Are Kegels Not Working? Pelvic Health with Dr. Megan Rorabeck

Pelvic floor

https://mcdn.podbean.com/mf/web/zvy7tx/pelvicfinal_-_2_22_22_956_AM6mlg3.mp3

EISODE SUMMARY:

Dr. Megan Rorabeck, a board-certified women’s health clinical specialist, physical therapist, and author of the best-selling book Between the Hips: A Practical Guide for Women, offers help and education to women suffering from pelvic floor-related problems. In today’s episode, we sat down with Dr. Rorabeck to discuss the specifics of the pelvic floor, reasons for incontinence, pelvic pain, and pelvic organ prolapse.

First, we asked Dr. Roraback about what specifically makes up the pelvic floor. She explained to us that the pelvic floor consists of many different muscles and organs. There are three layers of muscle, all encompassing the clitoris, urethra, and vaginal opening. The muscles have sexual functions as well as contracting and relaxing when doing kegels and orgasming. They also support the bladder, uterus, and bowels. Along with muscles, the pelvic floor includes pelvic organs, the abdominal wall, and bones such as the tailbone, pubic bone, and bones beneath the butt. The pelvic floor plays a role in incontinence, and when asked how to improve bladder function, Dr. Rorabeck stated numerous options. While doctors often suggest doing kegels to strengthen pelvic floor muscles, doing kegels properly can be difficult. A true kegel is achieved by exclusively using pelvic floor muscles, without engaging your butt or thigh muscles. Incontinence may also need to be resolved not by strengthening the pelvic floor but rather lengthening the muscles. Other causes of incontinence include the consumption of bladder irritants, such as caffeine, and acidic and carbonated drinks, and lack of proper muscle coordination function. Physical therapy is the best way to resolve incontinence or any pelvic floor issues. While you can refer yourself to a physical therapist, for those with Medicare or state insurance, you need a doctor referral before seeing a physical therapist.

When asked about the urge signal program, a concept mentioned in her book, Between the Hips: A Practical Guide for Women, Dr. Rorabeck told us that the signal system is the ways in which our bladder tells us we have to use the restroom. Our bladder will send us three signals: one when it is 1/3 of the way filled, a second, stronger signal, and a third signal, which is the strongest. A fear of incontinence can cause people to empty their bladder after the first signal, but Dr. Rorabeck advised against this, for it can cause the bladder to shrink and lose the ability to store urine over time. However, bladders are trainable; you can overcome your habits. When training, Dr. Rorack suggested drinking water throughout the day, rather than chugging a ton of it at once. We also spoke about recommendations for dealing with pelvic pain, and Dr. Rorabeck said the best solution is to see a physical therapist, since pelvic pain is completely treatable. Pelvic pain is commonly caused by muscular dysfunction but can also be a result of vaginal dryness. Vaginal dryness can cause tissue to dry out, leading to pain. Dr. Rorabeck suggested topical creams, both hormonal and non-hormonal, as treatment. She also mentioned using dilators and a pelvic wand that targets the third layer of pelvic floor muscle.

Pelvic floor-related problems can also lead to constipation, and when asked why, Dr. Rorabeck explained how it is due to lack of muscular relaxation. Without being able to relax the muscles, the stool cannot easily come out. Diet, fluid, and exercise also play a huge role in causing and treating constipation. It is crucial to eat fiber, stay hydrated, and stay active for healthy bowel movements. Constipation can also lead to hemorrhoids, which can cause more pelvic pain. These issues can be helped with physical therapy. For pelvic organ prolapse, Dr. Rorabeck said that the issue occurs when an organ begins falling down onto itself or into the vaginal wall. This can lead to pelvic pressure or heaviness, lower back pain, and bladder, bowel, or pelvic concerns. Those struggling with a prolapsed pelvic organ will feel better in the morning than they do at night, for the activity throughout the day will leave the organ irritated by the time they go to bed. Dr. Rorabeck emphasized the importance of seeking out a physical therapist to find the root cause of the organ prolapse so that it can be properly treated. Surgical repairs can be done to fix the organ; however, it is still important to attend physical therapy, even after surgery. Physical therapy can help keep the surgery from failing and leading to the need for another procedure.

Finally, we asked Dr. Rorabeck about why we get up in the middle of the night to use the restroom. She told us this can be a habitual behavior caused by a person training their bladder to go at night. This can also be a result of insomnia from perimenopause and menopause. How a bladder behaves during the day reflects how it will be at night, so to help with any issues, Dr. Rorabeck suggests making sure you’re getting enough water and avoiding bladder irritants.

Dr. Megan Rorabeck

Dr. Megan Rorabeck is a board-certified women’s health clinical specialist physical therapist and author of Amazon’s #1 best-seller Between the Hips: A Practical Guide for Women. She founded Between the Hips, LLC to provide education on women’s health topics via writing, coaching, and speaking platforms. She is a full-time clinician and adjunct professor for Carroll University’s PT program.