Pelvic Floor 101
What’s a Pelvic Physio?
I remember sitting down at my first pelvic course. I was still completing my Masters of Physiotherapy at the time, but I had already found my passion in pelvic floor physio. I sat there, surrounded by about 25-30 other peers all eager to learn more about the pelvic floor, how we could help others, and for many of us, how we could help ourselves. Let me tell you that first day was more than I could have ever imagined. It was like learning about an entirely new world. All within our bodies. How had I never connected to an area so intimately related with every movement we make, with each breath we take?
The next 30 hours were intensely filled with the ins and outs of the pelvic floor, the anatomy, the conditions we can help, and how to assess and treat internally. (In order to be a practicing pelvic physio you need to certify through one of the recognized companies such as: Pelvic Health Solutions, Uro Sante, or Herman Wallace. Every therapist must complete the necessary requirements to practice internally.) It was one of the most empowering moments of my educational career, and probably one of the most nerve-wracking. As pelvic floor therapists, we have the knowledge and abilities to complete comprehensive internal and external evaluations. How do we learn this? Well by practicing and learning on ourselves. Yep. That’s right. And I I hope I never forget the feelings of nervousness, anxiety, or unknown that I felt with that first exam, because that is exactly what most people’s first time will feel like. And you know what I learned that entire weekend? We are all different, we are all beautiful, and we all have some of the same questions. And that a lot of our symptoms are common, NOT normal.
Peeing when you laugh?
Peeing when you sneeze?
Peeing with activity?
Experiencing increased frequency?
Pain with sex?
Unable to hold it while you rush to the bathroom?
Waking up more than twice in a night to go?
Having to use the bathroom more than 7 times in a day?
Common. But not normal. But the best thing? There is something you can do about it! Step 1 is learning the basics, so let's dive in!
5 reasons your pelvic floor is amazing and why you should get to know it better:
The pelvic floor is like a hammock that supports the bladder, rectum, and uterus against gravity and any increase in excessive strain (pregnancy, hormonal changes, atrophy). By coordinating with the muscular control (see point 2) it also helps control increases in abdominal pressure (think of coughing, laughing, sneezing, lifting something heavy, or even just holding your breath).
Issues we can see here are any type of heaviness or pressure in the vagina or rectum which could be a symptom of prolapse. This can be assessed by a pelvic floor physiotherapist, who can then work through management strategies.
2) Sphincteric Control
There are a whole lotta muscles down there that we had no idea existed sometimes forget about.
These are the guys that help control against leakage and prolapse. They also allow the flow of urine and bowel movements by…. RELAXING. I don’t know about you but this was a mind blowing concept to me when I first learned it. That means, if you are straining while on the toilet, you’re doing it wrong. More on that later though.
The most important part here is a nice balance of knowing how to contract the muscles when we need them, and knowing how to relax and lengthen them when necessary.
Issues we see here are leakage, difficulty with emptying bowel or bladder, and also even hip and low back pain.
The fix: way more than just kegels. You should always first be assessed before undergoing any treatment. Sometimes issues can arise when there is not enough strength and control to turn the muscles on, but there can also be issues when you don’t know how to turn the muscles off. This can lead to both tightness and weakness! The best thing to learn is awareness of your pelvic floor and all of the actions it can control.
3) Sexual Function
Good strength is necessary for orgasm. Excessive tension and sensitivity can lead to pain during or after intercourse. If intercourse is painful for you, please connect with a pelvic floor physio or your doctor.
Issues we see here are: painful intercourse (dyspareunia), incontinence with orgasm, painful orgasm or ejaculation.
4) Sump pump
The pelvic floor is an amazing part of your “core four” muscles. It’s action, along with your thoracic diaphragm creates a pumping action that actually helps to move blood and lymph through your pelvis and whole body.
Issues we can see here can be a build up or restriction of blood/lymph flow that can lead to pelvic congestion.
Due to the connections between the sacroiliac joint, your sacrum, coccyx, and spine, the pelvic floor helps create stability within the hips, the pelvis, and the back.
Pelvic floor dysfunction has been linked to chronic hip and low back pain.
Other issues pelvic physio can help with:
Urinary & Fecal:
Over Active Bladder
Chronic Recurring UTIs
Post Void Dribble
Persistent Pelvic Pain
Painful Bladder Syndrome
Persistent Low Back SI Joint / Pubic Symphysis Pain
Chronic Constipation IBS/Bloating
Female Pelvic Health:
Endometriosis/ Adhesions/ Scarring Dysmenorrhea
Diastasis Rectus Abdominus (ab separation)
Round Ligament/Pubic Pain
Vaginismus/ Vestibulodynia/ Vulvodynia
Male pelvic health issues:
Pelvic Pain including Chronic Prostatitis, Testicular and Penile pain syndromes
Nocturia (frequent urination at night)
Diastasis Rectus Abdominus and Hernias