The pelvic floor is a critical component of the core system that connects to breathing, back health, bladder function, bowel health, and reproductive health; dysfunction in this muscle can manifest as back pain, urinary incontinence, constipation, hemorrhoids, and reproductive issues, making comprehensive assessment and treatment essential for effective rehabilitation.
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Pelvic Floor Webinar Series Part 1
Added:Hello everyone. Very good evening to all of you.
>> Hi ma'am. Very good evening.
>> How are you?
>> Fine ma'am. I'm going well.
[Music] I'm sharing video uh my PPT with all of you and then we'll start talking.
Hello. Hi everyone now. Okay, good to go. You can see the slides.
>> Yes, ma'am.
>> Okay, great.
>> Yes, ma'am.
So um first we will start with a little bit of introduction. I know that the timing is very very important and we don't want to waste it. It's already uh 4 8 as per India.
This meeting is being transcript for AI companion. Okay.
stop sharing and let's discuss with each other. I'm sorry. Ignore this. There was a kind of festival. So that's why that mahi thing is there.
A very very very good evening to all of you as usual. uh this learning is very important for all of us as a physio and I hope you all are comfortable with the language English and uh I only know these two three languages English, Hindi, uh Gujarati a little bit of Punjabi but I don't know the Tamil and um that language. So I'm so sorry if you don't understand and if you have any difficulty you can always ask me in English. Okay, English is always good for all of all of us. Yes.
Uh when we talk about that uh learning program so I really want to make you very comfortable be my friend from the starting and don't uh you know see that I'm your guide or something. I will just keep we'll just keep learning with each other. I'm also learning and you might tell me something if I miss. So keep adding from your side also keep exploring more during this time period whenever we are going to know go through this important subject which we have missed in our curriculum so far pelvic floor rehabilitation and understanding about this muscle its function dysfunctions assessment and the treatment. If you know that something I'm missing somewhere or if you have any suggestion which might be important for the patient care. So please keep writing or keep uh know raising your hands and we can always discuss about that during this 8 to 9 days or 10 days of time when we are going to go through this if you see any patient in your clinic. So I really really want you to know do a little bit of assessment uh towards that area also about core assessment. So pelvic floor is a part of the core. So start assessing the core. So I'll give you that external assessment. So don't feel that pelvic floor is something where we have to remove the clothes and only then we can go for assessment. No external assessment is also possible. So you can keep doing that little bit with your patient. uh starting from tomorrow itself whatever understanding you're getting from this webinar and keep discussing the patient I have shared you one link of my pelvic care uh international group where we are discussing always the patient so you can keep keep an eye on that group also because from that group itself you can have lot of understanding and learning about and about this patient and KAC case studies very very helpful group and you can also write your um about your patient whatever finding is in the same group or you can call me or you can send me a message also so I can also help you what next we can do and that is going to give you a little bit of um p practice you know uh of asking questions taking history it will be very helpful so yeah u without taking me as your senior or someone who is expert count me as your friend and please keep pen and copy with you. So keep uh writing all your doubts on one page if you have and also keep writing whatever information you found is valuable because sometimes whenever I am uh doing the this kind of training sessions I sometimes you know the experiences also comes uh patient experiences things are not into books might be something is missing in my PPT I might just say and it might be very it has a value which you might miss. So it is very important that you keep note something which is important. I will keep sharing the video recording with you after the session. Uh but not the same session. I will not share you the video of the same session which is happening. Uh my past uh webinar, same topic but past webinars link might be you get some revision also through that webinars and you get little bit extra also from that webinar because people keep asking me questions. So every question can give us little bit of more understanding and learning. So by hoping that at the end of uh our uh completion of our sessions um I don't know how much time that it is going to take. It might take 8 days, 10 days or might be 12 days also depending upon how much questions you guys are asking. The subject is very very very deep actually. And uh when I say that um I I'll just tell you the 100 hours is also less. So it's a kind of continuous process and um so we will try to give I will try to give my level best uh during this particular time period uh and but I but I am expecting that after completing this you will be someone who can easily assess or understand any case related to the pelvic health related to the pelvic floor. Uh this session is specifically for female female pelvic floor rehabilitation. We have a male different there are some muscles which is different some conditions which is different in male case also. So uh I might not be able to cover that part in detail but I will keep giving you little bit of understanding wherever it will be important and uh I hope that we will enjoy this learning program and it will always stay with you and it will always help you uh in our community this particular service is uh not there not everyone is serving that uh this area.
So the good news is that we have we can be the uh kind of there's no competition actually no such competition so we can be that expert in our area and you can that can also help in little bit of your career growth and new patient uh flow to your clinic. Uh so far we are somewhere dealing with the muscularkeleton, neuro cardio, that rehabilitation but pelvic floor like like helping the community with urine incontinence helping the community managing uh some prolapse issues or managing constipation or managing that piles, hemorrhoids, back health which is related to that core actually whenever we are saying um that is going to be a kind of you know adding something extra in their life which not every physios are doing little bit more assessment, little bit extra depth uh no treatment and care. This way their rehab will be very easy and it will be kind of permanent. Uh they will not keep coming keep coming with the same issue because you will understand how to deal with it.
So by keeping that in our mind uh let's with the good and great hope let's start our learning about pelvic floor.
So uh if I tell you that uh pelvic floor muscle so you might be you might have heard some of my videos someone else people are also saying and nowadays it is into era also so many of the so many of us we are practicing into pelvic floor we are educator into pelvic floor we are doing this training and yeah it is very important because something it is missing uh you might be thinking uh it might be very tough but I will try to give you the learning in a little bit easy way so that can stick with you forever. Okay, I have a PPT. I will also share books with you after completion of this webinar series. So you can always compare the learning with whatever you have broughten written on that u notes.
You can always go and just uh check that with the books also. So definitely it will help you and uh books will also help you in sharpen your skills more later on but I will try to make it easy.
So u that should not be into the mind that is very tough and that shyness because this muscle this area is very private. So u we are not very comfortable asking the question directly to the patient about the pelvic health.
But I will try to give you some solution of that also that it is compulsory every patient which is coming in your clinic doesn't matter what issue they are suffering from it might be the abdominal weakness it can it can be the COPD cases it can be uh there is a thoracic pain there can be back pain there can be foot arch there there might be TMJ everywhere it is related to the pelvic floor you can understand in our body the pelvic flow is a central part. We have upper half and we have a lower half and pelvic floor somewhere is in the middle. So upper side and lower side everything is going to affect this muscle. And if this muscle is um not strong enough, it is very tight also. It has a weakness. It can definitely affect your upper body and your upper side as well as your down uh downside. Okay. So definitely more uh better care you are going to add after learning pelvic floor in your life. So with this hope let's start.
Yes Pity is there but easy way. So if you see that we have our like cavities in our body. So you can see that this is the thoracic cavity. After that we have abdominal cavity. So thoracic cavity is separated with this abdominal cavity through this abdominal diaphragm. So we have this abdominal diaphragm and then we the thoracic cavity abdominal diaphragm and then we are having a abdominal cavity. After this abdominal cavity we have some pelvic cavities also present there. into pelvic cavity pelvic organs are lying and after that the floor of that pelvic cavity is made up with a muscle and that muscle we are calling it as a pelvic diaphragm. So we have two you can say we have two important part one is upper part one is lower part. So diaphragm is up abdominal diaphragm is down pelvic floor. So very important and the the way I'm making my hands you can say we have little bit of you know upward ascending way. So this ascending is very very important. So this is our dome shape diaphragm abdominal diaphragm and same way we have ascending means upward we have pelvic floor pelvic diaphragm. So these are the two part important part of your core abdominal and pelvic diaphragm very very important. So abdominal diaphragm is the floor of your thoracic cavity and pelvic floor is the floor of your pelvic cavity. The way we have thoracic organs are present same way we are we are having our pelvic organs present into this pelvic cavity. Now when we say the pelvic cavity so I'm talking about this important area and when I'm I'm just holding it. So this is a bone and we all understand this bone. We have a pubic symphysis anteriorly. You all can palpate your pubic symphysis by touching uh anteriorly. So we have this pubic symphysis right and left and they are joining the pubic bone and they are joining with this kind of connective tissue. We call it as a pubic symphysis.
So right and left pubic bone and then we have this ilium going on and then we are having uh sectum at the back. So iliam pubic eium is also there downward which is you can say this the east tuborosity uh you can just move right to left and you can feel the sitbone. So we are talking about this sitbone. So we have the sitbone posteriorly we are having this cakes then we have this sacrum and this is two illium. So when this ilium is joined with the sacrum. So this is the sacraliac joint. Yes, we all know about this important fact. Anteriorly again there's a connection. Now downward if I just rotate it like this. So downward we have this area. So all of this area is covered by these muscles which we are calling them as a floor of the pelvis. So these are the pelvic floor muscle. You can see into this model. Okay. So this cavity is completely this cavity is completely covered and protected by this flow. So in this way you can see that we there's a bowel shape. It is making a bowel shape and into this bowel our pelvic organs are present from anterior to posterior. So why it is very very important? Now you can understand because this muscle is the very very important part is that it is somewhere stabilizing the whole bone.
So anterior to posterior lateral to medial this muscle is the muscle has a good tone. So this stability of the pelvic bone will be good. So if these muscles are somewhere you can understand if they are very tight too much of tension is there into the muscle. So what will happen to all these openings like to this uh you can say this easter of this side this side cockage or you can say pubic symphasis. So what will happen to all these areas if the muscles are tight there will be can kind of tension. So this the bone will come closer together to each other the moment the bones will start coming closer to each other. So this there was a they were having a neutral but now assume that bone are the muscle is tight. So what will happen to the bone? They will be kind of pulled together. The more the bone will get pulled together, you can understand there will be increased space anteriorly around the pubic area. So patient can complain about pubic symphysis pain. The same thing can happen during pregnancy whenever this female is like no relaxing hormone is improving that inlet just to accommodate the baby. So this inlet is increasing.
So you can understand the pelvic downward will be kind of congested at the particular time period. So that can be a reason of pubic pain in a female uh pubic symphasis pain and same way if this these bones are coming closer you can carefully see what will happen to SI can you see there's a little bit of space so definitely SI joint pain can also come into picture so the bone is directly going to give you the strength of this muscle tension into this muscle is going to directly give you back pain issue that's why this mus Anteriorly you can see over here our uh core muscles are also coming and they are inserting.
