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It’s Time to Take the Floor

Pelvic floor therapy can help women and men take back control of their health and get back in step with their lives.

It’s somewhat ironic that women can put their feet into the stirrups and allow their gynecologist to poke, prod, and swab during an exam but they are too embarrassed to ask questions about issues they may be experiencing “down there.” 

Before you stop reading, men, you’re guilty of it, too. Men endure a digital rectal exam and cough on command during the hernia exam, but shy away from asking their doctor questions about problems they’re having. 

Embarrassment and fear aren’t the only things keeping people from talking to their doctor about issues involving their nether regions. Accepting that those issues are just “natural” and something you have to live with are just as common. Just ask Julie Starr. A nurse practitioner with Women’s Health Associates in Columbia, she specializes in treating women with pelvic floor disorders. 

The fact is that if you’re having pelvic or lower abdominal pain, sexual dysfunction, or bladder or rectal issues, it’s time to talk turkey with your doctor. You may be one of the millions of adults with a pelvic floor disorder (PFD).

A Brief Lesson in Anatomy

Lesson one: Women and men both have pelvic floors. The pelvic floor comprises a small group of muscles with a very large job to do. They stretch from the pubic bone to the tailbone holding the pelvic organs in place. That includes the bladder and rectum, the uterus in women, and the prostate in men. If the pelvic floor doesn’t have proper support, the normal functions of all those parts are affected. 

The muscles may be too tight or aren’t tight enough. The key is to learn how to use those muscles correctly, relieving stress if they’re too tense, and strengthening those that are too weak.

PFDs Are Common

Pelvic floor disorders aren’t rare. The statistics vary from source to source, but all indicate how common they are. Among them are that 30 percent of women don’t properly contract their pelvic floor muscles. One in five people will experience PFD in their lifetime. And 25 percent of women over age 20 have PFDs—including 50 percent of women over age 55. Considering how common they are, why does the topic seem to be taboo for many people?

Perhaps it’s the terminology. “Rectum,” “urine,” “stool,” “vagina,” “constipation,” “erection” and “penis” can be uncomfortable words to utter aloud. Maybe it’s disclosing the subject at all, even to a medical professional, out of embarrassment or a sense of hopelessness.

“All the symptoms we treat are really embarrassing for women to talk about,” Julie says. “Women don’t want to let their doctor know oftentimes that they leak urine. A lot of times, women just normalize urinary incontinence. They think, ‘Well, I’ve had a baby, so I’m going to leak a little urine sometimes,’ so they don’t seek treatment right away because they think that there’s nothing that can be done.”

Embarrassment and fear aren’t the only things keeping people from talking to their doctor about issues involving their nether regions.

PFDs are common because the causes are common. Trauma to the pelvis, suffered in a car accident or fall, can lead to PFD. So can weight gain, aging muscles, pregnancy, vaginal delivery, or obesity, as well as any type of pelvic or lower abdominal surgery. Straining while lifting weights, lifting kids, lifting items at work, or lifting anything repeatedly can lead to PFD. Even chronic coughing, common among those suffering from allergies or asthma, can cause the condition. 

PFD is typical in men who have had prostate surgery because some of the pelvic floor muscles are removed with the prostate during the procedure. And those with erectile dysfunction might discover it’s due to inadequate blood supply caused by overly tight pelvic floor muscles. 

Many women suffer from vaginal prolapse, especially as they age. It may happen due to a weakening of the pelvic floor muscles, common after difficult vaginal deliveries, delivering larger babies, or multiple deliveries. It may also occur if anything held in place by this set of muscles shifts or is removed, such as in the absence of the uterus after a hysterectomy.

But PFD isn’t just reserved for women who are pregnant, have had children, or older women. Julie says she also treats young women who have never been pregnant. They suffer from pelvic pain, bladder or stool leakage or constipation, or pain with sexual intercourse. Their symptoms are often related to pelvic muscles that are too tense or too weak.

Quality-of-Life Issue

PFD doesn’t cause any fatal conditions, but it could herald the end of a great quality of life. 

“Quality of life is what is comes down to,” says Julie. “It’s not an emergency. But if you wake up 10 times a night to go to the bathroom or if you have bladder control problems, it affects your life.”

For example, Julie says she knows about women who won’t get in a car and travel because they’re afraid of having an accident in someone’s car. They won’t spend the night with someone because they don’t want to dispose of pads in someone else’s trash. And they won’t go to a wedding because they aren’t going to go out and be on the dance floor. 

“It’s oftentimes keeping them from doing what they want to do,” Julie says. “And they aren’t going to tell their daughter or granddaughter why. It can lead to isolation and depression all because they don’t think there’s something they can do about it or don’t want to talk about it because they’re embarrassed.”

But the fact is, no one should stop living their life because of a pelvic floor disorder. 

Julie Starr-nurse practitioner

“Quality of life is what is comes down to. It’s not an emergency. But if you wake up 10 times a night to go to the bathroom or if you have bladder control problems, it affects your life.”

Julie Starr, nurse practitioner

Therapy Is Hope

Improving quality of life begins with pelvic floor therapy. And the sooner a patient begins to address the problem through therapy, the better. 

“Honestly, the sooner a woman seeks treatment for their bladder or bowel control problems, or their prolapse problems, and even their pelvic pain, they’re going to be much more likely to have a successful outcome with therapy,” Julie says.

For Julie’s patients, that therapy begins with a thorough review of their medical history, followed by a pelvic exam. She takes measurements, looks for weaknesses, and applies gentle pressure to determine where a patient might be experiencing pain or see if the patient can properly contract their pelvic floor muscles. Once she diagnoses the specific issue, she discusses treatment options with the patient. 

Kegel exercises are a go-to treatment. Done correctly, they’re designed to strengthen the pelvic floor muscles. There are multiple sources to instruct people how to do Kegels, but pelvic floor therapy helps ensure whether the exercises are done correctly and to confirm whether patients should be doing the exercises. If the problem is tight muscles, Kegels can do significant harm. There are other exercises that will relax them instead.

Julie employs biofeedback therapy. Sensors measure muscle activity, and a monitor illustrates electrical activity. That way, if patients think they’re contracting or relaxing muscles in a target area, such as the abdomen, vagina, or rectum, the monitor will show whether the patients are doing it correctly. This helps with muscle coordination and retraining, which is important because most people think they’re moving the right muscles when doing Kegels, for example, but they actually aren’t.  

“With visual aids and auditory clues, we can help them do a very efficient contraction of their pelvic floor muscles,” Julie says.  

There are surgical interventions for vaginal prolapse, but Julie says many women want to avoid it. She treats many of them by inserting a pessary into the vagina. It’s a ring-shaped silicone device that pushes against the vagina wall and the urethra to hold them in place. If placed correctly, the patient doesn’t feel the ring, but will be relieved of the symptoms of prolapse. 

As a nurse practitioner, Julie often refers patients to a physical therapist who can help them with muscle strengthening for those with weak muscles and downtraining for those with overactive pelvic floor muscles. Boone Therapy Services, Mizzou Therapy Services, and Truman Veteran’s Health Care Therapy Services all provide pelvic floor physical therapy for men and women. 

It’s Time to Dance

If something isn’t working right “down there,” let your doctor know. Unless you’ve just put off going to the bathroom too long, peeing a little when you laugh or lift isn’t normal. It’s a medical condition that can be helped through diagnosis and pelvic floor therapy. And that can send you back out to the dance floor, footloose and symptom free.  

For more information about PFDs, visit VoicesForPFD.org

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