By Alison Chui
Washington - The coronavirus pandemic has been blamed for a rise in mental health conditions, weight gain, broken toes, skin picking and dental issues. But, according to physical therapists and urologists, it also may be responsible for problems in an often-overlooked part of our bodies: the pelvic floor.
Located at the base of the pelvis, the pelvic floor consists of a group of muscles that provide support for internal organs, including the bladder, rectum, uterus and prostate. The muscles are also involved in posture, urination, bowel movements and sex.
Anecdotally, some pelvic floor experts say they have seen an influx of patients during the pandemic with new or worsening pelvic floor problems related to working from home and heightened levels of stress and anxiety.
"The combination of stress and then just sitting and not getting up to go to do those different activities throughout your workday definitely seem to have contributed to people's symptoms," said Alicia Jeffrey-Thomas, a pelvic floor physical therapist at Greater Boston Urology.
Long stretches spent sitting in front of computers at makeshift workstations and less movement throughout the day can shorten the pelvic floor muscles and cause them to become tight, which can lead to pain, experts said. And people who are feeling stress may unknowingly tense their pelvic floor muscles - similar to people who clench their teeth in response to stress.
"The need for pelvic [physical therapy] has kind of exploded in the last year," said Jeffrey-Thomas, who started posting informative videos about pelvic health on TikTok (@scrambledjam) during the pandemic, many of which have gone viral.
@scrambledjam We are the sum of our actions. Little habits can have huge consequences down the line. ##LearnOnTikTok ##TikTokPartner ##bladderretraining
♬ Bad Habits - Ed Sheeran
Yet, she and other experts said, awareness and education about pelvic floor issues, which can affect any person regardless of gender, are lacking. "The pelvic floor is complicated," said Emily Slopnick, a urologist at the Cleveland Clinic who has specialty training in female pelvic medicine and reconstructive surgery. "It's a part of our body that most of us are not used to being aware of or thinking about."
What's more, many people experiencing pelvic floor dysfunction are often embarrassed to openly discuss their symptoms, which can include incontinence, constipation and pain during sex.
How do pelvic floor muscles work?
Think of your pelvis as a large cereal bowl, said Susie Gronski, a pelvic floor expert who specializes in men's pelvic health and sexual pain. The pelvic floor muscles are the bottom of the bowl, stretching from the pubic bone to tailbone and extending between your sit bones, she said. Inside that bowl are the pelvic organs.
Beyond supporting these organs, the muscles work with your core and act as a postural stabilizer, said Mary Austin, director of the Pelvic Health Physical Therapy Residency at Johns Hopkins Hospital. They are involved in bladder and bowel function by contracting so you don't leak urine or produce stool at inappropriate times and relaxing so you can urinate or defecate. The muscles also play a major role in sexual sensation and arousal.
To locate the muscles, Gronski recommends sitting and sliding your hands underneath your sit bones (or the ischial tuberosity, the bones in the lower part of your pelvis that support your weight when you sit). Then, she said, cough, laugh or sing a song. "The change in intracavitary pressure will translate down into the trampoline-like pelvic floor," she said. "Your pelvic floor will adjust to the tissue demands placed on it, and you might notice some movement in your hand. For example, you might feel a contraction or lifting up sensation or a gentle pressing sensation into your hand."
What causes pelvic floor dysfunction?
Pelvic floor dysfunction is "a broad term for anything that's happening with the pelvic floor that is not a normal state," said Heather Jeffcoat, president-elect of the Academy of Pelvic Health Physical Therapy, and typically occurs when the muscles are either overactive or underactive. Symptoms include pain in the pelvic area or during sex, as well as difficulties with urination and bowel movements, experts said. In some people, problems can lead to pelvic organ prolapse, which is when your organs drop out of their normal position because the pelvic floor can no longer support them.
