What is the pelvic floor?
There has been a lot of buzz about the pelvic floor in the last few years, but mystery remains about what it is and why we need to pay attention to it.
WHAT IS THE PELVIC FLOOR?
The pelvic floor is a collection of muscles, nerves, tendons, blood vessels, ligaments, and connective tissue that are all interwoven into the bony pelvis.
The pelvic floor is comprised of 3 layers of muscles that attach to the pubic joint at the front, the coccyx (tailbone at the base of the sacrum) at the back and the two sitz bones (ischial tuberosities) on the sides. The first layer is primarily responsible for sexual response, the second layer manages the openings of the urethra, vagina and anus (think continence) and the third layer is primarily responsible for organ support (bladder, uterus and rectum).
WHAT DOES THE PELVIC FLOOR DO?
The pelvic floor has many important jobs that can be highlighted as the “five S’s.”
Stability – the pelvic floor plays a role in stabilizing and helping control the spine and pelvis.
Support – the pelvic floor plays a role in supporting the internal organs – the bladder, uterus and rectum.
Sphincteric – the pelvic floor is key in our continence.
Sexual – the pelvic floor is an essential part of your sexual response.
Sump Pump – the pelvic floor acts like a sump pump in coordination with the diaphragm in respiration.
Optimal function of the pelvic floor muscles means you are continent, pain free and moving well with confidence and power. Essentially, if the pelvic floor is working well, you don’t think about it at all. When the core is functioning optimally, your movement is anticipated, coordinated, and balanced. Meaning when you bend over to pick something up, your body, your core, knows you are doing that before you actually do it — it anticipates and prepares you for that movement. It’s this anticipatory action of your core that is so key to its optimal function. When things are going awry, it’s often that anticipatory action that has been lost.
WHAT HAPPENS IF THE PELVIC FLOOR IS NOT WORKING OPTIMALLY?
The most common types of pelvic floor dysfunction are incontinence, organ prolapse, pelvic pain, and back pain.
When urine leaks out of your body at any time other than when you are wanting to eliminate it, it is considered incontinence. You may hear it called “light bladder leakage” or “sneeze-pee” or “peezing,” but truth be told, pee coming out when you don’t want it to is incontinence and it doesn’t just happen to the elderly population.
PELVIC ORGAN PROLAPSE
The definition of pelvic organ prolapse is the descent and eventual protrusion of an internal pelvic organ through the vagina. The types of vaginal prolapse are:
Cystocele – when the bladder bulges into the front wall of the vagina. It is also called a bladder prolapse or an anterior wall prolapse.
Rectocele – when the rectum bulges into the back wall of the vagina. It is also called a posterior wall prolapse.
Uterine Prolapse – When the uterus descends it is most typically referred to as a uterine prolapse.
Rectal prolapse – when the rectum bulges out the anus; this can happen in male and female anatomy.
Symptoms of prolapse include difficulty emptying the bladder or bowels, feeling like there is something inside the vagina, discomfort with insertive sex, and a sense of heaviness especially as the day progresses. Some people may even see or feel a bulge at or near the entrance to the vagina.
PELVIC GIRDLE PAIN (PGP)
Pelvic Girdle Pain is typically associated with discomfort or pain in the joints of the pelvis. Pubic joint pain, typically referred to as symphysis pubis dysfunction, SI Joint pain or Coccyx (tailbone) pain are the most common.
LOW BACK PAIN (LBP)
Low back pain is typically pain in the mid to lower back. People describe it as a dull ache that’s chronic, or possibly shooting or throbbing pain on occasion. A group of Canadian researchers found that 95.3% of study participants for low back pain were determined to have some form of pelvic floor dysfunction.
These conditions are typically accepted as “normal” after having kids or regarded as something that happens as we age, but there is a lot that can be done to prevent these conditions from happening or worsening and also to treat them if they do develop.
WHO CAN DIAGNOSE PELVIC FLOOR DYSFUNCTION?
A great first line of defense is to make an appointment with a pelvic floor physiotherapist for a thorough assessment. You can also see a gynecologist or urogynecologist. However, it is essential that a pelvic floor physiotherapist be part of your pelvic health care team.
HOW DO YOU FIND A PELVIC FLOOR THERAPIST?
The best place to start is to google “pelvic floor physiotherapy” (or physical therapy if you live in the US) and your city. You can also check out the Canadian Physiotherapy Association or the American Physical Therapy Association. In Canada you do not need a referral to see a pelvic floor physiotherapist. It is not covered by our healthcare system, but if you have extended health benefits it is covered like regular physiotherapy. In the US it varies by state, but the option of private pay exists in most states. You will need to check with your state and your insurance plan and the therapist to see what is covered in your area.
HOW DO YOU FIX PELVIC FLOOR DYSFUNCTION?
Most people are told to “go home and do your kegels.” While we do have evidence to support the effectiveness of kegels, they are not the only option and they are not a “one size fits all” exercise either. We also have evidence that most people are doing them incorrectly and it is not their fault. We have never been taught how to do kegels and unless you know about pelvic floor physiotherapy, no one has done a thorough assessment of your pelvic floor to see if you are doing them correctly and how you may need to tweak them based on your current situation. Many doctors themselves do not know how to do kegels and yet they are prescribing them. Optimizing pelvic floor function requires a whole body approach.
We need to address diet by eating non-inflammatory foods and removing bladder irritants. We also need to ensure we are hydrated. Most women with pelvic floor dysfunction restrict fluids with the hope that they won’t have bladder urgency, frequency or leaking but this actually concentrates the urine and irritates the bladder so it starts to signal more often and more urgently to get the urine out.
How we sit and stand throughout the day influences how our pelvic floor works. A neutral pelvis means the pelvis is under the rib cage. The pelvic floor works in synergy with the diaphragm so when we breathe in the pelvic floor expands and lengthens and when we exhale the pelvic floor contracts and lifts. When we are sitting with our tailbone tucked underneath us, it impairs this synergy.
Kegels are a form of pelvic floor exercise and do work when done correctly and consistently. Their effectiveness can also be heightened if we coordinate kegels into whole body movement like lunges and bridges and even bicep curls. In a lunge, for instance, you would inhale as you lower down and then exhale to engage the pelvic floor just before you rise back up from the lunge.
It is important to know there are options and people to help you. Let’s end the silent suffering associated with pelvic floor dysfunction and get everyone back to living their best life.
A group of Canadian researchers found that 95.3% of study participants for low back pain were determined to have some form of pelvic floor dysfunction: Dufour S, Vandyken B, Forget MJ, Vandyken C. Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskelet Sci Pract. 2018;34:47-53. doi:10.1016/j.msksp.2017.12.001
Kim Vopni, The Vagina Coach
Author, Speaker, Pelvic Health Coach
Pelvienne Wellness Inc
If you enjoyed this article check out Optimal vaginal health during menopause.
This article is sponsored by Kim Vopni, The Vagina Coach.