If pubic is going for separation that is going to weaken up that abdominal muscles anterior ball and same way you can also say the po it is going to affect the posterior ball also. So the downward part if that is tight so this ascending so that can give you anterior pain as around the pubic lupus or posterior pain around the sacrum and if these muscles are tight they can definitely because muscles are going to attach with the coxix the tailbone if these muscles are tight so you can understand they will pull the coxix anteriorly and patient will be always complaining about the sacral pain. So sacral pain, SI joint pain, pubic symphysis pain, weakness of abdominal muscles, tension into the back muscles.
So yeah all is some affected by the tension into these muscle and the muscle is yeah it will affect same way if this muscle will be saggy, loose, weak. So you can understand it will not be able to pull the eal tuberosity in a stab in stability that position. So this east tuborosity will go away from each other.
You can understand because muscles are holding them in a neutral position. The moment these muscles are weak and saggy they will not be able to pull the chill tuberosities closer to each other and they will not be able to maintain the stability. In this way what will happen?
mild if you can say mildly look again there will be pain at the back at SI joint pain back pain so again it will be it's going to cause back pain issues in a patient if muscles are weak you might have seen a lot of your patient they are coming for back pain issue back health issue but their back pain is not going you are treating them uh here and there by doing everything but still their back pain is not going now why the might you haven't addressed that import that base of that that might be tight or weak. So this assessment is very important if your patient is suffering from back health issue. Okay. So you can understand how important this floor is for back. Same way if this floor is tight or weak it can definitely going to affect your central muscle of abdominal that is your rectus abdominis muscle and that you will have a linear elbow. So you can see that if these muscles will be this pubic symphysis will go for separation because muscles are tight down there. So that can definitely going to give you diastasis recti below the navl like this over here. So diastasis recti can can be present in your patient and back pain definitely the sacral pain and uh that issue will be present in the patient. So yes linear alpha and if these muscles are you can understand that if these muscles are loose and saggy so they are going to again strain your obliques. So again obliques will be tensed tight and they will keep pulling your rectus abdominis again the diastasis recti at the amical level. So yeah so that is what is the core with the pelvic floor. Okay. So very important uh like know we should learn about that understand this muscle and try to help our patient with um this core what we are saying is abdominal if tension or tension is there or the weakness is there or back tension is there or weakness is there or the pelvic floor. So that is the one correlation and the second very important correlation is abdominal correlation with the thoracic cavity. You can understand that we we are always with a very important part of our life is the breathing. Breathing is like you know and we are all we don't know but we keep doing the this breathing norm normally we don't focus on the breathing. So there's a kind of passive movement somewhere going on when you are sleeping also sleep the breathing is going on.
Have you ever thought how this breathing is what this breathing is doing? Yes it is like we are providing the oxygen to the organs.
We need the cells needs that but all they are creating some kind of maintaining the pressure into the cavities. The moment you are inhaling the air inside your thoracic cavity is expanding isn't it? You are feeling air in your uh lumps and that is going to give you chest expansion and during this when the chest is going to go for expansion the diaphragm of your abdom this thoracic cavity is going to descend you are feeling assume a balloon you are filling a balloon you're feeling air inside the balloon so the more you will in insert like know you put the air inside the balloon will go for expansion anterior posterior 360° and even downward also the dome-shaped diaphragm will descend downward and it means the thoracic uh cage is expanding and the uh pressure is there and this pressure is going to even um you can understand push the diaphragm downward and due to this downward push of this diaphragm which where the pressure will increase what will happen to the abdominal pressure so because when you are descending you're push pushing something down. So this descending of the diaphragm is going to increase the pressure in the thoracic cavity also. So increase of the pressure in thoracic and the abdominal sorry abdominal also downward. So it means more air there. So means abdominal is also going to go for expansion and pressure is going to increase into that area. So if this diaphragm is moving down pressure is high into the abdominal cavity. So in abdominal area all the muscles anteriorly, obliquely, posteriorly you can understand assume another balloon there. So that balloon will be pushed down. So due to this pushing downward, it will expand anteriorly, posteriorly, laterally as well as downward. So this pressure abdominal pressure increased intraabal pressure is going to even put a load on your abdominal cavity as well as your back uh and the pelvic area. So into the pelvic area we have organs. Now which organs are present? Assume that bladder is there, uterus is there if she's a female, rectum is there. So this downward pressure is going to increase the pressure over the organs. If I'm a organ pressure is increased, I will be descending down. I will be under the load. So I will affect. So same way I am doing my functioning. I'm bladder. I'm collecting the urine. I'm a rectum. I'm collecting the feces. I might be uh you know that reproductive area of a female.
So every organ is present and every organ has a canal. So as a bladder I'm collecting the urine but I'm storing it.
I'm not keep passing it throwing outside. I am storing it. And male or female the people they have a control they will only going to urinate as per their like know their wish if they they see there's a urinary is there they will go for urination the urgy will be there if there's no urge they might hold the urine so I have to keep expanding expanding as a bladder so I have another passage attached with me and the name of this passage is urethra so this urethra is going to pass through this pelvic floor because you can understand this B muscle is present and the uh outside if I'll just place this organ here anteriorly so this is a bladder and bladder urethra is passing out through the ur uh through this pelvic floor so pelvic floor is working like a support around the urethra support around this bladder so bladder is resting on the inner muscle muscles deeper muscles of the pelvic floor and its canal urethra is passing through the whole pelvic floor outside. So you can understand that this muscle should have a strength good tone to support the organ against that pressure which is coming in which is building in inside that abdomen. So this is very important. So if the muscles are strong enough they will keep this ascending pressure when this descending pressure is going on from the abdomen. But if the muscles will not be strong so what will happen to the uh this canals so that this pelvic floor is weak for example they are weak. So there will be more descending pressure and during this increase in pressure there might be more descending of the organs downward. You might have heard about pelvic organ prolapse. So why the organs are falling down? What is the reason behind that? The reason is because muscle is not strong enough to keep increasing the ascending tone. So tone is not good. It is descending tone. And due to this descending tone, gravity downward we are always playing around like like know against the gravity. This muscle is kind of transversely praised muscle and gravity is always pulling it down in our all you know walking, running, jumping, sneezing, coughing, doing um any any job whenever we are standing and you can understand the gravity is always going to pull it down.
So you can see that this muscle should have a good strength tone to work against the gravity and to support the internal pressure which is coming during normally also throughout the day and very important that this person this pressure should be maintained during those activities which is increasing intraabdominal pressure like sneezing, coughing, jumping, you know pushing whenever your innal pressure is increasing as a physother therapist I like no one can be better person rather than you to understand um how much in a day our intraabdominal pressure is always increased. So no we are loading the patients we are giving them exercise we are giving them stretching exercises we are loading their heavy limbs on we are giving them stretchings so our uh internal pressure is somewhere on a higher side. So this is what I have seen in my practice that most of the physiotherapist they have weakness into the pelvic floor due to this always descending uh increased interval pressure and descending pressure over the pelvic region and they are not aware about the pelvic floor muscle action. So you can understand that yes this breathing and normally also and as well as when it is forceful breathing that uh can even have more uh increase of this pressure inside. So yes it is important when you are doing forceful breathing or force like like assume that you're holding the breath like this. So which conditions we are holding the breath during defecation when you are constipated? Uh any patient is constipated they will keep having this kind of uh that kind of you know pressure. Uh this descending pressure can weaken your pelvic floor. So that's why the constipation is a culprit for that weak pelvic floor also. So you can understand the increase in shraabdul pressure somewhere whenever the person is keep doing that in his his or her life uh it can be the athletics the sports people when they are lifting the heavy loads you can understand their pelvic floor will reversal pelvic floor.
So uh if the any person who is having high like know tight six packs so very tight core so in that case the pelvic there are high chances that pelvic floor can be either weak or either tight. So assessment of pelvic floor is very important whenever we are having high training high intensity interval training it can be high weightlifting whatever. So athletic people uh that activities sports people when they are doing a lot of jumping running high chances that their pelvic their pressure will be always increased abdominal pressure and that can definitely affect the pelvic floor. So it is very very important that we understand this uh muscles in a deeper way. And the second is yes as I told you that how it is related to the back health, how it is related to the breathing. Now whenever we are breathing our diaphragm is moving down increasing the pressure into the abdominal cavity increasing the pressure over the pelvic organs and somewhere it is putting descending pressure over the pelvic floor. So they're working like a piston on the same direction pelvic abdominal diaphragm and the pelvic diaphragm during inhalation they will descend down during exhalation when you are exhaling coming exhale out.
So it will be ascending diaphragm. So pressure will be now go up because you are taking the air out. So your diaphragm will be relaxed. It will go for contraction like this. Same way the downward pressure which was increased will also relax and that will take a pressure out out from that abdominal area as well as from the pelvic organs and the pelvic floor muscles will be also relaxed and will be kind of come in a neutral position ascending. So they both will ascend during the exhale and the both will descend during the inhalation. So now how I want all of you to practice this important u uh you know kind of co correlation of both of them.
So if you are ready just simply exhale first leg breathing try to do exhale for four to 5 seconds and when you're exhaling can you focus around your pelvic floor is it ascending can you feel some contraction down there do it you need to do this is your homework and when you will inhale you will feel your pelvic pelvic is descending down. So this is very important correlation and u now if someone's breathing is not perfect it is not good. So you can definitely rule out how this breathing will affect the pelvic floor in this sort of breathing in my patient what sort of pelvic floor there are high chances what kind of pelvic floor my patient will be having.
So it is very very important that in just simply by looking at the patient breathing pattern we can assess the status of the pelvic floor and how to treat the pelvic floor by correcting the breathing pattern isn't it? So it is very important for all of your patient not only only specifically to pelvic floor all the patients when they are coming do check their breathing pattern and according to that you can just guide them. So very very important. Now as I'm telling you that these are the importance of the pelvic floor and same way uh the organs organs health is seriously depending upon the health of the pelvic floor every organ if I say that this is a bladder. So bladder is present into the pelvic cavity I know that bladder cannot stay there if the floor is not there it will fall down isn't it? So we need this floor but if this floor is weak so definitely the bladder will start descending down because the floor is descending down. So if I'm holding something on my hand and if my hand if I increase the surface area so definitely what whatever I'm holding it will descend down because I don't have the strength to hold the organ in a right position. So the good strength or you can understand this is how it is descending. Okay. So this descent so organ support is the first priority of this muscle. If the muscle is not strong organ will displace down if this muscle is very tight. So you can understand this was my urethra and the bladder and I as a muscle is very tight.
