Pelvic Myths: True or False?

In Pelvic Floor Physical Therapy by Stephanie Prendergast3 Comments

By Melinda Fontaine

Have you heard these common pelvic rumors? Can you guess which ones are true or false?

 

As a pelvic floor physical therapist, I’ve heard quite a few old wives tales about the pelvis. Test your Pelvic IQ with these 16 true or false statements!

 

  1. T/F   Drinking water will make me have to pee more.
  2. T/F   Everyone should do kegels to maintain continence and improve sex and orgasm.
  3. T/F   You can catch venereal disease from sitting on a public toilet seat.
  4. T/F   A normal bowel movement requires straining on the toilet.
  5. T/F   Sex is uncomfortable after childbirth.
  6. T/F   Needing lube means I am not good enough/not turned on enough.
  7. T/F   Kegels are only for women.
  8. T/F   I should pee, just in case.
  9. T/F   Everyone will probably need adult diapers at some point.
  10. T/F   Waking up to pee at night is part of getting older.
  11. T/F   At some point, I will get too old for sex.
  12. T/F   It’s normal to pee a little when you laugh, cough, sneeze, or jump after childbirth.
  13. T/F   Everyone knows how to kegel.
  14. T/F   I’m the only one with pelvic problems.
  15. T/F   Pelvic PT can help.
  16. T/F   Only women go to pelvic physical therapy.

 

1. Drinking water will make me have to pee more.

 

      • FALSE. Contrary to popular belief, drinking more water can actually make you have to pee less frequently because it dilutes the urine in the bladder which is less irritating to the lining of the bladder.  However, if you do drink a large amount of water in one sitting, then your bladder will stretch quickly which makes it want to empty, so you will still have to pee.  Your best bet is to drink plenty of water, but space it out evenly throughout your day.   

 

2. Everyone should do kegels to maintain continence and improve sex and orgasm.

 

      • FALSE. OK, I’m sorry. This is one of those tricky questions that is false because the statement says “Everyone”.  Kegels are a strengthening exercise for the pelvic floor muscles.  These exercises can improve incontinence if the cause is weak muscles that cannot create a good seal.  However, if the incontinence is caused because of overworked muscles or a weak abdominal wall, then kegels will not help and may even make it worse. A PT can help you figure out which category you fall into.  Kegels can also make sex and orgasm better because they strengthen the pelvic floor muscles that are involved in arousal and orgasm.  If the muscles are already strong, then strengthening will not improve function, and may even cause new problems if the muscles become too strong and tight.  Also, if there is something else impairing sex and orgasm, then strength training will not help.

 

3. You can catch venereal disease from sitting on a public toilet seat.

 

      • FALSE. Chances are extremely low that you will catch a disease from sitting on a public toilet seat.  If you still don’t believe me, then use a toilet seat cover, but pretty please sit down. Hovering over the toilet seat activates the muscles that are supposed to be relaxing in order to open the floodgates and allow you to evacuate. (As a side note, your cell phone probably has more disgusting germs than a toilet seat.)

 

4. A normal bowel movement requires straining on the toilet.

 

      • FALSE. A normal bowel movement should be soft yet formed, like toothpaste or soft serve ice cream.  It should come out easily with a deep breath with your feet up on a stool, such as the Squatty Potty.  

 

5. Sex is uncomfortable after childbirth.

 

      • FALSE. If sex feels uncomfortable, this is a clue that something else is going on in the body.  Sex could be uncomfortable due to scar tissue, too much tightness in the muscles of the pelvis, hormone imbalance, active infection, or other causes. Physical therapy can address some of these issues to make sex pleasurable.

 

6. Needing lube means I am not good enough/not turned on enough.

 

      • FALSE. Some women just need/like extra lubrication, so bring on the lube. This can be especially true for women who have low hormones level, such as women who are on birth control, postpartum, or post menopausal.  Smoking, anorexia, stress, polycystic ovarian syndrome, and pituitary or hypothalamus issues can also cause less lubrication. (Stay tuned in May 2016 for some good hints on how to pick a lube.)

