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.
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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