Pelvic floor health in men and women ‘such a misunderstood area’

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Pelvic floor health in men and women ‘such a misunderstood area’


Growing up, my mother and grandmother constantly told me that having kids changes your body in many ways. In addition to sagging breasts, baby weight and stretch marks, peeing your pants would become a common trend during fits of laughter, coughing or sneezing as well as a side effect of jumping or jerky movements.

And the worst part about peeing episodes was that there was nothing you could do about it.

“That’s just the way it is,” they’d tell me.

So after I had my son, I resigned myself to living the rest of my life knowing any sharp movement, cough, sneeze or belly laugh could result in wet undies.

It wasn’t until I was well into my 40s when I made a trip to my gynecologist for my annual pap smear and well-woman exam that I found out living with leaks wasn’t “normal” in any sense.

When asked if there was anything else she could do for me, I quipped, “Yeah, come up with a cure for leakage.”

My doctor asked me some questions about what I was experiencing and come to find out, there are treatments for this problem. Despite what my mother, grandmother and millions of women around the work think, leakage after having kids is NOT normal.

The reason for my leaking came down to a common issue: pelvic floor muscles. Mine were either too weak or over-stressed.

Though women tend to have more problems with their pelvic floor muscles, men can also experience leakage, constipation, pain and other issues with their pelvic floors.

“If we have something wrong with our knee and it hurts and we start falling down, we go tell somebody,” said Michelle Faris, a physical therapist with UCHealth. “Pelvic floor dysfunctions aren’t talked about as much because it’s always been this taboo thing. Except we all have pelvic floors — men, women, kids, older adults — and there’s a lot of things we can do to help them.”

The pelvic floor muscles are layers of muscles that form a type of “hammock” or bowl. They are located between the tailbone, or coccyx, and the pubic bone within the pelvis, according to the Continence Foundation of Australia. The muscles support the bowel and bladder, as well as the uterus and vagina in women.

In men and women, the urethra and anus all pass through the pelvic floor muscles — which are “always on,” explained Leanne Johnston, a physical therapist who specializes in pelvic floor therapy at Adeo in Greeley.

“For example, like when you are sitting here, your bicep is at rest, but if you go to pick something up or bend your arm, then those muscles are working,” Johnston said. “Pelvic floor muscles are one of the only muscles in our body that are always on until you go to have a bowel movement or to urinate, then those pelvic floor muscles have to relax.

“It’s such a misunderstood area.”

Leanne Johnston, DPT is the clinic director and Pelvic Floor Specialist at Adeo Physical Therapy in Greeley. (Photo courtesy Adeo Physical Therapy)

Pelvic floor muscles are part of the body’s “core” or “trunk” muscles and work together with the abdominal muscles, back muscles and diaphragm to support the spine and control pressure inside the abdomen, Faris said.

“We really have to look at the whole picture because a lot of times, even people with low back pain, as providers, we should be asking if they are having bowel and bladder issues because the nerves that come out of the back also have branches that go to the pelvic floor and can cause issues,” Faris said. “We talk about everything down to the belly button and then everything below the hips and miss the middle.”

Pelvic floor muscles can become damaged, weakened or over-stressed from things like an injury to the pelvis, surgery such as prostate surgery, aging, pregnancy and childbirth, menopause, being overweight or obese, nerve damage, consistent heavy lifting and genetics, according to Columbia Surgery.

These muscles give you the ability to control the release of urine, stools and gas. When muscles are damaged, problems with bladder and bowel control can arise.

The muscles also play a large part in sexual function. For men, the pelvic floor is important for erectile function and ejaculation, while in women, the contracting of the muscles aid with sensation and arousal.

“I joke with people that pelvic floor muscles work automatically our whole life — until it doesn’t,” Faris said. “As a society, we have accepted that maybe it’s normal as we age to leak or have pain with sex or to have any of those things after you have a baby or cancer. But pain and leaking are never normal.”

While we want these muscles to be strong to support our organs and prevent leaks, we also don’t want them so strong to where they can’t relax. Muscles that are too strong, or over-stressed, can cause problems releasing things like urine and stool. Conditioning muscles to the optimal strength is a fine, yet tricky, balance.

“If those muscles aren’t functioning, there’s a problem. I find that there’s usually more tension than weakness,” Johnston said. “So you could have one side that is functioning well, but the other side is full of tension. Together, they can’t do what they need to do.

“The muscles in our body really want to be in balance; they want to be in homeostasis.”

