Pelvic Floor Therapy

Understanding the pelvic floor in times of function and dysfunction

Pelvic floor therapy has been growing as a treatment option for a number of concerns. You’ve likely heard of it, but you may not know what it’s involved or why you might benefit. Do you know what your pelvic floor muscles do - or where they are?! To understand how we use pelvic floor therapy to support your concerns, it can be helpful to understand what the pelvic floor does when it’s working optimally!

So…What IS the Pelvic Floor?

The pelvic floor is a dome-shaped collection of muscles that spans from the pubis (that bony prominence right at the front of your pelvis) to the sacrum/coccyx (your tail bone) and to your ischial tuberosities (your sits bones) on either side. It is actually made up of three layers – each contributing to how the pelvic floor functions. We can assess the outer-most layer of the pelvic floor externally – you can feel it yourself too! The more internal muscles can only really be assessed through either a vaginal or rectal exam - as they are deeper in the pelvis. That said, we can put together a lot of clues about how your pelvic floor muscles are functioning based on the symptoms you have and your unique health history - an assessment isn’t always necessary if you aren’t comfortable.

The Main Functions of the Pelvic Floor:

1.     Supports of the pelvic organs (it not only looks like a hammock, it acts like one too!) - the bladder, urethra, prostate (in those assigned male at birth), vagina and uterus (in those assigned female at birth), anus, and rectum, as well as generally supporting the rest of the abdominal organs.

2.     Contributes to continence of urine and feces by controlling our sphincters.

3.     Contributes to sexual function including arousal and orgasm.

4.     Provides stability to the pelvis, impacting low back pain, pelvic girdle pain and hip pain

When the pelvic floor is working well, it is able to respond quite strongly and quickly to changes in intra-abdominal pressure. The pressure in our abdominal cavity increases when we sneeze, laugh, cough, jump, run – essentially, when we brace our abdominal muscles! Our core muscles are also very responsive to movement so that we maintain stability. Even small movements can increase activation our deep core. This activation slightly changes the size/shape of the abdominal cavity and therefore increases the pressure in the system (that’s a mini physics review for us!). A pelvic floor that is functioning well can respond to this increase in pressure so that we don’t leak or experience symptoms of prolapse. That said, the pelvic floor doesn’t work in isolation to manage our intra-abdominal pressure – it is just one part of what we call our “core”.

The Pelvic Floor is a Key Component of our Core

Our core is not just our six-pack muscles (rectus abdominus), it is actually composed of several groups of muscles that support all side of our abdomen.I often find it helpful to have patients imagine their “core” like a soda can. Our diaphragm is the top, our pelvic floor muscles make up the base, and our transverse abdominus muscle wraps around us like a corset. Some small muscles our spine are also part of the picture! These muscles work in harmony to provide support and stability. They are also inextricably linked to our breathing. When we breathe in, our diaphragm descends to allow our lungs to fill with air. Our pelvic floor naturally relaxes and descends in synchrony. Along with a relaxation of our transverse abdominus muscle, this relaxation of the pelvic floor helps keep a steady pressure in our abdominal cavity.

What happens when one (or more) part of the system isn’t functioning optimally?

A wide variety of conditions can be related to pelvic floor dysfunction and a number of factors can play a role in creating this dysfunction. Typically, issues arise when we either have too much tension, or we are not able to generate enough tension. When either of these conditions arise, we can end up with urinary symptoms – frequent urination, urgency, incontinence (involuntary leakage);  gynecologic symptoms – which could be pain with (or after) sex, prolapse (uterus or vagina descending/herniating below where it should be – even becoming visible outside the body); digestive – constipation, fecal incontinence; or more general/wide spread – chronic pelvic pain, low back pain etc.

So why can’t I just do “kegels”?

Because we now know that pelvic floor dysfunction can be due to either high or low tension, there are some symptoms that can help us make educated guess about what we think the cause is - but won’t know for sure without an assessment. If you are experiencing urgency and leaks because of a high amount of tension in the pelvic floor, doing kegels will likely make your symptoms worse! Learning how to connect to and relax your pelvic floor will be more important.

An assessment helps me understand where we need to direct our treatment and goals, but it also helps you understand and connect with your body. The pelvic floor is a part of the body that many of us haven’t spent a lot of time thinking about. Learning to connect the brain to the pelvic floor muscles can be one of the most frustrating parts of treatment… and having some feedback can be helpful!

Who could benefit from pelvic floor therapy?

Anyone experiencing any of the conditions mentioned above could benefit from an individualized plan to treat and manage their symptoms. It can be helpful in maintaining strength and preparing for labour in pregnancy, as well as rebuilding strength and managing symptoms postpartum. It can helpful in managing pelvic pain and pain related to endometriosis. There’s also a place for addressing pelvic floor coordination in athletes. We know that increased abdominal pressure puts strain on the pelvic floor, which then has to have enough strength and coordination to respond! Running sends a tremendous amount of force through our system and it’s quite common for runners to experience some urinary leakage – especially towards the end of a hard effort!

There’s power in understanding your body and building awareness around what it needs to feel good! Working with a pelvic health therapist can help build that awareness to help reduce symptoms and improve function.

Curious about whether pelvic floor therapy might be a benefit to you and your symptoms? Consider booking a complimentary meet and greet apppointment to ask Dr. Fiona some questions and hear about her approach.