Tag Archive for: physiotherapist

Kegels aren't always a good idea

Kegels: Friend Or Foe?

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Kegels in layman’s language refers to the process of activating the Kegel muscles (pelvic floor muscles) to generate tension and increase strength.

What are Kegel/pelvic floor muscles?

Pelvic floor muscles are muscles that are located at the floor of the pelvis. You can think of your pelvis as a bowl and the pelvic floor muscles as a hammock from the pubic bone in the front to the tailbone at the back.

In an individual with a vagina, three holes pierce through these muscles namely, the urethra from bladder, the vagina and the anus. In an individual with a penis two holes pierce through namely, the urethra through the penis and the anus. There can also be variation in anatomy when there has been reconstructive surgery in this area.

What is the function of the pelvic floor muscles?

• Control of the sphincters around the urethra and anal openings to prevent leakage of urine and bowel, as well as controlling the process of urination and passage of stool.

• They have a sexual function, helping you to achieve and maintain erections and play a role in orgasm.

• Support of the pelvic organs namely bladder, uterus and rectum during activities of daily living.

• Provide stability to the pelvis and lower back as they are part of the ‘core’ support in this area

When are the Kegel/pelvic floor muscles your friend?

i.e. When should you consider doing Kegel exercises:

• Post prostatectomy: During the procedure of removing the prostate gland, the muscles that are just below the bladder but above the prostate are removed as part of the procedure. These muscles, when intact, work automatically to maintain urinary continence. After the procedure, to maintain urinary continence, the pelvic floor muscles immediately below where the prostate gland used to be can be trained by voluntary control to generate tension in them to maintain or improve urinary continence.

• During orgasm: During orgasm the pelvic floor muscles can go into explosive pleasurable contractions. When these muscles are weak the intensity of the orgasm will be reduced. Strengthening the pelvic floor muscles helps to achieve stronger orgasms.

• Post partum: The pelvic floor muscles can be weakened by pregnancy itself and/or the mode of delivery (particularly vaginal delivery). Individuals can complain of struggling with bladder control, struggling to hold in gas voluntarily, feeling that the ability to ‘grip’ a penetrative object in the vagina is decreased, or a feeling that the pelvic organs are ‘sagging through the vagina’ (pelvic organ prolapse). When the pelvic floor muscles are underactive they need to be activated by generating more tension to provide better support.

When are Kegel/pelvic floor muscles your foe?

i.e. When should you consider avoiding Kegel exercises:

• During sexual intimacy: one might have difficulty progressing in the sexual response cycle, for example, difficulty in getting aroused. Your pelvic floor muscles could be having excessive tension and not allow for the relaxation that encourages blood engorgement in the clitoris or penis. Here activating the Kegel muscles would lead to further frustration.

• Vaginismus is a medical condition where an individual with a vagina struggles with any kind of penetration, and at worst cannot achieve penetration through at all. This can be penetration with a penis, a sex toy, a tampon, or a medical device e.g. a speculum or vaginal examination. Doing Kegels here would definitely be your foe and make things worse.

• Dyspareunia refers to painful sex. Here penetration is achieved but it is painful. Your pelvic floor muscles are likely to be tight with increased tension so they need to be relaxed. Doing Kegels would only make things worse.

• Tight (overactive) pelvic floor muscles during orgasm: in individuals with penises, during orgasm as the pelvic floor muscles explosively contract, it can cause an ascension of one of the testes into the pubic area resulting in excruciating pain. Kegels in this instance are not advisable.

Your pelvic floor is part of an integrated system

It should be noted that the pelvic floor is part of an integrated system. This means that dysfunction in another area of the system could be driving the perceived tightness or weakness of the pelvic floor. Working on the affected tissues in another area can have a positive resultant effect on the client’s primary complaint, for example, dyspareunia (painful sex).

It is therefore advisable to seek help from a physiotherapist who works in pelvic floor rehabilitation who will be able to do a comprehensive assessment. A pelvic floor physiotherapist will be able to teach you how to assist your pelvic floor muscles to respond appropriately by increasing or decreasing tension in addition to using other techniques.

It’s also important to note that treatment is usually multidisciplinary, involving pelvic floor physiotherapists, medical doctors, clinical psychologists, sexologists, or sex therapists depending on the individual’s condition.

