Deborah Howell (Host): No matter your age, knowing how to keep your pelvic floor healthy is essential. Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System.

In this podcast, Fay Wilson, a Physical Therapist at University of Maryland Medical Center Outpatient Rehabilitation Services, who specializes in pelvic floor therapy; shares insights on daily habits that affect pelvic floor health, how pelvic health changes over time, and when it's time to seek help from a specialist.

Welcome, Fay. So glad to have you.

Myrna “Fay” Wilson, PT, DPT, CLT: Oh, thank you for having me this morning.

Host: Let's just jump right in and I would love if you could explain what the pelvic floor is and why it's important for overall health.

Myrna “Fay” Wilson, PT, DPT, CLT: The pelvic floor is series of muscles, it's several layers thick, that is located within our pelvis. The muscles run from the pubic bone all the way back to our tailbone and then they kind of flare over to the hips. And what they do is they help to support our organs above. They help us with urination and having bowel movements and controlling our urine. 

They also help during pregnancy, supporting the fetus. And so they're very, very instrumental throughout our lifetime.

Host: Pretty important stuff. How does pregnancy affect pelvic floor muscles and what can women do to maintain pelvic floor strength during and after pregnancy?  

Myrna “Fay” Wilson, PT, DPT, CLT: Well, pregnancy is definitely hormone dependent. And so the hormones help to relax the ligaments, which is what we need in order for the baby to be able to move down inside of the pelvis. And so it makes everything get a little bit loose. The pelvic floor muscles, because it attached to the bones, they can be affected that way. 

And so with pregnancy, you have the weight again of the baby and the fluid from the amniotic sac pushing down on that pelvic floor, which can make it get weaker still. And so what we do is we try to have people work on building up their strength during pregnancy so that those muscles will be able to support that extra weight that is coming down into that region. 

And so we usually teach people specific exercises that they can perform to try to keep that tissue able to contract so it doesn't get weakened over time.

Host: And now, what are some common pelvic floor issues that women experience as they enter into perimenopause, menopause, and beyond?

Myrna “Fay” Wilson, PT, DPT, CLT: Well, some of the common pelvic floor issues during that time frame, are really related to estrogen and loss of estrogen. So estrogen typically helps to keep our tissue nice and strong and kind of fluffed up and pumped up, and supported. And so as you start moving into perimenopause and those estrogen levels start to come down and as we move into menopause, where you are no longer having the same level of estrogen, or it's no longer being produced, you have a tendency for the muscles to be even weaker in that region. And as a result of that, women could have problems with incontinence of urine, or feces. They could have what we call prolapse where the organs just don't have enough support from the muscles to stay in the right position.

And so things may start to kind of come down and descend down. People can develop you know, constipation, because of the weakness, the bones themselves can kind of shift a little bit, which can cause people to have pain in the region. And possibly during, you know, intercourse, there's always the possibility of having some discomfort.

Host: Yeah. None of the above are very fun. So, what is pelvic floor therapy, and how does it help with conditions like incontinence or pelvic pain?

Myrna “Fay” Wilson, PT, DPT, CLT: Well, pelvic floor therapy is therapy that is being done by either physical therapists or occupational therapists that are focused specifically looking at the dysfunctions of the pelvis and the pelvic floor. And they use specific techniques. We can use strengthening techniques. We can use stretching techniques. We may use modalities, all of those things in order to help to, improve the deficits that the person is presenting with. So we provide a comprehensive evaluation. And based on what we find during the eval, and based on the things that the patient tells us are their own goals, we will create a plan that will address the areas where they have their biggest deficits. 

Host: So, are there specific exercises or habits you recommend for maintaining pelvic floor health throughout life?

Myrna “Fay” Wilson, PT, DPT, CLT: Well, again, we always recommend that patients be evaluated if possible. Just because there are some patients that have weakness of their pelvic floor, but as I said before, you can also have a situation where the bones can also shift a little bit. And so in that case, they definitely should have an evaluation by someone because in that case we may not want to work on strengthening because they might already be twisted in that area and they may need stretching exercises or down training exercises.

