Pelvic Floor Exercises

Hi Minimoo

It is great to read that you are asking these questions and seeking to understand this very complex 3D space with its multiple layers of muscles, and its 3D organs. I think Christine's book is pretty good, but I also have a half scale skeleton that I have almost coaxed into WW posture, and a couple of good anatomy books.

The trouble with anatomy illustrations is that they draw the pelvis in the position which results from 'anatomical position', which is what a cadavre does on a mortuary slab. The spine straightens and loses its lumbar curve. The pelvis tilts back. This is why we hear doctors talking about the bowl-shaped pelvis. Yes, it is a bowl, but it is actually tipped on its side when we stand up. You can feel this with your hands when you are in WW posture. Feel the front of the crests of your pelvis, just down from the waist on the sides. Find your pubic symphysis (feeling underneath to see how far back it goes it goes), centre front. Feel the bottom of your tailbone. Now compare these positions with each other and you will see how wrong the average diagram is for a living, standing woman.

So it you look at diagrams, mentally rotate the pelvis through about 45 degrees until it is on the correct angle .

The pelvic floor is difficult to visualise because it is a multi-layered group of muscles that are often left off muscle diagrams. Perhaps it is too much information for the anatomists? Perhaps they cannot make sense of it because they are looking at it from the wrong angle? If you write down the names of all the muscles you can google each muscle separately, using Google Images.

There is an interactive 3D body viewing programs called www.anatomy.tv, which you can download as a 30 day trial. It is amazing to plug in the names of the body parts and see them illustrated, and be able to rotate the body to view it from different directions. If you have access to a University login, and the Uni does any human biol, medicine, nursing, physio studies you might be able to view it as an e-resource. This is where I first found it.

I have never been able to find any clinical evidence that pelvic floor muscles can overcome prolapse or heal it. The only thing that will take the pressure off the pelvic floor muscles is tilting the pelvis forward so the pelvic organs kind of roll forwards onto the pubic symphysis, to rest against the lower abdominal wall, and the pelvic floor goes from horizontal to diagonal at the back, becoming not a floor, but a stabilising wall. The other thing that happens when the pelvis is tilted forwards is that it moves slightly on the sacroiliac joints, which are not parallel. This opens the pelvic outlet a little at the back, by lifting the tailbone, and separating the ischial spines. This sounds like it would make the pelvic floor more vulnerable, but it actually stretches the pelvic floor muscles tighter from front to back and from side to side, like tightening a drum skin. This makes them sag less, and work more, which makes them automatically stronger, simply by using them in everyday movement like walking and dancing!

This is why pelvic floor exercises are not a part of Wholewoman exercise. They don't need to be! If your pelvic floor is particularly slack some physio and pelvic floor exercises can give them back some tone, and improve your continence, and improve your sex play, but you have already done that now. No amount of extra pelvic floor exercise will improve your prolapses any further. sorry if this disappoints you. I was rather glad to be able to give them up, because they didn't seem to be making my POPs any better. Now I know why.

Hope I have answered your questions satisfactorily. Now off you go. Find a skeleton in a closet at your local school, and get googling. Oh yeah, buy Christine's book too! It does have some very good explanatory diagrams which you will battle to find anywhere else.

Louise

I don't know why but have felt the results of exercises. My testamony is 2 days ago I could hardly walk and I was in constant raw pain. (Just got off a cruise with no exercising.)Today, I worked all day and hardly felt my POP. What happened? I began the Beginning exercises twice a day, the right posture, and healthy eating. In two days I go for a pessary fitting. Hopefully, I will have less setbacks with added exercises too. I'm on board with the exercises. I thought I ate healthy until I continued on the DVD into the Kitchen. I don't think I can be a vegetarian, although I love and eat a lot of vegetables, can't live without some fish and meat. When I began to lay low on gluttens I lost my cravings for sugar. Result? 15 pounds gone! Back to the exercises...love them without knowing all the reasons!

