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To Kegel or Not: That Is The Question

Pelvic floor muscle dysfunction (PFMD) can include both overactive and underactive muscle problems, and sometimes the infamous Kegel exercise can cause more harm than good. Even the way Kegel exercises have historically been prescribed has changed, as new emerging evidence arises. For example, it was previously stated that you should practice doing Kegels while urinating on the toilet, by slowing down or stopping the stream of your urine. We now know that this type of prescription should be avoided, as it can lead to other problems. There is also a wide body of evidence linking PFMD with chronic low back pain, pelvic pain, and hip pain. If a patient is not improving with continued treatment, then perhaps the pelvic floor is the missing link!

So how can a practitioner tell which type of PFMD a patient has, and therefore if they should be doing Kegels or not? An external and internal pelvic floor exam can help a therapist understand if a patient’s muscles are tight and/or weak, and are contributing to their symptoms. During an initial assessment, the physiotherapist will gather information through questionnaires, subjective report, and an objective exam to determine the likely cause. Then a treatment plan will be carried out with a reassessment performed around 4-8 weeks to determine the effectiveness and to understand if the patient’s goals have been met.

Types of PFMD that can be treated with pelvic floor physiotherapy:

  • Urinary and Fecal Incontinence

  • Pelvic Organ Prolapse

  • Persistent Pelvic Pain and/or Coccyx Pain

  • Constipation

  • Dyspareunia (pain with intercourse)

  • Nocturia (getting up to urinate at night)

  • Dysmenorrhea (painful periods)

  • Rectus Diastasis (abdominal separation during/after pregnancy)

  • Vulvodynia

  • Vaginismus

  • Lichens Simplex, Complex, and Planus

  • Genitourinary Syndrome of Menopause

  • Pudendal Neuralgia

  • Endometriosis

  • Irritable Bowel Syndrome

  • Interstitial Cystitis and Bladder Pain Syndrome

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