Pelvic Floor Rehab: A Solution to a Silent Problem
Do you go to the bathroom “just in case” before leaving your home to avoid leaking while you are out?
Do you ever have accidental leakage of urine while running, lifting, jumping, laughing, or sneezing?
Do you go to the bathroom more than once every 2-4 hours or 6-8 times per day?
If you are sexually active, do you have pain during or after intercourse?
If you answered yes to any of these questions, you are not alone! It is estimated that as many as 1 in 3 women suffer silently with some form of pelvic dysfunction, whether it be incontinence (urinary or fecal leakage), pelvic pain, or pelvic organ prolapse. Not only do these conditions have physiologic consequences, but they also play a huge psychological role in a women’s overall quality of life. Several women plan their social activities around where bathrooms will be available and this is not okay. While very common, no amount of leakage or pelvic pain is normal at any age. Pads, diapers, and medications are often utilized to help improve quality of life, but these methods of dealing with the problem only treat the symptoms. You have the power to treat the underlying cause and physical therapy can help!
Understanding Your Pelvic Floor as a 3-Dimensional System:
The pelvic floor musculature can be viewed as the base of our core, which provides support to a large system designed to react and transfer forces from our upper to lower extremities and vice versa. The front of the core is comprised of your abdominals, the back is composed of the hip and back musculature, and the top is the respiratory diaphragm. All of these muscles are covered by a thin layer of connective tissue called fascia, which surrounds individual muscles and connects groups of muscles together. Due to these connections, dysfunction in any one of these places can cause a problem in another part of the system. “The diaphragm is fascially connected to the core and loads the anterior and posterior walls elevating and depressing the roof from the top and the pelvic floor from the bottom “ (Christie & Colosi 2009). Our core must be activated through all three dimensions – the sagittal (forward and backward), frontal (side to side), and transverse (rotational) planes – in order to properly load and strengthen the pelvic floor so that these tissues can work successfully to provide support to the organs above, control over urination and defecation, sexual function, pelvic stabilization, and to help promote drainage of the lymphatic system. Just as the pelvic floor can be loaded from above, it also can be loaded from below due to its fascial attachment to the hips, especially the hip rotators (deep to your gluteals) and adductors (inner thigh). These muscles must be able to be lengthened and loaded symmetrically in all three dimensions in order to stimulate similar lengthening and loading to the muscles of the pelvic floor.
Kegels are Not Enough!
A healthy pelvic floor must be both strong and flexible. Unfortunately, a one-exercise-fits-all kegel – conscious isolated contraction in which the pelvic floor muscles are lifted up and in – is most often prescribed. Kegels can be helpful in certain situations to identify and create mind-body awareness around a muscle group that needs to be strengthened; however, they are often performed incorrectly, are not training the muscles to load functionally as part of a 3-dimensional system, and may even be counterproductive depending upon the root cause of your pelvic floor issues.
Bladder control should not have to be something that you think about. When toddlers go through potty training, muscles of their pelvic floor are strengthened as they begin to move more by rolling, squatting, crawling, creeping, and walking to ultimately help gain control of their bladder function. It is through 3-dimensional movements such as these that we can help women restore control of their pelvic floor musculature.
It is important to note that there are several causes for pelvic floor dysfunction and strengthening is not always the answer. Some women are unable to relax the muscles of their pelvic floor and have trigger points that need to be manually released. Others have muscle imbalances and flexibility issues that are leading to misalignments in the pelvis that can also cause pain. If you answered yes to any of the questions at the beginning of the article, a proper physical therapy evaluation conducted by someone specializing in women’s health may be beneficial in helping to identify the root cause of your issues and to identify the driver of the dysfunction to help you get back to the activities that you love.
Nancy Boyd, PT, DPT, FAFS
Nancy is a women’s health specialist, fellow of applied functional science, and USAT Level 1 Triathlon Coach. Nancy is passionate about educating the public that while common, incontinence and pelvic pain are not normal and physical therapy can be invaluable. If you have any questions on women’s health physical therapy, Nancy can be reached by email at firstname.lastname@example.org or feel free to schedule an appointment for a pelvic floor physical therapy evaluation.
Christie, C., & Colosi, R. Paving the Way for a Healthy Pelvic Floor. Idea Fitness Journal. May 2009.
Herman H., R. 2014. Continuing education course: Pelvic Floor Level 1, Durham, NC.
Gray, G. & Tiberio, D, 2012. Continuing education course: Chain Reaction. The Gray Institute, Chicago, IL.