We Need to Talk About Pee, Poo and Sex…

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When I provide an assessment to a client for their pelvic floor I always start with their story. How did they get here? What path brought them to seek out Physiotherapy as means to heal from their condition? I need to understand when their symptoms started but also how they have dealt with them – sometimes for years. Our bodies are complex and so pelvic rehabilitation requires individual, tailored treatments. This begins with the very personal story of each client but I will tell you that one thing every client does have in common is that pelvic floor conditions are really hard to talk about!

Why is that you ask? Well, basically people find their way to me because they are having trouble with one or more of the following: pees, poos and sex. There are other symptoms, such a low back pain or other muscle issues, but really what people struggle to reach out for help with is the “down there” stuff.

In case you didn’t know, and it’s totally common not to know, your pelvic bones connect in the front to form the pubic bone and in the back to form your sacrum. Underneath, there’s a group of muscles called the Pelvic Floor that connect from the pubic bone all the way to the sit bones, tailbone and sacrum. This spans the saddle area that you sit on. So it’s a pretty big area that houses your organs responsible for digestion, elimination and sex! So all these organs and their functions can be impacted by an injury or excessive tension to the area (think birth trauma or pain / difficulty urinating), weakening with age (think trouble holding in pee or poo), and loss of abilities to have sex (think vulva pain or difficulty maintaining an erection), even skin care can be an issue (think tissue irritation and unexplained recurring yeast infection).

Recently, I watched a TED Talk with a Physiotherapist Claire Baker who talks about the pelvic floor and how she works to help people with the above mentioned issues. The thing that really resonated with me was that she was focusing on how hard it is to talk about these issues and how people will live in silence. Pelvic health is still a taboo subject and is rarely talked about – even with our closest friends and family. As Claire so candidly explains, “who wants to have a coffee with a friend and say my vulva pain is really acting up today or my pre-ejaculation is ruining my relationship”. Yes. That is literally the reality for so many people.

Pelvic floor issues affect 80% of the population, according to Claire, but even she admits that she used to “keep a little black box over the pelvic floor” so as not to talk about it. It is also so hard to describe these muscles to someone – since it’s hard to demonstrate visually! You literally have to teach someone how to feel them. It is part of the reason I want to hear my client’s story and their symptoms – so I can understand how they relate to their pelvic floor. But it is also so I can help them really talk about what they are going through and how it is impacting their well being.

What resonates for me from this talk, and my work at MM, is that because of the silence around this topic people suffering from the symptoms slowly withdraw from their lives. They stop exercising (because they leak urine or feces), they limit their outings (because they have trouble urinating or intense needs to urinate), and they struggle in their relationships and at work (because of chronic pain in their vulva or scrotum). They slowly stop doing the things they love or need to do.

Pelvic health is missing in our overall approach to health and wellness and it needs to be right up there with efforts we make to eat well, exercise, create healthy sleep habits, hygiene and regulate stress. Our emotional wellbeing depends on good pelvic health – we can literally hold tension there.  Our toilet habits can negatively impact our pelvic health. Our exercise of choice can make us prone to issues in an area we are disconnected from. As Claire would say, “get to know all of your body and if you are experiencing these symptoms seek help…it’s super common but it’s not normal”.

Sarah, PT

Sarah provides Physiotherapy for Pelvic Floor and Core Stability at MM Therapy Centre.  After 10 years of clinical practice, and recovery from her own pelvic floor issues, Sarah has come to appreciate the integral role that the pelvic floor and a strong responsive core play in a healthy, active body. Sarah treats both men and women of many ages and stages in conditions ranging from incontinence, prolapse, diastasis rectus, and pelvic pain.

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