Anatomy

What is the pelvic muscle?

The pubococcygeus muscle or PC muscle is a palm size, hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx (tail bone) forming the floor of the pelvic cavity and supporting the pelvic organs. It is part of the levator ani group of muscles .

What is its function?

• Controls urine flow. A strong PC muscle has been linked to a reduction in urinary incontinence.
• Contracts during orgasm. A well-developed pubococcygeus muscle can enhance sex and orgasm in both sexes.

PelviLates® is designed to strengthen and give voluntary control over the pubococcygeus muscles. With regular exercises we can increase and maintain the strength and flexibility of these muscles. This is important to prevent incontinence and other diseases.

By permission. GNU Free Documentation license.

The decrease in muscle mass (atrophy) of the pelvic floor

There are several reasons why a muscle can lose its mass:

• lack of exercise
• poor blood circulation
• ageing
• certain diseases

When the pelvic muscle loses its mass it becomes weaker. It is not able to support the weight of the lower internal organs anymore. The weaker, stretched muscle can not control the urine flow. In post-menopausal women, the walls of the vagina become thinner.

Muscle atrophy can be opposed by an increase in muscle size. One of the most common treatment recommendations include exercising the muscles of the pelvis. PelviLates® strengthens the affected area. The pelvic floor is a group of muscles and connective tissues running side-to-side and front to back along the bony ridges of the pelvis. Visualize the pelvic floor as a “hammock” or “bowl”. For everything to be working properly, this hammock should be worked out like every other muscle in the body. Therefore exercise can stop and reverse muscle degradation.

“Increasingly there is evidence of the effectiveness of pelvic floor muscle exercise (PFME) to improve bladder control. For example, urinary incontinence following childbirth can be improved by performing PFME.”

Haddow(2005)Effectiveness of a pelvic floor muscle exercise program on UI following childbirth. Western Australian Centre for Evidence-based Nursing . 3 (5), 103-146.

By permission. GNU Free Documentation license.

Stress incontinence

Stress urinary incontinence (SUI) is caused by weakness of the pelvic floor muscle. Laughing, sneezing, coughing, exercising can cause a loss of small amounts of urine. These movements increase the pressure on the bladder. In women physical and hormonal changes resulting from pregnancy, childbirth, menopause often cause stress incontinence.

The urethra is supported by fascia of the pelvic floor. If the fascial support is weakened, due to pregnancy and childbirth, increased abdominal pressure can move the urethra downward, causing stress incontinence. Stress incontinence can worsen during the week before the menstrual period. That time, lowered estrogen levels can lower the muscular pressure around the urethra, increasing the chances of leakage. Following menopause lowered estrogen levels increase the incidence of stress incontinence.

See my post on Mecations that can cause urinary incontinence

PelviLates® strengthens the pelvic floor and sphincter muscles and may stop or reduce stress leakage.

Vaginal atrophies

Some women can hear air leaving their vagina after shoulder-stand or other similar exercises. This can also happen during squatting, leaning forward, making love, walking, being on all fours. During swimming water can go into the vagina, and when later it drips out it can stain the panties. In post-menopausal women, the walls of the vagina become thinner.

PelviLates® strengthens the muscles and enhances the blood circulation. This helps to prevent or slow the degradation process.

Hemorrhoids

Cushions of tissue filled with blood vessels at the junction of the rectum and the anus. Approximately half of all Americans have had this condition by the age of 50. Possible causes of hemorrhoids are:

• Increased straining during bowel movements, by constipation or diarrhea. It is common in women due to constipation caused by water retention during premenstrual syndrome or menstruation
• Obesity by increasing rectal vein pressure
• Sitting for prolonged periods of time. Poor muscle tone or poor posture can result in too much pressure on the rectal veins
• Pregnancy causes hypertension and increases strain during bowel movements

Anal (fecal) incontinence

Loss of regular bowel control. At first it makes difficult to hold back gases, and can cause problems during diarrhea. At the later stages it is even hard to control the solid, formed stool. Fecal incontinence is most often caused by injury or weakness of one or both of the ring-like muscles at the end of the rectum, the internal and external anal sphincters. During normal function, these sphincters help retain stool. Anal (fecal) incontinence can be caused by:

• childbirth due to using forceps or episiotomy
• hemorrhoid surgery
• a dropping down of the rectum ( rectal prolapse)
• protrusion of the rectum through the vagina ( rectocele)
• and generalized weakness and sagging of the pelvic floor

Appropriate exercise of the sphincter muscles can help restore muscle tone, and reduce or even eliminate anal incontinence.

Orgasmic dysfunction

The inability or difficulty to have orgasm. Although several psychological and physiological factors can cause this problem, many times the weakness of the muscles around the vagina is a major contributor.

Prolapses

If we do not treat the above conditions with PelviLates®, they can become more serious. The weakened ligaments and muscles are not able support the weight of the internal organs anymore; they leave their anatomical positions and start to sink in the abdomen.

Rectal prolapse

The walls of the rectum protrude through the anus and they become visible outside of the body. The condition can also occur in children.

