Here, we move to the issue that affects a lot of women and contributes heavily to the burden of disease globally. It is the issue of pelvic floor disorders and it has some very real postural links.
While it is possible for men to experience pelvic floor dysfunction, it is an issue that is often thought of as a women’s problem because the burden of pregnancy and childbirth can contribute heavily to pelvic floor problems. Such problems can include bladder or bowel control problems as well as pelvic organ prolapse. It has been reported that nearly one-quarter of them have symptoms. [1,2].
Commonly, treatment options are limited to biofeedback training, relaxation techniques, medication, and surgery. But one does not have to look far to discover that posture and pelvic floor function are very much linked.
Risk factors for pelvic floor dysfunction
Currently, there are a number of factors that are thought to increase a person’s risk of developing pelvic floor dysfunction. they include [3]:
- Pregnancy (present, or historic)
- Menopause (past, or present)
- Past gynecological surgery such as hysterectomy
- Elite athletic activities including running, gymnastics, or trampolining
- Past prostate surgery
- Obesity
- Chronic coughs
- Regular heavy lifting
- Constipation
- Pelvic region trauma (like a fall or radiotherapy)
- Back pain
The back pain link is not where it ends in terms of pelvic floor function, posture, and potentially the role of chiropractic care. In fact, it’s just the beginning. Posture is a common inclusion in pelvic floor training advice. Among the commonly accepted pelvic floor realities are the following [4]:
- A slumped posture (with thoracic kyphosis) increases downward pressure on the pelvic floor.
- Correct posture and spinal alignments improve the effectiveness of strengthening exercises.
- Correct posture promotes deep abdominal activity and enhances diaphragmatic breathing, which can enhance pelvic floor muscle activity.
Maintaining the lumbar curve, avoiding thoracic kyphosis, and ensuring correct hip posture and sitting posture are all thought of as significant for a pelvic floor. In fact, from breathing to posture, pelvic floor dysfunction is increasingly being thought of as a whole-of-body problem. [5,6] How?
Forward head posture can cause decreased mobility in the upper thoracic area, compromising proper breathing and decreasing muscle activation in the abdomen and pelvic floor.
This can then lead to “pelvic floor weakness, incontinence and prolapse because the pelvic floor muscles become rigid from lack of use [5].”
Although it is hidden from view, your pelvic floor muscles can be consciously controlled and therefore trained, much like your arm, leg, or abdominal (tummy) muscles. Strengthening your pelvic floor muscles will help you to actively support your bladder and bowel. This improves bladder and bowel control and reduces the likelihood of accidentally leaking from your bladder or bowel. Like other muscles in your body, your pelvic floor muscles will become stronger with a regular exercise program. This is important for both men and women.
For more information about exercises follow the links here:
Like all exercises, pelvic floor exercises are most effective when individually tailored and monitored. The exercises described are only a guide and may not help if done incorrectly or if the training is inappropriate.
Incontinence can have many causes and should be individually assessed before starting a pelvic floor muscle training program. Tightening or strengthening pelvic floor muscles may not be the most appropriate treatment so speak to a health professional if you have persistent problems with your bladder or bowel.
The pelvic floor – posture link
In 2017, Zhoolideh et al published a paper titled ” Are there any relations between posture and pelvic floor disorders? A literature review.” It was a review spanning four major journal databases that offered up to 22 relevant studies in order to examine any potential postural, bony, or muscular changes in patients with pelvic floor disorders.
The results showed “increased thoracic kyphosis, decreased lumbar lordosis, wider transverse pelvic inlet, and outlet, increased contractions of pelvic floor muscles with the ankle in dorsiflexion, increasing protrusion in shoulders and decreasing in the angle of the head in patients with PFD’s compared to control group [7]. The authors remarked that it was true for different research papers with different methodologies.
Whilst the authors were looking at global posture changes and even looking into bony structures vs. soft tissue as well as flat feet, it is interesting to note that the spinal curve was highlighted as an issue for attention.
