Pelvic Floor Awareness

How I Practice Video Series
Sandra Koch, MD, FACOG

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When I see women at their annual exams, and every time I see them for the postpartum exam, I will ask them, as I'm completing my bimanual exam, to squeeze my fingers. Often I have a laugh from the patient when I ask them to do this. But they do understand that I am asking them to show me the strength of their pelvic floor. About half the patients will either not be able to move any of the muscles in their pelvic floor, or they'll actually have a pushing sensation. Clearly if a patient is pushing when they're practicing their Kegel exercises, they are not going to be very effective. In patients who can't identify their pelvic floor muscles, asking them to show you what they'll do if they need to prevent themselves from passing gas is a very good tip. That seems the best way to help them identify their pelvic floor muscles. Once they've identified the pelvic floor muscles, they need to strengthen them. And in addition, in patients who have developed already some urinary stress or incontinence or pelvic floor pressure, they need to be able to use those muscles, to trigger those muscles to contract every time they increase their inter-abdominal pressure. I tell them it takes about 12 weeks for them to reestablish this habit once it's been broken. Encouraging women to be aware of their pelvic floor is a good way to promote quality of life and long-term health for women. This is how I practice. 


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