“If my muscle is tight, why am I still leaking?”
This is a great question. As a pelvic floor physio, I’m asked this often. The best way to answer, is to imagine we are talking about a different part of your body, such as your neck!
Most people will have experienced a sore neck at some point in their life. And when you’ve had that sore neck, it’s hard to turn your head, or you do so with trepidation, much slower than usual. During this uncomfortable time, if you’ve reached up to rub your neck and touched the muscle groups that are responsible for your neck movements you will have noticed how tight and tender they are to touch.
So, we have pain, we have tight muscles and we have loss of function. This is exactly what is happening in your pelvic floor.
Most often, something will have occurred in the pelvis to cause your pelvic floor muscles to become overactive and tight. For example: a painful experience with constipation, a urinary tract infection, or perhaps an uncomfortable sexual experience. As a result of this, the pelvic floor muscles may go into spasm, or the individual may begin subconsciously holding tension in the pelvic floor muscles as a way of providing protection to the area.
This causes the muscles to become short and stiffened. When muscles are held in a shortened position, they have less ability to contract and perform their function in a responsive and timely manner.
If we go back to the example of the neck; turning your head – the function of the neck muscles, may be reduced, and will be performed more slowly in the presence of tight, stiff muscles. In the case of the pelvic floor, the ability to contract to support the bladder – one of the functions of the pelvic floor, will be reduced, and performed more slowly when the pelvic floor muscles are tight and stiff. This can lead to urinary leakage.
So, if this is the case, doing lots of pelvic floor exercises focused on squeezing and holding is not going to improve urinary leaking. In fact, it may make it worse or lead to a different condition due to even more tension in the pelvic floor muscles. Instead, what will assist this woman is if she can learn to downtrain the muscle tension. This can be taught and practiced and once we have a healthy muscle, sitting at a good resting length, we can then teach appropriate functional recruitment of the pelvic floor which will lead to long lasting continence.
Kym Veale is the Director at Womankind Physiotherapy.
Phone: (03) 9431 2530