It's always so frustrating to experience a setback. Well, you've learned just how quickly you can bounce back! When I first started this work, it would take me up to a week to start to feel better after I did something to annoy my prolapse- then a few days and now it's a few hours max. Keep it up, the toughest part is the fear and anxiety of a setback. Once you know you can make it through a few of those and come out on the other side feeling better than before, you will not even worry when you feel a little low because you will know just how fast you will feel good again.

That's great Kmscott. You have discovered another tool in your toolbox. It is all about finding tools, even if they are tools that others do not find helpful. I do want to say though, that when I say pelvic floor muscle exercises I am talking about Kegels, whereas WW exercises are quite different. I do think there are often benefits in doing Kegels, but they will not make your pelvic floor muscles strong enough to hold up a prolapsed uterus, bladder or rectum because they are not the right type of muscle fibre or structure to hold up an organ that has compromised fascial support.

Great article, guys (gals)! LOL. Never really thought about doing pelvic floor exercises. Seems like an interesting concept. Pardon my naivete. =P

I've just finished reading Christine's book and watching the DVD, and so I am awash with wonderful, clarifying options for my bladder and uterus prolapse. I agree with Minimoo, that it is very difficult to really grasp through diagrams, how all the pelvic organs actually work together. I do see that the pelvic floor becomes a stabilizing wall when the correct WW's posture is found. I just began to suffer from frequent urination a few months ago, at age 66, and today went to a PT appointment with a well-known physical therapist, who says she agrees with a lot of Christine's concepts. Then, for my first week's homework, she gave me a home exercise program of plain ole Kegels, with narry a word about tilting the pelvis forward. My question: I would like to give this PT's work a try, as maybe she does have some helpful ideas. If I keep my pelvis forward, will it hurt me to do Kegels, as she prescribed pretty serious tightening of pelvic floor muscles, for many contractions several times a day.
I read a recent study from a group of PTs in Norway, who concluded that there were benefits to pelvic floor muscle exercises, and that 35% of a large group of women went from stage 3 to stage 2 prolapse. Should I try to find what exercises these women were given, or does someone already know?? I read a short summary of this study,which apparently was discussed in American Journal of Ob/Gyn in April 2010.
My goal is to follow Christine's program first, as it is sooo filled with common sense. But, I have a strong fear that my insides will fall out of my vagina and I'll be forced to have surgery. If this happens to any of us, arent we forced to then have surgery?? And if this becomes a necessity, what type of surgeon do we look for? I had been dr.shopping before I read Christine's books, and havent felt at all happy with any of them.

Hi Harmonics

You seem to be getting the hang of what Wholewoman is about. One of important things to realise is that nobody can force you to have surgery. It is your decision. Once you learn some more about your body, by more study, and by observing your own body, you will be in a much better position to make any decision for yourself regarding surgery, or any techniques for managing pelvic organ prolapse. Once you realise that your body is in your hands and not anyone else's, it all becomes much less scary.

Re Kegels, if you are in WW posture you can still do Kegels, but you will feel less tightening sensation, because in WW posture your pelvic floor/wall muscles are already quite taut, so there will be less movement. This is because of the mechanics and geometry of the pelvis, sacrum and spine, and how they work together. As you walk the two sides of your pelvis operate independently, with the pelvic floor muscles alternately relaxing and contracting on each side. Taking longer, and relaxed strides accentuates the degree of this alternating movement. If you are relaxed your body will extend your stride, open out your chest and shoulders, extend the spine and allow you to walk in WW posture. When we are tense we tend to hunch over and the spine tends to flex, putting us into a C shape as a protective mechanism.

Kegels are not evil, but pelvic organ prolapse is caused by many factors, the most significant being stretching and damage to endopelvic fascia, not weak pelvic floor muscles. Weak pelvic floor muscles are a factor, but only because poor posture does not work these muscles in everyday movement, which allows them to lose tone. Fix the posture and the muscles will slowly become stronger. You can make them stronger with Kegels as well, but unless you fix the posture they are still trying to support a vertical load, and that type of muscle, which is thin and sinewy, is not designed to support a vertical load, but to act as a spring, stabilising from behind, in the same way that the abdominal muscles are springs that stabilise from the front.