Michelle Faris is a physical therapist with UCHealth that works with patients experiencing pelvic floor issues. (Photo courtesy UCHealth)

Damaged, weakened or over-stressed pelvic floor muscles can lead to issues including frequently needing to use the restroom, constipation, leaking stool and urine or straining when trying to have a bowel movement. Other issues may include pain during sex and urination, pain in the lower back, pelvic region, genitals or rectum, infection or inflammation of the prostate and erectile dysfunction.

About 24% of women in the U.S. experience one or more pelvic floor disorders, according to a study funded by the National Institutes of Health. The study also revealed that pelvic floor disorders increase with age, affecting more than 40% of women ages 60-79 and about 50% of women 80 and older. The study found only 4.4% of men of all ages reported any type of urinary incontinence.

Adult diapers: A billion-dollar industry

Over the years, the adult diaper industry has grown into a $15.4 billion global market with revenue estimated to reach $24.2 billion by 2026, according to a report by Businesswire.

As more adults find themselves needing the products, adult diaper manufacturers are working to remove the stigma and embarrassment associated with incontinence by making products more discreet, avoiding terms like “diapers,” placing items in the personal care aisles alongside deodorants and trying to normalize talking about it through advertising.

Many manufacturers have begun to make products in different colors, added designs and created pull-on styles with cloth or plastic backing. Products are also available for nighttime protection and heavy absorbency for the day.

“People keep the fact that they have incontinence secret from their loved ones, from their husbands, brothers and sisters — this is a deep secret for many consumers and yet it’s just a fact of life. It’s a physiological reality,” said Fiona Tomlin of Kimberly-Clark’s adult and feminine care division in a 2019 article by Reuters.

Exercises for women to strengthen the muscles of the pelvic floor. (Photo credit Vector illustration)

With women three times more likely to experience urinary incontinence than men, companies like Speax, Thinx, Cora and Knix have developed leak-proof underwear. The products appeal to women of all ages who don’t want to constantly use pads or wear adult diapers.

The underwear also work for menstrual purposes, eliminating the need for tampons and pads. Leak-proof underwear come in a variety of colors and styles such as thongs, briefs and hipsters and are offered in sizes up to XXXXL. Prices range from $20 to $46 per pair.

Leak-proof underwear are also available for men in brief, boxer and boxer-brief options through companies like Confitex, PropHim and WearEver. Prices range from $18.99 up to $40 per pair.

Diagnosis and treatment options

Pelvic floor dysfunction can be diagnosed in a number of ways, including internal and external exams. Typically your primary care doctor, gynecologist or urologist can help diagnose pelvic floor dysfunctions and determine how well the muscles are functioning.

Depending on the diagnosis, a doctor may prescribe treatments such as topical estrogen cream, medication, surgery or dietary, lifestyle or behavior changes, according to WebMD.

Years ago, whenever a woman had a problem with her pelvic floor, the go-to fix was to advise her to do Kegel exercises — when a person repeatedly contracts and relaxes the muscles in the pelvic floor. But research shows Kegel exercises can do more harm than good.

“A very big misconception is ‘Kegels, Kegels, Kegels,’ because that’s the only thing we’ve heard about, and it’s the answer to everybody’s pelvic floor problem, and it’s not,” Faris said. “A lot of times and in a lot of cases, the symptoms are occurring because the muscles are too tight and it needs to be relaxed. Then it can be strengthened properly with a Kegel.”

As with other muscles in the body, experts have found that physical therapy can also be applied to the pelvic floor. Physical therapy has become the first course of action when treating pelvic floor dysfunctions.

“Pelvic floor PT is this hidden gem that not many people seem to know about,” said Johnston. “But people need to know about it because there’s so many things we can do with it.”

In pelvic floor physical therapy, a therapist will help relieve tension and re-train the muscles.

The therapy can include external manual work that includes deep tissue massage, skin rolling and joint mobilization.

Internal manual work is when the therapist goes in through the vagina or rectum to perform trigger point therapy, which applies pressure on a specific point. While somewhat invasive, internal physical therapy for pelvic floor dysfunctions is highly effective.

Physical therapy for the pelvic floor is recommended not just when a person is having a problem. Prior to having a baby or undergoing surgery like a hysterectomy or prostatectomy, Faris advises people seek out pelvic floor therapy to help the muscles become healthy before the healing process.

