Pelvic floor dysfunction is a common problem that often gets swept under the rug as no big deal, leaving many who could benefit from treatment to live with their discomfort. Pelvic floor physical therapy is vastly underutilized – perhaps because not enough people understand the pelvic floor, the available treatments, or the benefits of checking in with a pelvic floor specialist for a simple wellness consult. In this article, we discuss the pelvic floor anatomy, function, and the unique role of a pelvic floor specialist.
What are the pelvic floor muscles?
The pelvic floor is comprised of several muscles that work together as a unit. While many may default to thinking that pelvic floor therapy is only for those with female anatomy, it is equally relevant for those with male anatomy. The pelvic floor for those with female anatomy is responsible for supporting the bladder, urethra, vagina, uterus, large intestine, rectum, and anus, contracting and relaxing to go to the bathroom and pass gas, facilitating blood flow and vaginal contractions during sexual intimacy and orgasms, and assisting with childbirth. The pelvic floor for those with male anatomy is responsible for supporting the bladder, urethra, prostate, large intestine, rectum, and anus, contracting and relaxing to go to the bathroom and pass gas, and facilitating an erection and ejaculation during sexual intimacy.
What are the main components of pelvic floor wellness?
Core and Lumbopelvic Stability
The pelvic floor muscles are the base of the core and play a foundational role in core and lumbopelvic stability. These muscles work in tandem to support and stabilize your spine and pelvis. For more information on core stability, check out our Core 101 article!
Bladder and Bowels
The pelvic floor muscles support your internal reproductive, bowel, and bladder organs, as mentioned above. They help to keep them secured in their appropriate anatomical space while also enabling them to function properly.
Sexual Health and Wellness
The muscles of the pelvic floor must be strong, coordinated, and flexible for comfortable intimacy to occur.
Why might the pelvic floor not function properly?
It is important to have strong pelvic floor muscles so that they can remain lifted and function properly. Weakness can occur after pregnancy, surgery, or due to hormonal changes during menopause. When your pelvic floor muscles exhibit weakness, this impacts your core, bowel and bladder, and sexual function in different ways.
Pelvic floor weakness and the core
When the pelvic floor muscles are weak, this directly impacts the stability of the overall core. Since the pelvic floor muscles serve as the base of the core, this will impact pelvic and spinal stability. To have a functional core, your pelvic floor muscles must be strong enough to remain lifted throughout daily activities, exercise, or anytime intra-abdominal pressure increases (such as with lifting or sneezing). If they are weak, they collapse downward and are unable to perform their stabilizing duties. This can lead to low back pain, hip pain, and poor core control.
Pelvic floor weakness and bowel and bladder health
Weakness of the pelvic floor muscles can result in urinary and bowel incontinence. Urinary incontinence is a very common problem and can be further classified into various types including stress, urge, overflow, functional, and mixed incontinence. The types most frequently experienced include stress incontinence (urinating when you cough, laugh, or lift a heavy item) and urge incontinence (feeling the sudden urge to urinate and being unable to hold it). Bowel incontinence is less common but can include difficulty controlling bowel movements and passing gas. Another concern with muscle weakness is pelvic floor prolapse. Pelvic floor prolapse occurs when the pelvic floor muscles are unable to hold the pelvic organs in place resulting in these organs protruding or bulging typically into the vaginal canal.
Pelvic floor weakness and sexual health and wellness
Pelvic floor muscle weakness can place an individual at a higher risk for low back and hip pain, incontinence, bladder leakage, and difficulty achieving climax/orgasm during sexual intimacy.
Pelvic floor muscle tightness is the opposite of weakness in the sense that the muscles are hypertonic, or very tense and unable to relax. This can be a result of childbirth, sexual trauma, accidents, stress, and other medical conditions.
Pelvic floor tightness and the core
When the pelvic floor muscles are too tight, this can also result in low back and hip pain just as when they are too weak. The muscle tightness causes discomfort and muscle imbalances, hindering the necessary flexibility for comfortable and controlled movement.
Pelvic floor tightness and bowel and bladder
Constipation, difficulty voiding urine, urinary urgency, and urinary frequency can occur as a result of tight pelvic floor muscles. The pelvic floor muscles must be able to sufficiently relax to allow for the voiding of urine and feces. If they are unable to do so, this disrupts the natural flow of these bodily processes making it difficult and potentially painful.
Pelvic floor tightness and sexual health and wellness
Tight pelvic floor muscles can hinder comfort during sexual intimacy. If the muscles are too tight, intercourse, arousal, and touch can be painful. Due to the mind-body connection associated with pain and sexual intimacy, this can lead to a difficult pain cycle that requires professional guidance to navigate. In the event of sexual trauma, it is very important to work with both a pelvic floor physical therapist and a mental health professional who specializes in this area.
How can physical therapy address the symptoms?
Addressing the musculoskeletal impairments
A physical therapist who specializes in pelvic floor treatment will be able to perform a thorough evaluation that often encompasses an internal examination of the pelvic floor muscles. This allows them to assess muscle health and assists in determining if the problems you are experiencing stem from weakness, tightness, or both. They will prescribe you various therapeutic activities and exercises to address the underlying musculoskeletal impairments that might include pelvic floor strengthening, diaphragmatic breathing, relaxation techniques, and more.
Providing patient education and lifestyle modifications
Addressing musculoskeletal impairments is only one piece of the puzzle. According to Natalie Sebba, a OneStep Doctor of Physical Therapy and Certified Pelvic Floor Specialist, two of the most important factors of pelvic floor physical therapy come down to patient education and lifestyle modifications.
“Without thorough patient education and meaningful lifestyle modifications, patients will not see the results they desire. This is an area of pelvic floor physical therapy where telehealth and digital resources can be leveraged to reach more patients and improve their outcomes,” says Dr. Sebba.
Consult with a pelvic floor physical therapy specialist today!
Did you know you can consult with a licensed physical therapist who specializes in pelvic floor therapy from the comfort of your own home? Connect with us today to see if we have a certified pelvic floor specialist in your state. Our specialists can provide you with a free pelvic floor wellness consultation along with customized programs that meet your unique needs.
Pelvic Floor Muscles. Cleveland Clinic. Updated April 13, 2022. Accessed July 5, 2022.