The pelvic floor is an important part of human anatomy. Considering how important it is, it always amazes me how infrequently the pelvic floor is discussed. It is responsible for correct bowel and bladder function, it is also responsible for normal sexual function. One could think of the pelvic floor as the structure that holds in and supports your insides. If the pelvic floor is weak due to trauma, abnormal muscle recruitment or injury, then the pelvic floor muscles are not equipped to support your internal organs, which can lead to other dysfunctions.

Some of the dysfunctions that can result from pelvic floor weakness is incontinence. That can include bladder and bowel incontinence. Incontinence means that you have diminished, or lack of control of, your bladder or bowel. Symptoms include leakage with coughing, sneezing, laughing or any jarring movement. Other symptoms include increased frequency of going to the bathroom, difficulty starting the flow of urine, or very strong urges to empty your bladder but minimal volume with emptying.

Trauma to the pelvic floor can also lead to weakness. Trauma can include an injury to the hip, pelvis or back, can include sexual abuse, removal of the prostate due to cancer or can result from a very challenging childbirth experience. Sometimes the muscles of the pelvic floor “forget” how to contract again once they have been traumatized. Or, if there is scar tissue, for instance after an episiotomy, then the muscles don’t contract as effectively. Sometimes after injury there is some loss of sensation and so the brain is unable to “find” the pelvic floor muscles in order to contract them and strengthen them.

There is another type of pelvic floor dysfunction that can lead to pain in the pelvic floor. Sometimes the muscles of the pelvic floor get very shortened, tight and weak. This can lead to pain with intercourse, pain with bowel movements or constipation. Many times people with shortened pelvic floor muscles experience radiating pain in their lower back, buttocks or inner thighs and can be confused with a pathology of the back or hips.

While both of these dysfunctions cause problems, they are addressed differently. Both dysfunctions will eventually require strengthening and re-education. The shortened and tight muscles first have to learn to relax before they can be strengthened. Both dysfunctions can be addressed by a physical therapist that specializes in pelvic floor rehab. Men and women can both experience both of these dysfunctions.

For those who do not know how to do pelvic floor strengthening, or who perform the exercises incorrectly, here is a review of how to perform a kegel. Sometimes people read to try to stop and start the flow of urine when emptying their bladder. This is contradictory to how the body should function. I do not recommend that technique. The motion you are going to do is a “lifting” of the pelvic floor. Think of the pelvic floor like a sling or a hammock and when you contract the muscles it is lifting, or tightening the sling.  Once you get more familiar with contracting the muscles you want to perform two types of contractions. You want to hold them for a period of time, say 10 seconds. You can think of these muscles as postural muscles that require more endurance. You also need to perform quick, strong contractions. Think of these muscles as your sneeze muscles, as they help to support your organs when you sneeze.

If you find you have any of the above issues, or questions regarding your pelvic floor, please do not hesitate to contact me for a consultation or evaluation. I look forward to hearing from you!