In order to understand what pelvic organ prolapse is, we must first understand female pelvic anatomy. At the front (anterior) of the pelvis, there is the bladder and urethra, in the middle there is the vagina, and in the back (posterior) there is the rectum. The vagina has two main walls, the anterior wall and the posterior wall. What supports these structures is a muscular sling known as the pelvic floor.

Causes

When the pelvic floor and ligaments supporting the pelvic organs weaken, the pelvic organs can descend causing a bulge, or prolapse, of one or more walls of the vagina. This can be caused by any condition that increases pressure on the pelvic floor such as pregnancy and vaginal delivery, chronic cough, chronic constipation, obesity, or repetitive heavy lifting. Prolapse can also occur after hysterectomy or pelvic surgery.

Symptoms

A person with pelvic organ prolapse may experience incontinence, difficulty having a bowel movement, pain or numbness during intercourse, and/or the sensation of heaviness around their vaginal opening.

Management

Many conservative treatments can be used to manage the symptoms of pelvic organ prolapse, such as:

• Breathing correctly to manage pressure placed on the pelvic floor
• Performing pelvic floor exercises to improve the strength of slow and fast twitch muscles of the pelvic floor
• Improving body mechanics while lifting heavy objects
• Treating constipation by increasing fiber/water intake, correcting toileting body mechanics, and using breath to decrease straining during bowel movements
• Strengthening core and hip muscles to support the pelvic girdle
• Using a pessary, a device inserted into the vagina to support the vaginal walls

Hormone therapy and surgery are also options used to treat pelvic organ prolapse if conservative measures do not improve symptoms. If you suspect you may have prolapse, you should consult with your primary care doctor, gynecologist, or pelvic floor physical therapist for treatment.

The post What is Pelvic Organ Prolapse and Ways to Manage It appeared first on MOTI Physiotherapy.

Pain with penetration can be a symptom of pelvic floor hypertonicity or having pelvic floor muscles that have too much tension. When your pelvic floor muscles have too much tension you might experience these other symptoms as well:

-Pain with penetrative sex (during or after)

-Pain or inability to use tampons or menstrual cups

-Urinary urge and frequency

-“Shy” bladder or having to strain to urinate

-Constipation or straining with bowel movements

-Pain with bowel movements or urination

-Painful orgasm or difficulty reaching orgasm

-Tailbone pain

-Clitoral or penile pain

-Perineal or anal pain

-Hip pain

How do I know if I have a hypertonic pelvic floor?

A hypertonic pelvic floor can be identified with an exam by a Pelvic Floor Therapist. Your therapist can determine if pelvic floor muscle tone is normal or abnormally high. For more information regarding what to expect on your first visit with a pelvic floor therapist, check out this article.

How can Pelvic Floor Therapy help a hypertonic pelvic floor?

A pelvic floor therapist will help facilitate the lengthening of your pelvic floor muscles. Treatments with a pelvic floor therapist can include:

-Manual therapy (external, intravaginal, or intrarectal, depending on patient needs)

-Patient training to use vaginal dilators

-Biofeedback

-Home exercises including stretching and coordination exercises

What about other treatments?

Medical management of hypertonic pelvic floor muscles can include pharmaceuticals or procedures such as trigger point injection or botox. These options will have to be discussed with your doctor. 

How do I schedule with a Pelvic Floor Therapist?

Consult with your doctor to see if you are a good candidate for pelvic floor therapy and to get a referral for pelvic floor therapy. The pelvic floor therapy team at MOTI have undergone additional training to be able to perform pelvic floor examination and treatment and are ready to help you on your healing journey!

Exercises to Try Today

The following exercises are helpful to relax your pelvic floor, give them a try today.

Diaphragmatic Breathing

The diaphragm and pelvic floor are both soft domes of muscle in the abdomen that move together when you breathe. Diaphragmatic breathing can help restore rhythm between the two and balance tension in your abdomen. Start in a seated position or lying down on your back. Place one hand on your chest and one hand on your stomach. As you inhale, allow the pelvis, belly, and lungs to expand and fill with air. Both hands should rise and fall at the same time. As you exhale, you’ll feel the air gently leave the body, without any strain. Repeat for 5-10 minutes.

