I have had a number of new patients over the last month who have all asked me the same thing: “ I have always done my pelvic floor exercises regularly but they just don’t work, I don’t really know what you can do for me?”. This is a common misconception about pelvic health physiotherapy, that we “just teach kegels”. As with so many things, it’s not as simple as it seems.
First thing’s first, when people tell me they are an A grade student of 20 years with pelvic floor exercises, I ask them to talk me through it. Often what they have been told is pelvic floor strengthening may be a glute strength exercise or even a yoga stretch. The pelvic floor could be indirectly involved in the movement, but it’s not working for them. However, even when the technique is correct- as a solo strategy it isn’t the whole answer, particularly with stress incontinence and prolapse.
So, what am I looking for when I assess a pelvic floor if not just “strong or weak”? With what may seem to be a straightforward examination, there is a lot of whirring going on in my head about the “how” and the “why” of what I can feel, put together with what the patient has just told me about their symptoms.
The pelvic floor does not always need strength training and if it does, there are different types of muscle activation which are useful for different conditions. The pelvic floor has layers, like an onion and we don’t necessarily want all of them working the same way all the time. I work out what should work harder and what needs to relax a little. Poor coordination and timing of the muscles is a common issue (hands up if you hold your breath and bum cheeks/thighs/clench fists as you squeeze….!) I will also look at your musculoskeletal system as a whole. Often issues with the mid back, breath patterning or hips can cause secondary issues around the pelvis. The brain can also be a major factor in how you move and why. Injury and negative experiences can lead the brain into protective or unhelpful movement patterns without you even noticing.
I hope you can now get an idea of why even people diligent with their kegels may not be any better, even after many years. Pelvic health physiotherapy is far from a one-size-fits-all, cookie-cutter approach. I have a whole person in my clinic room, not a pelvic floor!
Finding out someone’s history and goals and a thorough, whole system assessment is key in ensuring we set off on the right treatment path. For many, pelvic floor muscle training will be a component, but it’s never the whole answer!
Mrs Claire Sampson MCSP
Specialist Pelvic Health Physiotherapist
Appointments with Claire Sampson,Pelvic Health Physiotherapist (for men and women), are available at the practice on alternate Fridays and one Saturday morning in every four..... You can check availability via our online booking site, but to book an initial consultation with Claire, please call our reception team on 10780 480889
