By Catherine Lewan, PT, DPT, CYT
Did you know that your pelvic floor is part of your "core"? Core muscles include the
multifidus, the transversus abdominus, the diaphragm and the pelvic floor. Together they support and stabilize the pelvis and spine. When one area is weak, you can experience pain and/or dysfunction. While we may exercise various muscles to stay fit, the pelvic floor is often neglected, since most folks don't even realize there are muscles there to strengthen!
So where are these muscles, and how do we keep them healthy? First of all, everyone has a pelvic floor, so guys, pay attention! The pelvic floor is comprised of pelvic muscles and layers of fascia that make a sling at the bottom of the pelvis. Picture muscles that attach from the pubic bone in front to the tailbone in back and from one sit bone to the other sit bone, making up the floor of the pelvic bowl.
Your pelvic floor is critical to:
- Support your internal organs and contents of the abdominal cavity: A weak and overstretched pelvic floor can result in the bladder, uterus, or rectum falling out of the body — a condition known as pelvic organ prolapse. Because the female pelvis has a larger opening designed for babies to squeeze through, women are particularly at risk for prolapse.
- Stabilize your pelvis and low back: Contraction of the pelvic floor draws the tailbone closer to the pubis and stabilizes the pelvic girdle and lumbar spine. Together with the lumbar multifidi (deep back muscles) and transversus abdominis (deepest layer of abs), the pelvic floor muscles play an important role in preventing back and pelvic pain.
- Sexual function: Contraction of the pelvic floor muscles increases blood flow and sensation in the area, and contraction of pelvic floor muscles provides the sensation we call orgasm. By strengthening these muscles, you can strengthen your orgasms, and preliminary research shows that pelvic floor strengthening helps to prevent erectile dysfunction in men (2). For women, pelvic floor muscles need to relax enough to allow penetration – pelvic floor muscles that won't relax can cause pain with internal examinations or sexual penetration.
- Control of voiding: When the bladder fills with urine, stretch sensors in the bladder or rectum tell the brain it's time to go to the bathroom. The brain then tells the pelvic floor "hang on!" until you can get to a bathroom. When you get to the restroom, your brain tells your pelvic floor muscles to relax, which allows for voiding. If you experience leakage of urine or feces, strong urges to go to the restroom, or frequency of voiding, then your pelvic floor muscles are probably not working correctly (3).
Regardless of whether you're currently experiencing symptoms, there are things you can do to prevent pelvic floor dysfunction or alleviate symptoms (4).
- Avoid "just in case" trips to the restroom, when possible. Forcing yourself to go when your bladder is not full can disrupt the natural rhythm of the voiding cycle and can contribute to symptoms of urge and incontinence.
- Never hover over a toilet seat. Yes, there are some gross seats out there, but hovering is an activity that tells your pelvic floor muscles to contract when they should be relaxing to allow for voiding– this can be very confusing for a pelvic floor! Cover the seat with TP if needed, and sit!
- Make sure you are actually RELAXING. Don't rush, strain, or multi-task.
- If you're having symptoms, avoid exercises or activities that put downward pressure on the pelvic floor such as high impact cardio or deep squats or lunges (5).
If you have any reason to suspect that your pelvic floor is not functioning as well as it should, we recommend that you talk to your doctor or physical therapist about your concerns. Many people are embarrassed to bring up pelvic symptoms, or they think it's normal to have symptoms at a certain age or after having kids, and they're surprised to learn that a physical therapist can help. At Andersonville Physical Therapy, we have physical therapists who specialize in pelvic health, and rest assured your comfort and privacy will be respected! We encourage you to speak up if you have symptoms of incontinence, urge, or pelvic pain. Even "a little bit" of urinary leakage or pain with intercourse/examination is not something that you should have to live with.
For more information, visit the pelvic health section of our web page. You can also give us a call if you have any questions about pelvic health evaluations or the kinds of programs we design.
- Image from http://www.continence.org.au/
- Stein, A. (2009.) Heal Pelvic Pain. New York, NY: McGraw Hill.
- Dorey, G. (2001.) Conservative Treatment of Male Urinary Incontinence & Erectile Dysfunction. London, England: Whurr Publishers Ltd.
- Section on Women's Health of the American Physical Therapy Level 1. (2011.)