Spring time! If you are like me you eagerly wait all winter long for those first signs of Spring for that means that warmer and longer days are ahead… And an increase in urinary incontinence and/or urgency? Although you may be saying “Wait, what?”, this may in fact be the case for you if you are experiencing pelvic floor dysfunction. Let me explain!
Intra-Abdominal Pressure Management / Soda-Can Analogy
Anatomically the pelvic floor is a term which is utilized to describe the group
of muscles which span across the base or opening of the pelvis and form the “floor” of the trunk with these muscles one of the four which make up the inner core. The inner core is composed of the pelvic floor muscles, Transverse abdominis, spinal multifidus and the respiratory diaphragm. When taking into consideration the function of these muscles the analogy of a ‘soda can’ is often utilized as shown to the right. (1)
Pelvic Physical Therapy Foundations - The Anatomy of Breathing
During a state of rest, inspiration (breathing in) is caused by a contraction or shortening of the muscles of inspiration, to include the respiratory diaphragm, with expiration (breathing out) caused by relaxation of these same muscles.(2) During inspiration, shown in the picture below, the respiratory diaphragm contracts and descends into the abdominal-pelvic cavity thus allowing for expansion of the thoracic cavity and subsequently lung expansion.(1)
This anatomical phenomenon, known as diaphragmatic breathing, occurs secondary to pressure regulation with pressure flowing from high-to-low. Lung expansion forces pressure down into the abdominal-pelvic cavity thus causing expansion/lengthening of the abdominal muscles and pelvic floor. Abdominal and pelvic floor muscle lengthening subsequently causes reflexive contraction of these muscles thus allowing for a change in the pressure gradient and respiratory expiration/exhalation.
The Anatomy of a Cough and Sneeze
Taking back into consideration the anatomical significance of pressure regulation, a cough, basically a forceful exhalation, is produced through an increase in intra-abdominal pressure which allows one to forcefully expel air up and outward. To produce this degree of force the abdominal and pelvic floor muscles forcefully contract to help force the air up and out. If you have ever had abdominal surgery, you may now understand a little bit better why coughing can be so uncomfortable!
Spring - The Season of Coughing, Sneezing... and Urinary Incontinence?
If you experience, or have previously experienced, pelvic floor dysfunction, such as urinary incontinence/urgency or pelvic/perineal heaviness, you may have noticed a worsening of these symptoms during or after times of respiratory illness. With dysfunction of the pelvic floor muscles, repeated exposure to increased strain, as produced by the forceful nature of coughing and/or sneezing, may lead to further weakening or dysfunction of these muscles over time thus leading to an increase in symptoms.
If this post resonates with you and you are ready to regain control of your life, contact us today to set up a pelvic health physical therapy evaluation!
References:
Massery M. Musculoskeletal and neuromuscular interventions: a physical approach to cystic fibrosis. J R Soc Med. 2005;98 Suppl 45(Suppl 45):55-66. PMID: 16025768; PMCID: PMC1308809.
Park, Hankyu, and Dongwook Han. “The Effect of the Correlation between the Contraction of the Pelvic Floor Muscles and Diaphragmatic Motion during Breathing.” Journal of Physical Therapy Science, vol. 27, no. 7, 2015, pp. 2113–2115., https://doi.org/10.1589/jpts.27.2113.