It can be hard to tell… One study shows about 25% of us perform pelvic floor muscle exercises (Kegels) improperly following purely verbal cues (Bump et al, 1991). A good pelvic floor muscle contraction should feel like you are bringing together the ischial tuberosities (sitz bones) while also drawing together the pubic bone and tailbone. It should not feel you are bearing done or pushing out in any way. And muscles need oxygen! Calm, steady, abdominal breathing should be maintained throughout the contraction.
Another important consideration is that the muscles of the pelvic floor consist of both slow and fast switch muscle fibers. Slow twitch fibers maintain the structure and stability whereas fast twitch take care of the sphincters and orgasms. All pretty important stuff! Slow twitch muscles benefit from endurance training while fast twitch muscle fibers are strengthened by quick repetitions.
There are several products on the market for strengthening the pelvic floor muscles, with a whole range of prices. Prior to purchase, it can be very helpful to have your own personal trainer (Pelvic Rehabilitation Specialist) to learn how to access and strengthen your pelvic floor, as well as to assign appropriate exercises with an eye toward progression of intensity.
Sometimes, Kegels aren’t really what is needed for improved function. Like every other muscle in our bodies, the muscles of the pelvic floor can be strengthened or lengthened, can become weak or spasm, can get too tight and cause pain or be too lax to do the job properly. Pelvic floor dysfunction manifests in a multitude of different ways: urinary or fecal incontinence, dyspareunia (painful sex), other pelvic pain, anterior or posterior vaginal wall prolapse, low back or hip pain….
To find out if we can help you, we invite you for a free consultation with our Women’s Health Nurse Practitioner, Linda Anzalone. Call us at 503-287-4970.
Studies show up to 25% of women experience some variation of chronic pelvic pain (CPP) at some point in their lives. That sure is a lot of ladies. The etiology can be gynecological in origin (endometrial adhesions, fibroids, adenomyosis), gastrological (irritable bowel syndrome, colitis), urological (cystitis, painful bladder syndrome) or musculoskeletal (pelvic floor hypertonicity, myofascial pelvic pain syndrome). A thorough history and physical can point the patient/provider team in the right direction to discover and treat the underlying cause or causes. Treatment is based on the source of pain with a goal of restoring function. Treatment may include medication, pelvic floor physical therapy, behavior modification and very rarely a referral for surgery. Unfortunately, many women are misdiagnosed and misunderstood for many years before appropriate care is found.
Types of pain include nociceptive, neuropathic and central pain. Nociceptive pain is often sharp and localized and is a result of injury or inflammation. Neuropathic pain results from specific nerve damage and is described as burning, numbness or tingling. Pelvic floor physical therapy can be life changing in these circumstances.
One of the trickiest situations is when, regardless of the initial reason for pain, the central nervous system becomes sensitized to pain signals and essentially “turns up the volume” without an actual increase in the source of pain. This phenomenon is considered “central pain” and the mechanism is thought to be similar to fibromyalgia. In these cases, one must consider the current level of pain in addition to the etiology. The chronic nature of central pain can be particularly challenging for patients and may present with comorbidities of depression, anxiety and addiction. Cognitive behavior therapy, medication and a home program of pelvic floor physical therapy exercises may all benefit the patient in this situation. Longer term situations require a longer healing period.