Pelvic Floor Dysfunction

Oops, I did it again…

… Think a little less Britney and a little more Depends.

After giving birth to two babies, jumping jacks and coughing weren’t quite the same. And let’s not forget the trampoline park — did you know that the higher you jump, the bigger surprise you get, and it doesn’t matter if you empty your bladder ahead of time? What’s the deal with that?

Many of us do not talk about our struggles and live in silence, so we may feel like we are the only ones having these issues. I want to let you know — you are not alone!

Pelvic floor dysfunction is not rare.

• It is estimated to affect up to 50% of women who have given birth.
• You can have pelvic floor dysfunction even if you have not been pregnant. Age, surgeries (such as bowel or uterine surgery), inflammation (such as from colitis or endometriosis), and previous radiation can all cause problems down there.
• And gentleman, you do not need to be a woman to have these dysfunctions. Pelvic dysfunction is quite common for older men with prostatic issues. My father suffered from urinary leakage after his prostatectomy.

For those of you suffering silently, you don’t have to! There are things you can do to help!

First, let’s look at the most common reasons for pelvic floor dysfunction.

• Hypotonia — the muscles are too loose. This can occur after surgery or having an 8-lb baby sitting on your pelvic floor for months on end. Generally, it will show up as urinary leakage with coughing or sneezing, needing to go to the bathroom urgently, or having stool incontinence.
• Hypertonia — the muscles are too tight. This can cause relaxation problems, making it painful or hard to urinate or have a bowel movement, and it can sometimes produce symptoms of urgency. There may also be constant pelvic/abdominal pain or pain during intercourse.

Sometimes, which type you may have is obvious, but other times, it may not be as obvious. As the treatment differs between these two types, seeking guidance from a pelvic floor therapist can be very beneficial. More about that below.

Simple things to get you started:

For those with weak muscles, just like any other muscle, you must work them out! Great starting exercises include Kegels and hip bridges. As you get stronger, you will be able to advance your movements.

1. Kegel Exercises. These aren’t just for women! Men can benefit from this as well!

How to Kegel:

1. Identify your pelvic floor muscles. The easiest way to identify these muscles is to stop your urine midstream. Think of pulling your vaginal up and into your belly button.
2. While lying on your back, contract those pelvic floor muscles. Try not to contract your abdominal muscles or hold your breath as you do so. Hold the contraction for 3 seconds, then release. Repeat ten times. Try to do this three times a day.
3. As you get stronger, try these exercises sitting or standing.
4. Consistency and patience are key! Try to get your Kegels in daily and allow yourself at least a few months to see improvements.
5. Bridges and toe taps.

• Bridging:

1. Lying on your back, bend your knees with your feet flat on the floor.
2. Exhale and tighten your lower abdominal muscles — like you are trying to zip up those too-tight jeans. Then, contract your pelvic floor (remember pull that vagina into your belly button).
3. Now, slowly lift your hips off the floor into a bridge while still squeezing those pelvic floor muscles. Hold that for 3 seconds.
4. Relax and roll back down. Repeat ten times.

• Toe Taps:

1. Lying on your back, elevate your legs to 90 degrees.
2. Keep your core and pelvic floor tight and your lower back touching the floor.
3. Lower one leg at a time to the floor, keeping it at a 90-degree angle. Lower it only as far as you can while keeping your lower back touching the floor and your core tight.
4. Repeat the next leg.

Things can be more complicated for those with tight pelvic floor muscles. Stretches, such as the Happy Baby pose and Child’s pose, can be helpful, but you will also want to consult a pelvic floor therapist for other modalities to improve your condition.

When Kegels and stretching are not enough:

While the above are great places to start, consider seeking guidance from a trained pelvic floor therapist if:

• You are not sure what type of dysfunction you may have.
• You have not found relief.
• You have more complex or severe issues, such as pain or uterine prolapse.
• You simply have no idea how to begin!

A trained pelvic floor therapist will help diagnose and guide you through a treatment plan and utilize things such as:

• Pelvic floor training beyond Kegels.
• Biofeedback — therapy that uses sensors to guide you in controlling your pelvic floor muscles.
• Electrical stimulation. Okay, I am sure someone said, “What??” Don’t worry; it’s not a taser. It is a gentle current to help strengthen your muscles.
• Manual manipulation.

As always, incorporating lifestyle interventions, such as weight loss, decreasing inflammation, and reducing stress, can all reduce symptoms.

If you are interested in learning more, check out Pacific Pelvic Health at pacificpelvic.com

Wishing you a dry and happy pelvic floor!

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About the Author:

Dr. Eri Shimizu is a board certified in Internal Medicine Doctor and certified through the Institutes of Functional Medicine. She earned a Bachelor of Science in Environmental Bioengineering from the University of Hawaii at Manoa and graduated summa cum laude from Creighton University Medical School. She completed her Internal Medicine residency at UCLA and worked at a Los Angeles county hospital. In 2012, she returned to Hawaii and served as a Hospitalist at Maui Memorial Medical Center. Maui is now home with her husband, two children, and a fighting fish named Rainbow.

Schedule a FREE Functional Medicine Health Consult with Dr. Eri.