SINGLE KNEE TO CHEST

Begin laying on your back. Bring one knee to your chest, cradling the knee with the arm/hand. Hold the stretch for 30-90 seconds. Breathe. Repeat on the other side.

MODIFIED HAPPY BABY

Laying on your back, hug both knees to the chest, using your hands or a stretching strap/towel behind the thighs. Hold the stretch for 30-90 seconds while performing your diaphragmatic breath.

CAT COW

Start on all fours, exhale as your round the spine like an angry cat. As you inhale, come into a back extension, allowing the belly to sink towards the mat and eyes towards the sky. Move slowly with controlled movement. Perform 5-10 reps. 

CHILD’S POSE WITH SIDE STRETCHING     

From all fours, stretch the glutes towards the heels, walking fingertips forward. Hold the stretch for 30-60 seconds while perform deep breaths. Walk the fingertips toward the right side of the mat, until you feel a side stretch on the left. Hold for 30-60 seconds. Repeat on the other side. 

SUPPORTED SQUAT STRETCH

Come into wide leg squat onto a low stool, a stack of sturdy books or yoga blocks. Focus on dropping the pelvic floor and perform diaphragmatic breathing. Hold for 30-90 seconds. 

The post Pain with Sex or Tampons? How Pelvic Floor Therapy May Help You and Five Exercises You Can Try Today appeared first on MOTI Physiotherapy.

So you were recently diagnosed with pelvic floor dysfunction, but what does that mean? Let’s talk about what the pelvic floor is, what it does, and what happens when it is not working correctly. 

What does your pelvic floor do? 

Your pelvic floor is a group of muscles that runs from your pubic bone to your tailbone and acts as a muscular sling. It is responsible for the 3 S’s: Support, Sphincter, and Sexual Function. The pelvic floor acts as support because it works in conjunction with your abdominal muscles and diaphragm to provide stability to your pelvis and support your internal organs. Your pelvic floor also surrounds your urethra and anus and is responsible for sphincter function. Lastly, your pelvic floor plays an intimate role in your ability to have pleasurable intercourse, reach orgasm, and, for men, maintain an erection.  

What is pelvic floor dysfunction? 

Pelvic floor dysfunction is an umbrella term for any issue that may cause the pelvic floor to not function properly. Usually, pelvic floor dysfunction falls into two categories: tension or weakness. 

What happens if your pelvic floor is too tight? 

Tension occurs when the pelvic floor muscles and surrounding musculature are too tight and have trouble relaxing. Risk factors include frequent yeast and urinary tract infections, endometriosis, interstitial cystitis, nerve entrapments, constipation, urge urinary incontinence, abdominal surgeries, and fibromyalgia. Symptoms can include pain around your abdomen, vaginal opening, inner thighs, rectum, back, and buttocks. You may notice that it is uncomfortable to urinate, insert a tampon, have intercourse, or have a gynecological exam.  Orgasms can be painful because your muscles are tight and stay contracted after climax. 

Pelvic floor tension can also cause urinary and bowel issues. Muscular tension around your anus can cause constipation because it is hard for stool to pass through the sphincter. Similarly, if the muscles that surround your urethra are tight, you may experience urinary hesitancy and have difficulty starting the flow of urine. Another common urinary symptom of pelvic floor tension is frequency. You may find that you have the sensation to urinate every 30 minutes to an hour or wake up multiple times a night to pee.   

What happens if your pelvic floor is too weak? 

Pelvic floor weakness occurs when your pelvic floor lacks the strength and endurance to perform its regular function. Risk factors include older age, pregnancy and childbirth, abdominal surgery, obesity, and activities that involve high impact or heavy lifting.  