The main things that we can start off with would be diaphragmatic breathing. And so our diaphragm actually moves in conjunction with our pelvic floor or our pelvic diaphragm. And so if we can teach people how to actually breathe correctly, it actually helps to improve the movement within the pelvic floor.

So that's one thing that we can start with. Now for patients that actually are presenting with a true weakness, then we would teach them something called a Kegel. And a Kegel is a way of contracting the muscles down in the pelvic floor. We use different ways of doing it based on what works best for each patient.

But generally you want to think about locating. We have to locate the muscles first. And so one of the easiest ways for people to do that is that when they're urinating, not when the flow is coming out initially, but after it's been coming out for a couple of seconds, they just try to see if they can kind of slow down the flow of the urine or see if they can cut off the stream.

That is the muscle group that you want to be addressing. Again, part of the therapy is that we teach them to use that group of muscles. We don't want them tightening up their abdominals. We don't want them tightening up their buttocks or their leg muscles. But we really want them to target the right group of muscles so that they really get the best benefit of the exercise.

Host: And you really need some guidance when you're trying to learn these things, right?

Myrna “Fay” Wilson, PT, DPT, CLT: Yes. And that's why I said, if the patient is having some issues, we ask them to please, talk to their doctor, talk to their primary care. If they see a specialist, ask for that referral, patients are their best advocate. Many times they hear about something on the internet or they see something on television and they say, oh, I got that problem.

And, they go to their doctors and they say, yeah, I really would like a consult and see a pelvic floor therapist. Now you would ask me about some other things about habits. Some other habits that people need to do again is posture. That's something we learn in school. Stand up straight.

But a lot of times people don't really know what that means. So I learned coming to therapy again, we would teach them what good sitting posture is, what good standing posture is. I always tell patients, don't cross your legs, don't cross at the knees because that can also throw off those bones and then potentially the pelvic floor is also going to be adjusted at that time into a different position. You know, avoid slouching. When they're toileting, having a bowel movement, put some books, put a little step stool underneath of the feet. That helps to position the anus and the rectum in the right position so that they can actually allow them to have a better bowel movement.

Limiting the time that they're actually sitting on the toilet. If they sit too long, that can also cause weakness of the pelvic floor because it's hanging down. So having a healthy weight. Again, if you are carrying more weight, that's more weight inside, more fat inside where the organs are, but that's also weight that's pushing down on that pelvic floor, which then tends to weaken it. 

Other things, if people have pre-existing conditions, if they have problems with their knees, they have problems with their back, if their feet are flat, if they don't have any orthotics, if they're having pain; those are things that they can do by getting consults and having those things addressed.

But, I guess the biggest thing is really, is people know their body. If they know that something doesn't feel right, they just need to get a consult so that we can help them to handle that problem and improve it.

Host: Exactly. All right. On another tangent, how can pelvic floor health affect sexual function, and what can be done to address related issues?

Myrna “Fay” Wilson, PT, DPT, CLT: Well, pelvic floor dysfunctions in that area can occur again if there's relaxation, if the muscles are weak, if they're not very supportive, then that could cause some type of dysfunction. If the tissue is slightly twisted or the bones are twisted, then that's going to potentially cause pain. 

And so what we do is we always recommend patients to have a consult, to come in, we can talk with them privately, we can talk with them confidentially, in a private space, and really address the issues that they're dealing with, and provide them with an individualized program to address that area.

Host: Now, you've touched on this before, but let's just make it clear. What are the signs that someone might need to see a pelvic floor therapist?

Myrna “Fay” Wilson, PT, DPT, CLT: I would think the first thing is if they notice there's a change with their urination, or their bowel function, if they notice that they are leaking before they can get to the toilet, if they are having any complete loss of urine, that's a problem. If they are constipated and they hadn't had a problem before, then that is something that a pelvic floor therapist would be able to help them with.

If they have pain, pain anywhere down there that is new is pain that needs to be addressed because again those bones can move and they move, the muscles also move. And there are nerves down there, and then the nerves can also get trapped. And so, anything that's either in the pubic area, or the coccyx, or their hips, or their back, anything around the openings of the pelvic floor, all of those things are pain that can be actually improved with proper treatment.

