Our Collaborator David Serra this time he talks about the importance of pelvic floor care in women athletes
Our loss of urine during sports practice they are more frequent than we think, up to 80% in some sports. Impressive right ?. It is a situation that is carried on in silence thinking that it happens only to us, but it is much more frequent than we suppose and it leads many women to abandon their favorite sport and that it suits them so well.
The good news is that can be prevented y in many cases heal. Physiotherapy in urogynecology, obstetrics and coloproctology is responsible for this, a specialty that takes care of our pelvic floor and abdomen and is very new and still somewhat unknown in our country.
What is the pelvic floor?
It is the most unknown musculature of our body and most hidden by our taboos and culture because it is a source of pleasures. It is located in the lower part of our pelvis and intervenes in basic functions for all of us such as urination and defecation, the continence of urine, gases or feces, pregnancy and childbirth, sexual relations, it supports our pelvic viscera (bladder, uterus, vagina, rectum) and contributes to lumbar stability and posture in its synergistic action with deep abdominals. Lumbar stability means fewer injuries and less back pain.
It is totally linked with the abdomen-pelvic sphere, delimited superiorly by the diaphragm, laterally by the deep abdominals and the deep musculature of the back, and inferiorly by the pelvic floor itself. This sphere is a manometric cavity, that is, like a bloated balloon in which pressures are transmitted perfectly and which functions as a unit.
What are pelvic floor dysfunctions?
It is any problem that has its origin in this anatomical area. The most common are Urinary incontinence which is any involuntary loss of urine and the most common type of which is stress urinary incontinence (loss that occurs when exerting, sneezing or coughing); the gas or fecal incontinence which is any involuntary loss of gas or feces; he genital prolapse It is the descent of a part or viscera through the vagina, initially it is asymptomatic and later a lump or heaviness is noticed; the pain in sexual relationships which may be due to excessive tension (hypertonia) of the pelvic floor, muscular contractures, episiotomies ...; or the constipation.
And we no longer have to suffer in silence, many of the dysfunctions can be treated and prevented.
Why are they happening to us?
Age, pregnancy and childbirth are the major risk factors for women, to which is added the performance of impact sports, previous cases of problems in women in the family, obesity, diabetes, neurological diseases or respiratory, postural incorrectness, surgery in the lumbo-pelvic area, constipation ...
The awareness that the impact sports practices (those involving jumps, impacts, sudden braking, or load of weights such as running, aerobics, paddle, basketball ...) is an additional risk factor for dysfunctions in the pelvic floor It is basic to be able to perform prevention by adapting the training and the practice itself. This should be especially important for women who already have losses or symptoms of prolapse or for those who accumulate several risk factors.
The impact on the ground in the race generates downward pressure on the viscera, which has to be braked in each stride by the pelvic floor muscles. Furthermore, the pelvic floor musculature also has the role of pelvic stabilization when the other stabilizing muscles are not adequately worked (transverse abdominis, deep abdominal muscles, gluteus medius ...).
Too much responsibility for an ignored musculature that does not train Does not our pelvic floor deserve the same care as our favorite sport?
And after the information, action. Some recommendations.
1. Ideally, a specialized physiotherapist assesses our pelvic floor and abdomen, since the pelvic floor is a musculature that is not seen and in many cases little is felt. It will inform us of how we are, indicating if we have to carry out treatment or it will propose what to do to prevent dysfunctions. It will assess, for example, if the contraction is correct, if there is the appropriate tone and strength or we have to reinforce it, if we have hypertonia or contractures and therefore manual techniques must be applied, it will guide us to tone our abdomen without generating hyperpressures, it will help us to have a more relaxed and less hyperpressive diaphragm or will teach us to perform correct Kegel exercises without compensations to incorporate the perineal contraction before sports effort to counteract the effect of the impact.
Although lazy or shameful, it's a great way to make sure we do what we need and that we do not get hurt so much.
2. Practice hypopressive abdominal gymnastics to improve tone and reprogram the abdominal girth and pelvic floor. Created by Marcel Caufriez, it is a fantastic way to prevent incontinence, prolapse and herniated discs, to improve your figure and your postural correction, to increase your sports performance, as well as your sexual and general health. The secret of its effectiveness is to do it correctly, so I recommend that you learn it with specialized people.
3.Work on lumbo-pelvic stability through training based on the concept of "abdomino-pelvic sphere" or "central box" (Pelvic Core), basic to increase the effectiveness of sports movements when correcting compensations and to avoid lumbar injuries. This cylinder of stability is formed by the diaphragm, the deep muscles of the abdomen (transverse abdominal, internal oblique) and the back (multifid…) and the pelvic floor. It is musculature composed mainly of tonic-postural fibers that stabilize the spine and pelvis during the movements of the spine before we even make movements of our arms, it is a great natural girdle. The exercises are performed incorporating the breath and prioritizing in each movement the costal opening and the stability of the shoulder and pelvic girdle.
4.Avoid hyperpressive workouts like classic abs that work rectus abdominis with large trunk or leg levers (Roll-up, Roll-over, crunch, reverse crunch…). If there is no choice but to perform them, adapt them: perform them on expiration, making a previous non-maximum contraction of the pelvic floor, keeping the feet supported and flexing the trunk very little, just lifting the shoulders.
5.In sports with races, jumps or lifting, use umbrella type intravaginal devices to prevent organ drop. They enter the vagina and unfold once inside. As there are 3 sizes, it is best to seek advice from a specialized physiotherapist on which to use.
6.Perform preventive care at any age. Take care of our posture and our diet, discover and become aware of the pelvic floor and abdomen and use them correctly in all daily activities, prepare them for pregnancy and childbirth, carry out postpartum recovery, and treat any dysfunction that appears to avoid its chronification and worsening.
7. Enjoy sports with awareness of your pelvic floor and abdomen, taking care of you as a woman.
Ana Escudero Vírseda
Physiotherapist specialized in urogynecology, obstetrics and coloproctology
Team of David Serra Physiotherapy