By Stephanie A. Prendergast, DPT, MPT, Cofounder, PHRC Los Angeles
“Girls aged 12 to 17 should be taught in school how to do pelvic floor exercises, according to new draft health guidelines.” – BBC News
For the past 21 years my career has been focused on advancing the field of pelvic health. Last week the BBC posted an article that was frankly shocking, as nothing like this has ever happened for our small little field. At first glance it discusses educating all young girls about pelvic floor muscle function, which is a huge win for the field of pelvic health and for girls and women. However, there was information and suggestions that were as concerning as the educational piece was exciting. The full BBC News article: Teach pelvic floor lessons in school, say guidelines.
Girls should be taught about their pelvic floor muscles as these muscles are an integral part of our anatomy. It is wonderful to see this under-discussed part of the body is getting attention! As girls hit puberty they may notice things such as painful periods, pain with tampon insertions, and/or bowel and bladder issues. It is so important for girls to know periods should not be painful, tampons and sex should never hurt, and for girls to know what normal bowel and bladder function is.
While girls may encounter a few issues boys may not, pelvic floor education should be part of sex education for both sexes. Pelvic floor disorders are more prevalent in women, but all people have pelvic floor muscles and are therefore at risk for developing a pelvic floor disorder. Generally speaking high-tone disorders are associated with pelvic pain syndromes and low-tone disorders are associated with diagnoses such as pelvic organ prolapse and stress urinary incontinence. Boys should not be excluded from the conversation as they can also develop both types of pelvic floor dysfunction.
This article suggests that teenagers should focus on strengthening their pelvic floor muscles, which raises concern because of the high-tone pelvic floor disorder subset. The high-tone umbrella of pelvic floor dysfunction includes pain syndromes such as Vulvodynia, Interstitial Cystitis, Endometriosis, Pudendal Neuralgia and Chronic Pelvic Pain Syndrome. The majority of people with these syndromes have pelvic floor pain caused by tight pelvic floor muscles. Symptoms included urinary urgency, frequency and pain in the absence of infection, painful sex, constipation and diffiuclty evacuating stool, and genital pain that can be provoked (with touch) or unprovoked at rest.
Pelvic floor physical therapy is first line treatment for pelvic pain and it involves stretching and down-training the pelvic floor muscles. Subjecting tight pelvic floor muscles to repetitive contractions (kegels) causes further tightness, pain, and exacerbates voiding and sexual dysfunction. Pelvic pain disorders may start as early as the teenage years and without proper knowledge of one’s individual pelvic floor and its relative amount of strength, tightness, or weakness, the indiscriminate exercises suggested for ALL teenage girls in this article can backfire. Education around what is normal with pelvic floor exercises will be imperative to identify and prevent causing pelvic floor dysfunction.
The pelvic floor muscles are unique in that they are always active, and they work as part of our core. The pelvic floor muscles are the only skeletal muscles in the body that have autonomic and voluntary features, they are always active and they never rest. Under normal circumstances they tighten when we tighten our core or increase intra-abdominal pressure. They are active when we use the restroom or engage in sexual activity. Because of the unique physiology of the pelvic floor most people do not need to strengthen these muscles unless risk factors are present. In fact, and as stated above, teenagers are more at risk of having tight pelvic floor muscles, especially in teenage athletes or girls with painful periods or congenital forms of vaginismus or neuroproliferative vestibulodynia.
Risk factors for pelvic floor weakness include (but not limited to) high BMIs, chronic constipation, chronic coughing, pregnancy, and vaginal deliveries. As all people age, our strength decreases. People in their 40’s and 50s are at risk for pelvic floor weakness, especially as our hormonal levels decline and we undergo low back and hip injuries and develop bowel and bladder complaints and changes in sexual functioning.
While it is exciting to see pelvic floor education in the news, the exclusion of all people with pelvic floor muscles and the general instruction that all teenage girls should strengthen their pelvic floor muscles is disappointing and frankly potentially harmful.
Everyone can benefit from a better understanding of our pelvic anatomy and physiology, it’s complicated and involved in crucial aspects of our well-being. We must do so with caution and at the end of the day, work to do no harm.
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Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
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FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.