What is the Pelvic Floor and how is it treated?
Our Pelvic Floor Muscles are often misunderstood and underappreciated. This is because they are difficult to visualize and are hard to feel, and yet they play vital roles. The Pelvic Floor has four main functions: stability for the entire body, bladder function, bowel function and sexual health. Since they are part of many of our unconscious everyday activities, and we can’t see them, how can we train them?
“I pee when I run”, “I pee when I cough”, “I have pain during intercourse”, “I have chronic lower back pain that isn’t improving”, are all signs you may have pelvic floor dysfunction. While these symptoms aren’t always the easiest to discuss, the role of a Certified Pelvic Health Physiotherapist is to be comfortable discussing sensitive topics, and to support you as you create a plan for healing.
The Pelvic Floor Muscles support the pelvic organs – the bladder, rectum, and uterus or prostate. These muscles span the length of our “sit bones”. Many therapists describe this area as a muscular sling or trampoline, one that has the ability to move up and down. If you have a vulva, your pelvic floor has three passages: the urethra, vagina and anus, and its main function is to help keep these passages closed. It is not always strengthening that is needed to improve the function of your Pelvic Floor. While it is certainly the case for some, in others it is actually relaxation and retraining that is needed. In both cases, to get to the root cause of Pelvic Floor Dysfunction, the Pelvic Floor Muscles need to be looked at as part of the entire person, their history, and their goals.
Certain activities and factors can disrupt the function and resilience of the pelvic floor. These include pregnancy, childbirth, constipation, chronic cough, heavy lifting, high impact exercise, age, and obesity. Pelvic floor muscles are also important in the role of sexual function. In people with vulvas, the pelvic floor provides voluntary contraction that enhances sexual sensation and arousal. It plays a vital role in helping women reach orgasm and making sex comfortable (that’s right, painful sex is not normal.) How about the pelvic floor’s role in chronic low back pain? These muscles are integral to stabilizing the lower back and supporting our lumbar spine.
What does Pelvic Floor Physiotherapy look like? The answer is going to be different for everyone. Here are some of the techniques that may be used:
Education: Understanding your unique situation and your anatomy is key. Learning about your history and the factors that have led to your current issues provides the basis for long-term relief and getting back to the activities you love. Education may also entail learning about how different habits and lifestyle factors may be affecting your symptoms.
Exercise: You will learn not only how to contract these muscles, but also how to relax them. This will be accompanied by breathing techniques and other techniques to address other areas of your body that may be contributing to your symptoms.
Manual therapy: Evidence-Based Techniques implemented by your Physiotherapist may include massage, Graston technique, and other options to improve blood flow, promote relaxation, and speed healing.
Biofeedback: Real-Time Ultrasound may be used in order to help you visualize how the muscles are working in order to enhance their ability to contract.
Pelvic Pain often goes undiagnosed or misdiagnosed because many Doctors in the field of Gynecology remain hyper-focused on the bladder, uterus, and vulva, ignoring the pelvic muscles almost entirely. A 2016 article in American Family Physician stated that chronic pelvic pain is estimated to affect between 6% and 27% of women worldwide. A 2012 article in the Journal of Obstetric, Gynecologic & Neonatal Nursing estimated that myofascial pelvic pain in women may be the underlying cause of chronic pelvic pain in 14% to 23% of cases. It also estimated that it may be the cause in up to 78% of cases of interstitial cystitis, which is a type of otherwise unexplained bladder pain.
A Certified Pelvic Health Physiotherapist you can trust will help you clearly describe your symptoms and map out a plan to move forward. This type of Specialized Physiotherapy has been shown to improve outcomes without medication, surgery, or other invasive techniques.
Am Fam Physician. 2016 Mar 1;93(5):380-387.
J Obstet Gynecol Neonatal Nurs. 2012 Sep; 41(5): 680–691.