August 08th, 2023

Does Your Pelvic Floor Really Matter? FACT  VS  FAD

It seems that everywhere you turn, there is an article about the pelvic floor or something.   Every woman's publication is talking about it, there are blogs all over the internet about it, and every PT clinic seems to be promoting it.   The reality is that women's health on a whole has been on the back burner since the beginning of modern medicine.  Many challenges that women face are chalked up to a typical experience of female puberty, then childbearing, then menopause, then aging.   Rarely do issues rise to a level of “No you don't have to just deal with this.”  So the fact that pelvic floor dysfunction is getting so much attention, well we say “IT'S ABOUT TIME!”   Time for our health to take a front row seat, time for you to stop waiting to take care of yourself, time for you to stop just putting up with it!

What is the pelvic floor anyway?  
The pelvic floor is a complex set of muscles ( deep and superficial transverse perineal muscles, piriformis, coccygeus, levator ani, obturator internus, bulbospongiosus, ischiocavernosus) ligaments, and tendons.     It is located between the “sit” bones side to side, the pubic bone in the front and the tail bone in the back.    It is part of what is considered your core muscles.    

The pelvic floor acts as a hammock to support the organs held in that cavity- bowels, bladder, and uterus mainly.  This support not only helps hold the organs in place but helps to absorb outside pressures from lifting, coughing, sneezing, etc in a way that minimizes downward pressure and protects those organs.  It has 4 other main functions to include stability- as a core muscle the pelvic floor stabilizes our pelvis and low back.  Next is sphincteric- controlling the release of urine, feces, and gas.   Followed by sexual function and lastly circulation- assisting with blood flow returning to the heart. 

Is pelvic floor dysfunction really as common as its being made out to be?
Actually it is!    According to UCLAHealth, 1 in 3 women will experience a pelvic floor disorder in her lifetime.    On a side note, the pelvic floor is also present in males and while we are focusing on women in this post, it is important to note that according to the Mayo Clinic, roughly 16% of males struggle with pelvic floor challenges.    Overall a massive amount of our population is affected by dysfunction of the pelvic floor, it deserves all of the attention it is getting. 


 What does pelvic floor dysfunction look like?  
Most people think about incontinence immediately when they hear pelvic floor problems.   This is true!  Leakage of urine is a common symptom that affects around 50% of women according to the Mayo Clinic  You see commercials for products to assist with this daily on TV so this topic is a little more socially acceptable but did you know that leakage of feces is also due to pelvic floor dysfunction and affects up to 1 in 4 women at some point in their lives!  Now no one wants to talk about that!
Maybe you have heard about organ prolapse in relation to pelvic floor dysfunction and this is also true.   Your uterus or bladder can literally drop down and bulge through the protective layer of the pelvic floor muscles and into the vagina!   Now do I have your attention that the pelvic floor deserves a lot of respect?

Rectal prolapse is not as often discussed but it is also related to pelvic floor dysfunction.  Rectal prolapse is when the rectum turns inside out and bulges through the anus.  Who wants to deal with that?

Painful intercourse is a symptom of pelvic floor dysfunction.  From adhesions, to limited range of motion and spastic muscles; there are many reasons why sex may be painful.  None of the reasons have to do with a woman just needing to relax.  Enough of that!

Pelvic and low back instability and pain are more often discussed but not often realized as a disorder of the pelvic floor.   Our pelvic floor is just muscles, ligaments and tendons.  It is a central part of the core muscles and without stability, pain happens.  

OK! The Pelvic Floor is Important. Kegels are Enough to Keep It Working Well, Right??
So strengthening the muscles of the pelvic floor is super important.   Kegels is one way to strengthen but it is not the only way and most women are doing kegels wrong.  Anyone who has tried to take an exercise class knows that the instructor is steadily correcting techniques of all participants in the room the whole time and the same is true for engaging the pelvic floor muscles.  Most women need help to learn the best technique.  

Also sometimes the muscles of the pelvic floor are actually really tight, just like hamstrings on many people.   When a muscle is so shortened, or tight, it is hard to engage it fully.   First you must learn how to lengthen it, then work on strengthening it.  Unlike a hamstring however, it is really not so easy to know if your pelvic floor muscles are tight.   Most people require the use of equipment to understand how to fully and properly engage those muscles.  This is called Biofeedback and works by providing a visual display of the muscle contraction and relaxation for muscle memory training.  This is a painless process and highly impactful.  

Being able to engage a strong contraction, strength, is only part of the equation when it comes to functional outcomes.   Endurance, how long you can hold that contraction, is also super important and has been correlated to sexual function, pain, instability, and incontinence.  

Another factor for improved pelvic floor function is range of motion of hip internal and external rotation, hip extension, and hip adduction.   Speaking of these motions, strength of each of those actions affects pelvic floor function greatly.  

Pelvic floor dysfunction can be related to scars and adhesions.   Scared tissue does not move the same way as other tissue and can restrict motion, restrict contraction/relaxation ability, and cause pain.   Adhesions are caused by micro and macro traumas of tissues and can negatively affect mobility causing pain.   There are techniques for addressing scars and adhesions to improve mobility, decrease pain and allow for smooth engagement of the tissues again.

Most importantly, strength is not the only thing that will improve pelvic floor function and most of the time, other body systems need to be incorporated into the strategy for optimal pelvic floor function.   

How Effective is Treatment for Pelvic Floor Dysfunction Actually?
This is the best news yet!   There are physical therapists who specialize in the treatment of pelvic floor dysfunction.   Under this directed care, most women report regaining full control of their bladder.  Definite decrease in frequency and amount of leakage.   PT has also been highly correlated to improved stability of the pelvic floor resulting in decreased pain and improved function.   Myofascial work for adhesion resolution and scar massage can drastically improve mobility and tissue alignment resulting in decreased pain.  PT is the standard of care for improving range of motion, strength and endurance.    

Each condition noted above from incontinence to pain with intercourse can positively be affected by working with a PT specialized in pelvic floor care.    You can avoid surgery, you can return to your chosen level of activity without use of absorbency pads, you can enjoy sex again!    Most women even report noticeable results after the first two treatment sessions.  

In conclusion- Yes the Pelvic Floor is Important!  Yes you Should Take Care of It!    Yes Results are Huge and Quick!    So Stop Waiting and Just Putting Up With It!!    We are the experts that you need! Let’s get you started now!