The most widely known cause of pelvic floor dysfunction is pregnancy and delivery, Austin said, noting that both vaginal and Caesarean delivery can result in muscle trauma. Other factors that can increase your chances of developing problems are aging; trauma to the pelvic area, including sexual abuse; surgeries, such as prostatectomies or gender-affirming procedures; and overusing the pelvic muscles by, for example, going to the bathroom too often or straining too hard, which can lead to poor muscle coordination, according to the Cleveland Clinic.
Overactive muscles are often responsible for pain symptoms and can also complicate urination and make it harder to have a bowel movement. Although people often associate underactive - longer and overstretched - muscles with urinary incontinence, experts emphasized that the overactive muscles, which are also weak and not coordinated, could be to blame.
Although pelvic floor problems are common, Jeffcoat urged people not to dismiss their symptoms as "normal."
What habits might be affecting my muscles?
Anything that bypasses the typical mechanisms of your pelvic floor could cause or worsen problems in that area, Jeffrey-Thomas said. When you use the bathroom, for instance, it's important to focus on relaxing rather than pushing, which can create pressure.
Don't hover over the toilet, she added. Instead, experts advised assuming a squat-like position on the toilet, with your knees supported a little higher than your hips, which is particularly helpful when dealing with bowel movement issues. "It actually causes more length in those muscles and lets you relax and lets you evacuate your bowels more easily," Austin said.
Additionally, be mindful of what and how you're drinking, and how often you're using the bathroom, Jeffrey-Thomas said. Sip water instead of chugging it, and try to minimize drinking caffeinated or carbonated beverages. She urged people to not make it habit to go to the bathroom as soon as they get home or to urinate in the shower, because they can train their body to have an intense urge to urinate when they put their key in their front door or hear the sound of running water.
For those with desk jobs or those still working from home, avoid sitting in one position for hours on end. "It might not be a very high load on the muscle, but a little bit of a low strain that happens every single day for several months is cumulatively going to build up," Austin said.
How do I take care of my pelvic floor?
If you have any symptoms, it's important to be evaluated by a licensed health professional before trying any exercises or technology on your own, experts said. People at greater risk of developing problems, such as those who are pregnant or postpartum or those preparing for surgery in the pelvic area, should schedule preemptive appointments, Austin said.
People often make the mistake of thinking that the solution to any problem in the pelvic area is to just do the contractions known as kegel exercises, said Slopnick, the Cleveland Clinic urologist. "The problem is if there are any undiagnosed issues with pelvic muscle tension or tightness, you can make things worse," she said, adding: "It's not all about the muscles being strong. It's also that the muscles need to be coordinated and also need to be able to relax appropriately."
If an expert suggests you do kegels, or if you're symptomless but are doing them as a preventive measure, imagine an elevator, Austin said. "Close the vaginal and rectal openings as if you're closing the doors of an elevator, and then you want to kind of send it up a few floors" by squeezing and lifting. The contractions should be gentle, Jeffrey-Thomas said. For people with penises, Jeffrey-Thomas suggested thinking about trying to gently contract to lift the penis and testicles.
Try to work pelvic floor exercises into your daily life, Austin said, such as when you're lifting something heavy or doing your regular workout routine. Depending on your fitness level and pelvic floor conditioning, you can do contractions while holding a plank position or squatting or lunging, she said.
To relax the muscles, experts suggest diaphragmatic breathing exercises, stretching and what are known as "reverse kegels," which require pushing down through the pelvic floor and lengthening the muscles.
There are biofeedback apps and devices that can assess your performance during these exercises, which experts say can be helpful for some people but are not always necessary. If you're comfortable looking at your own body, Jeffcoat said, all you need is a mirror. Angle the mirror so you can see your anus, she said. When you contract, it should "pucker up. . . . When at rest, it should softly open back up. And when it bears down, it should open out a little bit."
Should you discover or develop any problems, experts urged seeking a professional opinion. "These are often embarrassing issues related to urination, defecation, sexual activity, things that are kind of hard to talk about," Slopnick said. "But it's important to be straightforward, so we know what's going on and how to best help."
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