Most people suffering from pelvic floor disorder endure their condition in silence, often dismissing it as a normal sign of aging. learning how to walk? Two conclusions can be drawn from this. First, the ac-tions of muscles during walking helps to strengthen the pelvic floor, so train-ing the pelvic floor must occur in three dimensions (children move in all three planes). Second, the pelvic floor reacts to loading from gravity while trying to stabilize the three dimensional “wob-ble” of the pelvis and the trunk. The pelvic muscles integrate gravity with ground reaction forces and this hap-pens subconsciously. Thus, conscious exercises like Kegels are not the best way to strengthen the subconscious reactive muscle of the pelvic floor. AGING MUSCLES As people age, they become less effec-tive against gravity and ground reac-tions forces. One reason for this is the fact people are moving less and sitting more as they age. Evidence has shown that after any length of bed rest there is a significant increase in urinary in-continence. In other words, those that www.canadianchiropractor.ca are strong and healthy develop incon-tinence after prescribed post-surgery bed rest. This observation was pointed out in the paper, Problems Due to Hospitalization, Merck Manual, 2009. As mentioned earlier, the pelvic floor strengthens with three-dimensional movements. Even runners and walkers who exercise regularly need to move through all the planes to help prevent in-continence. Sports that move through all planes, like tennis and basketball, benefit people by moving in the transverse plane. This twisting (transverse plane motion) engages the pelvic floor as it attempts to control the pelvic movement. Let’s take advantage of our under-standing of the function of the pelvic floor to create a program for this whis-pered disease. • • • • • • • • • • Photo:shutterstock ASSESSING PATIENTS How many times do you leak urine each day? Do you wear protective garments in case of accidents? How often do you wear them? Is it harder to control your urine when you cough, sneeze, strain or laugh? Is it harder to control your urine when you run, jump or walk? Are you constipated? For how long have you been constipated? Have you tried pelvic floor exer-cises (Kegels)? Do they help? What procedures, surgeries or in-juries have you had? Have you fallen, had a car accident before? For female patients, you will ask if they’ve had multiple births. Were they C-section or vaginal births? Any bed rest and for how long? Do you have any other symptoms? Some of the questions to ask when assessing patients are: • How long have you had a problem with incontinence? EXAM Perform muscle test with no SI (Sac-ro-Illiac) belt, then with an SI belt. Test May 2014 Canadian Chiropractor 35
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