Strengthening pelvic-floor muscles can help with incontinence, pain

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This article was published 11/5/2015 (867 days ago), so information in it may no longer be current.

Crystal was so nervous about her frequent, almost uncontrollable urination that she skipped her honeymoon.

"Oh, God. It was frustrating. I started having anxiety attacks," says the Winnipegger, who requested that the Free Press not publish her real name. "I wouldn't want to go out anymore. I wouldn't travel."

After a year of seeing physicians whose medications didn't help, Crystal found a physiotherapist who changed her life, thanks to a referral from a new gynecologist.

"I was thinking, 'I've been to a physiotherapist before. I don't understand how someone working on my back is going to be able to help my bladder,'" says Crystal, 32.

She saw Kelli Berzuk, a rare type of physiotherapist who specializes in muscles of the pelvic floor. The pair discovered that Crystal had weak pelvic-floor muscles. With regular physio sessions at Berzuk's clinic in the Medical Arts Building and home exercises that flex her internal pelvic muscles, Crystal says peeing is the last thing on her mind now.

"I don't let this problem stop me anymore," says the woman, who has since taken her honeymoon — and gone on a dozen vacations — since first seeing Berzuk 10 years ago.

It's not surprising to Berzuk, a physiotherapist with a doctorate degree in urogyne-colorectal medicine. The Winnipeg specialist recently published a study, suggesting the majority of women who don't seek help for pelvic-floor disorders actually do have such disorders. As well, those educated about the pelvic floor experienced drastic improvement from their symptoms.

The randomized, controlled study appears on the International Urogynecology Journal website and will be in the journal's print edition this month.

Berzuk, who owns Nova Physiotherapy/Incontinence and Pelvic Pain Clinic, says her research is among the first of its kind to focus on the general public rather than those who have been diagnosed with pelvic-floor dysfunction.

According to the American Urogynecologic Society, one out of every three women will have a pelvic-floor disorder.

It's still a taboo subject, says Berzuk, whose services are not covered by Manitoba Health.

"It is unfortunate that these are still areas that are difficult for people to talk about. They are very sensitive in nature," she says. "I worry that so many people are not getting the help that they need just because of the embarrassment or the stigma."

Because of the silence, many remain confused by what the pelvic floor is. It's a group of muscles, bones, organs, ligaments in the pelvis and internal organs, including the bladder, the bowel and the uterus.

The area is responsible for bladder and bowel control as well as sexual function and pleasure in both men and women, says Berzuk, who first assesses her patients by chatting and then follows with an internal exam. Her subsequent sessions can include internal massage and release of pelvic-floor muscle trigger points. She treats men and women in her clinic.

Berzuk's 161 study subjects were divided into three groups and tested to establish their baseline levels of pelvic-floor knowledge and symptoms.

The first group received an intense pelvic-floor education session and the second group received less comprehensive training. The third group did not receive any education.

Berzuk says the first two groups' knowledge about the pelvic floor "skyrocketed" and subjects experienced vast improvement in their symptoms. The third group experienced no change in their symptoms.

Berzuk hopes the results of her study will bring attention to what too many view as a taboo subject. She compares the vaginal muscles, along with the muscles of the pelvic floor, to the muscles in any other area of the body.

"Most people understand that we exercise every area of our body," says Berzuk. "If we do not do exercise, the health of our muscle, like our heart muscle, is not going to be as great as it could be."

Pelvic-floor weakness can happen in all ages, whether or not a woman has given birth.

She notes that so-called Kegels, the set of pelvic floor exercises developed in the 1940s, are often misunderstood and can be harmful when done incorrectly.

"A pelvic-floor exercise program is based on scientific principles. So it should not just be this cookie-cutter approach that they saw in a Cosmo magazine or something," says Berzuk, who assesses the pelvic-floor muscles before recommending an exercise program tailored for each patient.

"Women that have had babies very often think (leaking) a little bit when they laugh, cough or sneeze... is just a fact of life and a consequence of haven given birth. It does not need to be like that. If we talked about it more, we could raise awareness."

Have an interesting story idea you'd like Shamona to write about? Contact her at shamona.harnett@freepress.mb.ca.