Yes, I think you are right. If you go to a surgeon they will encourage you to have surgery and they will choose the procedure. End of story. In your position I would be trying WW techniques for 12 months and see how much improvement you can get. I keep it in the back of my mind that I might have surgical repairs one day, but the possibility is becoming fainter and fainter. I can no longer see the point of it. If you have surgery first you go through a doorway that you can never return through, because your pelvic architecture has been changed permanently in ways that will reduce the effectiveness of WW techniques, which are based on our original design. See my story called The Two Doors. I think it is in the Village Library.

You might never get permanent absence of POP symptoms with WW, but I have reached a point where I am fine with staying the way I am, with my symptoms not affecting my life at all really. Occasionally I get symptoms, but I know what to do to make them go away. I hope you can get to that point too.

Can you point me to a link to the Norway PT study you referred to?

Louise

Thank you very much, Louiseds! I just cant remember the link for the article on PT from Norway research, but it was April 2010 American Journal of Ob and Gyn that was cited. I think I may have read the summary after I googled PT for Pelvic Organ Prolapse. There was no description at all about the types of PT exercises involved. I've just begun my path of reading research articles, and so I'm curious if there is an inexpensive, central, on-line clearinghouse of medical journal articles? I recently retired as an auxilliary professional from a major medical hospital in Bethesda,Md., and so had extremely easy access to any journal in the world! I just smiled at the librarian. Now I'm in Texas and havent yet explored my lower options.

Hi Harmonics

I am in the fortunate position of having a University login, which gives me access to the full range of Scholarly databases that your friendly Librarian had. However, some of those databases have free full text access anyway. You can access full text in these databases via the Web.

There are others that you can access via the Web, where you can get Abstracts of the papers, but not full text access, without a login or private subscription. An Abstract is often enough to give you the information you need. Then you can decide whether or not it is worth paying or smiling at a Librarian nicely to get a copy of the full text. You have to remember that Library Staff are beholden to their employer's legal responsibilies when it comes to use of database licences, so don't be offended if they decline to supply it. They are just in self-preservation mode.

Another way I have occasionally been able to find full text is by finding an Abstract of the article and searching the title of the paper on Google, enclosed in quotation marks. This sometimes brings up a full copy of the paper, published on a free access site, or on a site that simply requires you to register as a user. This often relates to papers that have been published some time in the past, so the authors are not so paranoid about somebody stealing new information. They are also published on Government health sites which are for health consumer access.

You can find free databases by googling "free scholarly databases online".

No, there is not a central repository. If there was, these database companies would not be the big businesses they are.

How do I know this stuff? I work in an academic library as a humble library assistant.

Hope this is some help.

Louise

Thank you so much again! I'm becoming more and more data-driven re POP, and the more I read, the more confident I'm becoming in my ability to be in charge of the flexibility and wholeness of my own pelvic organs!When I started my POP journey, I was horrified by my ignorance, and now I'm very motivated to start talking to other women in my community so as to learn and grow together.
My lurking anxiety, however, revolves around what surgery I should accept at some point in the hopefully very distant future if my organs drop from my vaginal opening, and who should I accept as my surgeon. In the past 2 months, I've been to 5 different surgeons, and have about 5 more on my list. Every time I go, I have increasingly specific questions to ask, which they often dont really answer. It would be great if some of us women could get together and develop an informal "questionnaire" ( a list of questions to ask any surgeon-candidate ) in order to assess what type of surgeon would be the best choice for last-resort POP. So far, when I've asked a specific question re what gets tied to what, and what is cut, the answer usually is "There are many different types of techniques, and I cant know for sure until I get in there." Not a useful answer. I'm also wondering if there are some other countries with more traditional, simple surgical techniques which perhaps we have overlooked. Once I answer these questions for myself, I can relax in the next year and just enjoy, do my best with Christine's DVD exercises and postures, and hope for another few years or a lifetime of organ stability.