So what I'll do I'll increase always keep increasing the ascending pressure over the organs and due to this ascending pressure I will not let this part of the organs to relax and they need to relax during the their functioning during the filling of the bladder during that evacuation uh duration they need relaxation but if I'm tight I will always keep creating congestion around that area and I will make their function difficult. They will uh the patient might have difficulty in comp like know kind of collecting a good amount of urine because there's always congestion going on the surface. I'm not letting the bladder expand as a pelvic floor muscles because I have a tension down there. I might not let that uh urination happens because I'm tight. I will not let the urethra to expand. So the tension into the into the muscles will give voiding difficulty. So patient will not be able to pass urine.
Hesitancy in passing urine. So whenever patient is telling you that my urination time is uh I'm taking too much time into urination. I don't urinate completely.
I'm just doing dibbling ribbling all the time. I'm spending a lot of time into the washroom. So it means that we need to definitely check these muscle status.
might be tight and they might be creating congestion around that area, congestion around the urethra, around the bladder not letting them to do their functioning. So this is what is we are calling a very very important functioning of bladder health and this bladder health is now directly related with the pelvic floor. You can see that and not only this kind of congestion they will create when the muscles are tight if these muscles are loose. So what they will do they will not be able to give support to the bladder and bladder prolapse organ will start descending down urethral prolapse urethra can start coming outside prolapse we are calling it as a descending of the organs because muscles are not strong enough to provide a better stability support around that urethra support around the bladder that's why they are descending downward okay prolapse can happen or if these muscles are weak they might not be able to provide a better contraction around the urethra and if they will fail to provide contraction around the urethra throughout the day our bladder is keep collecting the urine if internal sphinct urethra is also weak if the ton of urethra is also weak you can understand and my muscles are also weak so what will happen with this patient leakage dribbling of urine continuously throughout the day because muscles are not creating a sphinctric action complete closing action they fail to create that action So it means leakage can be another issue. Okay. Or whenever increased intraabdinal pressure will come there might be sneezing, coughing, laughing, jumping, uh more pressure over the pelvic organ from the abdominal cavity, put pressure over the bladder and urine will move downward and that can come outside during sneezing, coughing. This is what we are calling as a stress urine incontinence. During that stressful situation stress when the internal pressure is increasing the stress is the pelvic floor muscles are not they fail to take that stress it means they they are so weak that's why patient is leaking okay so you can understand that yeah bladder health is directly somewhere depending upon the pelvic health if pelvic floor muscles are not good enough they are overtight or they are over loose, they will definitely give a patient or person bladder health issue. Not only the female even the male because muscles are present there and male muscle like in case of males when we say there are some muscles of pelvic floor directly attach around the prostrate that is the gland and the urethra directly they are attached with that. So you can understand whenever the patient the male is going for prostrate surgery they are removing the prostrate. So you can understand those muscles which was attached with the prostrate they will be very either removed or either be very weak. So that's why 80% the studies are showing 80% of the people of male after having prostctomy they have a leakage problem. 80% is a big issue. I know these surgeries are going on in a later age 70 80 90 but 70 80 90 that generation that people they are suffering from leakage issue. So we are giving them home care we are giving them home health physotherapy. So why we are ignoring this important part of their life? Why they have to wear diaper? We need to give this we can you can assess them charge them do take extra sessions.
you can add extra revenue to your kind of income also and you can give them experty expert care of that particular area which is affecting them. So why not why to miss it? Okay. So it is very very important for main as well. Same way if I'll say that we have another organ which is present uh in which is very very important and basic organ for our function is the rectum. So large intestine is a part of large colon and this is the last part which is keep collecting the stool and it has anal canal and you can see that I'm placing it here and if I'm placing it the anal canal is passing through this pelvic floor and coming outside you have an out every day we are passing stone out from this canal so you can understand the status of these muscles around the area we are calling them anal muscles pelvic muscles external anal muscle. So they are very important. The first Yes, very important because they're supporting the rectum. So they they have to work as a good supporter. So the tone is important as just to maintain the angles, maintain the upward pool. So stool can just keep desend should not keep descending down. And not only they are supporting the organ, they are also supporting the veins which is present into the ano anal area. So in our whole vein, arteries, brain, we all understand their functioning. Now the veins around the anus they somewhere they are ending around the anus also anal region and after that we have this arteries and after that they have to take the blood back towards the heart. So we need venus uh you know return towards heart from that area whatever veins are around present around this part. Now these muscles are strong enough they will keep creating a contraction pressure maintaining the angle and we call it as anolctal angle external anesthemic pressure. If that pressure will be kind of upward pressure will be there. So you can understand if this is a vein and they have to pull the blood back towards the heart. I need this venus uh kind of return. So this muscle this my other hand is a muscle. If these muscles will be weak, they will not create a compression. And in this way, what will happen to this blood? This blood will keep and we have a gravity downward.
Gravity will keep pulling the veins down all the time. Now if this muscles are strong enough, so what they will do, they will compress it. The more they will compress, so better Venus return will be there towards the heart and we will not have this kind of uh you know dilation of the veins. This dilation of the vein is nothing rather than this hamoid and pines. So what is hamoid and pines kind of protrusion of this vein?
Why these veins have pro protruding down? The reason can be weak pelvic floor isn't it? And when they are weak they they fail to create a compression.
So they fail to create a Venus congest Venus uh return. So this is very very important that we have to understand and you can do your research. You can search in any book or anywhere uh 80% of people they have hemorrhoids. So kind of big uh issue and what is the treatment removing the hemorrhoid or doing that kind of uh you know some little bit of surgeries and using using this and that but the best thing like we should prevent the hemorrhoid is that keep creating the squeezing strengthening keep increasing the strengthening uh strength of your muscles. They should have that tone to keep creating uh compression over this way because when they will have strong strength and tone they will definitely apply upward pressure and due to this upward pressure venous congestion sorry Venus return will be facilitated. So yes we can prevent hemorrhoid by giving the good pelvic floor contractions around the end region and if they have already happened depending upon which grade we can definitely help them by strengthening the pelvic floor. Not only the strengthening of pelvic floor even tension into the pelvic floor can also give you hemorrhoid. So hamro we will understand that in more detail in upcoming sessions but you can understand that how uh even in hemorrhoid and piles we need our patient needs our care and pelvic is important okay and how the not only the piles or hemorrhoid also are I I don't want all the time like you know stool should keep the leaking of the stool oh it might be the worst situation in anyone's life so the stool so this organ is collecting the stool This is a organ. What the organ will do? It will expand to collect and then it will contract to do the defecation. So that that they can contract and relax and that is under this autonomic nervous system control. We cannot control that internal system. Okay. So yeah that is we can understand. But if I want I don't want to pass stool there I'm outside somewhere and uh there's no urinal or there's a situation I cannot go to toilet I'm stuck somewhere in the traffic or in a bus or in a car somewhere I can't defecate. So at that time what these muscles should do they should create a strong contraction. If the muscles will be strong enough they will have a tone then only they will contract. They will contact where around the anus. The more contractions means they will push back. Thus they will increase the pressure internally into the anal region and due to this increased pressure the stool will be moved back towards the rectum. The descending pressure will not be there and urge can be suppressed. Okay. So it is very important functioning of the pelvic floor. can delay your defecation if you want in those kind of situations, those kind of circumstances when you have to do that. So, but who can do strong pelvic floor? Assume that you are somewhere outside and suddenly urge came and your muscles are weak. So, what will happen in this case? Your urge will be more and might be not able to control and sometimes you will might you your patient might feel this kind of leakage and this is what we are calling it as a fal incontinence. not able to maintain the continence of fix pieces who the organ itself as well as the pelvic floor muscles. So they are important for maintaining the defecation and this continents around that area and if you want to the other side if you want to see that if I want to pass my stool and I'm sitting on a camode so what I want at that particular stage our internal system is completely relaxed bladder this rectum is relaxed that can that is ready to create a contraction but if these muscles which is present around that area this anal muscles if these muscles are tight. So I might feel difficulty in passing my stool. So that can give you defecation issues or incomplete emptying or it can be painful defecation. Okay. So that can be also I'm not saying I'm not using the word constipation here. Constipation can be uh due to different re regions. There can be so many reasons of constipation.
But one reason of not passing your stool and having difficulty in passing the stool or defecation can be tight pelvic floor. Okay. So if the tight pelvic floor will be there and if you can't pass the stool. So what will happen in your system you always there will be uh incomplete um kind of voiding incomplete amping of the stool due to the tension. patient might spend more time into the washroom and another thing is not only that more time into the washroom uh because there's not complete voiding of that. So there will be always some kind of gaslike you know scenario going on always kind of in indigestion they will feel gas-like sensations or you can see that what is going on congestion going on around the anorctal area or we can say yeah it is anorctyl congestion and if that congestion is there too much of pressure so you can also understand how it will affect the back health. This rectum is placed the same way or the same line like know you can say see from here following the sacrum angle. So this is our sacral angle and then this is the angle. So same way here. So if you have a congestion going on around that area you can definitely feel lot of tension on your sacrum or all the structures.
I'm not saying only the muscles the facial sheath the nerves that arteries that lymphatic system everything will be under the congestion around the posterior part and your back pain will be definitely can be one of the symptom of your patient okay and blotting inside back not able to defecate uh I'm having a back pain so isn't it making a sense that next time when your patient is coming for back health. Uh should we ask about their constipation, their bowel movement? The answer is yes. Of course, we need to ask them what what is the status of your bowel movement? Are you defecating every day or are you constipated? You can use the simple word but they can understand are you constipated? If they are constipated and they're saying yes, I'm just I'm using I'm passing the stool two times a week or every alternate day or it is very hard for me to pass the stool. So it is very important to give them that understanding that why the constipation is there. Try to find out go towards the constipation. Might be the constipation is one of the reason of their back pain.
Might be the pelvic floor can be the one of reason their back of their back pain.
So pelvic congestion. So in this way what is that um what is that body actually I always believe movement. So we need mobility everywhere. We need mobility in my rectum. I want mobility in my anus. I want mobility in my pelvic floor muscle and I that is I want mobility in my whole body. If mobility will be restricted so definitely congestion is going to affect me somewhere here and there. So very very important role it is playing into bowel health. So bowel health is yes pelvic floor bowel health. So bladder health maintenance, bowel health maintenance, back health maintenance, core health maintenance, abdominal health maintenance, breathing maintenance, everything is somewhere affecting our uh somewhere related to the penic fluid.
