When your pelvic floor is healthy and strong, it supports and lifts the internal abdominal and pelvic organs. It gives us control of when we hold or release the contents of our bladder or bowels. But 25 percent to 30 percent of adults between the ages of 25 and 55 have a weak pelvic floor. This can result in a variety of problems.
Listen to the interview at the link below or read the transcript that follows.
Common Pelvic Health Problems
UVM Medical Center: Can you tell me about some of the most common pelvic health problems?
Ann Greenan-Naumann: Yes. I work with patients that have a variety of problems going on. Most common ones are incontinence, either stress incontinence or urge incontinence or a mixture of both. I also work with a lot of patients who have pelvic pain. I work with both male and female patients for those problems.
UVM Medical Center: How common are they?
Ann Greenan-Naumann: Well, it’s hard to tell exactly how common they are because there’s a lot of shame associated with problems in this area. There’s thought to be a lot of underreporting of it. In terms of incontinence, different studies rate the prevalence as either 15% or up to 50% of women who have incontinence. It’s all over the board. We know it’s very common and that we’re not seeing all the patients that we could be seeing with this problem.
UVM Medical Center: What contributes to pelvic health problems?
Ann Greenan-Naumann: Most commonly, patients who have incontinence issues tend to be more often female and contributors include age. As we age, just like the rest of our muscles, our pelvic floor muscles can get weak. Women also get pregnant and have babies. The process of pregnancy and delivery can sometimes cause damage to pelvic floor structures and contribute to symptoms. Those are the big ones.
In men, we sometimes see men who have pelvic floor issues after they’ve had prostate surgery. But men also are subject to aging and gravity, which is the other big force that contributes to issues around pelvic floor function.
Treatment Options for Pelvic Floor Issues
UVM Medical Center: If somebody comes to you and says, “I’m having some issues,” where would they start? What are the treatment options?
Ann Greenan-Naumann: The first thing I like to tell patients, how people understand, is that people are often very embarrassed with having a problem with this part of their body and to reassure them that this part of your body, to us, is not any different than if you hurt your knee or if you had high blood pressure. This is what we do all day long and we don’t think there’s anything to be embarrassed about. You should come in and feel comfortable sharing with us what the problems are that you’re having.
Overall, I think the education of patients around what can happen to their pelvic floor in pregnancy and childbirth is underdone. There is not as much education as there could be. Keeping our pelvic floor healthy is part of keeping our body healthy. Just like we have to exercise all of our other muscles, we need to work on keeping our pelvic floor strong. During pregnancy is a key time to do that. I would say that that is under-understood by women.
I think, when you’re dealing with a pregnant woman, that sometimes everybody’s so focused on the baby that this can sometimes get lost in the shuffle. Having women understand that this is a part of their body that they need to care for and keep healthy is key, and then after childbirth, if there are issues, let your provider know and know that there are options out there. Pelvic floor physical therapy is usually where we start when we’re dealing with issues around the pelvic floor function.
Prevention of Pelvic Health Problems
UVM Medical Center: Maybe before we get into therapy, how can women help prevent issues from happening when they’re pregnant or even before they’re pregnant?
Ann Greenan-Naumann: Overall, generally being more fit is helpful in all of our muscle function. Certainly being overweight puts more pressure on the pelvic floor, more weight down on the pelvic floor structure. Keeping your weight at healthy level is a good thing. Then just working on strengthening those muscles. Lots of people know about Kegel exercises. Kegel exercises are awesome, these are the exercises that contract the pelvic floor muscles, working on those exercises.
If you’re not sure how to do those exercises, come and see a physical therapist and we can teach you. Often, patients are just told to do Kegels in their doctor’s office and they’re often, up to 25% of women do them wrong. Instead of pulling up and in, which is what should happen when you do a pelvic floor contraction, they’re actually bearing down, which is the opposite of what should happen and actually puts stress on the pelvic floor.
If you’re not sure what to do, you could come see a physical therapist. We have three physical therapists here at UVM Medical Center who work with pelvic floor patients. I see patients here at the Orthopedic Specialty Center and then we have another therapist who works at the Continence Center at the Fanny Allen campus. Then we have a therapist who works in our Aquatic Center who’s also trained in pelvic floor dysfunction.
We have three of us here that do this type of work and we’d be happy to see you if you’re having an issue with this area, or you’re just not sure how to contract these muscles, or you’re thinking about getting pregnant and you wanna be nice and strong and fit coming into it. You could come and do a consult and we could design you a program to get ready for pregnancy.
How to Know When to See a Doctor
UVM Medical Center: What kind of situations usually make somebody wake up and think, “Wow, I should go see the doctor?”
Ann Greenan-Naumann: Usually, they are having some leaking. They cough or sneeze and they get a little wet. They think, “Huh, that didn’t used to happen.” Or they’re having urge. The urge symptoms are when you get the feeling you have to go to the bathroom and you start to head to the bathroom and you can’t get there before you’re leaking. Those are symptoms that women often have. Those are symptoms that we can help with.
UVM Medical Center: It’s always seemed like a given, like, “Oh, that’s gonna happen.” But you’re saying that there are solutions.
Ann Greenan-Naumann: There absolutely are solutions. There’s many things that can be done. Pelvic floor physical therapy is one of them. If pelvic floor physical therapy doesn’t work, then there are other options, medical and surgical options, that help diminish these symptoms. But the other thing I wanted to say is that there’s a really high prevalence of incontinence symptoms in young women who are athletic. There’s some thought that the effect of gravity repetitively on the pelvic floor can have an effect on it not functioning as well.
