Gender Dysphoria, Binding and the Pelvic Floor

melanieGeneral health, Healthy Lifestyle, Pelvic Floor, Physiotherapy, self careLeave a Comment

Gender dysphoria is the psychological distress that results from a mismatch between one’s sex assigned at birth and one’s gender as per the American Psychiatric Association.  This may present as a strong desire to rid oneself of primary sexual characteristics (ie. uterus, vagina, penis, testicles) or secondary sexual characteristics (ie. height, body shape, body hair) that are associated with one’s expressed gender.  

Binding is a practice that involves compressing the chest to achieve a flatter shape. This is helpful in managing symptoms associated with dysphoria.  Although binding can be extremely beneficial in managing feelings of dysphoria, if performed for prolonged periods of time, it can negatively affect the mechanics of the pelvic floor. 

By compressing through the chest wall with a binder, we can create excessive pressure in the abdomen which would increase the daily load placed on the pelvic floor. Overtime, this can result in pelvic floor dysfunction (check out my previous blog post for more detailed info). This may present differently depending on the individual and treatment plans are most effective when they are tailored to someone’s specific impairments. The old adage that Kegels are for everyone is no longer true!

If you are currently binding or thinking of starting, it is important to be aware of signs and symptoms of pelvic floor dysfunction. 

5 Signs and Symptoms of Pelvic Floor Dysfunction Related to Binding 

  1. Leaking of urine or feces 
  2. Difficulty delaying going to the bathroom
  3. Incomplete emptying of the bowel or bladder (unproductive urges, streaking on underwear, excessive straining with bowel movements or difficulty starting the flow of urine)
  4. Pain in your low back or pelvic area
  5. Painful tampon insertion (if applicable) 

If you are experiencing any of the above symptoms, I would encourage you to seek out a pelvic floor physiotherapist in your community to get a thorough assessment and individualized treatment plan! Be sure to watch out for my next blog post where I will provide safe practices for binding. This will include some strengthening and stretching exercises that are critical in injury prevention. 

Safe Practices for Binding 

Limit binding to 8-12 hours per day

  • Do not bind at night.
  • Create a safe private space that allows you to take days off as able to give tissues and organs a break.

Avoiding binding when working out.

  • Sweat and decreased lung volumes can lead to episodes of fainting.
  • Try a sports bra instead.
  • Try sizing up on your binder with exercise.

Choose an appropriate size.

  • See below links for how to size yourself properly and check the website that you are ordering from as this may vary.
  • Don’t machine dry your binder, as this may alter the size. 

Do not use Duct Tape or Ace bandages

  • Kinesio-Tape is a better option!
  • Avoid leaving the skin exposed between tape strips and cover each strip by ~  ½ the width to minimize blistering.

Protect your skin 

  • Skin should be dry prior to putting on binder.
  • Fabric should be breathable and sweat wicking.
  • Binding should not lead to any blistering or wear and tear of the skin.
  • Avoid nipple piercings and binding as this may result in pain, bleeding or snagging.

Practice Diaphragmatic (“Belly”) breathing prior to and after binding for (10 breaths). 

Incorporate a daily stretching routine that could include the following: 

  • Pectoralis major stretch in a doorway
  • Child’s pose with side bending
  • Cat Cow
  • Chin Tucks or wall angels
  • Thoracic extension over a foam roller

Include postural strengthening exercises

  • Bird Dog variations
  • Plank variations
  • Banded Pull Apart or shoulder external rotations 
  • Rows with a band or cable machine

Resources for Safe Binding

Liseanne Nelson, Pelvic Health Physiotherapist at Body Co. Toronto

Liseanne Nelson, Physiotherapist

Liseanne graduated from McGill University in 2014 with a Bachelor of Science in Kinesiology and then returned home to complete her Masters in Physical Therapy at the University of Toronto in 2016. She then practiced in Canada for two years, gaining a wide variety of experience in both the hospital and private practice setting. Her experience includes outpatient amputee rehabilitation, pulmonary rehabilitation, complex continuing care, and outpatient orthopedics. Looking to challenge herself further, Liseanne completed her licensing exam for the United States in 2017 where she spent a year working at a sports medicine clinic in Manhattan.

Now back in Toronto, Liseanne is thrilled to join the Body Co team! Her treatment approach consists of a combination of manual therapy, patient education, therapeutic exercise, kinesiotaping and modalities for pain management. Liseanne has additional training in Pelvic Floor Physiotherapy and is able to treat a wide variety of conditions including diastasis recti, incontinence, pelvic organ prolapse, and pelvic pain. Liseanne is constantly taking new courses to improve patient outcomes and to stay up to date with current best practices.

In her spare time, Liseanne enjoys skiing, hiking, yoga, running, and playing fetch with her dogs Morgan and Charlie!

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