Your Pelvic FloorGet it working for you

Like the foundation of a building, your pelvic floor provides strength and support to your pelvis and spine. If this group of muscles does not work well, the problems that may arise can seriously affect your quality of life. However, help is available.

As its name suggests, the pelvic floor is at the bottom of the pelvis. These muscles span between the two bones that we sit on, extending from the pubic bone in front to the tailbone in back. This hammock-like structure supports the bladder, bowel, and uterus (the pelvic organs).

The pelvic floor muscles must perform a variety of tasks

Contracting and relaxing - The urethra (tube for urine to pass from the body), the vagina (birth canal), and the anus (passage for emptying the bowel) run through the center of the pelvic floor muscles. These muscles, along with circular (sphincter) muscles, contract to close these openings. They prevent the unwanted loss of urine, stool (bowel contents), and gas. These muscles must be able to relax to allow effective emptying of the bladder and bowel, and for pain-free intercourse.

Support - The pelvic floor creates a muscular shelf to help support the pelvic organs. The organs are suspended by ligament type structures from above. Pelvic floor muscles support them from below. If the pelvic floor muscles are weak, this can allow the organs to move downward away from their ideal position. Imagine a ball (the pelvic organs) sitting in the bottom of a hammock (the pelvic floor). If the hammock sags or is not well connected in the middle, the ball will sink into or through it. When this happens with the pelvic organs, it is called pelvic organ prolapse.

Stability - The pelvic floor contributes to our posture and core stability. It coordinates its action with the deep abdominal and low back muscles, as well as the primary breathing muscle (the diaphragm). Together, these muscles maintain stability around the lower spine and pelvis.

Sexual function - The more superficial layers of muscle contribute to orgasm. Improving the overall health of the pelvic floor increases the general awareness of these muscles, leading to more sensation and enjoyment.

Pelvic Floor Problems

Symptoms of problems with the pelvic floor include:

urinary incontinence (accidental loss of urine)

a strong desire to empty the bladder (urgency), or a need to go to the bathroom often (frequency)

fecal incontinence (accidental loss of stool or gas)

pelvic pressure, heaviness, or bulging into the vagina due to loss of pelvic organ support (pelvic organ prolapse)

difficulty emptying the bladder

constipation

painful intercourse and problems with sexual function

pain in the back, hip, pelvic area, or lower abdomen.

When the pelvic floor muscles do not work properly, one role or a combination can be affected. People of all ages are affected by pelvic floor dysfunction.

What can affect the pelvic floor?

Vaginal delivery of a baby – assisted delivery (such as a baby delivered with forceps) and prolonged pushing during labour can strain the pelvic floor muscles, organs, and nerves.

Chronic straining or constipation - this causes significant downward pressure on the pelvic organs and muscles.

Activities that involve heavy lifting or jarring - Elite athletes and those with physically demanding jobs are often affected.

Trauma - injury to the low back, hips, and pelvic region.

Chronic cough (as with asthma or COPD) - this acts like a repetitive strain injury that, over time, weakens the pelvic floor.

Surgery - particularly on the reproductive system.

Menopause - women’s bodies go through many physical and hormone changes at this time of life, which can noticeably affect the pelvic floor.

Being overweight (BMI over 25) - the extra weight will put a greater load on the pelvic floor.

Collagen - very flexible people can be at higher risk of pelvic floor problems, as the collagen in the pelvic floor is more relaxed.

What can you do about pelvic floor issues?

Pelvic floor muscles are relatively small in size, so it can be difficult to feel them. When they are not working properly, it is even more challenging to isolate and exercise them. Studies have shown that the first time women are taught how to do pelvic floor exercises (Kegels), more than 30 per cent do not do them properly, even after thorough individual instruction. An evaluation by a pelvic health physiotherapist can help.

A proper contraction should feel like a squeeze around the anus, vagina and urethra, as well as a drawing up and into the body. The buttocks, thighs, and abdomen should stay relaxed and breathing should be normal.