Another problem is, prolapsing. If the doctors have said that they have noticed that the organs are starting to descend down. Then that means the pelvic floor is just not really supporting those organs. And so they're descending downward. And so that would be another area where they would definitely need to see someone.

Host: Okay. Now, let's talk about any misconceptions about pelvic floor health, and maybe you can clear these up, especially for different stages of life like pregnancy, postpartum, and menopause.

Myrna “Fay” Wilson, PT, DPT, CLT: Well, misconceptions during pregnancy is patients sometimes just either, they don't know that they're that important to do, or they don't do them frequently enough or they may not do enough repetitions of a Kegel. And so we always stress to people, you know, you really want to keep that pelvic floor strong because just with normal aging, it's going to weaken. And so definitely during pregnancy, you have to continue to do the exercises. It's sort of like a person who's going to be a weightlifter in Olympics. If all they lifted were two pound weights, then they would never ever get to 200 pounds. And so you have to be consistent. If you're only going to exercise and do three repetitions and then you only do it once a week, then you're not going to get the benefit. You're not going to get those muscles to bulk up and hypertrophy is what we call it. It gets strong. And so consistency, you have to do them consistently in order to get benefit of strengthening those muscles.

Postpartum, people will think that because the baby is no longer there and they've delivered this baby that they don't really need to strengthen that muscle. But again, we know just with aging, that the pelvic floor is going to weaken. It has the potential to weaken. If women have had numerous babies, then that's going to give you even more weakness, potentially, to that group of muscles.

And so, it acts like a hammock. And if you continuously push down on a hammock or a trampoline, it's going to bow. And we don't really want it to do that. We want it to kind of stay up and support you if you were to jump on it or lay on it. So, it's the same principle is going to apply in the postpartum.

Is that those exercises still need to be done. I've had patients say, well, you know, I'm going to have a C-section. And so, I don't think I need to do any pelvic floor exercise. And I always tell them that, when you're pregnant, that is nine months of pressure pushed down on that pelvic floor.

It already has the weight of the organs, and now you've added a baby and all the fluid from the amniotic sac. And so, those muscles have weakened during that nine months unless you keep them strong. And so even if you have or you plan to have a C-section, you still want those muscles to be there for you because you do not want to have problems as you age and when the estrogen levels start to drop down.

And that kind of goes into the other part you said about the menopause. The same thing applies, just with loss of the estrogen, the tissue is not as strong as it was and so people still need to continue to do that so that they don't have issues of incontinence or prolapse or pain down the road.

Host: This is so fascinating, Fay. Any key takeaways for our listeners?

Myrna “Fay” Wilson, PT, DPT, CLT: Posture. As I said before, that's something that everybody can work on in the very beginning. They just need to look at how do they sit, make sure they're sitting with weight on both butt cheeks. No crossing at the knees. You cross at your ankles, but not at your knees. Look at how you breathe.

Are you bearing down when you're having a bowel movement? Are you straining? Are you sitting there too long when you're on the toilet? Make sure you can put a stool under your feet. That will help you to be able to evacuate your bowels a little bit more easily. Watch your weight. That's going to give you more pressure down on that pelvic floor. 

Stay strong. Stay active. Strengthen. We need to keep our muscles strong and we don't want to lose that protein as we get older because those strong muscles help to support and keep those bones all in the right position. And the biggest thing is if you see something and it feels like it's not right, if you notice that you have some new symptoms that you've never had before, you cough or you sneeze and you notice that you're leaking urine, seek help.

If you have pain of any origin down in that area, please talk to your doctor and get a consult so that you can come and see a pelvic floor therapist. I mean, they are very talented. They will use a host of skills that we use as physical therapists and occupational therapists. But they will use it targeted for the areas of dysfunction in order to try to help people to be back into a much more functional level.

Host: Right. Ah, such good information. Fay, thank you so much for taking the time to be with us today and to answer our questions about pelvic floor health. It was really, really interesting.

Myrna “Fay” Wilson, PT, DPT, CLT: Thank you so much for having me.

Host: You can find more shows just like this one at umms.org/podcast and on YouTube. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System.

We look forward to you joining us again, and please share this on your social media. That's all for this time. Have yourself a terrific day!