“With regard to the role of intra-abdominal pressure in causing POP [pelvic organ prolapse], it should be noted that changing in normal spinal curves might cause extra intra-abdominal pressure on to the pelvic floor. Anatomic studies showed a role of normal spinal curvatures in supporting pelvic floor from direct intra-abdominal pressures”, remarked Zhoolideh et al. They went on to state that the normal forward and backward curves of the lumbar and thoracic region “might help in supporting abdominal viscera and absorbing downward intra-abdominal pressure” before it reaches the pelvic region.
Interestingly, there is research that shows significant increases in intravaginal pressure in a hypo lordotic posture (while standing) in comparison to a hyper lordotic posture [8]. Typically, an EMG reading will reveal increased pelvic floor muscle activity during standing in comparison to lying. But we can now see (from Capson et al‘s work) that hypo lordotic posture may contribute to pelvic floor dysfunction.
It is becoming increasingly clear that the normal lumbar curve is important in maintaining pelvic floor health, as in the movement of the ribs in respiration. Therefore the thoracic/cervical curve is also important. It’s also interesting to note that the Herman Wallace Pelvic Rehabilitation Institute indicates that the goal there may either be to increase or decrease muscle activity and function [8]. This is where we need to take a look at our own professional research.
Chiropractic Research
In 2016, a groundbreaking study was published in the Journal of Manipulative and Physiological Therapeutics. It revealed that adjusting to pregnant women appeared to relax the pelvic floor muscles at rest, an issue important in childbirth [3]. A novel finding of the study was that participants in the control group, made up of non-pregnant chiropractic students who were adjusted often, we’re able to contract their pelvic floor muscles to a degree previously seen only in elite athletes.
The implications of this study are yet to be fully researched and understood, but it does show us that there could quite possibly be a link between a subluxation-free spine and greater pelvic floor control. In light of the Herman Wallace Institute’s suggestion that either a decrease or an increase in pelvic muscle activity may be a therapeutic goal (depending on the case), this piece of research is interesting. In the control group, their ability to contract their pelvic floor muscles was near elite athlete level. In the intervention group (pregnant women) their ability to relax their pelvic floor muscles was greater.
We do not know why yet. More study is needed to ascertain that. We just know that chiropractic care made a difference for the pregnant women in the study, but there was a fascinatingly high level of pelvic floor control in the non-pregnant chiropractic students who were adjusted often.
What we do know from other studies, however, is that chiropractic care can increase the brain’s ability to drive the muscles, and can increase the speed at which the brain and body communicate with each other.
Time will tell exactly what this means therapeutically. In the meantime, we know that posture matters, and chiropractic care may indeed have a role. This is encouraging knowledge indeed.
References:
- “Prevalence and Co-Occurrence of Pelvic Floor Disorders in Community-Dwelling Women”; Jean M. Lawrence, ScD, MPH, Emily S. Lukacz, MD, MAS, Charles W. Nager, MD, Jin-Wen Y. Hsu, PhD, and Karl M. Luber, MD
- Staff Writer, “Who is at risk?” Pelvic Floor First (The Continence Foundation of Australia)
- “How to Correct Posture for Successful Pelvic Floor Exercises” by Author: Michelle Kenway Pelvic Floor Physiotherapist
- The whole body connection with pelvic floor dysfunction by Katrina Barton | Jul 26, 2014 | Male and Female Pelvic Floor Dysfunction
- Sitting posture affects pelvic floor muscle activity in parous women: an observational study, Ruth R Sapsford, Carolyn A Richardson, Warren R Stanton
- “Are there any relations between posture and pelvic floors disorders?” A Literature Review, Parisa Zhoolideh, Fariba Ghaderi, Zahra Salahzadeh
- “The role of lumbopelvic posture in pelvic floor muscle activation in continent women”; Angela Christine Capson 1, Joseph Nashed, Linda Mclean
- Pelvic Floor: Does Posture Matter?; Holly Tanner; Herman & Wallace Pelvic Rehabilitation Institute