Now same way if we are a female.
So in a female body another organ is present which is situated inside the body and that is uterus. and two ovaries. are reproductive main reproductive organs, ovaries, two right and left and two fallopian tubes attached with this uterus and uterus having this cervix and this cervix is open into the vagina and uh every month when after puberty when our periods our minarch starts. So every month endometrial wall is going to form here and if female is not getting pregnant so this endometrial wall is going to shed out okay out through the vaginal canal and they will come out and we can collect this blood outside with our pad senatory pad and you can understand that this canal is so this is organ uterus which is inside ovaries inside vaginal canal is a passage through this the blood comes out and this passage and this whole organ is placed middle into the pelvic cavity in the central area. Okay. So they're like this and when I'm placing it you can understand this what vaginal canal is passing through the pelvic floor. Now anteriorly anterior to this vagina anteriorly this organ was present first okay bladder and now posterior to that vagina will go like this and this organ will uterus will like this kind of anti-verted antifraction you can see and this canal will pass and then posteriorly the rectum will be placed.
Okay. So this is all three pelvic organs present into the pelvic cavity anterior to posterior anteriorly bladder with urethra coming out. Okay. Then uterus vagina which is a canal coming out. Then rectum has a canal anus coming out. So these three organs anterior to posterior. More anterior better. Anyone of you if you haven't urinated you palpate supra pubically. So you have a privacy just touch there right now you touch there and press like this downward when you press you will feel urinal sensation. So in this case you can understand your bladder is expanded and came into the abdomen. So this bladder is highly mobile organ. It can whenever you are passing urine it is empty. The bladder will be like a pouch a squeezed pouch and it will go into the pelvic cavity. When the filling will start, it will keep expanding and it will keep come into the abdominal cavity. And when it is full, if you'll press, you can even literally feel the sensation of your ur urinal sensation that I have this sensation. Okay. So, this is the most anterior organ both in male and female. Okay. And rectum is most posterior organ which I already explained. So, in midline in the middle area anterior to posterior we have uterus. Reproductive organ is also present and all these organs are into the pelvic cavity supported by the pelvic floor muscle and we are calling them as a abdominal organs and if the muscles will be tight it will create a congestion tension tightness ascending pressure over the organs and it it can be anterior ascending pressure means difficulty in passing urine. It can be ascending pressure over the vagina upward might be difficulty in penetrating inside the vagina. Finger penetration, gynecological examination, uh insertion of the temple, insertion of the cup will be difficult for the female ascending uh pressure is there. So not relax completely or it can be that posteriorly the anal region is under the congestion. Anyone of these things are congested or tight they are not able to relax completely. We can tell that can come under this bigger broad perspective we can say pelvic congestion syndrome.
So pelvic congestion means pelvic organs are not able to relax completely somewhere there is a difficulty in their movement that it can be bladder health affected, bowel health affected or reproductive health affected. So you can understand if I'm saying this word reproductive health effective. So you can understand uh we are somewhere talking about the reproduction of a female. So if you can see that I'm saying that this is the vagina and I know that every month we have this egg are eggs are ovaries are doing their functioning and the eggs are coming into the fallopian tube and if the female wants to get pregnant so she needs sperms for sperm the penetration of uh penile structure is very important. the more closer the penis will go towards the cervix, the more better the cerv the sperm will go travel towards the uterus.
So we really want the full complete entry of the penile structure inside the vagina and at this particular time period whenever female is also they both are in they're doing their intercourse and they are doing their functioning you can understand the uterus is also contracting downward. uh even the penis is also there which is you know ejaculating the sperm. So it means this particular part is coming down. So the or this o the egg is facilitating ready for that kind of fertility and same way sperms are also ready to travel towards that area. So we need mobility during that intercourse time period and if the mobility will not be there of this organ so there might be um no congestion somewhere there and you can also understand okay I'm not saying only the mobility of this uterus even that vagina assume that vagina is crossing the pelvic floor okay like this and in this way if these muscles around the vagina if they are tight So you intercourse might not be possible. Uh penetration will not be possible. If penetration will not possible so ejaculation of the sperm will not be uh possible inside the vagina or towards the uterus. So female cannot get pregnant. Uh believe me in 2017 I started practice in 2016 actually. I was still like know exploring that era the subject in 20145 but 2016 I started know experimenting by that asking the questions histories taking the history from the patient 2017 I got my first patient she was married since 9 years her age was 28 years and uh she was she never had in 9 years of marriage life they never had intercourse and the whole family was uh they don't the whole because if me and my partner if we are not sexually active we we will not reveal it to the family isn't it sometimes we try to hide it and the family keep asking them that they need they want baby they want new baby and uh she was uh they were taking her for the fertility I like she was taking this they were forcing her for IVF consultation and this and that and uh this female came to me in 2017 And uh when I asked her, she told me that she's she told so many other doctors also that she never had intercourse with the partner because sperm that penis can't go. She has a always pain in that area.
So you can understand 9 years of marriage never had sexual intercourse.
And the second thing is you can understand that she can't get pregnant also. It is somewhere affecting the motherhood not only the womanhood even the motherhood she can't be the pregnant she can't become fertile. She is fertile but she can't get this fertility due to the this tight pelvic floor. So just relaxing the pelvic floor you can add lot of thing from your side in improving facilitating the movement inside the movement of whatever is there. It can be the urinal movement. It can be the sperm movement. It can be the uh uterine movement. It can be that do this ductal movement. Movement is very very important. And this pelvic congestion can always uh affect the movement of create the restriction over the organ and definitely affect the health of the system whatever is under more effect. So if anterior muscles are more tight, bowel health will be affected. Posterior muscles are more tight back health or that bladder health. Sorry. The posterior muscles are tight, bowel health will be affected. An anterior are tight bladder health will be affected and the muscles around the parinium that uh you know around the vagina around that penile structure if they are tight around the base of the penis if the scrotum if those muscles are tight there might be difficulty with the reproductive system. So the understanding of these muscles are now you can understand importance of that and so many of people they are uh sleeping like that because even we are not when the we are we are still yeah we are the awareness is there but still the taboo is very high uh speaking about freely discussing freely about that area I'm not saying that you come and go to tomorrow and start asking your patient oh you have a leakage or you have a constip No very systematically by understanding your community, your culture, the way, the language like simp modification, simplify and making it more comfortable for your patient. Very subtle in a very subtle way, it is very important to understand the pelvic health. If that health is not good, the system will not good. Okay. So this is highly highly highly important. So we will definitely go on that. But before going on so you can understand now how bladder health uh sexual health um I haven't used that word sexual but reproductive health bladder health sexual reproductive health as and uh this reproductive health when I'm saying about the penetration this penetration is important for male if assume there's a couple and they are into love with each other and but still they can't do penetration inside so I know the female is into pain but as a male partner He will not force the female to go for penetration. So it is going to somewhere affect their relationship also. So it is will it will affect the the couples. It will affect the relationships. It will affect their mental status. So definitely psychologically also it is going to affect and when she will not get pregnant it is going to affect her socially also. If she will leak any female who is leaking the urine she can't control urine. She has a urine. It is affecting her mentally, psychologically and socially. Okay. And same with the rectal issues are also there. Yes, they are loud. They can tell you I have back pain, back pain, back pain. And they might come to different people. They will they might come to us also. So only focusing on that one aspect is not complete rehab because this health is you can understand you know you can see in this image. So this is sacrum and these muscles are directly attached with this lower part of the sacrum. So they're creating they're providing the stability to the sacrum.
If the sacrum pain is there, back health is there. So these muscles we are always giving them perform stretching. Pformis is tight. So this part this part is yeah definitely covered by the pformis. But this down to the pipformis which muscle is there? Coxial muscle. So this coxial muscle is also very important and this coxial muscle is a part of the pelvic floor. So we should not uh count it as the sexual sexual only a bladder health, bowel health, back health everything on a kind of you know holistic approach we need to see you know it it will affect anterior downward everywhere the whole alignment if the mus and now another thing not only so you can say the whole broad is the broad base is covered by this muscle as a center. So if I'll tell you the simple assessment which all of you can do. I don't know you. I I have never taken your history.
Uh I don't know your age. I don't know your history, your status, whatever. But a simple assessment will you do for me?
Just simple do your TMJ test. Okay.
Today you palpate your TMJ with touch and by pressure also. All of you do that. This is the second homework. First you have to feel the breathing ascending descending and how it is when you are breathing in and breathe out forcefully how it is affecting your pelvic floor.
First do that and the second is please palpate your TMG or do your three-finger test with your mouth. If uh according to that if you cannot insert your three finger like this inside your mouth there might be tightness into your TMJ and if your TMJ is tight there are high chances that you will have a tension in your pelvic floor. Okay. So tight pelvic floor might be un you're not having urine leakage urine issues or urination uh uh you know passing urination you don't have any pain having sex you might you might have or might don't have pain or during you know passing but if you have pain here you will definitely there are high chances that there will be pain in your pelvic floor if you have more laxity your forefinger can go inside your mouth and your TMJ's legs so that can definitely going to show you a weakness in your pelvic floor. There are so many studies which has been published uh you can look on like scientific research gate myo but this pubad you will find out how TMJ is related to the pelvic floor. So I'm not saying that no remove your clothes and lie down on the couch and then I will assess your pelvic floor. That is the only way. No, you can simply check their TJ and if some issues are there, some pain is there, yeah, there might be pain into the pelvic floor and even reducing relaxing the TMJ can relieve the pain from your pelvic floor. Even strengthening the TMJ can strengthen your pelvic floor. So because of the Now what is the reason why they are connecting? You have to give me this answer tomorrow. uh send me that answers in the group so we all can understand what is the relation if you found any studies or something like that keep sending that relationship of TMG and the pelvic floor so that is another very important uh parameter to check the status of the pelvic floor indirectly without removing the root okay so yeah that is a second homework for all of you note only this upper connection I'm saying even the lower connection try to Understand any patient if uh okay assume that someone's this tuborosity are away from each other means they are not pulled muscles are they don't have tone muscles cannot pull them together so weak and lax muscle if muscles will be weak and less so what will happen to the isogosity they will come closer or they will go away from each other the answer will be yeah they will go away from each other Isn't it? Because muscles fail to pull them towards each other. So stability is hampered. Instable.