Pelvic health physiotherapy

Pelvic health physiotherapists treat all of the associated pelvic floor conditions. They often work closely with family doctors, nurses and other health care providers. They also partner with urogynecologists, doctors specially trained in the area of women’s urinary and reproductive systems, and in caring for women with pelvic floor dysfunction.

Remember the old tune - ‘the hip bone’s connected to the back bone?’ Likewise, the pelvic floor has strong connections to the low back, hips, pelvic girdle, abdominal wall and diaphragm. A pelvic health physiotherapist will look at all these parts of the body, as well as the pelvic floor. This way, the most complete treatment program can be tailored to your needs.

Many people have heard of Kegel exercises. However, treatment goes far beyond this simple concept of ‘squeezing and lifting’ the pelvic floor.

The pelvic floor must multi-task, being able to:

contract strongly and quickly under situations of high pressure in the abdomen like coughing, laughing, sneezing and jumping.

contract at low intensity for long periods of time for situations like standing and walking.

relax so the bladder and bowel can be emptied effectively, and intercourse can be pain-free.

It is about quality of movement, not just about tightening. Just as you should be able to fully bend and straighten your elbow, you should also be able to fully contract and relax your pelvic floor.

As with training any other muscle group, you must walk before you can run. With the pelvic floor, you will start by exercising for shorter durations and in easier positions. Eventually, you need to be able to do your pelvic floor exercises during your daily activities. This is when most people have symptoms of the pelvic floor not working properly.

What is a tight pelvic floor?

Many people hold a great deal of tension in their pelvic floor muscles without even realizing it. If you do this, the initial emphasis of treatment is to learn how to relax these muscles. Would you hold your shoulders shrugged up around your neck all day without getting sore and tired? No, and the same applies to the pelvic floor.

For instance, a person who has a problem with her low back, hip, or sacroiliac joint (where the spine and the lower limbs join) might not realize that her pelvic floor symptoms may be related. Pain may make her tighten or ‘clench’ the pelvic floor muscles, preventing them from working properly. In this case, the spine, pelvis, or hip must be treated in addition to the pelvic floor.

The pelvic floor is a complex and dynamic group of muscles. These muscles must work efficiently and coordinate with other muscles depending on the activity being done.

A pelvic health physiotherapist can use a variety of treatment techniques. These include:

manual therapy

massage and myofascial techniques

biofeedback

dry needling – acupuncture, intramuscular stimulation (IMS)

education and instruction on:

posture and body mechanics

how to properly empty your bladder and bowel on the toilet

pacing activity and managing pain

doing a home exercise program.

How to do a Pelvic Floor Muscle Contraction (Kegel)

Lie on your back with your knees bent or sit on a firm chair with equal weight on your sit bones.

Contract the muscles around the anus, vagina, and urethra, as if you are stopping gas or urine flow. Pull these structures up and into you as you contract. Continue to breathe normally. Keep your thighs, buttocks and upper abdomen relaxed. For men, you will see the base of the penis move in and the testicles move up.

Try to hold the contraction for a few seconds. Take a rest and repeat. Try to build up to three
sets of 10 contractions daily,
taking a 10 second rest between each contraction.

This is the basic contraction on which you will build a home exercise program for your pelvic floor and core stability muscles.

Other ways to keep your pelvic floor healthy

Avoid heavy lifting, and lift with good posture.

Breathe out when you are doing an activity that takes effort. Do not hold your breath, as this increases downward pressure on your pelvic floor.

Activate your pelvic floor muscles right before lifting, pushing or pulling a load.

Stay hydrated. Dehydration concentrates your urine. This irritates your bladder and puts you at greater risk for a bladder infection. If you do not have enough fluid in your diet, you are more likely to be constipated.

Reduce caffeine, soda pop, alcohol, citrus and spicy foods, which may also irritate the bladder.

What about men?

Yes, men can have pelvic floor problems too. Symptoms may include bowel or bladder urgency and frequency, constipation, difficulty emptying the bladder, pain in the lower back, pelvis, or genitals and sexual dysfunction.

Pelvic floor problems are remarkably common and there is no need to suffer in silence! If you think you have a pelvic floor problem, get help. This is about your quality of life, after all.