The pelvic floor is made up of a network of muscles, ligaments, connective tissue and nerves. Together they create a sling-like structure or hammock, which forms the base of your pelvis and core. These muscles are active throughout the day without us having to think about them unless one (or more) of these functions aren't working properly.
The 5 functions:
Support
Stability
Sphincteric
Sexual
Sump-pump
1. SUPPORT
The pelvic floor supports our internal organs such as the:
💦 Bladder 💩 Rectum 🐍 Intestines 🐣 Uterus in females 🌰 Prostate in males
If the pelvic floor is weak or tight it won't be able to provide optimal support throughout the day and you may experience pain and/or dysfunction. Symptoms may occur in your pelvic or abdominal region, low back, sacrum, or groin, to name a few.
💥P R O L A P S E 💥 is a common symptom of the pelvic floor not providing enough support. It's possible to have prolapse of the bladder, uterus, or rectum.
Excess pressure on the pelvic floor during pregnancy or delivery, chronic constipation, straining with bowel movements, weakening of the pelvic floor with age or hormonal changes, after a hysterectomy or other pelvic surgery can cause the pelvic organs to protrude near the vaginal or rectal opening.
What are signs and symptoms of pelvic organ prolapse?
The feeling that something is in your vagina or rectum when there's nothing there
Pressure or heaviness in pelvic region
Low back, hip or groin aches
Urinary issues: leaking, frequency, retention
Constipation
The good news is that these symptoms can be resolved with pelvic floor physical therapy by restoring normal function through specific strength exercises, neuromuscular re-education, behavioral and activity modifications.
2. STABILITY
The pelvis is the main 'intersection' of the body - all roads lead here. The pelvic floor is a very important part of our core and heavily influenced by movement from the legs and torso. Including breathing and the respiratory diaphragm.
The pelvic floor plays a major roll in counteracting forces from large muscle groups such as the quads, glutes, hamstrings, abs, low back and hips. It's a complex balancing act, and in part, what allows us to walk upright.
Injuries to the low back, hips or abs (from pregnancy or c-section to name a few) can cause the pelvic floor to work harder than it's meant to which can lead to dysfunction and pain.
One study showed that 95% of women with chronic low back pain also had pelvic floor dysfunction.
Treating the pelvic floor in isolation, or any region of the body, often will not completely resolve symptoms. That's why at Rooted Wellness PT, we focus our assessment and treatments on internal and external structures that may be contributing to your problem in order to get the whole picture and resolve the root cause of your issue.
3. SPHINCTERIC
S P H I N C T E R S are muscles that allow us "hold it" on the way to the bathroom, (or when we have to fart at the wrong time). They are the gatekeepers of the bladder and bowels. When it's time to pee or poo we consciously relax them.
How do they work?
Sphincters are circular shaped muscles
They wrap around and control the opening of the bladder and rectum.
They are always active.
When there's an increase in abdominal pressure with a cough, sneeze, laugh or jump, these muscles contract around the urethra and anus to prevent leakage.
If you've ever laughed so hard you peed a little you may understand!
If they are not functioning properly you may experience urinary or fecal incontinence, frequent urination or difficulty initiating a stream, to name a few.
Normal urination is anywhere from 4-8 times/day.
A good rule of thumb is to void at least every 4 hours.
Since urine is essentially a waste product, you don't want to keep it in there too long or it can irritate the bladder lining. While many with urinary leakage don't want to drink more water, staying hydrated helps dilute urine and keeps the inside of your bladder happy. Not drinking enough fluids may actually make you symptoms worse.
Normal bowel movement is anywhere from 3 times/day to 3 times/week depending on things like diet and what is normal for YOU. Just know that you shouldn't have to strain or sit on the toilet for more than a few minutes to have a 'normal' bowel movement.
The good news is that for those that do experience abnormal bowel and bladder function, symptoms can be assessed and treated by a pelvic floor physical therapist. As a Pelvic PT I am trained to restore normal function through manual techniques, specific exercises, neuromuscular re-education, behavioral and activity modifications.
4. SEXUAL
Sexual function is an important dimension of life and you may not ever know the complexities of it unless something goes wrong in this department. The pelvic floor muscles are responsible for arousal, function, and orgasm in women and men. The pelvic floor muscles have to both relax and contract for proper function. When the pelvic floor is not functioning optimally you may experience reduced sexual arousal, infrequent orgasm, painful sex or a complete lack of desire.
I think we all know sex is supposed to be a pleasurable experience but for many it is not. There are several reasons why someone may not enjoy or want to participate in sex but everyone should know that if you want help, there is help out there.
Confounding things further, providers may not know what treatments to offer or which specialists to refer you to.
You might be told to simply;
"relax more"
"drink a glass of wine"
Or offered treatments like pain medications, hormones or antibiotics that don’t provide any relief.
People often feel ashamed, embarrassed or even broken when they have problems in this area. As a society we don't talk about these issues enough and they become stigmatized. So many people feel alone and have no idea how many others are experiencing the same problems. I am here to tell you that if you have pain with sex, you are not alone and there is help available!
Properly trained pelvic floor physical therapists have specific treatment techniques to address a myriad of sexual dysfunction issues. This is not an easy thing to ask for help with, especially of you've asked in the past and been told "nothing is wrong", or "that's not a problem". If you have pain, then something is wrong and you deserve to be believed and helped.
5. SUMP-PUMP
Last but not least!
You probably have no idea how important your pelvic lymph nodes are until something goes wrong or you have them removed due to cancer or other disease.
Just like the calf muscles in your leg act to pump blood and lymphatic fluid back up towards the heart, the pelvic floor muscles act as a blood/lymph pump for the pelvis. A loss of this “sump-pump” action can contribute to pelvic congestion, swelling in the genitals and/or lower extremities.
There is a large lymphatic network in the pelvic/abdominal region of our bodies (swipe for pics). Lymphatic congestion in this region can manifest after any type of pelvic surgery, lymphadenectomy (lymph node removal), cancer treatments such as radiation, or from a defective lymph system.
Manual lymph drainage is an intervention that pelvic rehabilitation providers who are certified lymphedema therapists can offer alongside manual therapy, therapeutic exercise, education, behavioral therapies, and other modalities for patients who present with pelvic congestion. Exercise is always important for stimulating muscles to pump and promote lymph drainage.
Conclusion:
I hope you can see by now how complex and multifaceted the pelvic floor and its functions are! This is one of the many reasons why it's so important to see a specialists when issues arise in this region of the body.
It's a fascinating area of the body that I love treating. I hope you have learned something from this blog post and that it helped to demystify some of what the pelvic floor does, it does a lot!
At Rooted Wellness Physical Therapy we take a whole body approach in treating the pelvic floor. We think of the pelvis as the main intersection of the body - all roads lead here. Treating the pelvic floor in isolation often will not completely resolve symptoms, that is why we focus our assessment and treatments on internal and external structures that may be contributing to your problem in order to get the whole picture and provide relief that lasts.
We are now offering complimentary 15 minute discovery calls 📞 so that you can speak with a trained, licensed professional 👩🏻⚕️ about your concerns before deciding if pelvic PT is right for you 🤗
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