Instable means they will go away from each other. When they will go away from each other. So now try to understand if your descending perennium descending pelvic floor muscle descending pelvic floor muscle will fail to pull each tubity together. So what will happen to tubrosity? They will go away from each other. If they will go away from each other all of you you understand the biomechanics if east will be out means hip pelvic open okay pelvic is open downward because it is outward outwards so you can understand the moment I'll make my downward part outward you can say how this upper illium is moving anteriorly so they are going to create a tension into the side obliques those muscles and they will go like this so how they will impact your knee, your adductors. What will happen to that? If you will, there will be more gapping of your east tuberosity. They will go away from each other. And what will happen to your knee? So the moment you go like this, your knee will come closer. Okay, that bow bow that what do we say the other word? Welcome. Okay, so welcome. They the knees will come together. So you can because you have the issues are away from each other when the knee will come together. So what will happen to your feet? So what will happen to that inner part of your feet?
Foot arch will there will be high chances of getting feet arch or sorry flat foot or high foot high foot arch.
So in this way when the knees are closed um then that what flat feet isn't it?
>> Yes.
>> Yes.
>> Flat feet. Yeah. So you can understand the any person if he or she start like know standing in front of you just if it is not congenital that it is it was not present since the birth that flat feet if you can just check their flat feet and by looking at that feet and it is flat so you can ah the knee it is away.
So what can be status of is outward. So what can be that status of pelvic floor downward? Then you can ask them that okay you have reached you have this flat food or you have pain and then you'll found some muscles uh status of that genu also okay those muscle tension and same may directly when you go up if you ask them you'll found the lateral muscles of the abdominal will be tight obliques will be tight and strained and that so what we can assume here we are assuming we are still assuming because we haven't asked we will not direct Ask her a question. But what we can assume that there's a high chances that her pain will be descending. So yeah. So there there can be back pain issue present.
Yes or no? Yes. Okay. Back pain can be present. Okay. And why the back pain is there? Is the due to the back pain factor or due to this weak pelvic floor factor? It can be the flat foot. It can be the weak pelvic floor. So they are all interconnected. Okay. So that is the central part. But you can understand how the downward assessment can give you simple understanding that affect over the belief. Okay. Uh don't believe me there are so many articles you can just Google search askj chat GPT nowadays AI and uh that will also you will get your answers and they will send you they will also you can ask them about the research papers to evidence base and things and like this and that. Okay. So this this is what I believe we are missing in our assessment. We are only rigid to one area. If patient is coming for knee pain, we are only giving her the care or we have for knee pain. You don't understand this knee pain can be due to the votight pelvic floor or voted foot muscle. So this upper and lower if they are weak they can they might be giving this pain around the knee that that can be one additional factor and this is what we are missing this assessment and if we are missing this assessment we are missing complete treatment your patient will keep coming keep coming keep complaining about the knee pain their knee pain will never go so this is what I always believe the whole body approach if your body if your patient comes for back pain don't only focus on Back pain 60% your focus your assessment should be related to the back pain. 40% of your your assessment should be of whole body up to down anything whatever your patient is suffering from knee pain 60% assessment of knee pain 40% of whole body you might found different you know root why the reason of this pain okay there might be they are compensating okay their body try to compensate all the time so there might be compensatory pain she's telling you so look for the go for the whole body assessment I also I in my pelvic floor I use this term external body assessment. I can't treat the pelvic floor. If my pelvic floor is tight and I'm keep doing that rehabilitation for 20 session, 30 session and I'm not relaxing her jaw. So it will be always tight. So I have to relax the jaw also. I have to relax the feet also. There's a high fit arch. So it is a whole body approach even into the pelvic floor. It is a whole body approach. In back pain it's a whole body approach. in dysrecti it is how approaching knee pain high arch everywhere okay so this is what we are missing and I really want all of you to go through that what I'll do today I will send you one form assessment form which I'm using for my pelvic floor patients and in that assessment form very important segment is a external assessment for the pelvic floor that external assessment means whole body approach so this whole body approach doesn't only apply on pelvic floor patient. This whole body approach is important for all the cases. Okay, go through that and if you found value into that you can ask you can check those things on your other cases as well that might help you. Okay, is it making sense all of you think it is making sense?
Yes doctor. Yes ma'am.
>> It is of course >> everything is inter >> inter this is a whole kind of no holistically we need to see.
>> Yeah. Yeah. We have I have a patient with this pelvic uh floor issue.
>> So what you said no this same she is having a genu and this foot is very flat. So I'm just uh seeing okay this is >> tomorrow you'll be excited to see her again you know.
>> Yeah. Yeah. I'm just seeing because just randomly she came for a knee issue.
>> Randomly I asked this uh how about your pelvic floor and all. She was telling me this and all. Then I thought okay I'll start the pelvic floor exercises also.
>> So she was telling me yeah she was having this urinary incontent.
This I asked very randomly. So she said she's having it.
>> Ah so look it is there you have already.
>> Yeah. So now I can link it.
>> Thank you for adding. So now everyone else will get this courage. So only one question you can just ask them. Do you have a leakage issue? Can you control your urine? You can ask them in a very nicely subtle way which is not offensive.
You know slowly after one or two days.
So we'll try to find out. Okay. Lovely.
Thank you. Thank you so much Dr. Vishma uh for adding this. It is very valuable.
Okay. So shall we move? So far what I told you I have given you overview of it is not only the pelvic floor it is the whole body and into whole body you are missing pelvic floor. So this pelvic floor let's let me explore let me just give you a little bit of understanding of this muscle. If I'll ask anyone of you how many muscles are present in pelvic floor what is your answer?
The number of muscles can you please write it down in the chat box?
>> Two wrong 16 pairs.
>> Uh oh. Who is this?
Yeah, 16 pairs Dr. Kharijah. So there's a 16 pair. Isn't it kind of something uh excited and new? 16 pair it means 32 pelvic floor muscle in this simple area.
32 muscles are present. And when we say pair so 16 because our body is in right and left there's no muscle which is one.
It is always right and left right left.
So same way pelvic floor is also pelvic bone is also right and left ilium pubic right left. So muscles are also right pelvic floor left pelvic floor and they are joining around that you know somewhere in between and they are merging the fibers of right right is merging with the left into the center of the pelvic floor and through this center the center of gravity is passing. Okay.
So this is how these muscles are interlin and they are present. So this is not only one muscle they are network of muscles so many muscles arranged in a say different ways in that uh whole downward floor and the they are not only arranged right and left they are arranged in levels. So as we have floor in our house like you know ground floor and then first floor and the second floor these muscles are also lying into the floor. So outside externally we have ground floor then we will have a first and second floor. So we you we use the term uh more superficial so superficial layer more deeper so deeper layer and in between the superficial and deeper middle layer. So this is superficial this is deep and there's another something in that. So middle. So the muscles are arranged into three layers.
Superficial layer, middle layer and deeper layer. And the deeper layer, deeper layer means this layer inside this cavity. Now organs are resting onto the deeper layer. Okay. Now canals are passing through medial and the superficial layer and they're coming outside. If you if you are a male, so you can understand your penis your pen penile structure is passing through the medial and the superficial layer. So that is not resting onto the deeper layer. But who is resting on the deeper layer? Bladder is resting on the deeper layer. Uh upper part of the vagina is somewhere in relation to that uh deeper layer. Rectum is on the deeper layer.
But what is passing? Vaginal canal.
Lower part of the vaginal canal is passing. So lower part not the whole vagina is passing. No lower part is only passing. Vagina is still inside. So lower part is passing of the vagina. uh anus ns anal canal is passing through the pelvic floor muscle. So yes they are passing through the middle and the superficial and their organs are resting on the deeper layer. So that's why the deeper layer we are called what the deeper layer has to do if this is the organ and the organ is resting on me. So what I have to do this layer inside it has to always apply some tone resting tone. So that should have a good tone.
So the organ can rest in a same position without deviating the organ anteriorly or posteriorly or effect of the uh any pressure or you know our movement organ should not fall anterior posterior like this. So they should be supported by the tone of this muscle. So means we what we want we want elevation of the organs. So organs can stay there. So elevation levation up this is what we are calling another some some might you have heard the word levator ni. So levator ni. So this deeper muscle we are calling them as a levator ni. The muscle which over which the organs are resting. So now levator. So what is the function of this levator? Deeper muscle maintaining the support higher tone. So not higher tone good tone. So this good tone. So they can maintain the support and organs will not display here and there. Okay. So that is very important. That's why the name comes here levator ni muscle. Okay.
Deeper layer and we are also calling it the endop pelvic fasia. The mus the fasia which is covering the limit ni. So this is my skin and this is my clo. So now how this clo is on on top of my skin. So this is the fasia over the limit ni. So this is the we are calling it as a endo pelvic facial. Okay. So this fasia is a kind of one sheet the facial structure if you understand. So that is also very important. Anything any damage to this fasia can affect the whole limit ni. So you can say that during that penetration during that uh child birth any injury to the internal cy internal fasia limited ni muscles over streretching when the baby's coming outside any damage during that vacuum extraction any damage during that internal uh you know ex internal might be speculum when they are inserting the scapulum they are doing that assessment inside they might do the some damage or whenever they are doing some kind of radiation radiation radian radiotherapy in case of cervical cancer you can understand. So that can definitely affect the internal endopelvic fasia. So any deeper treatment done by the colctal surgeon around the colon around the rectum even removing of the hemorrhoid remov around doing this colactctal surgeries it can be any gynecological conditions they might do something endometriosis is there they have done surgery for that they remove the uterus they have done surgery for that any surgery through the vagina even the radiation through the vagina can they affect this endopelic fasia the answer is Yes. So in this case endopelvic facial sheath can have a tension and that can give uh tension around this levator ani muscle and levator ani muscle can become ascending pressure it will fail to relax and that can give tension and in this way the muscles will if this part is tight you can understand the whole muscle is going to somewhere stretch from some sides. So definitely u one facial damage one part of this facial damage can affect some anywhere. Okay. So it is very important this endopelvic fasia should be relaxed completely. We don't want any tension into this endopelvic fasia. But there are so many a factors which can create the tension into this endopelvic fasia.
Now which which tension? If I tell you that every month we are ovulating. You will be surprised that simply ovulation is also creating tension in our endopelvic fasia. How? You'll understand that we have two ovaries and out of these two ovary one ovary is going to ovelate. So it means like out of these two uh if I have my okay let me show you through this one.
Yes, this one.
