Angie is a specialist in pelvic health physical therapy, which includes treatment of male, female, transgender and binary individuals. She received her Doctorate in Physical Therapy from Eastern Washington University and is CAPP Pelvic Health Certified by the American Physical Therapy Association Academy of Pelvic Health.
When you hear the words “pelvic health,” you might think of Kegel exercises, which we’re told to do in order to strengthen our pelvic floor.
But pelvic health is so much more than that, says Angie Maxwell, a specialist in pelvic health physical therapy. Maxwell received her Doctorate in Physical Therapy from Eastern Washington University and is CAPP Pelvic Health Certified by the American Physical Therapy Association Academy of Pelvic Health.
At her practice, Maxwell treats pelvic dysfunction, which is …. Although pelvic health is associated with women’s health, everyone has a pelvis, and Maxwell treats women, men, and non-binary people with pelvic floor muscle dysfunction. The most common issues she treats are incontinence, both urinary and fecal, as well as pelvic pain.
Can your pelvic floor be too strong?
Kegels can be a part of pelvic health. But what you might not know is that it’s possible to have a pelvic floor that’s too strong. “In some cases with the pelvic floor, it is hypertonicity—where you have too much strength, tone, or tightness in those pelvic floor muscles. And so, it’s almost like we’re doing a reverse of that,” Maxwell explains.
If the pelvic floor muscles are too short, restricted, or tight, it can cause a range of pelvic health problems. “This can occur with many types of patients. We see pelvic floor restrictions in a lot of gymnasts, dancers, and figure skaters,” she says. “And that can cause restriction and tone, which make it difficult to relax those muscles to have a proper bowel movement or maintain urinary continence.”
So, should we all be doing Kegel exercises?
Maxwell says they’re not for everyone. “If your pelvic floor muscles are ‘normal’ you don’t need to do Kegels. Normal means if you’re able to maintain normal bowel bladder control—meaning you can sit down on the toilet, and release your urine, release your stool, and not push or strain,” Maxwell says. “Also, when you cough, sneeze, laugh, or jump, you should not leak urine, and you should be able to hold urine in your bladder for three or four hours.”
If you aren’t able to do those things, you’ll need to see a pelvic floor specialist, who might recommend Kegels. These problems can often crop up after childbirth, as labor and pregnancy itself can put strain on the pelvic floor.
In some cases, Kegels could be worsening your condition. It’s best to speak to a pelvic floor specialist if you’re having difficulty with incontinence.
How exactly should I be cleaning my vulva?
Remember, the vulva is the outside bit—you don’t need to wash inside your vagina as it cleans itself. “You don’t need a lot of cleansing. I would suggest more cleansing of the vulva itself, which would be the labia minora, and labia majora.”
Most vaginal washes and soaps aren’t necessary, in fact, they can irritate the sensitive skin in the area. Maxwell recommends using baby shampoo to cleanse the vulva. **“**Add a tiny bit of that on a washcloth and gently wipe the area and then rise it with water. That’s it. That area itself shouldn’t need a lot of cleaning.”
What should we know about our pelvis after childbirth?
Part of the reason why Maxwell got into this field is because women tend to be underrepresented in medicine. This often leads to women’s reproductive health being neglected, which can be particularly dangerous around childbirth and postpartum.
It’s a good idea to see a pelvic floor specialist after you’ve given birth.
After childbirth, a pelvic floor specialist can help you by:
- Checking your pelvic floor muscles
- Checking your abdominal muscles
- Talking about postpartum depression
- Discussing when you can return to exercise
- Showing you the proper way to handle your baby to avoid you taking physical strain, especially as the baby grows
“Something I’m trying to do is to get groups going where I can talk about the proper way to wear the baby [and] the proper way to carry a car seat,” she explains. “I think a lot of times after childbirth, women push themselves [too] quickly, and that can cause problems and even lead to things like pelvic organ prolapse.”
“Pelvic organ prolapse can be a loss of ligament support of your bladder, uterus, or rectum,” Maxwell says. “Fifty percent of women have prolapse of some sort.”
Why are UTIs so common?
If you have a vulva, you’re far more prone to urinary tract infections. This is partly because the urethra is shorter, Maxwell says. “I would describe [the urethra] as a moist little flap—and so if the proper pH and moisture isn’t there, then that flap can have a little gap in it, and that can cause a place for the bacteria to get in.”
Maxwell suggests you follow some basic rules for avoiding UTIs—wipe front to back, urinate after sex to clear away bacteria, and avoid using harsh soaps or cleansers on your vulva.
On a more general note, she recommends having good nutrition, staying hydrated, and being active. She recommends using multivitamins with a probiotic and prebiotic, as well as using organic tampons. These all contribute positively to the health of your vagina and vulva.