It doesn’t have to be women who’ve gone through childbirth. It may be women in their 20s who are very physically active, or who are overweight and there’s a lot of stress on that pelvic floor. If you’re having symptoms, then we can help you with that.
Pelvic Floor Physical Therapy
UVM Medical Center: Is your core strength related at all?
Ann Greenan-Naumann: Yes, absolutely. You know, if you think about your trunk or the middle part of your body as being almost like a canister, we have muscles in the front, muscles in the back, muscles on the bottom, and muscles on the top. We have to keep that whole core, and those muscles have to work together in order to keep your spine stable, in order to work your muscles in your legs and your arms, and to work your pelvic floor muscles. Your core is very key, yeah.
When we work with pelvic floor patients, we are always, in addition to working pelvic floor muscles, we’re also often working on core muscles. Abdominal muscles, back muscles, hip muscles.
UVM Medical Center: Can you tell me more about physical therapy and where you start and what it looks like?
Ann Greenan-Naumann: Yeah. Typically, the reason you might see a physical therapist for this problem, is that we are the experts on the musculoskeletal system. This is what physical therapists do. We work with bones and muscles, and these are just bones and muscles in a different part of your body. It’s not your shoulders, it’s not your hip, but it’s still bones and muscles. The strategies that we use and the concepts that we use are the same.
Typically, a physical therapist will do an examination and that means looking at posture, looking at alignment. It means looking at motion. Typically, I will screen the lumbar spine and make sure that that’s not part of the problem. Then we look at leg strength and then we look at strength of the pelvic floor. That means looking at the pelvic floor and it means seeing how well the pelvic floor contracts.
UVM Medical Center: Then what next?
Ann Greenan-Naumann: Once we determine what is contributing to the problem, the treatment might include exercises to increase awareness of pelvic floor muscles. Some women are weak in their pelvic floor muscles and some women are contracting their pelvic floor muscles all the time. We don’t just give Kegels to everybody. We want to say, “Okay, are you under-using your pelvic floor muscles or are you overusing your pelvic floor muscles?” If you’re overusing your pelvic floor muscles, we don’t want to be doing Kegels. We want to be teaching you how to relax them.
If the muscle is overactive, it’s like if you’re holding your elbow all the way bent and then we try to bend it further. There’s nowhere to go and those muscles can’t really generate any more force, whereas if the elbow’s all the way straight and then we ask you to contract it. There’s room for it to move and to contract. In patient who have overactive pelvic floors, we’re often trying to get them to relax those pelvic floor muscles and then learn how to turn them on and off.
Sometimes if you have an overactive pelvic floor, then doing Kegels will make things worse. If you’ve been on the internet and you’ve thought you know what to do and it’s not getting better, again, a physical therapist may be able to help you with that. Downtraining pelvic floor muscles, uptraining pelvic floor muscles. That means if you have weak pelvic floor muscles, how to get you to turn them on. That can be a combination of verbal cues, it can be tactile cues, and then we use biofeedback.
We have a sensor that is put on or near the pelvic floor muscles and then you contract those muscles and you can see on a computer screen whether or not you’re contracting and how much you’re contracting. That visual feedback helps your brain figure out how to turn those muscles on.
Then we train those pelvic floor muscles. Once you figure out how to turn them on, then we design an exercise program for you to do on your own.
UVM Medical Center: It sounds like the overall message here is that it’s not just one muscle group. It’s your whole core.
Ann Greenan-Naumann: Right, yeah. None of us are just our knee or just our shoulder. We’re a whole person and we’re going to try to look at you as the whole person and how you function standing, how you lift your baby out of the car if you’re a new mom, and do it in a way that doesn’t put stress on your low back and your pelvic floor and your other joints. Doing it with good mechanics. That’s part of what physical therapists do, also, is work with you on how to function and use your body in ways that aren’t going to injure it over time.
Where to Go if You Need Help
UVM Medical Center: Do you see a lot of male patients?
Ann Greenan-Naumann: I don’t see nearly as many male patients as female patients, certainly more female than male. But I’m trained in treating male patients and I see some male patients. Usually, male patients may have issues with continence or they may have issues with being able to go, because in men it’s a different problem. Learning how to work with that; we have to be able to hold urine and feces in and we have to be able to let them go. Working on both of those things.
UVM Medical Center: What’s your takeaway for men or women, if somebody thinks they might need help? Where do they go? What should they do?
Ann Greenan-Naumann: I think the first takeaway is that there’s something that can be done about this, that you don’t just have to accept that after childbirth or after surgery you have to put up with this, or that as you get older you’re going to leak. There are things that can be done to help with that. That’s my first takeaway.
My second takeaway is if you are having symptoms, come and see a physical therapist or talk to your primary care provider about what the options are and they can refer to physical therapy. Some insurances, patients can come right to us. Some insurances, they have to get a referral from their provider.
Then, to know that even if physical therapy alone is not helpful, there are other options available. There’s no reason for people to be living with leaking and changing clothes all the time and having to wear pads all the time without trying to do something about it.
If you’re experiencing symptoms and you’re interested in seeing a physical therapist, there’s two different sites here at UVM Medical Center where we provide these services, at the Orthopedic Rehab Center on Tilley Drive, 192 Tilley Drive. To make an appointment, you can call 847-7910. Our other site is at the Fanny Allen campus, so Fanny Allen Hospital in Colchester. It’s at the Continence Center. The phone number there is 847-5800.
UVM Medical Center: Our guest today on HealthSource has been Ann Greenan Naumann, a clinical lead physical therapist at the Orthopedic Specialty Center at the UVM Medical Center. Thanks for joining us.
Ann Greenan-Naumann: Thank you for having me.