This is another. So this is one ovary here. This one. So every month one ovary is go going to ovulate either right or left. We have two ovaries present right or left. If this ovary is going to ovelate it means that particular side of the ovary is going to go for enlargement because the eggs are getting bigger into that ovary. This enlargement of the ovary requires a uh kind of space and this is somewhere directly related to our because this organ is touching that um our pelvic floor muscles. So when this dilation is going on or this the size is increasing even during ovelation time period. So 3 into you know we have a size 3 into 3 into three of the ovary.
So that is going to increase. So that can create a tension in one side of our pelvic region pelvic cavity. I'm not saying on the pelvic floor one side of the pelvic pelvic cavity will be more restricted because the ovar is taking that space. So that surrounding area the fasia the peronial sheets they will go for expansion the loading will be there and due to this load one side of the facial load will be high and this can give you one side of that pelvic floor muscles under kind of low tension or their end and the pelvic fasia can be somewhere affected or the muscles might be affected congestion over that or even opterator intern of one side. So we have this opterator inter now directly what is going to fac this ovelation is going to affect this opterator in transis muscle because this is organ is now lying like this look if I'm putting this organ here so directly this is going to come in that relationship around the area opterator intern if opterator intern will be kind of somewhere um limited into action because this muscle will not let it will create a straining on that. So that can create strain on this muscle and now these muscles are pelvic floor which is coming from the fasia of operator internis. If operator internal fasia is restricted that can give refer pain to these muscles also. So every female they might have they might feel some of the female they might feel that one side of whatever like you know every month somewhere they might feel some kind of congestion on one side or other side might other month they might feel congestion on other side. So we can understand even muscles are under the impact of uh that organ functioning under this organ function ovelation can simply affect it and so ovelation second if I'll say that uterus so some females they can have like for example okay not only uterus I'm let's just stick to the ovary only assume that female who have PCOD polycystic ovarian uh disease or syndrome so what happens to their ovary their ovary will be more enlarged normally all the time. So because they're not might be they're missing their periods, they're not having their egg release, ovelation is not going on.
So the ovary size will be always big as compared to the normal female. So this big size can definitely going to affect that side of the operator interpacia, that side of the pelvic floor muscles and that side of adductor and that side of the body. I'm not saying the only pelvic floor even that side of your obliques what we say is a transverse abdominis muscle of that side every muscle which is around that area due to this ex uh extra size of that uh ovary that might be under the tension not only the muscle their fasia not only the fasia even their lymphatic system their arteries their veins everything will be under the load Today only I got one patient um uh she she just like she just um send she just called me and she's going to come tomorrow for assessment. I'll uh discuss tomorrow with all of you. She she told me that u I have lot of um kind of swelling all the time on one side of my uh adductor a lot one side of my vulva is always swollen. So now the moment she she said one side of the vulba always swollen. I asked her like what what is your period history? Then she told me she's suffering from PCOD.
So I'm just assuming she's going to send the reports tomorrow and I'm going to see her tomorrow. But I'm assuming that there might be bigger size and that might be affecting the whole system of the internas the ductor movement even that the pelvic floor and that might be that even she's saying that she has this u um what the vein vein issues also going on let me see tomorrow when she will come and then definitely I will discuss the case with you so yes the PCOD is also going to affect your one side whatever side ovary is swollen because the ovary if I am ovary in this tool uh and I I'm kind of oversized so definitely I'm going to create some compression on others associated structure whatever is there anterior posterior fasia nerves lymphatic system whatever is there okay and what I told you when we started the session mobility so mobility around that area that stress is going to hampered due to this ovary functioning so that can be the p reason of lot of restrictions into the body so now what is The treatment the treatment is increasing that movement internal movement and externally keep doing that stretching exercise keep increasing the flexibility keep lengthening the system.
Keep increasing the relaxation. So that internal uh keep using a lot of breathing and expansion inside the body.
Pelvic cavity, abdominal cavity expansion is very very important. Not only external stretching exercises even internally the uh expansion of the system expansion of the abdominal cavity so that internal uh relaxation can be achieved. So breathing is very important that flexibility exercises are also very important mobility improve any hot modalities which you can apply to improve the mobility is also very important. So that is again a part of the treatment and the organ functioning.
The moment you will improve uh you reduce the uh restrictions automatically the organ will start doing that organ will be free and freely when they will move the arteries which is supplying the organs. If they will move freely the blood circulation to that area will be increased and that is automatically going to improve the functionality of that particular organ. That organ can be ovary, that organ can be uterus, that organ can be fallopin tube, you might have uh you might I don't know how how much of idea you are having. Uh there's another issue which is affecting the mobility of your reproductive system.
The movement is mobility of your of felopin tubes. That mobility of fallopin tube is very very important to move the fimria of the fallopian tube towards that ovaries during the ovelation. So they can pick that egg. So this mobility of the fimria the mobility of the fallopian tube so that uh you know pick they can pick that egg after oberation and they can transport the egg towards the right part ampula where the egg has to stay and wait for fertilization. So mobility is very important. So you can understand if someone is having a assumed a scoliosis some some any female who has this kind of scoliosis and that is a kind of chronic and this you can understand that that side of ovary that side of ovulation that side of the fallopian tube that kind that side of the functioning of the reproductive organ will not be good in her case. So automatically this movement is going to affect the not only the spine the muscles even internal organ health. So it is not only one approach which we are taking muscular skeleton internal organ mobility. So equally important for the better functioning of a person. So we definitely are focuses improving the function of the body by taking care of the internal organ mobility also. So that should be always our first priority.
Okay. So you can understand that PCOD and blocked fallopian tube. So what is a blocked fallopian tube? Your ovaries, your fallopian tubes are blocked. Your either the sperms are not able to travel either that uh eggs are not going to travel. Somewhere some uh something is hampering that fallopian tube. It can be the tension, it can be adhashion, it can be the restriction of the movement around that area. So more mobility will enhance the chances that you know uh better functioning of your every organ of that side what whatever side is impaired or impacted due to this congestion due to this kind of swelling which is going on over the ovary or over that area. So very very important. So yes ovary uh ovary functioning ovulation PCOD can have a fact on endopelic fasia and one side of the restriction and that can give you the congestion. Again we can use the term pelvic congestion which is a kind of broad term like constipation is again a broad term pelvic congestion of right side of pelvic congestion of anterior pelvic congestion posterior pelvic cestion around abd.
So in middle area it can be the congestion due to endometriosis.
If any female who has uterus related issues like she has a hyperplacia into uterus bigger size of uterus or swelling of the uterus in case of PCOD too much of bigger size of uterus is there or fibroid is there that is increasing that uterus size. So you can understand the middle somewhere middle the load is there and the load can put definitely load into the central area which is the central part of your body. So central part means the central part of your pelvic floor also. So the load can affect your pelvic floor central part it can give you weakness and uh endometriosis can give you tension and anything cervical cancer when you are treating that central part through the vagina that can create a that radiations can create a stenosis. stenosis of the structure vaginal structure vagina can go for shortening stenosis. So yeah so in this case if vagina is going for stenosis and the pelvic fascia can go for stenosis. So this post cervical uh cancer rehab pelvic floor is must and now that is the second most severe cancer which is spreading very commonly you know across the world even in India so many of female they are diagnosed with the cervical cancer in stage one two if you are we are very active so might or either might be stage three they have to go for chemotherapy so so many of like their hormones are getting affected their structures are getting affected chemotherapy, radiations, this kind of uh when they are doing the surg surgical removal of those organs. So it is affecting their pelvic or area pelvic floor endopelvic fasia creating the tension and tightness and restriction and and the mobility issues. So you can understand the what is the treatment in those cases improving the relaxation and mobility uh whatever way externally or internally whatever approach your patient is allowing you. So it is highly important around that uterus. Same way when patient has a piles going on and she or he he or she piles is not only happening into female that can happen in male also because of this constipation uh defecation pressure all the time. So they're like know always putting downward pressure oh that kind of sound loading know over the pelvic floor during the defecation. So that can always create a lot of tension around that area and even and when the patient's going for um any anorctyl surgeries any uh you can understand uh this hemorrhtomy so they they they can definitely create effect over that muscles around that area which is around that anus. So stenosis can happen weakness can happen the tissues can get damaged so they might get tension. So we need to again improve the mobility uh improve that know blood circulation. So better healing can happen then working on to the mobility and then working on the strength. So one after another when there are one stage two stage or three stage treatment we have to understand what has happened with the patient. If uh patient has she has gone through the like you can understand that hectomy hemorrhoid has removed. So the first stage tension will be there and so first stage the healing is going on. So first is improving the blood circulation.
After improving the healing second the tension will be there reducing the tension. After reducing the tension the third stage will come where we will start activating the muscle activation stage. And on the fourth stage will come when we start working onto the uh strengthening. So step by step procedure healing and then relaxing then activating and then strengthening. So 1 2 3 four stages. So depending upon what happened to your person that is very very important. Uh rehab is depending upon that situation. Okay. And that's how the patient is going to take one session 10 session 15 session two month that is al always depending upon that particular phase. If someone has removed she was suffering from prolapse and she has removed her uterus. So when she removed the uterus so in initial one or two or three month healing is going on.
So in that case we will focus as a physio or as a pelvic therapist on healing or improving the blood circulation into that area. So better healing can take place. So healing and after that will start relaxing whatever effect happen because when they will remove the uterus what they will have what will happen with the vagina. So they have to suture the vagina with the pelvic cavity and then the tension will be there around the vagina. So first let the healing happen. Second let the relaxation happen. Uh let let create the relaxation and increase the mobility and then we will activate the muscles and then we will put the female on a strengthening protocol. So this female can take more time. So depending upon that uh it is very important to understand this pelvic organ and their relationship with the endopelvic fasia and that their relationship with the muscles. It can be the opterator muscle or it can be that pelvic floor muscle. I hope uh we are clear about the organ relationship with and their functioning relationship with the pelvic floor and their effect.
Are we clear?
Yes.
>> Keep writing. Any doubt um ask me at the end of the session.
Okay. So finally I hope you understood the whole body up down and um another thing which we I missed is you know that this is what you know one important segment is who can give me the full form of ISC in our body which we are missing all of us we are missing in our assessment. ISA stands for what?
Infra infra sternal angle.
Okay. So what is infraral angle? So this is my sternum. This is my ribs right and left. They're going downward. And can you see the right and left? They're creating one angle here.
All of you palpate your ribs and uh join your hands such a way that your upper uh finger touch the zifoid process right and left. Can you feel what angle is they are creating here?
Yes, they're making one angle.
>> Yes, sir.
>> So, are you checking this angle and what is the importance of this angle? Are you ever have you ever checked this angle in any of the patient?
