Updated: Aug 18, 2021
You’ve probably heard of the pelvic floor, and you know it’s somewhere down there.
But you might be surprised by what your pelvic floor is able to do for you on a daily basis.
What does my pelvic floor do, you ask?
Support. Pelvic floor muscles support your bladder, colon, rectum, vagina, cervix, and uterus. Think of these muscles like a bowel that supports your organs.
Stabilization. Working in unison with your hip muscles, your lumbar spine, and your diaphragm. Pelvic floor muscles stabilize your hips and trunk, helping you to stand upright, walk and dance.
Lymphatic drainage. Your lymphatic system is made of arteries and veins. The movement of your Pelvic floor muscles helps assist in some of this drainage. Which helps you regulate bloating.
Maintaining continence. Pelvic floor muscles help your bladder and rectum open and close on demand when you need to pee and poop. As well as making sure you don’t lose continence when you are exercising, standing, or anytime you're not sitting on a toilet.
Sexual sensation. Those same muscles that help to keep you from leaking urine are the same muscles that contract and release during the Big O (orgasm).
Basically, your pelvic floor muscles are working 24 hours a day. So you might be thinking if your pelvic floor is working 24/7 it should never get weak right? Wrong!!!!!!!!. Many factors can weaken your pelvic floor muscles such as pregnancy, childbirth, menopause, aging, and excessive straining from constipation or chronic coughing.
Now let's get more specific in regards to the muscles that form our pelvic floor
The obturator internus, piriformis, levator ani, and coccygeus muscles all form what we call the pelvic diaphragm. Each of these muscles works as a stabilizer for your pelvis. When it comes to stress incontinence the levator ani muscle and the obturator internus muscle are involved the most. By the way, these are my favorite muscles to talk about.
The levator ani is a collection of three muscles: puborectalis, pubococcygeus, and iliococcygeus. One of the functions of the levator ani muscle is to support pelvic structures like your bladder, rectum, uterus, and stabilizing your abdominal muscles. It also is one of the muscles that are used in urinary voiding, defecation, and sexual function. The levator ani muscle also resists intra-abdominal pressure that can be caused by sneezing and coughing.
Ok Nicole now explain that in plain English
When the levator ani muscle is working well with your pelvic floor muscles, you can sneeze or cough without leaking urine. Let's talk about a sneeze and what happens in your body. Your abdomen fills up with the pressure that is then forced downward toward your pelvic floor. If dysfunction of the levator ani is present, it will not work well with the other pelvic floor muscles, thus, the person will experience a urinary leak. The levator ani muscle plays a large role when a woman is in labor and delivering a baby.
Did you know!
The levator ani muscles and pelvic floor undergo changes during the second stage of labor to dilate enough for a woman to be able to deliver a baby. Studies have shown that 13% to 36% of women after vaginal birth had experienced an injury to the levator ani muscle.
Let’s shine some light on the second muscle I mentioned, the obturator internus also known as (OI). The obturator internus is the deep muscle of the hip joint which is also part of the lateral portion of the pelvic diaphragms. The OI muscle is in charge of moving your hip through external rotation, abduction, and serves as a stabilizer of your hip joint. It is quite common for this muscle to develop trigger points. If a woman has an OI trigger point she may experience symptoms of urinary frequency, urinary burning, itching, tingling, shooting pains into the groin and abdomen, just to name a few.
OI dysfunction is tricky because most people can’t pinpoint the pain area exactly. For example, they may have pain on the lateral side of their hip or pain in the buttock region. Then on another day they might describe a burning-type of pain at the insertion point of their hamstring muscle (the “sit bone”). Some people may be experiencing pain in all three locations at the same time.
It’s important to know that urinary incontinence is not solely related to the dysfunction of hip muscles. Urinary incontinence can involve many different muscles and body systems. Pelvic floor dysfunction is a complex issue and requires a clinician to take a look at the person’s total body.
Pelvic floor dysfunction can happen to anyone at any time. Statistics show 1 out of every 5 people suffers from some type of pelvic floor dysfunction at some time in their life!.
Pelvic floor dysfunction at times can present with lower back pain, coccyx pain, sacroiliac pain, hip pain, constipation, and frequent urinary tract infections (UTI). As a result, it's often overlooked or misdiagnosed. Some women may even experience symptoms that feel just like a UTI, but when a urine analysis is performed the results are always negative.
How do you know if you have pelvic dysfunction? Some other signs include:
Pelvic Pain Syndrome
Pain during or after sex
Pain after urination
Irritable bowel syndrome with constipation
Irritable Bowel Syndrome with Diarrhea
Prolapse / Organ Descent
Low back pain, Coccyx pain, and or Pubic pain
It's also crucial to know that the term weak pelvic floor can mean two very different things. If the pelvic floor muscle has difficulty lengthening during the relaxed phase of muscle contraction. This can result in tension and overactivity to the musculature. Thus, making the muscle “weak”. if a pelvic floor muscle demonstrates decreased activity tolerance and poor coordination the muscle can also be considered to be “weak”. Both scenarios can result in urinary incontinence. Although if the pelvic floor muscle has difficulty lengthening it can cause pelvic pain, pain with sex, and constipation.
Treatment for pelvic floor dysfunction really depends on what the muscle is exhibiting. If the issue is more related to difficulty lengthening during the relax phase of muscle contraction then a Pelvic floor OT may begin down training the muscle. In this case strengthening may not be appropriate and can actually worsen symptoms. For this reason, I always urge my patients not to perform Kegels as these can aggravate and increase muscle tension in the pelvic floor. If the pelvic floor is having issues with endurance and or coordination then treatment will focus on strengthening the muscle.
What does down training look like, a combination of breathwork, stretches, and manual therapy to help lengthen the pelvic floor muscles. Manual therapy can be performed both internally and externally to help address any trigger points or muscle tension. Once the muscle demonstrates the ability to lengthen during the relax phase, then strengthening could be possible. It's important to realize when a muscle is shortened or in layman's terms tense, the muscle is also considered to be weak.
When strengthening is an appropriate part of pelvic floor therapy treatment it should always go above and beyond the Kegels. Utilizing exercises that also strengthen the core, back, and hip muscles are crucial. Pelvic floor therapy can also include the use of biofeedback to help train and isolate the pelvic floor muscles when needed. Biofeedback is a technique that teaches the client to locate your pelvic floor muscles so they can focus on strengthening them. This painless therapy uses special sensors and a computer that captures information about their pelvic floor muscle activity. Biofeedback can even be used during exercise, functional transfer, and movements to help retrain the muscle. ESTIM is another modality that can be used to help strengthen the pelvic floor as well as decrease the overactivity of the bladder. Electrical stimulation treatment works by sending a mild electric current to nerves in the lower back or the pelvic muscles that are involved in urination.
Pelvic floor therapy looks different for everyone. Your treatment strongly depends on the symptoms, muscles, structures, and or body systems that can be involved. Pelvic floor dysfunction is not just a pelvic issue, but rather a whole-body issue. I personally think pelvic floor therapy should be used more often. One day I hope that it's a standard part of pregnancy and postpartum care. The best time to seek pelvic floor therapy really is, when a person is experiencing any of the following symptoms mentioned in this article. Even if a client is being treated by their physician, seeking pelvic floor therapy can really be a great benefit and maximize your outcomes. Pelvic floor therapy can also be used to prepare for pregnancy, and or surgical procedures.
Nicole Muriel OTR/L, HSP (Occupational Therapist/Pelvic Floor Therapist)