Am I Weak, Too Tight or Just Plain Uncoordinated?
Often as women we focus on how weak pelvic floor and core muscles affect our functioning in day-to-day activities. While this is very important, did you know having these same muscles be too tight can be just as problematic? Also, if these muscles don’t connect and co-ordinate properly dysfunction can develop.
Let’s review the differences, causes and strategies to help.
Weak (Hypotonic) Pelvic Floor
Unaware of how to use these muscles (or that they even exist) which leads to little or ineffective pelvic floor contractions
Pregnancy and childbirth
Hormonal changes as we age
Pelvic organ surgeries
Leaking urine when we cough / laugh / sneeze / run / jump / ride
Inability to control our urgency in using the bathroom
Pelvic organ prolapse
Decrease in satisfaction in penetrative sex
Hip and low back pain
Less effective use of the pelvic floor in pregnancy and childbirth.
With these ladies, we are looking to help them first become aware of and connected to the pelvic floor and inner core muscles, and then strengthen while maintaining the ability to relax the pelvic floor and core.
‘Too Tight’ (Hypertonic) Pelvic Floor
Common causes:Uncoordinated sex
Shortened / tight surrounding muscles such as the butt, inner thighs, calves, feet and back. These are the ‘basket’ holding and attached to the pelvic floor. if these are tight, then the pelvic floor likely is too!
Stress – Our stress and emotional state directly impacts the function of our muscles, including those in the pelvic floor and core
Trauma – This can be physical trauma such as a car accident or falling off a horse, or it can be emotional or psychological trauma such as impacts from unwanted sexual contact or grief / loss of a loved one
Over training – Kegels, kegels, kegels! For many years, we were told to ‘Kegel’… but what wasn’t mentioned is that the relaxation and lengthening of the pelvic floor is just as important to the function of the core system as the strengthening and shortening component.
Leaking urine in all the same activities as above (because the range of motion of the PF muscles is restricted)
Difficulty initiating urine stream when peeing
Pelvic girdle pain
Hip and low back pain
Sciatic pain or pudendal nerve entrapment
Pain with the use of a tampon or penetrative sex (aka dyspareunia).
With these ladies we need to take a multifaceted approach. First, we want to tackle the stress and inability to turn the brain ‘off’ and relax. We may use breathing, mindfulness, or any type of relaxation strategy to bring our attention to the present and allow for our brain to assist us in relaxing the muscles.
Next, we must actively work with the soft tissues to release and lengthen the muscles in the basket around the pelvic floor (this is why I carry foam rollers and manual therapy release balls in the clinic!).
Lastly, we use the core breath to train the pelvic floor and core to relax and contract in a coordinated and controlled fashion.
It is important to know, that sometimes we need to process past or current events such as the loss of a baby or a traumatic birth in order to be able to achieve relaxation. As an Occupational Therapist with years of experience in acute mental health, we can be there to walk with you in this process, or can refer you to the most appropriate resource to ensure you receive whole person care you require as our mind, body and soul are all connected. Sometime we just sit together and have a good cry, and that’s OK.
Uncoordinated Pelvic Floor and Core
To discuss this, we need to know, what is a coordinated pelvic floor and core?
Briefly, our inner core, whose role is to stabilize and manage our intra-abdominal pressure system, consists of:
Transverse Abdominis (innermost ab muscle)
Pelvic Floor (all 3 layers)
Multifidus (muscles running up both sides of our spine)
When our inner core system is not working together, we experience the same pelvic floor dysfunction symptoms as described above. In particular, we may unknowingly create downward intra-abdominal pressure which can lead to pelvic organ prolapse of the uterus, rectum, bladder or urethra.
With all clients, we want to ensure that you are able to use a strategy known as the ‘Core Breath’ to help coordinate the team members of the inner core. Check out this awesome YouTube video by Kim Vopni – The Vagina Coach to illustrate the core breath and coordination of the team.
Click 性生活唔協調 to book online a free consult or an initial assessment with Lindsey today.