I don’t know about you, but I find myself in the tunnel of google scholar very frequently and usually start with something pelvic floor related and end up at estrogen and brain health for women who are hitting menopause and wonder ‘how the hell did I get here!’
So I thought…
I do all this research around women’s health and I feel so excited to share what I have come across that I want to tell everyone why not drop it straight to your inbox and you can get excited with me. PLUS my partner will be so grateful that I have someone to share it with and maybe he won’t have to hear me babble on about how cool the female body is as often as I currently do.
So today we are touching on hips and the pelvic floor… why? Because I have so many clients who have chronic hip problems alongside pelvic floor dysfunction and have never had any treating practitioner, ask them about incontinence or symptoms of pelvic floor dysfunction.
I want to highlight how intertwined the hip and pelvis are to you in case you also have ‘hip’ clients and haven’t explored pelvic floor as part of the issue (or in some cases the actual cause of them problem).
Let’s jump to one of my favourite research papers looking at urinary incontinence symptom changes post total hip arthroplasty.
Tamaki, T., Oinuma, K., Shiratsuchi, H., Akita, K., & Iida, S. (2014). Hip dysfunction-related urinary incontinence: A prospective analysis of 189 female patients undergoing total hip arthroplasty. International Journal of Urology, 21, 729-731. doi: 10.1111/iju.12404. Click here to read the study abstract
They conducted the study on 189 female patients with hip OA who had undergone primary total hip arthroplasty. Of these participants 81 of them reported symptoms of urinary incontinence (through self-reported questionnaires). After the hip replacement surgery 64% of the incontinent women experienced an improvement in symptoms, 32% remained unchanged and 4% had worse symptoms of incontinence. In the continent women 3% reported a worsening of urinary incontinence post surgery whilst the remaining 97% remain unchanged.
So what are the main take aways from this:
- 43% of women pre-surgery had incontinence, whether this was a result of poor hip mechanics, who knows. But it’s safe to say it is quite common in those who have hip complaints.
- 64% of women had improved urinary incontinence symptoms 3 months post-surgery. There was no pelvic floor specific intervention post surgery however did post operative rehabilitation on day 1 which included both active and passive range of motion exercises and full weight bearing. This may have been a bit part of incontinence improvement and tells us that hip mechanics play a huge role in helping rectify symptoms of pelvic floor dysfunction.
- Some women (4% in the incontinence group and 3% in the continent group) had worse symptoms post-surgery. Obviously this is not ideal, but with my knowledge in pelvic floor function and hip mechanics. Sometimes too much tension in the hips and in the pelvic floor can hide incontinence and once tension is improved, we see leaking as a result of pelvic floor weakness that actually needs support through direct pelvic floor coordination and strength. There was no internal assessment performed on the pelvic floor so we actually don’t know if the incontinence was from pelvic floor laxity or pelvic floor tightness. Maybe this is what happened for these women?
- In the discussion section of the study, it was highlighted that the relationship between the pelvic floor and the hip was largely influenced by the obturator internus (a deep hip external rotator) which has a close relationship with the levator ani muscle through fascial connection. The study posed that hip pathologies tend to cause atrophy of the hip muscles such that tension is reduced impacting strength of the muscle and range of motion of the joint. Once surgery is performed regaining strength and muscular hypertrophy of the hip muscles (including the obturator internus) would ultimately feed into the levator ani and other pelvic floor muscles.
In my own clinical experience, clients with hip pathologies or pelvic pain tend to present with symptoms of pelvic floor dysfunction that are typically due to pelvic floor tightness, rather than laxity. Improving hip range of motion and balancing out strength across the muscle groups of the pelvis and hip often help reduce the tension within the pelvic floor and clean up pelvic floor symptoms. And if you didn’t already know incontinence is a symptom of pelvic floor tightness. I also see a large number of women who have chronic hip pain prior to pelvic floor retraining and once we get the pelvic floor working better the hip pain actually resolves.
I guess you can also ask… What comes first… pelvic floor dysfunction or hip pain?
So how can you use this information with your clients? If someone comes in with hip concerns, ask if they have pelvic floor symptoms. You might just be surprised to hear that they are actually a women’s health client… not a hip client. Then you’d probably need to start by addressing the pelvic floor so make sure you have a little bit of knowledge to get you started here and if you don’t well stay tuned for more pelvic floor education in my future emails and updates for the next intake of my 6-month mentorship opening up in December and kicking off January 2024.
Thats a wrap for this month’s research spotlight. I hope you found this valuable and learnt something new 🙂
If you want more of the juicy goods don’t forget to head over to my podcast where I share more women’s health content alongside bite sized self-development chats (yes, I am a sucker for this! It’s what has made me a better practitioner and I truly believe we all need it)
Catch you in the next one! BYE