The pelvic floor rehabilitation program that I teach, (PFP) Pelvic Floor Pilates, designed by Nevada urogynecologist Dr Bruce Crawford, was created to provide an effective alternative to the traditional recommendation of “do your Kegels.” Pelvic floor health is a fitness issue! Pelvic floor disorders are, for the most part, neuromuscular disorders and are well suited to neuromuscular solutions. With regular and high-quality conditioning, surgery for pelvic floor disorders can often be avoided, excluding when cancer is the diagnosis.

The scientifically researched exercises were studied over a 2 year period, and over 200 exercises were tried using EMG (electromyography) recordings to determine which were the most effective in recruiting the pelvic floor muscles, consisting of transversus abdominis (TVA),  adductors (inner thigh muscles), gluteals (min, max, and med) and external hip rotators.  These muscles all work in concert to provide support for the pelvic organs, and to restore and maintain pelvic health in both females and males.

I am specifically addressing the relevance of pelvic rehabilitation on urinary incontinence in men in relation to prostatitis, interstitial cystitis and prostatectomy.  There are many serious issues for men that can benefit from pelvic floor rehabilitation, including aging, obesity, chronic lung disease, chronic constipation, chronic corticosteroid use, genetics, previous pelvic surgery, sexual dysfunction, irritable bowel syndrome (IBS), and Crohn’s disease to name several.  Men are most likely to have pelvic floor disorders due to post-surgical complications, prostatitis or interstitial cystitis.

The job of the pelvic floor is to support the bladder, urine tube, prostate, and rectum, as well as provide sphincter control for the bladder and bowel.  It also provides support from intra-abdominal pressure created from straining, heavy lifting, chronic coughs, or just from laughing.  The weakening of pelvic floor muscles (atrophy) can be due to hormonal changes, including decreased testosterone.  Pelvic organ prolapse can result in loss of control of the bowels.   Night time voiding may be a sign of an overactive bladder (OAB), referred to as urgency incontinence, which is a condition common in both men and women.  So, there are a lot of conditions we don’t always associate with our pelvic floor, but it is actually our “core,” or our centre of strength.

In order to be functional, pelvic floor muscles (PFM) need strength, endurance and co-ordination. Kegel exercises have commonly been taught as the method of strengthening these muscles. Using research with electromyography (EMG), however, it has been found that the PFM do not work in isolation and need to work in conjunction with the regional muscles of the inner thigh, buttocks and the deepest layer of abdominals – the transversus abdominis (TVA).  Proper conditioning of these muscles not only requires a sustained contraction, but equal release.  More effective and functional than Kegel exercises is the plyometric activation of the muscles, requiring a pulsing type of movement originally used for athletes that need quick bursts of energy.

The Pilates exercises that I incorporate into my program include three different types of contractions to stimulate all the functions of the pelvic floor:

1) movement – repetitions

2) endurance – a holding phase during peak engagement of the muscles

3) pulsing – a phase where the muscles are contracted and then released rapidly with equal force to provide the plyometric type of conditioning

This is what makes these exercises so effective with urinary incontinence. They strengthen the muscles, train the muscles for endurance, and strengthen the urinary and anal sphincters.

Other techniques I incorporate into my therapy include breath work, posture and Therapeutic Yoga techniques.  The Yoga Therapy for the urinary system is structured to increase blood flow to the kidneys and strengthen the muscles that control the bladder. These techniques are taught to be performed in a very specific manner, hand in hand with the breath and strengthening through holding for a set period of time.

Yoga Therapy is proving to be very effective in conjunction with other forms of therapy. Some conditions where symptoms are often improved in both women and men include pelvic inflammatory disease, sterility or infertility, enlarged prostate, prostatitis, fibroid cysts, irritable bowel syndrome (IBS) and post-operative cancer, including post mastectomy and post prostatectomy.

In conclusion, more and more studies and randomized trials are being conducted in the fields of pelvic floor exercises and Therapeutic Yoga techniques, with positive results. The Cochrane Institute has supported pelvic floor muscle training (PFMT) for several years now as the first line of defense and support for urinary incontinence and pelvic floor dysfunction.

A recent example of this research is  Pilot randomized trial of conventional versus advanced pelvic floor exercises to treat urinary incontinence after radical prostatectomy:  A study protocol, Santa Mina et al. BMC Urology (2015) 15:94, Open Access, BioMed Central.

I hope this is helpful in explaining my approach to various pelvic floor issues and how pelvic floor rehabilitation can be a viable and effective choice. And finally, if there is anything that we can do to support you at Alongside You, don’t hesitate to reach out or call  604-283-7827 ext. 709.

Brenna Jacobson, (RYT), Yoga Therapy, Pelvic Floor Specialty, Pre-Post Natal Consultant