The Pelvic Floor. Perhaps you have heard this referenced before but did not have a definitive idea of what it was. Is it just a region in the body? A single muscle? Let us explore this very important topic.
What is it?
The Pelvic floor is a group of extremely important muscles located on the inside of the pelvis with a hammock like orientation. They attach to the tailbone (coccyx) at the back, the pubic bone in the front and span side to side.
Functions:
These muscles are involved in several complex functions but are often overlooked in their contribution due to their “out of sight, out of mind” presence. These functions include:
1) Bowel and Bladder Function and Support
Assists in control of the bladder and bowel (helping to prevent incontinence) in males and females. In females, the pelvic floor supports the uterus and other organs located in the pelvic cavity, helping to prevent prolapse. Prolapse is the lowering down of a pelvic organ from its normal position.
2) Contribution to our Core Muscles
The pelvic floor acts as the base of our core in combination with the deep back muscles and diaphragm for strength and stability of the spine
3) Involvement in sexual function
The pelvic floor plays a role in the sensation during sexual intercourse. Dysfunction of these muscles may contribute to painful intercourse, decreased sensation, and reduced erectile function amongst other symptoms.
4) Involvement in pregnancy and delivery
The strength of the pelvic floor muscles is very important during pregnancy. They help to support the extra weight of pregnancy, which can reduce certain symptoms of discomfort. They can also help to decrease the incidence of incontinence and prolapse. Additionally, they play a significant role during delivery in guiding the baby's head down the birth canal.
Symptoms of Dysfunction
When the pelvic floor is working in harmony, it plays a significant role in a variety of our physiological functions. What happens when something is not quite balanced in the pelvic floor? Symptoms may arise. They often present as a result of one of two scenarios: weakness in the pelvic floor or increased tension in the pelvic floor. It is common to assume that any pelvic floor concerns are automatically as result of weakness, and that Kegels should immediately be practiced. However, Kegels are NOT always the answer! If the primary finding in the pelvic floor is tension, Kegels can in fact do more harm than good.
So, what are some of the symptoms associated with pelvic floor dysfunction?
Urinary issues, such as the urge to urinate, incontinence, urinary frequency and painful urination.
Bowel concerns such as constipation and incontinence
Lower back pain
Pain in the pelvic region, genitals, or rectum.
Discomfort during sexual intercourse for women.
Pressure in the pelvic region or rectum.
Muscle spasms in the pelvis.
What are some of the Risk Factors for Pelvic Floor Dysfunction?
A history of back pain
Previous trauma to the pelvic region such as a fall or pelvic radiotherapy
Ongoing constipation (i.e. regularly straining to empty your bowels)
A chronic cough or sneeze (e.g. due to asthma, smoking or hay fever)
Being overweight, or having a body mass index above 25, and
Heavy lifting on a regular basis - either at work or at the gym most commonly
During pregnancy and post-partum, some factors may arise
Women who are going through, or have been through, menopause
Women who have had gynaecological surgery (e.g. hysterectomy)
Men who have had prostate surgery
Elite athletes such as gymnasts, runners or trampolinists
What is a Pelvic Physiotherapist and How Can We Help?
A pelvic physiotherapist has advanced training to assess and treat the pelvic floor through a combination of external and internal examinations for both males and females. Internal examination allows the therapist with specialized training, to evaluate the pelvic floor directly to identify contributing factors to an individual’s concern. Typically, tension or weakness are underlying imbalances in the pelvic floor. Although this is an area less known for its muscle contribution, the parallel of a shoulder injury should be drawn here, for example. In order to help treat a shoulder problem, a physiotherapist would still have to evaluate all the muscles around it and check to see where the dysfunction lies. Once found, these same muscles should be treated directly. This is the same principle to keep in mind when trying to understand pelvic floor dysfunction and subsequent treatment.
Treatment
Once a comprehensive history and examination have been completed, the pelvic physiotherapist discusses all findings and a treatment plan with the individual. Pelvic physiotherapy treatments vary depending on the individual, however, some of the techniques/methods often used include:
Postural training
Release and mobilizations to any external factors (often the low back, hips, etc. are involved).
Connective tissue release. Connective tissue is the thin layer found above our muscles and can cause tension pulls and compression in areas which may result in pain and dysfunction.
Dilator work
Internal techniques to release areas of tension, or to properly teach contraction exercises AND relaxation techniques- which are often overlooked
Exercises: positional to alleviate pain and pressure, to strengthen, stretch, activate, build endurance, improve coordination and several others depending on an individual’s concern.
Breathing techniques
In cases where internal assessment or treatment may be painful, external treatment can be initiated first. This can often reduce the tension contributing to the internal discomfort. Progressions can be made to achieve the ultimate goals of the individual.
It is also important to note that physiotherapists are primary health care providers, and therefore can see a patient without a doctor’s referral. However, upon examination if your physiotherapist feels that you may benefit from further diagnostic testing, communication with the physician an individual has identified, will be made.
Summary
Two of the most common phrases that I hear patient’s mention during or after a pelvic physiotherapy assessment are:
“I didn’t even know that this type of physiotherapy existed”
and
“I wish I knew about this sooner”
These phrases are often derived from patients who have a pelvic concern which has significantly affected their function and/or from the belief that nothing could be done about their concern, besides “living with it.”
My hope is that the education about pelvic physiotherapy becomes known and just as commonly sought after for treatment as our rotator cuff friends. After all, they both involve muscles that can be identified, assessed and treated. Take care of your pelvic floor, it is literally of foundational importance!