Let's talk about your pelvic floor
Written by: Joanne Ukposidolo, Registered Physiotherapist
Pelvic floor muscles have been getting quite a bit of attention and for good reason. Whether it is pregnancy, orgasms, menopause or core workouts, your pelvic floor is essential to the quality of life you want to live! In this post we will review the form and function of the pelvic floor muscles, the three common pelvic floor dysfunctions and how pelvic floor physiotherapy can help. So, take a seat, grab your favourite beverage and let’s talk about these gorgeous muscles.
What Are Pelvic Floor Muscles?
The pelvic floor consists of layers of muscles, nerves, ligaments and connective tissues. Lengthwise, they connect front to back, from pubic bone to tailbone, and widthwise between sitz bones. Their architectural design creates a bowl or hammock at the bottom of the trunk and have five specific functions.
1. Support: Provides support for abdominal and pelvic organs i.e. bladder and uterus
2. Sphincteric: Continence for bowel and bladder
3. Sexual: Orgasms and erections
4. Stability: Strength and coordination for low back, pelvis and hip
5. Sump Pump: Pumps blood and lymph back to the heart
How To Locate Your Pelvic Floor Muscles
During a pelvic floor contraction, you should feel the muscles pull in and up.
· Pretend to stop the flow of urine (the sensation of closing around your urethra)
· Pretend to hold in a tampon (feel the sensation of closing around your vagina)
· Pretend to stop the release of gas (feel the sensation of closing around your anus)
Nobody watching you should know that you are contracting your pelvic floor muscles. If they can tell, you are most likely compensating. Stop and try again! Some compensations can look like breath holding, using your legs, butt or stomach muscles, clenched teeth and or bulging eyes (at this point you’ve gone too far, please stop).
Pelvic Floor Dysfunction & Symptoms
Pelvic floor dysfunctions occur when these layers of muscles weaken, become lax or tighten, preventing the muscles from completing their normal functions optimally. These dysfunctions could lead to a host of symptoms and issues, some more common than others.
Urinary incontinence is the involuntary loss of urine. This condition affects approximately one in three Canadian women.
There are three common types of incontinence
1. Stress Incontinence:The involuntary loss of urine with an increase in intra-abdominal pressure. You may leak when you laugh, cough, sneeze or with physical activity (jumping, running, walking). It is caused by the lack of support to the urethra and bladder neck and is prevalent amongst women who have given birth vaginally.
2. Urge Incontinence:The involuntary loss of urine following a strong urge to urinate that can not be controlled. It’s caused by unpredictable contractions of muscles in the bladder wall and is prevalent with postmenopausal women.
3. Mixed Incontinence: A combination of stress Incontinence and urge Incontinence. It is very common to have Mixed incontinence as opposed to pure stress or pure urge incontinence.
Please note: Although urinary incontinence is common, it is a misconception to think that it is a normal part of any phase of life (after childbirth or as you age). It is not, there is help!
2. Pelvic Organ Prolapse
Pelvic Organ Prolapse (POP) occurs when one or more pelvic organs (uterus, bladder, rectum) protrudes into the vaginal canal. This is due to the weakening of pelvic floor muscles and connective tissues that function to provide support for the pelvic organs.
Common contributing factors for weakness within the pelvic floor include
· Vaginal delivery
· Being overweight
· Chronic coughing
· Hormonal changes that occur with menopause
If you do have POP, you may notice a protrusion at the opening of your vagina. The protrusion, although not dangerous, can be uncomfortable. Some women with POP have no symptoms, however symptoms of POP may include
· Feeling of heaviness or pressure that increases against gravity (standing or walking) and decreases with lying down.
· Pain with intercourse
Please Note: Pelvic Organ Prolapse affects up to 65% of women at some point in their lives. It is a misconception to think that there is nothing that can be done about it!
3. Painful Sex
Dyspareunia is an experience of pain before, during, or after sexual intercourse. Pain with sex may occur occasionally or every single time. For some women, just the thought of having sexual intercourse can trigger the cycle of tightness, pain and avoidance of sex. This condition can greatly decrease sexual desire and enjoyment, strain relationships and significantly decrease your quality of life.
Symptoms may be mild or excruciating and can be described as a “extreme tenderness, burning, stinging or sharpness”. You might feel
· Pain with sexual penetration
· Pain with every penetration, including putting in a tampon
· Deep pain during thrusting
· Burning pain or aching pain
· Throbbing pain, lasting hours after intercourse
These symptoms may be experienced in the outer genital (vulva), within the vaginal opening, within the vagina, or deep in the pelvis. Symptoms of Dyspareunia can start suddenly or develop gradually. There are many contributing factors and causes of Dyspurenia, the most common can be found below.
· Vaginismus: An involuntary clenching of the pelvic floor muscles to prevent penetration
· Vulvodynia: A nonspecific generalized pain around the opening of your vagina (vulva) with no identifiable physical findings.
· Hormonal changes with menopause
· Psychological or emotional factors
· History of sexual abuse or an unpleasant pelvic examination
· Skin Disease
· Pelvic Organ Prolapse
· Infection of the Urinary Tract
· Reconstructive surgery
· Musculoskeletal Injury
Please Note: Sex should NOT be painful! I repeat, Sex should NOT be painful!
How it Relates to Your Core
Along with your deepest abdominal muscles (transverse abdominals), diaphragm and deepest back muscles (multifidi) your pelvic floor muscles make up your inner core unit. These core muscles are the first to contract before any bodily movements can occur. Your core functions to stabilize your body and provide an anchor for your limbs to move in space. Because of their unique, intimate relationship, an injury in one of these core muscles could cause compensations in other components of the core. In other words, your long-standing low back or hip pain can be related to your pelvic floor. Your previous abdominal surgery (C-section, appendectomy, laproscopy) could be contributing to your pelvic floor dysfunction.
Please Note: A poor pelvic floor leads to poor core activation which leads to poor movement patterns.
Questions for Your Pelvic Floor
If you are wondering whether your pelvic floor needs help, feel free to answer the following questions
· Do you urinate more than 5- 8 times a day?
· Do you feel that your bladder is not emptied after urination?
· Do you have an uncomfortable sensation of wanting to urinate that will not go away?
· Do you experience urine loss (coughing/sneezing/laughing/jumping/on the way to the bathroom)?
· Do you feel pelvic pressure and/or heaviness?
· Do you have bowel movements that are challenging to pass or less frequent than every three days?
· Do you experience pelvic pain?
· Do you experience painful intercourse?
· Do you experience pain with pelvic/speculum examinations?
· Do you experience pain within your hip, low back, sacroiliac joint and/or pelvic pain?
· Are you pregnant?
· Have you been diagnosed with any pelvic floor conditions i.e. Dyspareunia?
If you answered yes to any of the above questions, problems with your pelvic floor muscles, connective tissue or nerves may be contributing to your symptoms/pain.
You may be a candidate for an assessment from a certified pelvic floor physiotherapist to assess the integrity of your pelvic floor muscles in relation to your core and symptoms. A gold standard internal and external “hands-on” manual techniques will be utilized to evaluate and treat your pelvic floor muscles in addition to associated joints, ligaments and muscles within low back and sacroiliac joint.
Based on your symptoms, condition, and goals, a tailored, individualized treatment plan will be created to help manage pain and discomfort within your pelvic region.
For more information please speak with Joanne Ukposidolo Registered Physiotherapist and Certified Pelvic Health Specialist
Book an appointment, let’s talk. Your pelvic floor will thank you!