 

7. Kegels are only for women.

 

      • FALSE. The kegel exercise was first described for women, but it is a strengthening exercise for the pelvic floor muscles.  Both sexes have pelvic floors, so men and women can do pelvic floor exercises.  This involves tightening the muscles used to hold back the flow of urine or the passing of gas.

 

8. I should pee, just in case.

 

      • FALSE. If you do not have a full bladder, then you do not need to empty it.  Doing this routinely can actually cause your body to get confused and think that it is always supposed to empty when it is partially full.  This may lead to frequent urination or urinary urgency.  

 

9. Everyone will probably need adult diapers at some point.

 

      • FALSE. Adult diapers and incontinence pads have their uses for sure, but I don’t want people thinking this is the only choice. Often the cause of urinary or fecal incontinence can be treated.  As you reach for that next pack of adult diapers, also make a resolution to speak to your physical therapist or doctor about treatment options.  Many times, people can regain control over their bowel and bladder with proper medical care and can avoid or stop using diapers.  

 

10. Waking up to pee at night is part of getting older.

 

      • TRUE, but not as much as you would expect. As we age, our bodies create less of the antidiuretic hormone as we sleep which is what tells our bodies to stop making as much urine, so we can sleep all night. A healthy older individual should be getting up 0-1 times per night.  Conditions such as diabetes, pregnancy, sleep apnea, congestive heart failure, and prostate enlargement will increase the number of times someone gets up to pee.

 

11. At some point, I will get too old for sex.

 

      • FALSE. This is a bold faced lie!  Everyone should be having pleasurable, satisfying sex for the rest of their lives. If this is not the case, there is help.

 

12. It’s normal to pee a little when you laugh, cough, sneeze, or jump after childbirth.

 

      • FALSE. Just because it is common does not mean it is normal. This is called stress urinary incontinence, and it can occur because of a change in anatomy, pelvic floor muscles that are too weak or too tight, a weak abdominal wall, or hormone changes.  

 

13. Everyone knows how to kegel.

 

      • FALSE. Oftentimes, what people think is a kegel is not, or it is not a very effective kegel. Researchers gave women verbal instructions on how to do a kegel and then checked them.  Only 49% were doing it right.  25% were actually doing something that could make incontinence worse! To find out what a kegel really is, check out Allison’s blog post.

 

14. I’m the only one with pelvic problems.

 

      • FALSE. Why else would we have so many chairs in the PHRC waiting rooms? Up to 30% of the population in the West has urogenital problems. And those are only the people we know about…

 

15. Pelvic PT can help.

 

      • TRUE. Pelvic PT can help people with pelvic pain, urinary or bowel symptoms, sexual dysfunction, and pregnancy or postpartum concerns.

16. Only women go to pelvic physical therapy.

 

Have you heard any other pelvic myths? Post them in the comments section below!

 

 

Regards,

 

Melinda Fontaine, DPT

2016MFheadshot-resize

Melinda is a native of Concord, California and is part of our Berkeley team. Melinda earned her bachelor’s degree in exercise biology from UC Davis and her doctorate in physical therapy from Simmons College in Boston. When she’s not at PHRC, you’ll find her either dashing around in her running shoes or cooking up delectable meals in her kitchen. She’s famous for her killer baked chimichangas and her inability to stick to a recipe

 

Nilsen R. (2014) Where does natural vaginal lubrication come from? http://www.livestrong.com/article/15810-does-natural-vaginal-lubrication-come/

[1] Kegel AH (1948) The nonsurgical treatment of genital relaxation; use of the perineometer as an aid in restoring anatomic and functional structure. Ann West Med Surg.2(5):213-6.

[1] Bump RC, et al (1991) Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol.165(2):322-7.

[1] Legendre G, et al (2013) Menopause hormone treatment and urinary incontinence at midlife. Maturitas 74:26-30.

[1] Prendergast SA and Rummer EH (2016) Pelvic Pain Explained: What everyone needs to know. Lanham: Rowman & Littlefield.

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.

Comments

  1. Reply

    Excellent job clearing up some of these misconceptions. I particularly like that you made it a point to distinguish between something being “common” and being “normal.” Anything that happens frequently just happens a lot, but it does not necessarily mean that it is supposed to happen. If someone experiences frequent bladder issues, they should see a doctor to be sure it’s nothing incredibly serious.

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