Hi Harmonics

What more can I say? This is how surgeons work. It is very hard to get an exact answer out of them because dong a repair job inside a woman's pelvis is very much like renovating an old house. Often they find things they are not expecting, and have to change tack in the middle of the job, and that is understandable. They don't want to commit themselves to doing one procedure when they have a woman under anaesthetic and cannot change their mind without seeking her permission. It is all about informed consent. So they just don't specify! It is an act of faith, accepting that they will just make up their mind when they get in there.

This is one of the reasons why pelvic repair surgery, no matter how skilful the surgeon, often has unexpected consequences. Unfortunately it is not the doctor, but the woman, who has to live with the results. If the repair is satisfactory you can sing to the rooftops.

It is pretty hard to believe it happens that way, but you need to understand that this is a risk taken by anyone having a repair.

In your situation I would close my Surgeons Notebook for now, and go with Wholewoman techniques for twelve months, to see what you can do with the body you have. After that time you will probably know a lot more about your body and have a clearer picture of the need or lack of need for surgical repair. Save yourself the worry now. Deal with it in twelve months' time if you still think you will need repairs.

Louise

Wow! Thank you! I just made an assumption that the surgeons I saw just didnt want to share. Your description of renovating an old house is just perfect! I just imagined that the surgeon's techniques were similar to DaVinci-- conservative, pre-planned, and now, robotic. Now I truly can see the Picasso and Salvador Dali in the hoped-for outcomes. My surgeon notebook is now shut.

LOL!

My cautionary notes are nothing personal against gynaecologists. They are just doing what they are trained to do. Women need to understand this and realise that they are selling services just like any business. "Let the buyer beware" applies to what we allow others to do to our bodies, as much as (probably more than) what we allow a mechanic to do to our cars.

I understand that in the USA women go to their gyn for their annual checkup. In Australia we need a referral to see a gyn. All our women's health checkups are done by the family general practitioner or at walk-in women's health clinics where the PAP smears, breast checks etc are all done by nurse practitioners or other trained individuals who might or might not be doctors. They can refer a woman to a gyn if she wants it, or if they think it is warranted.

I think I have seen a gyn twice in my life. The first was when I had a weird rash that had not responded to normal medical treatment, and when my dropped cervix was first detected about 16 years ago. The second was just after I found this website, when the gyn told me I needed a hysterectomy, cystocele repair and rectocele repair. I called out over my shoulder as I fled, "Don't call me. I'll call you!" Needless to say, I didn't.

No, I lie. My first baby was conceived with infertility treatment (a positive gyn experience). The second baby likewise, but I was passed on to another gyn/obstetrician for the pregnancy and birth. This was another positive experience. The third baby, a spontaneous conception, was under the care of our family doctor.

So, It's not all bad with gyns. I just don't think they are relevant for the average woman with POP, but if they are the first port of call for preventative healthcare it would be much more difficult to escape their clutches as the normal body changes in an ageing woman's life happen. It is too easy to believe that they are inevitable, progressive, unstoppable and fixable with a little op.

The difference is that we can send the car to the recyclers if repairs go pear-shaped, and buy a replacement, but we cannot do this with our own body. We are stuck in it until the grave.

You were very sensible to do the research you did. Many women never think about *selecting* a surgeon, or their country's healthcare system doesn't allow them to. Asking the questions you asked enabled you to see that pelvic repair surgery is not as simple as putting a new water pump in your car.

Well done. Hope you progress well with WW techniques and never need to dig out the notebook again.

Louise

So, Louise, am I going to get the exercises and WW stance (what is that?) when I buy the book and dvd? There are a lot of terms being used, like POP, that I don't understand, also.
Help....
Thanks,
Daphne

Daphne, have a look at the product descriptions at the Whole Woman Store. You can also see excerpts from the DVD's on YouTube under Wholewomaninc channel.

The DVD First Aid for Prolapse is probably the best one to start with. The book will give you a deeper understanding of how and why Wholewoman Posture works. There is so much to learn. Ya gotta start somewhere.

POP is pelvic organ prolapse.

Only you can decide which is the best for you.

Louise