Look around, do you see that elephant standing in the middle of the room? It’s standing right there! Everyone of us can see it - maybe even feel it - but nobody seems comfortable enough to acknowledge it. Even among trusted friends, family, or even medical professionals, many of us will choose not to mention this elephant that lives with us, yet it poses a tremendous impact on our lifestyle and well-being. What is the name of this elephant I speak of? Pelvic floor dysfunctions!
Research suggests the prevalence of pelvic floor dysfunction (PFD) to be as high as 1 in 4 women throughout a lifetime, which is twice as much as low back pain! Yet, research, diagnosis, and treatment of low back pain far exceeds that of PFD. Many people still do not even know what PFD is.
Pelvic floor dysfunctions include several conditions. The most common are incontinence (urinary or fecal), urgency/frequency, and pelvic organ prolapse. Other conditions include various types of pain inside the pelvis (which merits an additional blog post).
But, what do these names mean? And, how do you know if you have any of these issues. Let’s simplify it further. Here are 10 questions for you to answer:
Do you have any leaking with coughing/sneezing, laughing, or hiking?
When you have to pee, do you have to go to the bathroom right away?
Have you ever leaked on your way to the bathroom?
Do you find yourself going to the bathroom all the time?
Do you find yourself peeing out of habit (eg: having to pee as soon as you sit in the car, enter the house, etc.)
Do you do “just in case” peeing so that you don't have enough urine in bladder and to avoid leaking?
Do you wake up more than once at night to pee?
Do you cut down on fluid to avoid leaking?
Do you have any leaking of stool?
Do you ever have the sensation that something is coming out of your vagina or rectum?
If you answered “yes” to ANY ONE of the questions above, you have some form of pelvic floor dysfunction. Now, you may ask, why do I care about a little leaking? I have my way of managing things. I wear a little pad, and that works for me. Well, according to studies, women pay up to $900/year out of pocket for incontinence management (incontinence pads, laundry, dry cleaning, and other supplies. The treatment cost would be far less than that, and this problem becomes more challenging to manage as we age. In fact, it is the second-leading reason for placement of older adults into institutionalized care and the primary reason why many elderly persons are not accepted into assisted living facilities.
Pregnancy and child birth is a major contributor to incontinence. Research found that 12.8% of women who had never given birth experience pelvic floor dysfunction, while 18.4% of those who have had one child, 24.6% of those who have had two children and 32.4% of women who have had three or more children, reported pelvic floor dysfunction. And let me be clear, this problem is not simply a “women’s issue”. Men deal with pelvic floor dysfunctions too! Prevalence of PFD in men is recorded at 15%, with the most common reason for incontinence being prostrate surgery for men.
At this point, I hope you are choosing to stare down this elephant the same way I am. Now, what can we do about it? There are several treatment options available depending on the cause and severity of the condition. One of the most conservative and effective treatment options is pelvic floor physical therapy. With this treatment approach, we provide pelvic floor muscle rehabilitation, behavioral training, bladder re-training, manual and myofascial release of pelvic floor muscles (yes, directly to the pelvic floor muscles), posture, and even breathing re-training. It is no different than going to a PT for knee rehab, only this happens to be inside your pelvis…and YES IT WORKS!
I believe it is about time we expose this elephant and talk about pelvic floor issues openly. We have a right to the latest information and treatment options about the conditions because suffering quietly with this enormous elephant is not acceptable. Whether you are living with this problem yourself, suspect or know a loved one may have this condition, or simply want to know more about prevention and treatment, please do not hesitate. Remember, you are not the only one with a giant mammal in your living room or a little bit of leaking!