I’m a physiotherapist who works in women’s health. A lot of what we do is help patients with pelvic floor dysfunction, which happens when the “sling” or “hammock” that supports the pelvic organs is not functioning in an optimal manner.
More common disorders can include urinary incontinence (losing control of your bladder), fecal incontinence (same thing, but with your bowels) and pelvic organ prolapse (weak muscles leading to organs “dropping” onto the vagina). Other common concerns include pain with intercourse, over-active bladder and constipation.
While these may be common, pelvic floor dysfunction is not “normal.” It’s not something that you should expect to happen as you age, and physiotherapy can help you if you’re experiencing any of these issues.
During my work, I encounter numerous questions from patients about their pelvic floor. I’m always happy to clarify any “myths” that I come across.
Here are eight of the most common pelvic floor myths I’ve encountered so far:
1. Myth: Urinary incontinence is normal after childbirth and as we age
FACT: It is common – but it’s not normal.
To say something is normal is to accept that it is inevitable and that there is nothing to be done to change it.
This is similar to saying that ACL injuries are normal in female soccer players. The prevalence of ACL injury in female soccer players is high, and is common, but it is not accepted as a normal injury. Athletes take action to prevent this injury.
Approximately 3.3 million people in Canada experience urinary incontinence. Let’s stop normalizing something that can be treated by physiotherapy intervention.
2. Myth: Pelvic pain and pain with intercourse are normal following vaginal delivery
FACT: While it is common following childbirth, pain is never normal.
The birthing process is a beautiful event, but it can be very difficult on your body. Perineal tearing and episiotomies, as well as stretching the muscles during the pushing process can lead to pain and dysfunction. Physiotherapy can help to reduce the pain.
3. Myth: Having a Cesarean section will prevent all dysfunction of the pelvic floor
FACT: Not the case.
A Cesarean section is abdominal surgery. The muscles of Transversus Abdominis and the uterus are cut. Like all major surgery, this process can create dysfunction. Transversus Abdominis is part of the deep core system and plays a large role in pelvic floor function. Neither a vaginal delivery or Cesarean section will prevent all pelvic floor dysfunction, both processes can be difficult on the body, however physiotherapy can help if you experience pain or other dysfunctions.
4. Myth: Pelvic floor dysfunction only happens if you’re a woman
FACT: Men and children have pelvic floors too.
Their anatomy is very similar to the female anatomy. Pelvic floor dysfunction comes in many different forms, and does not just include incontinence. Anyone at any age can experience pelvic floor dysfunction.
Some common pelvic floor dysfunctions include:
- Urinary Incontinence
- Pelvic organ prolapse
- Dysparuenia (painful intercourse)
- Vulvo/Vestibulodynia (pain around the vulva and vestibule in women)
- Chronic non-bacterial Prostititis (inflammation of the prostate-men only)
- Nocturnal Enuresis (Bed wetting)
If you experience any of these pelvic floor dysfunctions, your physiotherapist can help.
5. Myth: All pelvic health concerns are related to weaknesses in the pelvic floor
FACT: There are typically two types of pelvic floors that can cause dysfunction.
The first is a hypotonic pelvic floor, or, low muscle tone. This type of pelvic floor will experience issues related to incontinence and pelvic organ prolapse.
The second is a hypertonic pelvic floor, or, muscles that are too tight. This type of pelvic floor issue usually relates to urgency, frequency, constipation and pain with intercourse.
For a muscle to be functional, it must be able to both contract and relax, just like any other muscle in your body.
6. Myth: Kegels will cure all of your pelvic health concerns
FACT: Not all dysfucntions are related to weakness. In fact, more pelvic floor dysfunctions relate to muscles that are too tight. Exercising muscles that are already too tight will not help the problem.
Secondly, many don’t know how to effectively perform a Kegel contraction. What commonly happens is something called co-contraction, which means that other muscles often accompany the attempt to do a Kegel. The consequence is that you might end up doing a Valsalva manouver (holding your breath) instead of a Kegel. Without proper guidance, you might also end up using muscles other than the ones that you actually want to strengthen.
Thirdly, Kegels are typically done statically, sitting at a desk or in the car. Just like how a sprinter would never train for an event by sitting on the couch and repeatedly contracting their legs, we cannot expect to gain muscle strength and endurance by training a muscle in a static fashion. Performing Kegals should be part of an active system and only done once evaluated by your pelvic floor physiotherapist.
7. Myth: All pelvic health dysfunction is caused by a problem in the pelvic floor
FACT: Our body is an interconnected system of bones, muscles, joints and connective tissues and must function that way. Any shift in the system can cause a pelvic floor dysfunction.
For example, a high level athlete experiences stress from urinary incontinence. Upon initial examination, the pelvic floor functions well and her muscles are able to contract and relax. However, her abdomen is tense. When she exercises, this tension increases the pressure in her abdomen and the downward force placed on her pelvic floor. In this example the athlete’s pelvic floor is fine – it’s her abdominal muscles that are causing the issue.
8. Myth: The vagina should be cleaned with soap for optimal pelvic health
FACT: The vagina and the surrounding vulva are self-cleaning and should not be scrubbed clean with soap.
Cleaning your vagina with soap actually disrupts the vaginal flora and pH balance that it’s able to maintain on its own. Soap can actually make an individual more susceptible to yeast infections, urinary tract infections and vulvar pain.
Some tips for vulvar health:
- Avoid washing with soaps and shampoos (warm water is all you need)
- Always wipe from front to back. This is one of the easiest ways to avoid contaminating your vagina.
- Wear breathable, cotton underwear during the day and sleep in the nude at night
- If you’re more susceptible to yeast and urinary tract infections, avoid wearing pantyhose
- Remove wet clothing and swimwear immediately following use
- Use scent and color free toilet paper
- Avoid irritants like scented lotions, deodorants and vaginal wipes (again, you don’t need wipes, because your vagina is self cleaning)
- If you use personal lubricant, ensure it is natural and free-from parabans, preservatives and alcohols.
- This one is so important so I’m repeating it twice: always wipe from front to back.
Any pelvic floor dysfunction you think you might have should be evaluated by a trained healthcare professional. They’ll help you determine a more accurate diagnosis and an appropriate, individualized treatment plan.
Even though the idea might make you uncomfortable, it’s so important to maintain positive pelvic floor health. Give it a try and ask for help – your pelvic floor will thank you!
Lisa Flanders is a registered physiotherapist at the Ottawa Integrative Health Centre in Ottawa, Ontario. She has a special interest in Women’s Health and Pelvic Floor Physiotherapy. She treats the whole person, considering each patient’s unique needs and individualized approach to care.
The Canadian Physiotherapy Association (CPA) represents physiotherapists, physiotherapist assistants and physiotherapist students across Canada. CPA members are rehabilitation professionals dedicated to the health, mobility and fitness of Canadians.
Physiotherapists are primary health care professionals who combine their in-depth knowledge of the body and how it works with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury or disability.
More than 20,000 registered physiotherapists work in Canada, in private clinics, general and rehabilitation hospitals, community health centres, residential care and assisted-living facilities, home visit agencies, workplaces, and schools.