There are three main conditions of the rectal prolapse:

• Full-thickness rectal prolapse, when the entire rectum protruding through the anus
• Mucosal prolapse, when only the rectal mucosa (not the entire wall) prolapsing
• Internal intussusception, when the rectum collapses but does not exit the anus

Possible causes of rectal prolapse are:

• the weakening of ligaments and muscles that hold the rectum in place. In most people the anal sphincter is weak
• advanced age
• long term constipation
• long term diarrhea
• long term straining during defecation
• pregnancy and stresses of childbirth
• previous surgery

The progression of rectal prolapse: begins with prolapsation during bowel movements, sneezing, then through daily activities such as walking until finally it may become chronic and ceases to retract.

Urethrocele

The prolapse of the urethra into the vagina . Weakening of the tissues that hold the urethra in place cause it to move and to put pressure on the vagina, leading to the descent of the lower front wall of the vagina. Urethroceles often occur with cystoceles, (involving the bladder as well as the urethra ). In this case, the term used is a cystourethrocele.

Urethroceles are often caused by:

• childbirth, the movement of the baby through the vagina causing damage to the surrounding tissues
• or a weakness in the tissues of the pelvic floor

Cystocele

(SIS-tuh-seal) is a medical condition that occurs when the tough fibrous wall between a woman’s bladder and her vagina (the pubocervical fascia) is torn by childbirth, allowing the bladder to herniate into the vagina. Cystoceles often occur with urethroceles .

This condition may cause discomfort and problems when emptying the bladder. This injury is often, but not the only cause of cystocele. The elastic tissues of the vagina may compensate for this tear for some time after the injury occurs. Prior to menopause the hormone estrogen helps to keep the elastic tissues around the vagine strong, however, during menopause when estrogen levels decrease cystocele may occur.

The bulbocavernosus muscles are located at the entrance the vagina. The levator muscle passes around the vagina and the rectum and inerts into the levator plate, which can elevate rectum, the vagina and the bladder neck together.

These muscles benefit from the PelviLates® exercises and often result in the elevation of the levator plate which may compensate the herniation.

Rectocele

Rectal tissue bulges into the vagina, as a hernia. Mild cases may simply produce a sense of pressure or protrusion within the vagina, and the occasional feeling that the rectum has not been completely emptied after a bowel movement. Moderate cases may involve difficulty passing stool ( because the attempt to evacuate pushes the stool into the rectocele instead of out through the anus ), discomfort or pain during evacuation or intercourse, constipation, and a general sensation that something is “falling down” or “falling out” within the pelvis.

Severe cases may cause vaginal bleeding, intermittent fecal incontinence, or even prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus.

Main causes of rectocele are:

• childbirth, especially with babies over nine pounds in weight, or rapid births.
• the use of forceps
• episiotomy or lower vaginal tears play little role in the formation of a cystocele,
• hysterectomy or other pelvic surgery,
• chronic constipation and straining to pass bowel movements,
• decreased level of estrogen after menopause. In younger women this hormone helps to keep the pelvic tissues elastic.

The risk increases with the number of vaginal births, although it can also happen in women who have never borne a child.

Prolapse of the vagina

The vagina, one of the most important supports of the lower internal organs can slip out through the vulva. This is common after the removal of the uterus. The condition is mainly caused by weak ligaments and muscles.

Prolapse of the uterus

The uterus can fall down or slip out of place The prolapse makes the organ extend inferiorly into the vagina because of weakened muscles. Prolapse of the uterus has multiple phases:

• the cervix sinks into the upper section of the vagina,
• the uterus sinks half way into the vagina,
• the cervix reaches the lower end of the vagina,
• the cervix appears through the vulva,
• the whole uterus can slip out through the vulva.

Watch out !

If we do not recognize these symptoms in time and do not seek the help of a physician, our condition can eventually worsen. Many times the prolapse of one organ will cause the sinking of others, because they form a tight bond in our abdomen.

The position of the uterus in the abdomen.

Anteverted uterus

Retroverted uterus

In this position the uterus is tilted backwards instead of forwards. One in three to five women has a retroverted uterus, which is tipped backwards towards the spine.

In most cases, a retroverted uterus is already present at birth, but in some cases it is caused by pelvic surgery, pelvic adhesions, endometriosis, fibroids, pelvic inflammatory disease, or the labor of childbirth.

Uterine position has no effect on fertility . A tipped uterus will usually right itself during the 10th to 12th week of pregnancy.

If a uterus does not right itself, it may be labeled persistent.

Retroverted uterus with flexion (retroflexion)

Similar to the retroverted uterus, as the fundus (the top portion of the uterus) points backwards, but the anterior (front side) of the uterus is convex.

“Persistent retroflexion of the pregnant uterus is incompatible with advanced pregnancy. If spontaneous or artificial reposition does not occur, the patient either aborts or develops symptoms caused by incarceration of the uterus before the end of the fourth month. In exceptional instances, however, pregnancy may proceed, resulting in uterine sacculation. Spontaneous delivery is impossible, and rupture of the uterus may occur.”