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March 2010

Do You Have Risk Factors For Loss of Bladder Control?

28 Mar 2010 Posted by pfilates in Pelvic Floor Fitness

“Obesity (BMI > 25 kg/m(2)), being postmenopausal, having two or more vaginal deliveries, having a history of hysterectomy, and being a current user of hormones increased the odds of having urinary incontinence” It is clear that being over weight puts women at greater risk for urinary incontinence. The glass half full version of this story is that women who are overweight and incontinent can, in most cases, become continent by losing weight. And not as much weight as you may think. In one study the majority of obese incontinent women who lost as little as 10% their starting body weight resolved symptoms of urinary incontinence (something to at lease consider before having surgery). What’s more, surgery for stress incontinence may be less effective among overweight women when compared to normal controls. It seems counter intuitive that both being postmenopausal and…

Hormones and the Pelvic Floor

22 Mar 2010 Posted by pfilates in Pelvic Floor Fitness

Listen to this Did you know that estrogen actually suppresses enzymes that break down collagen? Well it is true. A class of enzymes called metalloproteinases (MMP13 in particular) degrade the collagen that supports the pelvic organs and may contribute to prolapse of the pelvic organs over time (as an aside… one has to wonder what they are doing to our skin). In February 2009 the journal Biology of Reproduction published a paper that demonstrates that estrogen and progesterone are suppressors of these collagen attacking enzymes. Add this to the list of quality of life benefits we can ascribe to hormone replacement. What about testosterone? We now that androgens (like testosterone) promote skeletal muscle hypertrophy (growth). We know that the levator ani, urethral sphincter, and anal sphincter all have androgen receptors. We know that a weak pelvic floor is associated with…

Sexual Response and Pelvic Floor Conditioning

16 Mar 2010 Posted by pfilates in Pelvic Floor Fitness

It is interesting to note that the importance of pelvic floor conditioning in sexual response is becoming more of a mainstream issue. In this months issue of Women’s Health (p 72) 4 “sexercises” are recommended to strengthen “those little muscles” essential for an “excellent finale”. What four exercises do they recommend? Well three of them are Pfilates movements! 1. Samurai Squat (Second Pfilates Movement) 2. Bridge (Sixth Pfilates Movement) 3. Hovering (Eigth Pfilates Movement) 4. Stability Ball Jack Knife The fact of the matter is that when we were doing the research that resulted in the Pfilates program we found that many of the movements previously recommended for pelvic floor strengthening actually did test well on our EMG recordings. Here is the thing…. the performance of the pelvic floor is not just about strength. Performance of the pelvic floor, and…

True Story

11 Mar 2010 Posted by pfilates in Uncategorized

Here is a true story that illustrates just how serious a pelvic floor disorders can be. Think a weak pelvic floor is purely a quality of life issue, an inconvenience? Consider KL. KL came to see me about 6 months ago with an advanced degree of pelvic organ prolapse. Pelvic organ prolapse is a very common, but seldom discussed, women’s health issue where the bladder, uterus, and or rectum fall toward, or beyond, the vaginal opening. In KLs case way beyond the vaginal opening. KL, 77 years old, came into my office last Fall with “a bulge”; the typical report of a woman with an advanced prolapse. In KLs case the bulge was a complete prolapse of her uterus and vagina. Although the geometry is a challenge to explain suffice to say she was experiencing a complete turning “inside-out” of…

What Exactly is Pfilates??

01 Mar 2010 Posted by pfilates in Uncategorized

Pfilates Summary Pfilates is a program of neuromuscular conditioning based on extensive EMG recordings taken from the pelvic floor. Pfilates was created by an American Urogynecologist to provide a method of home pelvic floor fitness training accessible to a broad population. Pelvic floor disorders are absolutely epidemic. Stress urinary incontinence, overactive bladder, female sexual dysfunction, pelvic organ prolapse, and fecal incontinence are so commonplace they are often regarded as the inevitable consequences of childbirth and aging. When these conditions are treated they are to often regarded as purely mechanical disorders requiring a surgical solution. Although trained as a surgeon I have come to regard these disorders as principally neuromuscular disorders deserving of a neuromuscular solution. It is clear that programs of pelvic floor neuromuscular rehabilitation successfully improve pelvic floor symptoms. Such programs typically involve a set schedule of isometric pelvic…