Pelvic Floor Dysfunction Causing Urinary Incontinence: Part 2

So why does pelvic floor dysfunction occur? For postpartum women it can occur for several reasons. One reason is from carrying a baby for 9 months. Remember, the pelvic floor supports the uterus, so a constant downward pressure of a growing baby places a lot of stress on the pelvic floor causing weakness. In addition, a cleverly named hormone called relaxin is released throughout pregnancy. Relaxin allows for your ligaments to stretch and is believed to soften the pubic symphysis, two important pregnancy changes that allow for the baby to grow and be delivered (4).


For older women, especially postmenopausal, the pelvic floor weakens due to an overall decrease in muscle fibers. In one study done by Perucchini et al, it was found that the total number of muscle fibers that surround the urethra (bladder opening) decreases 7x as women progress from age 15 to 80 years (2). Due to the decrease in muscle fibers it leads to a decrease in force output of 35% (2).

It makes sense why pregnant women and elderly women would develop PVD, but what about women outside these categories? Why, for example, do elite athletes develop PVD? The answer is similar to the reason pregnant women develop PVD–a constant downward pressure on the pelvic floor. If you remember from our previous article, the pelvic floor opposes intra-abdominal pressure and prevents bladder leakage. Sports that exert a persistent downward pressure on the pelvic floor (trampoline, gymnastics, track and field, tennis, etc) can weaken the pelvic floor overtime, particularly with overtraining. (3)

Learning how to strengthen the pelvic floor is important, particularly if you’re already suffering from PVD. To begin you must learn how to engage the muscles of the pelvic floor. Kegel exercises are fairly common but often underutilized. During Kegels, you draw your pelvic floor inward and upward, mimicking an action that would stop the flow of urine or from passing gas. A proper muscle engagement will include the pelvic floor without squeezing the buttocks, or glutes. It’s also important to exhale as you engage the pelvic floor. Holding your breath during a Kegel will increase your intra-abdominal pressure. (1) Once mastery has been achieved the exercises can be progressed with other core exercises: planking, bridging, bird-dogs, etc. Again, it’s important to avoid holding your breath.

For those suffering from PVD you’ll want to avoid exercises that can be harmful to your pelvic floor. These include:

Harmful Exercises

Pelvic floor first. Continence Foundation of Australia. http://www.pelvicfloorfirst.org.au/. Updated 2013. Accessed July 12th 2014.

Cardio Exercises:

1. Jumping
2. Running
3. Sports involving starting/stopping; tennis, basketball and hockey.

Strengthening Exercises:

1. Sit ups
2. Wide legged squats
3. Dead lifts
4. Lifting/pushing heavy weights
5. Deep lunges.

Safe Exercises

Cardio exercises:

1. Walking
2. Swimming
3. Biking
4. Low impact exercise classes

Strengthening exercises:

1. Planks on knees
2. Bridges
3. Bird dog
4. Balancing on 1 leg

Does the list of what not to do look depressing? Are you disappointed because you see all of your favorite activities? Don’t worry. Strengthening your pelvic floor with progressive, safe exercises improves control and ultimately allows for introduction of greater function (harder exercises). Eventually you’ll be able to resume more difficult activities. As always, if you find you’re having a hard time understanding or performing pelvic floor strengthening you can always consult a physical therapist who has an understanding of pelvic floor dysfunction.

References

1. Pelvic floor first. Continence Foundation of Australia. http://www.pelvicfloorfirst.org.au/. Updated 2013. Accessed July 12th 2014.
2. Bo, Kari, Berghmans, B, Morkved, S, Van Kempen, Marijke. Evidenced Based Physical Therapy for Pelvic Floor Dysfunction Bridging Science and Clinical Practice 1e. Philadelphia, PA. 2007.
3. Bo, Kari. Urinary Incontinence, Pelvic Floor Dysfunction, Exercise and Sport. Sports Med. Volume 34, issue 7. 2004. 451-464.

urinary, incontinence, pelvic, floor

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