Yes or no?
Or any understanding about that angle assessment?
Uh hopefully no. Most of you yes or no? No. Yeah. So it is very important very important very important.
Now how why? All right. So uh we call it as a infraral angle and I think it is going to take um okay what what I'm going to give you another homework infraernal angle you if you have time that is a third homework look for that an infraral angle relationship with your back muscle with your abdominal muscle your diaphragm and your pelvic floor if you have time. uh otherwise I will explain you in detail in our upcoming session during the assessment because it is very important part of assessment and this angle um okay if I want to tell you in a short very short story long story cutting short so what happens actually every male or female normally we have a one significant angle present so the male can have a narrower angle as compared to female uh because our body in such a way we have a external organ extra organ in our body and that is uterus. So due to that we have a kind of more wider cavity pelvic inlet is more our pelvic cavity is wider. So same like our we have more expansion into pelvic cavity and that is going to give expansion into the abdominal cavity lateral expansion and that is going to give a little bit later little expansion over the uh this um thoracic cavity and we have breast also over here. So they have a different structure. So R in first angle is little bit wider as compared to male. So if this angle is wider it means who is away from each other in female as compared to male the ribs. So ribs are more kind of away from each other as compared to male. Okay. So due to that pressure of your breast and your downward structures. So now normally this angle is approximately 70° in male and this angle is approximately 80 to 90° in female. Now another thing is when and how you are checking this angle. If you are checking this angle in lying position if the female is in supine or male is in supine the angle can be 90.
If you are assessing this angle in is in a standing position it can be a little bit here and there. So 80 to 90 in female that's a normal angle and 70 to 80 in male. So all of you check your angle. Uh you can use the gonometer. You can just mark with the pen by just palpating the ribs of one side and mark down to up last rib to up last rib to up and try to just see that how much angle it is creating. So normally in fe normal female it should be 90° and uh during that male fe it it can be 80 max. So now how it is important? So if this angle is more than 90 in a female. So what does it mean? It means that ribs are away from each other. Okay. If the ribs are away from each other. So let me just create assume that this is uh this is not paper but assume that this is the thoracic cavity assume it is a thoracicity. So I'm talking about this angle uh okay assume that this angle uh this is a zifoid and this is your ribs.
Okay so this should be 90° if this is more than 90. So now what happen the ribs are away from each other. If the ribs are away from each other the angle will be more. So what will happen to the thoracic cavity in this case and we in thoracic cavity we have a diameter anterior posterior diameter we have lateral diameter also. So if the ribs are this angle is wider so which diameter of thoracic cavity will increase lateral. Yeah little diameter. Am I right?
Yes.
>> Yes ma'am. Yes.
>> And what will happen to the diaphragm?
The muscles which muscle which was like dome shape. If this ribs are going away so what will happen to this diaphragm?
It will be descending or ascending?
Descending.
>> Yeah.
>> Descending it will flatter.
>> It will flatten. If it will be descending so one function of that diaphragm will be always restricted which contraction diaphragm will fail to contract though dome dome will not happen it will be descending down. So now due to this descending down the air whenever air is coming in air and when we are exhaling so during exhale it should go like this diaphragm but this functioning during exhaling will not present. So now diaphragm function will not be proper. So patient will be only keep doing this kind of thoracic breathing. So because the air will not be able to push the diaphragm upward when during exhale. Okay. So it will be always shallow breathing patient will keep doing and you there will be always there are high chances that the flatten diaphragm and flatten abdominal diaphragm. What does it mean with the abdominal cavity? If the this diaphragm is flattened. So now which muscle is coming from the center of the zifoid right and left rectus abdominis right and left they're going like this string and they are inserting into the pubic symphysis complete string. So now if this ribs are away from each other so what will happen to the rectus abdominis muscle?
Think about that tomorrow. And when it will be kind of away descending pressure rectus abdominis mus is going to affect what will happen to the obliques internal and external obliques. What will happen to uh back? So understand that and this is very very very important part. And now coming to the this is like kind of core. When I tell you that so this is descending diaphragm is descending it means which pressure is increased where pressure is increased abdominal pressure is increased all the time due to this downward descent. So abdominal pressure is increased. So means from inside the balloon will be always inflated balloon that is going to give more strain over the abdominal muscles. So is there chances of desta in this case?
Yes.
>> Okay. And if diastasis rectile will happen, it will the diastasis recti will happen. It will fail to pull iliam in a neutral position.
Okay. It might be like this. It can be like this. It will fail to pull it in a right position. So very very important.
And this ascending pressure will be abdominal pressure will be kind of high.
And this abdominal pressure is going to always put pressure over pelvic organs.
So due to that pelvic organ will be always compressed and descend down. And when the organs will descend down their legs means their passage will also be under the downward pressure. So now when they are under the pressure their muscles pelvic floor muscles which is holding the legs will be also under the pressure. So what can happen to the pelvic floor in this case?
It can cause weakness.
>> Weakness you can understand. So it can be weakness into pelvic floor. So very important assessing this infraernal angle. It can give you downward displacement displaced pressure.
Downward displacement of abdominal diaphragm, downward displacement, pressure of the abdominal pelvic organ and weakness of the pelvic floor. And when the pelvic muscles will start getting weaker it will fail to pull the eal tuborosity closer and it it will fail it is going to give you the genu and it can give you the flat feet also.
So it is very very very important assessing infraernal angle. So your homework is tomorrow uh all your patients when they are coming to you just assess their infraral angle and try to correlate with their issue. Is it bad something which you are uh not assessing and might be somewhere uh important the moment you will correct this rib we call it as a rib flare. Okay rib flare this is a a term which we use ribs are flared. So now what is the treatment you know reduce this pressure. So reducing the pressure by relaxing those muscles which is tight and strengthening activating those muscles which is weak.
So that will be strengthening relaxing and strengthening both program you might you have to give your patient which is creating this kind of uh you know um rib flare or increased infraal angle and this angle is always very high during pregnancy when your baby is getting your uterus is flared up and that is putting pressure over your ribs. So there high there's always high 100 110 you'll always assess your patient during the pregnancy it will be always high. So we have to keep correcting that infraral angle keep relaxing those muscles which is tight and pulling the ribs outward.
So relax those muscles and strengthen those weaker muscles and automatically try to relieve the back or abdominal strain or the pelvic strain. It is very or that strain which is going on downwards and this can this infrasinal angle is going to affect your shoulder movement also your trapezius pain also there will be upper cross syndrome present uh the tightness in your body.
So there are so many things which is related to the infrastructural angle and yeah because we are not discussing a lot of lot of about the core we are we are discussing about one part of the core which is pelvic floor but I'm giving you that important understanding that this is all interconnected so understand about infraral angle more into detail and how it is going to affect your upper body lower body pelvic floor abdominal back and thoracic, lumbar, every region of your site and we are missing it. No one no one has ever taught us this assessment and that's why our patients are not always 100% corrected whenever or treated or they have they're getting relief because you know we are missing so many things we are missing in first angle we are missing pelvic floor somewhere we are that's why this whole core is not core core core means core means abdominal no core is not only abdominal so if I'm saying that I If I'm saying that this is the core anterior side, back down and up. It's not only abdom. So keep uh always like you know treat your patient it can be male or female even male obesity. So whenever there's a kind of big tummy viseral fat is high big tummy. So what can be present in those obesity cases?
Uh what kind of angle? Wide or narrow?
Wide. Okay. There are high chances any obese a person can be male or female that angle can be wide and we have to correct that angle. Very very very important.
That was the second thing. So I haven't uh given you any understanding about uh that you know reality that was the overview which we discussed in today's session. So now um I hope you understood that central pelvic floor downward bit idea upper bit idea and never treat it only pelvic floor only back end like this. Any question you can ask me muscles step by step all these 16 pair we will understand in more detail layer wise superficial layer, middle layer and deeper layer. Okay. Now uh tomorrow we will start that. Now if I'll say that you have a female in front of you or male in front of you and now forget about um the externally assume that your patient is telling you okay I like you know we are going to go for assessment and your patient the first guideline we are telling the patient okay remove your clothes and lie down because we are uh we want to see that pelvic floor. So I'm not going the whole body approach I'm just want to assess the pelvic floor. So for assessing the pelvic floor the clothes should be removed down there.
Okay. So lower half we'll tell them to remove the clothes even including the panties if it's a male or female both.
Once they will remove that depending upon what we will see externally. The first thing is hair presence of hair and we know that if it's a she's a female so there will be vulva mon pubis and vulva.
If she he's a male there will be mons pubis and uh penis you will see as soon as they will remove the clothes. So so this a male and female but once they are on the table. So the first thing which can be seen is their genitals. The second things which is going to be observed by us will be hair. So pubic hair the presence of that if it is not shaved. Some people they shave some people don't shave. It doesn't doesn't matter for us. So uh pub we call it as a pubic hair. So we know that hair is present around that area pubic area pubic hair that hair are all all also present around that vulva.
So uh labia majora so hair is present and assume that after assume that you are removing the hair after removing the hair the skin will be visible. Okay. So assume that you are removing the skin also. So once you will remove the skin now internally subcutaneous tissue will be present. So after that a muscle will present which muscle superficial layer of the pelvic floor. So superficial muscle will not be visible. You have to assume that under the skin subcutinous tissue fat layer is there and under that muscle is present. Okay. Once you assume that we are removing the superficial muscle after that in a female body a very important organ will be there we call it as a clitoris. So let me show you.
So she is a female and we have this external skin. There's no here. So external skin underneath the skin this will be present. What is this pelvic floor muscle superficial layer muscles around there like some some muscles present here some muscles are present here some muscles are present here some muscles are present downward superficially and once you remove this muscle. So look these are the muscles superficially and once you remove this muscle superficially there will be another structure present here and what is this? This is female sexual organ.
Now I'm making a very very important statement here. Vagina is not sexual organ. Okay. Vagina is not a sexual organ for female. Vagina is our part of reproductive system. There is no sensual nerve present inside the vagina which is giving us sexual uh feeling or stimulations or female cannot have orgasm only with the vaginal touch or vaginal stimulation. Okay. So vagina is not our sexual organ. Female sexual organ is clitoris. And clitoris is not only this pin kind of P-shaped small structure which is present here. No, it is deeper than that. Like a ice tip of the iceberg which you can see externally is a tip of iceberg. This clitoris and this clitoris is big like that quite big. It is the same size of a male penis. But that organ is hidden inside.