Like pelvic floor tension, pelvic floor weakness can also cause urinary and bowel issues. Because the muscles that hold back urine are weak, you may have stress incontinence and notice leaking during activities such as lifting, jumping, or sneezing. After you urinate, you may also notice slight dribbling because your pelvic floor muscles that surround your urethra do not close it completely.  

A weak pelvic floor can also cause issues with support of your pelvis and torso. You may experience a sensation of heaviness or falling out around your vaginal opening that can be a symptom of pelvic organ prolapse. Additionally, pelvic floor weakness can also contribute to a separation of your abdominal muscles called diastasis recti.  

What can you do if you think you have pelvic floor dysfunction? 

See a women’s health physical therapist! An evaluation with a trained women’s health physical therapist can help you determine the type of pelvic floor dysfunction you have and begin to work towards correcting those issues.  

– Dr. Fei Zang, PT, DPT

The post The Functions of the Pelvic Floor appeared first on MOTI Physiotherapy.

Let’s start with the basics. What is your pelvic floor? The pelvic floor is a sling of muscles at the bottom of your pelvis. Their primary functions are to help you control urination/defecation and to aide in supporting your pelvis and torso. Both men and women have pelvic floor muscles to perform these functions. However, women will have a more complex use of the pelvic floor muscles if they choose to have a baby. 

Which brings us to: What does the pelvic floor need to do in childbirth? The answer may surprise you. Those of us that are aware of the pelvic floor mostly know that it is something that needs to be contracted in order to hold back urine. Many people have heard of Kegels, or pelvic floor contractions, at some point. Contraction of the pelvic floor can be helpful during pregnancy to provide additional pelvic support and help control urination in the face of increased pressure on the bladder. However, when it comes to childbirth, the pelvic floor muscles actually need to be able to relax and lengthen. Once we think about what needs to happen during birth, this starts to make a lot of sense. As the baby descends into the birth canal and begins to exit the pelvis, they must pass through the sling of pelvic floor muscles. If those muscles are tight and short or are holding on strongly, the baby will encounter an elastic wall that impedes their descent. The same holds true once the baby is beginning to exit the vaginal canal. If the pelvic floor muscles are too tight and are keeping the vaginal opening more closed and taught, then it will be harder to push the baby out and the risk of tearing at the perineum is increased. You can think of the pelvic floor as a gate at a driveway. The gate needs to be open for anything to pass through! 

So what can you do to get your pelvic floor relax in the months and weeks before birth? Below are 4 positions/exercises that can help promote pelvic floor relaxation and lengthening. 

1. Wide Leg Squat

Coming into a wide leg squat position helps open the pelvis, and gravity will naturally promote lengthening in the pelvic floor. This is best performed as a repetitive exercise instead of a position that is held. Step your feet wider then your hips, with your feet angled out slightly. Slowly lower into a squat, thinking of pushing your knees out and letting the muscles around your groin relax. Try performing 5-10 of these in a row. 

2. Supported Deep Squat

A deep squat position will further open the pelvis, and the addition of support will let you relax more completely into the position. Start facing a chair, sofa, bed, or any other sturdy object. Using your hands to support yourself on that object, lower all the way down into a deep squat with the legs wide and then rest your forearms on the object in front of you. Your arms should be supporting at least some of your weight so that you can let your hips and your pelvic floor relax. With every inhale think of letting your groin relax more. Hold the position for 1-2 minutes, or as tolerated. 

3. Supported Child’s Pose

This more fully supported position can help the pelvic floor relax even more. Kneel in front of a stack of pillows, or a firm bolster if you have one. Widen the knees to straddle the pillows, and then let your torso lay down on the pillows so that they support you from the waist up. Turn your head to one side and let the pillows fully hold your weight. With every inhale feel the muscles in between your legs relax and descend towards the ground. Hold for up to 5 minutes, or to your tolerance. 

4. Supported Butterfly Pose

This position allows for a lot of opening in the pelvis and pelvic floor, as well as the inner thigh muscles. Position yourself in a semi-reclined position, with a bolster, wedge or pillows supporting your back. Bend your knees with your feet together and then let your knees fall open wide. Place pillows under the thighs/knees as needed to ensure your legs can relax fully without discomfort. Allow the pillows to support you and breathe deeply, feeling the entire groin area relax with every inhales. Hold for up to 5 minutes, or to your tolerance. 

