What Every Woman Didn’t Know Was Part of Race Training By Meghan Soby, DPT

(Taken from Upper Valley Running Club April Newsletter)

Ladies, lets talk about your core. Nope, not your abdomen, this one is even deeper. I’m talking about the one inside your pelvis, the one that when it fails, no one likes to talk about. Ever had any pain between your legs during a run? Had leakage of urine during a run or after a particularly grueling workout? The feeling of heaviness between your legs? More likely than not, you may have experienced some of these symptoms or similar ones, and it can indicate an underlying pelvic dysfunction that may impact not only your running activities, but your daily life.

The pelvic floor consists of muscles that provides support to your pelvic organs, control toileting, assist with stability of spine with the abdominal and back muscles, contribute to sexual arousal and climax, and for women, provide support to a growing baby. Dysfunction of the pelvic floor can result in a wide variety of symptoms such as accidental leakage of urine or stool, the feeling of heaviness or as though something is falling out, pain with activities such as running, and pain or difficulty engaging in sexual activity. It is estimated that 1 in 3 women will have dysfunction of their pelvic floor muscles. Women have a higher risk due to their anatomy (men have two openings through the pelvic floor with the urethra and anus while women have three including the vaginal opening), pregnancy and labor, and body changes during menopause.

Now if you are in an activity that increases the load or force through the pelvic floor such as running, you put yourself at a greater risk. Each impact of the foot hitting the ground forces the pelvic floor to contract against the downward force of the organs within the pelvis while maintaining its hold on the urethra and anus to prevent accidental leakage. That’s tiring work! In some cases, the pelvic floor demonstrates no impairments and is able to hold up to the changes in demand. Others may notice a slow development of issues like the ones mentioned above that worsen progressively with continued running.

So after last month’s article, you may be thinking, “ok, I’ll just do some kegels and that will fix it.” No. Kegels are not the answer to everything when the pelvic floor is compromised, in some cases it may worsen your symptoms. Reasons for this stem from the fact anywhere between 25 and 35% of women are not performing a kegel correctly and some individuals have very tight pelvic floor muscles that become more painful with contraction and are unable to relax. What do you do to fix this issue then? Depending on your symptoms, there are a variety of different treatment options. But if you are having symptoms, I recommend you follow up with your doctor or a specialist such as a gynecologist or a urologist so they can assess the issue and monitor it.

In regards to treatment, there’s PT for that! A physical therapist specializing in the pelvic floor can assess the strength and flexibility of the pelvic floor muscles and provide an individualized program that will progress toward your goals. Treatment interventions with physical therapy can include exercise, breathing techniques, re-education of the internal muscles with and without electrical stimulation, massage to tight muscles (internal and external), and education engaging the pelvic floor during activities such as running.

Much like physical therapy for other joints or body regions, it does not guarantee the symptoms will go away completely. An example: If you have sustained an injury to the knee that is not addressed early on, you may develop muscle imbalances, adjust walking or running pattern to avoid increasing pain, and you may even dramatically reduce your running frequency or duration. The longer the issue persists, the higher the chance of needing more invasive treatments to correct the impairment. The majority of women I see for pelvic floor dysfunction report YEARS of dysfunction, its become a part of their everyday life and have developed habits to avoid addressing the dysfunction within. In some cases, simply tuning one into how their pelvic floor is supposed to work and helping to relax and/or strengthen the muscles will dramatically resolve symptoms. For others, there may be need for surgical intervention. Much like a knee injury requiring surgery, it does not correct the underlying muscle weakness or incoordination, most will still require some guided physical rehabilitation to get everything back in working order. You can’t escape PT, embrace it, love it.

My suggestion if you start noticing symptoms, get seen sooner rather than later. It is much easier to rehabilitate this area when symptoms have not been persisting for several years. While aging, childbearing, and anatomy predispose women to a higher incidence of pelvic floor dysfunction, it does not mean it is a normal part of aging. The symptoms can be embarrassing, frustrating, and isolating. But it can be resolved, and you can get back to what is most important to you.

Meghan Soby is a pelvic floor physical therapist from Valley Regional Hospital.

Exercise:

Try this exercise: lay on your back with your knees bent. Place one hand on your tummy and another on your chest. Draw a slow breath through your nose and let your belly rise, the chest should not move. Slowly exhale out through pursed lips, letting the belly drop. This is called diaphragmatic breathing. This technique also moves pelvic floor in time with your transverse abdominis, the deepest muscle of the abdomen and very important core stabilizer. I use this exercise to start the coordination of the core of your abdomen and back with the deep core of your pelvis during treatment of a wide variety of pelvic dysfunction. As the belly expands, the pelvic floor and abdominal muscles stretch, while during exhale, or belly down, the muscles recoil. This exercise is wonderful because it is both relaxing to the body as well as improving the recruitment of the pelvic floor muscles.

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