Male penis is externally visible but our organ is quite big. This is the legs of that clitoris. This is the body of the clitoris and this is the glands of the clitoris. What is visible externally is only this glands of the clitoris which is kind of small P-shape and everyone is saying that clitoris is a P-shaped small organ and people are saying that vagina is a sexual organ. The answer is no.
Vagina don't have any sexual nerve. if vagina would have been that sexually stimulated. So try to understand during the gynecological examination whenever any gynecology she's touching vagina. So females should have this kind of sexual sensation. Now but no one of us we never had the sexual sensation whenever any doctor is touching us. Why? Because there's no stimulation. There's no nerves into that which is going to give us that sensation. If you will directly touch our clitoris we will get sexual sensation. Okay. Because this organ you are touching that that organ which is responsible for that functioning clitoris. So this clitoris is placed present just below this superficial layer of the pelvic floor. Bulbocinosis and another muscle is present here isosis. Once you remove these muscles from one side you can see this organ is present clitoris. Okay. Uh so that is very important. So that was a superficial muscle and this is the part which is visible externally but organ is completely inside hidden. Our our problems are always hidden. We are hidden. We try to hide our problems. We don't speak and we are shy and this and that. God has given us this hidden organ also. And you will be surprised. I should not give you so much homework. So I will send you one video about the clitoris. The truth about clitoris the world the whole world even the science was not aware about this big organ present in our body since late '9s so whole era so far people were not knowing that we have another organ in our body and that is clitoris so I'll send you that video uh there are so many videos like that you will find so still myths are there that is a sexual organ we have to have intercourse without inside the vagina and male most of the male they don't even know about this important fact that's why they fail to uh you know kind of you know when we say the satisfactory rate between male and female 80% of female they are not sexually satisfied because their partner they are not aware about that important uh fact of their life their women's life even as a women we don't know about the important factor of our life. So u about this so I'll send you one um whenever our our session will be off in between during the festival time period I'll keep sending you some videos. So I'll send you the video about female sexual health. That video is around four to five hours and that is going to give you more clarity about the female sexual functioning and what is important during the sexual stimulation for a female and how we have to understand our body and how we have to convey this to our male so they can also understand what we like and what we don't like. Okay. So that is very very important. That's why 80% of female when they are not satis sexual like kind of satisfactory satisfaction is not there. So that reason is we are not aware about their body ping. So this is the organ present just below the superficial layer and once you remove this organ then the another layer will come deep middle layer of the pelvic floor. So this is the middle layer this is the clitoris and this is the superficial layer. So can you see the clitoris is sandwiched between that pelvic floor muscle. So the more good muscle now we need sexual sensations orgasm is a word very good word. So when we say orgasm so for an orgasm we need this muscle this organ to get stimulated. So who is going to give stimulation to this organ? The first is the more erection into this organ. Like male is having erection which is visible but female also has erection which is not visible which is inside. So during this when the blood comes into the penis it goes for uh kind of you know erection. Same way when female is aroused blood starts coming into that uh organ and it it goes for kind of erection. So erection happens in the whole legs of that. So whatever size of this legs it is going to go for more dilation. So more erection is directly depending upon the blood circulation how much blood d blood capillaries how much your heart is functional your arteries are functional so that is going to send lot of blood into that area and there's more signs nitrous oxide release is there what the female is thinking she really want that hormones to come into into action which is going to give direction to the her to pump blood toward that so it's a kind of quite uh deep science which will be explained to you. I will share the video today only.
If you have time, you can just go through that. If you don't have time, whenever you have time, you just go through that video. So, it's very very important. So erection now you can understand erection means swelling of this organ inflation of this organ everywhere and during that infl inflation what will happen to it is going to push that pelvic floor muscle anteriorly posteriorly and during this activity if female pelvic so what sort of pelvic floor muscles we need we want the muscles which can relax when this is going to go for expansion so muscle should go for relaxation when the erection is going on here and once the erection will be achieved. What we want, we really want at that stage also to keep going for relaxation or we want contraction. We want toned muscle. The more tone muscle female will have, the better it will compress the what the nerves the whole organ organ is sending signal to the brain. So the more good tone into these muscle superficial and middle they or pelvic floor they will keep compressing this organ. More compression of this organ means more uh stimulation sending to the brain and female will have more better sexual uh functioning going on and that can lead to orgasm. So means which which sort of pelvic floor muscles we need here the muscles which can relax to facilitate this you know erection and muscles which can contract which has a good tone. So any female who has a weak pelvic floor weak muscles will not which they will fail to create a compression over this organ during the or stimulation phase.
We have a certain phase of sexual functioning like desire phase, arousal phase, stimulation phase and then we have orgasmic phase. So you can understand when you have you don't have a stimulation you will not have orgasm.
When you not have orgasm you cannot have relaxation of your body or your mind that type of female will never get orgasm. She will ne never get sexually satisfactory satisfaction or she will also be always frustrated female because her brain and body never got released.
So orgasm gives you your mind it will take your mind into deep state of relaxation. So very very very important.
So who is important for this functioning? Yeah I know that psychologically relationship with the partner and I want to go for it or I don't want to go for it. It's my my mind my brain command. So that's the first factor and after that psychologically physiologically my body how my body is responding the hormones is important.
Then uh the right hormones is important.
Then right uh functioning of the heart is important. The functioning of the uh you know respiratory muscles are important. The functioning of your pelvic floor muscles are important. If the muscles are good tone, better relaxed muscles, better toned muscle, better good orgasm female can have and that is the completion of the sexual activity means completion of that physiological need means brain mind psychologically female will be more relaxed. So it is very very important which is the fact that this simple organ not simple organ it's a unique organ God has given us something extra so and we are hope like thankfully in our generation we are aware about that but our mothers they were not aware about this important fact and we really want know you and even gyex they all are aware about this fact so but they are not telling us I don't know why what is the reason but we I really want we we are not loud We are not going to the society and telling them oh this is your choice. No at least whoever is telling you in your life that they are they they are having some issues related to their sexual life. So we can give them answer but when we can give them answer when we have clarity. So having this clarity is very very very important. So, so you can understand the superficial muscle, clitoris, middle muscle and after that this deeper muscle u levator ani and through that we have three openings urethra will cross vagina will cross and anus will cross. So this is how these muscles are layered up in superficial middle and deeper between superficial and middle crus is present in a female body. In male uh between superficial and middle prostrate is present you know that is attached middle ear is attached with the prostate not the superficial middle uh is attached with the prostrate which is a male organ. Um so same way externally superficially superficial muscles are attached with um if I just show you I'll show you structure is also there so you can you can see that how that muscles of pelvic floor are attached with the penis base of the penis. If this is the penis, so half of the base of the penis is covered by the pelvic floor muscle. So very beautiful present like kind of um u support to that sexual organ or penis is not only the sexual organ it is doing the multiple. Yeah, penis is a sexual organ but the urethra has a different three function. So that muscles are attached with the male sexual organ and after that superficial middle and the deeper is a liar which is going to just come in with relationship with the organs. So this is how beautiful body is there.
Pelvic cavity, pelvic organs supported by a very nice, very good uh muscle uh pelvic floor. But um fortunately or unfortunately this muscle God has not created this muscle for um taking that much of load of your abdomen all the time. Because whenever we are standing our abdominal load, upper body load is always falling on this muscle pelvic floor and the gravity is also pulling it down. God has not created us like this.
Uh he has given us a big muscle uh to work against the gravity. Not this small muscle. God has given us which muscle abdominal because we were on our four when our ancestors. But this revolution theory from four like when we were on our four like animals the big abdominal muscles used to build for uh work against the gravity against this abdominal load and the load should not go to that back muscles isn't it that more muscles through which the passages are passing but due to this revolution load transfers and the load came into um over this small muscle and that's why issues happens pelvic floor issues. I think very beautifully God has designed us and yes as a girl we are so lucky because God has given us uh urethra for urination, pletoris for sexual functioning, God has given us vagina for reproductive functioning. So three different organ for three different functioning. So reproductive functioning period coming out, baby coming out, sperm going in, vagina is there. Uh urination that via thigh is there and sexual functioning is there. But for male they have only one organ penis and into the penis there is one uh urethra and that urethra is responsible for reproductive function. So means ejaculation is going on through the vagina uh through the uh penis ejaculation of the sperm. Urination is also going on through the same uh urethra which is crossing from that penis. So penis is a organ and through this this is organ and through that this urethra when canal is coming and through this canal ejaculation urination is going on and this organ the whole external around the any space around then this surrounding this canal urethra we are calling it as a corpus cavosas of the male uh the penis in our inside the penis corpus cavosas are present but that penis is responsible possible for erection but as a whole if people don't understand urethra and penis as a a different entity antitity so we can use the simple word penis so penis is responsible for erection urination and ejaculation so god we are favorite to god god has given us three different function and one one three different organs for three different functioning and one organ to for all these three functioning so we are happy.
We should be uh happy that we have three different organ. We have we can become mother. Um yeah they have different strength and things but we are blessed.
So this was a kind of bit understanding about initial of the pelvic floor. I hope now I'm going to stop my session here. I hope you get a little bit out of today's session and u you might find it valuable. anything which you found valuable you must have written it and make keep making notes because as I told you that um it's it is all experiences which is keep adding things are sometimes it is not even into the books which we keep discussing uh so keep making your notes you can always keep uh uh checking it uh through different different platforms one day you will you will get answer that it is right one day you might get answer that something goes wrong so don't worry let me know also I will also learn with you but hopefully I will not give you wrong information okay all the take care of yourself all the very best I'm so happy that we have a girl and boys both into these sessions and if you are a girl keep shining keep uh you know spreading this awareness with other women's in your life support them because no one is supporting them with this intimate health issues and private health issues or bladder and b health issues or sexual health issues not even discussed. Same way if you are a male so I hope that you can understand better. You are female now and you can also give these guidelines to your male friends. Uh convey the right information to the world. We can generate the education focus on to awareness that is also part of phys. Okay. So take care of yourself. Uh keep loving yourself, stay happy and uh stay informed and um stay full full of love, full of information, full of acceptance all the time and love the person you see in the mirror every day as soon as you wake up. So keep uh looking in the mirror and keep smiling all the time. That's going to give you a different side of um different kind of experience, positivity. This positivity is going to give um who is going to give you this positivity you. So believe in yourself. This world is just revolving around you only. If you are not there nothing is there. So love yourself. This is what I really want. Take care of yourself. See you tomorrow. Any question you can ask me.
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