: Scale, strengthen, protect. BJOG Debate.

Kruger J. Against: is high-impact exercise really bad for your pelvic floor. BJOG Debate.