What is Pelvic Floor PT?
While it’s not the easiest subject to discuss, acknowledgement and education about pelvic floor health can go a really long way. Pelvic floor discussions usually involve asking the not-so-comfortable questions, but when handled appropriately, can make a huge impact. Both men and women can suffer from pelvic floor dysfunction, and it’s not always related to trauma. The pelvic floor is just another set of (very important) muscles that needs to be talked about in more normalcy. There is no reason for someone to suffer with urinary incontinence (ie leaking), pain with sex or any other pelvic pain, and have embarrassment or fear around reporting it. We should be encouraged to talk about all areas of the body if they are in dysfunction, no matter the location.
What is the pelvic floor? It is comprised of several layers of muscle supporting the bottom part of the pelvis. Its bony borders include your pubic bone in front, right and left sits bones on the sides, and your coccyx or tailbone at the back. Each layer of muscle plays a different functional role, but in general, these muscles are essential in bowel and bladder health, sexual function and overall pelvic stability. Think of the muscles that have to contract when you really have to use the bathroom. Voila – you just found your pelvic floor and probably did what is commonly known as a “kegal”.
Pressure management is a huge function of the pelvic floor muscles. Your body is constantly adapting to changes in pressure from both internal forces ( breathing/ sneezing) and external forces ( jumping/ running). The pelvic floor plays a big role in controlling this pressure. Think of your trunk as a soda can. You have your respiratory diaphragm on top, pelvic floor on the bottom and abs comprising the sides. (In real life, it’s not that simple.. but you get the point.) With each inhale, the respiratory diaphragm contracts and descends to bring air into your lungs. To control for this change in pressure, the pelvic floor has to descend and relax. During exhalation, the respiratory diaphragm relaxes and ascends to get air out. Simultaneously, the pelvic floor contracts and ascends to assist in the pressure control. This is happening on repeat every single time you breathe. Higher pressure activities like coughing/ sneezing, running and jumping tend to reveal when the pelvic floor is not working optimally.
Pelvic floor dysfunction can present in a variety of ways. Any sort of bladder or bowel leakage can be a sign things may not be working properly. In athletics, there really shouldn’t be a time where leakage is normalized. I’ll say it again.. Leaking with running, jumping or sneezing is not a regular response in the average person. Oftentimes, it gets normalized as something that you just have to deal with during hard work outs or, for females, after childbirth. This is an issue that can be treated, we just have to open up the conversation.
Pelvic floor dysfunction can also present itself by way of pain. This can be straight pelvic pain, pain with sex, or pain with bowel and bladder function. It can also appear as pain in the surrounding areas such as the hip, groin, abdomen or low back. Your body works as a system and thepelvic floor is another part of that system.
These muscles can begin to function improperly for several reasons. Some pelvic floor dysfunctions can be related trauma such as childbirth, sexual trauma or sports trauma. Issues can also arise from chronic overuse or poor mechanics during activity. The pelvic floor doesn’t always have to be weak to cause dysfunction. It can also be too tight, creating poor movement quality and a potential issue in the pressure management system we discussed before. In general, the pelvic floor should be able to function just as any other set of muscles in the body. They should be able to contract, relax, and lengthen when needed. When it comes to symptoms and dysfunction, it’s important to remember that everyone’s body is unique. Two people may have similar symptoms, but the cause of their symptoms may be different. There is no one size fits all, especially when it comes to the pelvic floor.
If you suspect you may be having pelvic floor dysfunction, get things checked out! There are plenty of people out there who can help you. There is no need to suffer through any symptom because of embarrassment. If a pelvic exam seems scary, there are other options. I evaluate most of my patients with pelvic floor complaints by first looking at their alignment, muscular coordination and breathing technique. A pelvic exam may be necessary, but it is not the first step and can always be discussed with your practitioner. Education and discussion about this is important. There is no need to suffer through any symptom because of embarrassment.