One of the most frequently ignored muscles in the body is the pelvic floor—it’s hard to work out, impossible to see, and until you actually have a problem, it can be difficult to comprehend the importance of taking care of it. So, to find out why it’s so important and what you can do to keep your pelvic floor in tip-top shape, Molly talked to Laura Powers (BPHE, MPT), a physiotherapist in Collingwood, Ontario. She’s been focusing on helping women—primarily athletes—rehabilitate their pelvic floors and regain daily activities, like jumping or running they had been avoiding. Laura has focused her practice on this area of physiotherapy for the past few years and considers educating the public on the topic to be one of her primary passions.
Why does the pelvic floor matter?
It’s a major muscle, just like any other! We’ll get into the problems women can have with their pelvic floor, but those problems, when left unaddressed, can really affect everyday life: your self esteem, your social life, your confidence, what you enjoy doing… We can help women so much.
What are the most common pelvic floor issues you see in female cyclists?
One in four women have some kind of urinary incontinence, so if you take athletes and apply that to them, it’s not as uncommon as you might think. For cyclists in particular, though, it’s a low impact sport with no jumping, so stress urinary incontinence isn’t as common. Most commonly, I’m seeing women with pelvic pain, numbness, sexual disfunction—they just can’t get orgasms—all due to the prolonged compression on the saddle. There are a lot of nerves, veins and arteries that get compressed and can create those sensations. That’s likely what we see: deeper, inside pelvic pain, superficial numbness, or that sexual disfunction. If you’re avoiding sex because of discomfort, that’s a bad sign.
What are some early warning signs that a woman needs to do something about her pelvic floor?
As a female athlete, if you’ve had a baby, you should be doing pelvic floor exercises or seeking preventative treatment. I advocate for seeking some kind of guidance after childbirth. But in terms of early signs, those symptoms I mentioned in the last question often start out infrequently or in more mild forms. If it goes unaddressed, it gets worse. Pain becomes longer and more intense. So any of those symptoms are signs that something isn’t right: even a little bit of leakage isn’t normal. A bit of discomfort on the saddle isn’t abnormal, but if you’re having it, you should think about ways to make your ride more comfortable to avoid the issues getting worse.
What certifications should a cyclist look for when looking for someone to help?
A lot of physiotherapists claim to treat pelvic floor, but a lot of them only do external work. They’ll educate on positioning and how to engage your core, and that’s fabulous and greatly needed. But you probably want someone who does internal exams and assessment, who will internally palpate the muscles. That makes a big difference. When looking for one, look for a physiotherapist registered to do internal palpations for the pelvic floor. It’s the most effective way to assess and treat pelvic floor problems. Women come in all the time and tell me they’ve been doing Kegels, and I do an exam and it doesn’t feel like they’ve done anything because they haven’t been doing them properly. And what we need to assess is the tightness of the pelvic floor. There’s a certain tightness that’s considered healthy. In a weak pelvic floor, the muscles feel softer and that’s when you tend to have that stress incontinence. On the other hand, a high-tone pelvic floor feels tight and restricted. That’s when you see more pelvic pain issues. Both require very, very different treatments, and that gets missed with external treatments.
What can a patient expect going for the internal treatment?
It’s similar to when you go for a physical. But when women think of that, you think of the speculum and having your feet in the stirrups. But it’s not like that. You’ll feel some pressure, but most women say it’s not as bad or as weird as they thought it would be! It’s not very invasive, and it’s a comfortable setting. But people are nervous about the internal part—I just tell people they’re in complete control and we can stop anytime.
What are some exercises a woman can do to strengthen pelvic floor?
I’m a huge proponent of home exercises, because I only see women once a week. They need to be doing home exercise to maintain the work that we’re doing. For a cyclist with a tight pelvic floor, that means lots of stretches. I like Child’s Pose, deep breathing, anything to create relaxation. If you have loose muscles though, that’s when we’re doing Kegels. But really, it’s like any other training program—just like other muscles, they need that training effect. You’d go for regular massages and stretch if you had tight neck muscles!