As a pelvic floor physiotherapist we provide a service that looks quite different from regular physiotherapy. In order for us to properly treat a pelvic floor issue we need to assess and treat the entire person, which includes screen for and treating stress.
Often times what I find is women are coming in for incontinence thinking they have a weak pelvic floor but don’t realize that they are actually holding a lot of tension. Did you know… tightness in a muscle can lead to weakness? Women will report to me that they have been practicing their “kegels” but they didn’t help, because the muscles are overworked and simply have no more energy or room to contract further.
If there is tightness, then “kegels” may actually make the situation worse. So it is important to assess not just for weakness, but also for pelvic floor tension. First we release then we strengthen.
So where does the stress part come in?
If during the assessment it becomes apparent the woman is working a stressful job or is running around to various activities for the kids or has other external stressors, we must address these stressors. We first start by educating how stress impacts the pelvic floor.
Anytime we become stressed, we release stress hormones and those hormones signal the fight or flight system. Of course this is all happening automatically in the sub-conscious functions of the nervous system. When the fight or flight system is activated it releases adrenaline, cortisol and epinephrine. These are hormones that without you knowing cause muscles in your body to tense and that includes the pelvic floor.
As part of treatment we not only provide stretches, pelvic floor relaxation exercises, we will also provide stress management strategies that evoke the relaxation response in the nervous system. For example thorugh breathing techniques, positive affirmations, gratitude journal, yoga poses, mindfulness meditation, mindfulness movement based exercises and when appropriate even a referral to psychotherapy.
As a physiotherapist if I only release the tension and provide stretches this may not be sufficient to counter-balance all the times you may be tensing the muscles in the day due to stress. We need to teach your pelvic floor what it feels to stay relaxed throughout the day.
There was a study in 2001 that showed women a series of 4 random videos to see how muscles, including the pelvic floor reacted. They had sensors placed on various muscles to see if they contracted. They showed a neutral video, an erotic video and 2 different videos that showed a potential danger for physical harm. What they found was that women tensed their pelvic floors reflexively whenever they saw the videos with potential danger.
When the fight or flight system is activated in the brain, the brain, does not distinguish between survival (i.e lion chasing you) and missing a deadline on a project. Both situations are perceived as threatening and causes the body to tense.
So it is important to have on-going discussions about stress management and ways to decrease the brain/body response to stress.
When the pelvic floor achieves a more relaxed state, some women actually notice their strength improves without even doing any strengthening exercise.
So, if you are experiencing incontinence despite doing “kegels”, book in for a comprehensive assessment today to gain the benefits of expert advice, by calling us at 905-803-0307.
Written By: Madelaine Golec PT, Pelvic Health Physiotherapist