Behind the Scenes of Pelvic Pearls

We are living in a very challenging time, one that has impacted every aspect of our lives and families, with much unknown still ahead. Many important services have been curtailed due to social distancing, including the work I do as a pelvic floor physical therapist. My daily schedule and ability to work with patients has changed significantly since March, yet I have tried to find the silver lining of this situation and utilize the extra time that I have been granted in a productive manner. While it is extremely tempting to binge watch Netflix, it is much more meaningful to spend time on professional projects that I have dreamed about but never had the opportunity to explore.

One of those projects is creating informational videos to educate the public about pelvic floor physical therapy. As a passionate pelvic floor physical therapist, I am grateful for the opportunity to share valuable knowledge and spread awareness of this extremely important specialty, especially considering that many people are needlessly suffering in silence. I enjoy giving lectures, blogging, and even answering questions that arise conversationally from curious friends. Knowledge is powerful, and the more that people know about their pelvic health, the better equipped they will be to address any issues that arise. That is why educating my patients about their conditions and instructing them on self care skills is one of my favorite parts of my job. I enjoy helping people understand the biology and physiology underlying their experiences, and I have found that it empowers them to take a more active role in their healing process.

Considering my thirst for both learning and dispensing knowledge, I have decided to shift gears and use the extra time to educate a larger audience. It is with great excitement and humility that I announce the recent launch of Pelvic Pearls. Pelvic Pearls is a YouTube channel which offers pearls of wisdom about pelvic floor physical therapy in short videos. Topics addressed include bladder dysfunction, bowel dysfunction, sexual dysfunction, pelvic pain, and prenatal and postpartum issues. This series is intended to educate and offer practical tips to listeners as well as explain how pelvic floor physical therapy can help address these conditions.

I am very grateful to my friend and colleague, Dr. Ivy Branin, for patiently teaching me how to create these videos, and I would also like to thank my roommates for allowing me to turn our apartment into a recording studio. I am also grateful to them for tolerating the constant sounds of “pastel slide short” introductory music that has been echoing through the rooms of our apartment incessantly. (One of them jokingly suggested that instead of a swear jar, our apartment should have a Pelvic Pearl music jar. Anyone who accidentally plays the song out loud owes money to the jar to be used by the other roommates as they please. #guilty)

Please subscribe today to access each and every Pelvic Pearl as they are posted. If there is a topic that interests you which has not been covered, please contact us and inform us what you would like us to address. We are here to help you in any way that we can during these trying times. Until we have the opportunity to meet and share knowledge in person, we look forward to continuing to do so with you virtually via Pelvic Pearls.

To Kegel or Not to Kegel?

A Timeless Shakespearean Inspired Question Relevant to Pelvic Floor Dysfunction

Not all pelvic floor issues are created equal. In fact, some exercises that benefit certain patients could potentially be counterproductive for other patients. Unfortunately, many patients learn this the hard way.

“I’ve been experiencing pelvic pain for several months/years, and I did some research and discovered the concept of Kegels. I tried, them, but they made my symptoms worse!” I have heard this one too many times from new patients at their initial evaluation. That is why I have decided to blog about this very important topic and to hopefully clarify a widely held yet incorrect misconception. Namely, Kegels, or pelvic floor muscle strengthening exercises, are not appropriate for all patients.

The conditions that impact the pelvic floor can be broadly subdivided into UNDERACTIVE and OVERACTIVE pelvic floor dysfunction. Underactive dysfunction includes: pregnancy, postpartum, aging related changes and muscle weakness. These often manifest as bladder incontinence, fecal incontinence, and pelvic organ prolapse (descent). Overactive dysfunction is associated with tightness of the pelvic floor muscles, which often manifests as urinary urgency, urinary frequency, constipation, pain with prolonged sitting, coccydynia (tail bone pain), chronic pelvic pain, and sexual dysfunction.

Underactivity of the pelvic floor muscles requires an uptraining (or strengthening) program. Overactivity requires a downtraining (or stretching) program.

Kegels, or pelvic floor muscle strengthening exercises, are inappropriate for individuals experiencing overactivity of the pelvic floor muscles. Attempting to contract a muscle that is already in spasm will only make the problem worse. It can further tighten the muscles and result in additional pain. In other words, muscles that are constantly “on” don’t want to do any more work.

If a person is experiencing both weakness and tightness, it is crucial that they address the tightness before they attempt to strengthen the muscles. Muscles that are at a normal resting tone respond better to exercise than muscles that are in a contracted and shortened position. Once the muscles are stretched and have achieved an improved resting tone, it may be appropriate to initiate a strengthening program.

Therefore, if you or someone you know is experiencing pelvic floor muscle issues and are unsure whether to perform Kegels, please speak to a pelvic floor therapist. As musculoskeletal experts, we can assess whether the problems are due to muscle tightness, muscle weakness, or a combination of the two.

At Revitalize Physical Therapy, we will diagnose the type of pelvic floor muscle issue at hand and treat it accordingly, including a customized home exercise program tailored to your specific needs. We look forward to the opportunity to help you!