“Maybe nothing is wrong now, but they may want to know about all the good things I can do now to strengthen and have a healthy pelvis so that things return back to normal as soon as possible after,” she said. “The pre-hab component can be very beneficial. All the literature says, ‘Hey, this helps,’ but we just don’t have the awareness about it.”

Many insurance companies will pay for pre-hab pelvic floor therapy prior to childbirth or surgery, Faris added. Patients, any sex and any age, can go to a pelvic floor physical therapist with or without a referral.

One of the newest products on the market to help treat incontinence is the BTL Emsella.

The Emsella is a chair patients sit on, fully clothed, that stimulates pelvic floor muscles through electromagnetic energy. This causes the muscle to contract, essentially allowing the patient to do thousands of Kegel exercises in a little less than 30 minutes. The contractions “re-educate” the muscles to help prevent incontinence in men and women.

Seven Trees Aesthetics, 1357 Water Valley Parkway, Unit 300, in Windsor, purchased an Emsella chair in October so that the medical spa could begin to offer the treatment to clients.

“It works on both men and women and is equivalent to 12,000 Kegels in 28 minutes,” said Paige Hobbs, Seven Trees co-owner. “Some people will have improvement after the first session, and some people need two or three. But we haven’t had a single person not have some sort of response from it.

“It’s been a game-changer for women who haven’t known there is something they can do. And that’s why we wanted to get into that part of this.”

Patients describe the treatment as a “tingling” sensation, and they can feel the muscles contracting during the treatment. Daily activities can resume right after the treatment.

“You come sit on the chair for 28 minutes, and you can work on your laptop or read or take a break,” Hobbs said.

The BTL Emsella chair is an FDA approved non-invasive treatment for incontinence in men and women. Seven Trees Aesthetics in Windsor offers BTL Emsella treatment packages for clients of all ages. (Tamara Markard/Staff Reporter)

A few men have come in to use the chair after they’ve healed from a prostatectomy.

“Incontinence is a big issue for them, and this is like doing super Kegels,” Hobbs said. “It also helps with erectile dysfunction.”

Sessions are done twice per week for six to 10 sessions. Results will depend on each individual, with some people needing several sessions and others only needing a few sessions.

The price for six sessions is $1,800 and $2,200 for 10 sessions.

For more information on BTL Emsella sessions at Seven Trees Aesthetics, call the medical spa at (970) 236-4777.

Pelvic floor problems in children and teens

Though pelvic floor dysfunctions are often associated with adults, children and teens can also experience issues.

The Herman & Wallace Pelvic Rehabilitation Institute, which offers courses for physical therapists in the treatment of pelvic floor dysfunctions, reports “pediatric pelvic floor dysfunction is common and can have significant consequences on the quality of life for the child and family, as well as negative consequences to the lower urinary tract if left untreated.”

Child with pelvic floor issues face issues including:

  • Day- and nighttime urinary incontinence
  • Urinary urgency and frequency
  • Backflow of urine into the kidney
  • Pelvic pain
  • Inability to fully void urine or stool
  • Constipation

“When we think of pediatric bowel and bladder issues, we primarily focus on what is happening to cause the bowel or bladder leakage and treat it accordingly,” writes Dawn Sandalcidi, a teacher at the institute. “It is imperative to teach a child that she/he did not have an ‘accident’, but their bladder or bowel had a leak. It makes the incident a physiological problem and not something they did.”

Education on the pelvic floor anatomy, behavior modifications including fluid intake, timed or scheduled voids, toileting postures and avoidance of holding maneuvers, diet, avoiding bladder irritants and constipation are just a few ways doctors and parents can help children overcome pelvic floor dysfunctions and incontinence, Sandalcidi wrote.

There are also pediatric pelvic floor physical therapists that specialize in helping children and teens with issues, Faris said.

“They can help kiddos with things like constipation, bedwetting and potty training beyond when it should be and things like that and a lot of re-training or training the kids,” Faris said. “This is kind of relatively newer in the last five to 10 years. I think this is also another area of pelvic health people don’t know about.”

Again, no matter your age, incontinence, pelvic pain, constipation and similar problems are not “normal,” “part of having kids” or “something that happens when people get older,” Johnston and Faris stressed. If you are experiencing any of these symptoms, or other problems in your pelvic region, make an appointment with your primary care physician for evaluation.


For more

For more information on pelvic floor dysfunctions, treatment options, symptoms or how to maintain a healthy pelvic floor, check out these resources:



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