Pelvic Floor 101
After talking with my friends and followers, I came to the realization that not everyone understands what the pelvic floor is, which made it difficult for them to understand why all the PT and yoga exercises that I like to talk about geared for the pelvic health even matter.
So here is a break down and a couple of visuals for you.
Image credit: Heal Pelvic Pain by Amy Stein, MPT
WHAT IS THE PELVIC FLOOR?
If you think of your pelvis as a bowl, the pelvic floor muscles (PFM) are at the bottom of that bowl. These muscles connect in a bunch of directions, from your sitz bones/ischial tuberosities to your tailbone/coccyx to your pubic bone at the front. Your pelvic floor actually has five main functions:
Support // keeps your pelvic organs (bladder, vagina/uterus, prostate gland, colon) in place against gravity and sudden increases in abdominal pressure like a sneeze, cough, laugh or jump.
Stability // When you think of your core, you might only think of your abs. But if you imagine your core as a big house, your abdominals are just the walls wrapping from front to back. Your diaphragm is the roof and your PFM are the foundation. They help stabilize your hips to your pelvis and sacroiliac joint (SIJ), all the way to your low back and abdominals.
Sump pump // The pelvis contains big storage for blood vessels and lymph nodes, because there are so many organs there! Contraction of the pelvic floor muscles helps to stimulate movement of blood and lymph, keeping the fluids from becoming stuck and stagnate.
Sphincter // They actually contract and relax around both male and female urethral and anal sphincters. They prevent leakage with a light constant resting tone, but can allow for healthy passage of waste (bowel movements and urination) with ease during relaxation when working properly.
Sexual // Resilience is necessary for PFM function for full and pain free penetration/sexual intercourse. It’s also needed for orgasm! If your pelvic floor is sensitive, it can contribute to pain during or after intercourse or even child labor. For males, if the prostate gland is enlarged or sitting in an off place, it can put pressure on your PFM and can affect your sphincter control as well.
If there is some sort of dysfunction, which can come in the form of weakness (hypotonicity), tightness (hypertonicity), or incoordination, there can be a whole range of issues. Leakage of waste (incontinence), prolapse of pelvic organs, and pain with intercourse are just a few things that people deal with on the regular.
Anterior view of pelvis // Front
Superior view of pelvis // Top
MYTHS + TRUTHS OF PELVIC HEALTH
MYTHS
It’s normal and ok to pee a little when you laugh, cough, or sneeze.
You should test to see if your pelvic floor is working correctly by stopping your flow of urine while using the restroom.
You (and your little ones) should go pee – just in case – before long runs or drives.
TRUTHS
Leaking is absolutely NOT NORMAL, but very common amongst a lot of women, especially after any kind of childbirth. Even a cesarean.
Please don’t do this. This messes with your PFM’s connection to your brain and to your sphincters. You’re disrupting the important neuro-feedback loop in your body that tells your pelvic floor to relax to open the sphincters to relieve yourself. Don’t confuse it! It will only make it harder when you actually DO want to relax your pelvic floor.
This is teaching your bladder to not fill fully. Your very first instinct telling you to go pee is usually when your bladder is 50% full. Going at your second internal notification or urge to go is more beneficial for training your bladder to fill all the way. Normal urination frequency is about 5-8 trips to the bathroom/day. For bowel, about 1-3/day is indicative of a healthy flushing out.
If for any reason, these aren’t your normals, let’s talk! Or I’ll help you get hooked up with a pelvic floor PT in your neighborhood who can physically check you. Don’t hold off on this stuff. It can be very liberating to know you don’t need a bathroom every 30 minutes or can have pain-free sex with your partner.
IN MY OPINION…
One of my roles as a holistic pelvic physical therapist is not only raising awareness of these issues, but to treat them if you’ve got them, and to prevent them through education.
And this is what I do. I can evaluate and treat by going internally (yes, through the vaginal canal for females) and see/feel what’s going on. I can also watch for your coordination and effort of contracting and relaxing. This is a truly unique, special, personal, and IMPORTANT part of someone’s body that needs to be treated with the utmost respect for boundaries and levels of modesty. Some people are super comfortable in their own skin, but this can be a triggering experience, with an old pro or newer practitioner. If there has been trauma to the area through sexual abuse or a trying labor, for example, this evaluation needs to be done with care and compassion.
And on that note- even when you’re getting an annual physical from your doc and they are performing a prostate check or pap smear - you can always say no, ask for them to tell you what they are doing before they do it, slow down, or have no eye contact if that’s what you need. Don’t be afraid to ask for anything that is going to make you more comfortable with your care. This is your body, your rules. Every practitioner should understand and respect that.
Again, if you have any questions or comments, leave them below! Hope you learned something new and interesting about your body and about this awesome profession.