In summary

It’s important to remember that doing Kegel exercises isn’t always a good idea, depending on what the problem is. If you, or someone you know, has any concerns about your pelvic floor, such incontinence or pain during sex, it’s best to first see a pelvic floor physiotherapist for a proper assessment.

Author

Lorato T. Mosetlhi-Molelowatladi

Pelvic Floor Physiotherapist

SASHA Executive Committee & Membership Committee

Email: physiotherapytouch@gmail.com

The Role of Physiotherapy in Sexual Health

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I’ve been in several situations where I’ve seen people’s eyes grow wider and wider as I explain to them what pelvic floor physiotherapy entails. I don’t think it’s because they were scared of the treatment itself, but rather because it was totally new to them. They didn’t know what to expect, or that it even existed at all. 

In my experience, going to see a pelvic floor physiotherapist feels more or less the same as when you need to visit a gynaecologist. I cannot speak for men, but I think they get a similar feeling when they need to see a urologist. Having anyone near your genitals can make you feel vulnerable!

What does a pelvic floor physiotherapist do?

We treat conditions such as urinary and faecal incontinence, sexual dysfunction, pelvic and perineal pain, constipation, and over- or under-active pelvic floor muscles in men, women and children.

Common problems we treat include conditions such as pelvic organ prolapse (the descent of the pelvic organs through the vaginal walls) and erectile dysfunction, especially post-prostatectomy (removal of the prostate).

The pelvic floor muscles play a huge roll in most of these conditions, but it’s not the only thing we focus on during assessment and treatment. With all conditions, we follow a bio-psycho-social approach to treatment, which is patient-centered.

What does the pelvic floor physiotherapist look for?

We assess (and treat where indicated) different components that may contribute to a certain condition or dysfunction.

This may involve physical components, such as posture, breathing, general fitness, functioning of the peripheral, central and autonomic nervous systems, and contraction and relaxation of the pelvic floor muscles, diaphragm, abdominal muscles, or other muscles we might think are involved.

This usually includes assessments of the joints, specifically in the pelvic, lumbar and hip region. It is also important for us to note how these muscles, nerves and joints work together and coordinate their movements, as it may cause imbalances and problems in other areas – contributing to the dysfunction.

What does the pelvic floor physiotherapy treatment entail?

We have several ways of investigating and treating the pelvic floor muscles, sometimes using devices that can assist us, as these muscles are located quite deep and are not always visible or palpable from the outside of the body.

Examples of these devices include electromyography, ultrasound, and neuromuscular electrical stimulation. We may also use these in our treatment plan, together with appropriate exercises which usually forms a large part of the treatment plan. The type of exercises done will mainly depend on the aim of the treatment, be it to relax or strengthen the applicable muscles.

We always work as part of a team

As physical therapists we obviously focus a lot on the physical aspects of the treatment, but we also need to address any environmental, social or health factors that may be contributing significantly to the condition.

If we are concerned about medical or psycho-social factors, or have severe cases, we refer appropriately.

The multi-disciplinary team is crucial in the management of pelvic floor dysfunctions, as they can often be quite complex due to different contributing factors. We work closely together with social workers, psychologists, dietitians, general medical practitioners, gynaecologists, urologists, sexologists, gastroenterologists, orthopaedic surgeons, physicians and nurses.

As a team we can provide our patients with the best possible treatment plan and get the best results.

Pelvic floor dysfunction is not something you should be ashamed of

Going to your first pelvic floor physiotherapy session can make you feel anxious and vulnerable, but believe me – by the end of the session, you will feel so much better about it.

Pelvic floor dysfunction is not something to be ashamed of. Help is available for you. By talking about it, you can get the help you need, and stop suffering in silence.

Author

Dr Corlia Brandt (SASHA Executive Committee)
Pelvic Floor Physiotherapist, Senior Lecturer, Researcher.
South African International Urogynaecology Association Physiotherapy Representative.
Chairperson of Pelvic and Women`s Health Physiotherapy (South African Society of Physiotherapy).

Facebook: www.facebook.com/corliaphysio

Email: corlia.brandt@wits.ac.za