All of these are good options for helping practice pelvic floor relaxation and lengthening. The best strategy is to try them out and see which ones work best for you. In what positions do you feel the most comfortable and relaxed? In what positions do you feel you can relax your pelvic floor the most? These will be the best positions for you. And when it comes time for the birth, these become good options for laboring and helping the pelvis open before delivery. For further help learning how to relax the pelvic floor and prepare for birth, consult with a Women’s health/Pelvic Floor physical therapist! 

– Dr. Lindsay Brunner, PT, DPT, OCS

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Let’s talk anatomy. Your pelvic floor is like a sling or hammock at the bottom of your pelvis. This means that important exit paths for waste, like your urethra and your rectum, need to pass through it to get to the outside. One particular muscle, called your puborectalis, plays a very important role in your bowel function. This muscle encircles itself around the rectum like a tether. When the muscle is pulled more tightly around the rectum it cinches the passageway and helps us keep fecal matter in. This is good most of the time because we certainly don’t want to have a bowel movement at the wrong time! Conversely, when we do want or need to have a bowel movement, that muscle needs to be able to relax and lengthen so that the rectum can become an easy passageway.  

So what does this mean for how we have a bowel movement? This anatomy means that the position we’re in while having a bowel movement can impact whether the puborectalis muscle is pulled taught (constricting the rectum) or allowed to lengthen (leaving the rectal passageway more open). When we’re sitting, as we are on standard Western toilets, our positioning doesn’t help us loosen the puborectalis. But if we come into a squatting position, as many Eastern countries do, the puborectalis muscle relaxes and lengthens to allow stool to pass more easily. 

 The good news is that you don’t need to throw out your current toilet! All you need to do is place your feet on a small stool in front of you to get your knees higher than your hips. Once you’ve done this you’re essentially in a squatting position and your puborectalis will be easier to relax. If you are dealing with constipation this can make bowel movements both easier and more comfortable. Managing diet, getting regular exercise, and reducing stress are also key pillars in dealing with constipation, as well as working with your doctor and a pelvic floor physical therapist on determining the underlying cause. However, understanding the mechanics of bowel movements and changing your position is one more small way to make things easier! 

– Dr. Lindsay Brunner, PT, DPT, OCS

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If you answered yes to any of the above questions, you may be training your bladder to signal to your brain that it is time to urinate when it is not actually full.  

 
A healthy bladder can hold between 300 and 500 milliliters of urine, and even more at night (for reference, a standard can of soda holds 355 ml). When the bladder is about halfway full, stretch receptors located in the smooth muscle of the bladder walls will become active and stimulate the micturition reflex. This reflex causes the detrusor muscle in the bladder to contract and the internal urethral sphincter to relax. The bladder also transmits a signal to the brain which is interpreted as an urge to urinate. In addition to the internal sphincter, we have an external sphincter that we can voluntarily control. Relaxing or contracting this sphincter determines whether urine is allowed to exit the body. Contraction of the external sphincter will calm the detrusor muscle and the urge to urinate will dissipate as a result.  

 
When you habitually urinate “just in case,” you may be emptying your bladder when it is less than half full. Constantly doing this will train your bladder to think it is full when it is not. The stretch receptors will begin to send signals to your brain at lower and lower thresholds, thus creating the urge to urinate more and more frequently. 

 
In my practice as a pelvic floor therapist, I see the habit of “just in case” voids all too often. Usually it starts as a behavior learned early in life or during pregnancy. If you find that you are going to the bathroom frequently, routinely urinating less than fifteen seconds in duration, or waking up multiple times a night to urinate, I would recommend that you see a pelvic floor therapist to address these issues. Just as the bladder can be trained to hold less urine, with physical therapy, the bladder can also be trained to comfortably hold more! 

– Dr. Fei Zang, PT, DPT

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