Five Things That You Should Know About Your Pelvic Floor

Written by: Gina Peterson, DPT, FAAOMPT, EP-C

When I tell people that I am a physical therapist, I think that they usually imagine me treating ankle, back, knee and shoulder problems. Most individuals are surprised to learn exactly how broad the physical therapy discipline is. Physical therapy encompasses any and all parts of the body that can move, and it often comes as a shock that physical therapists treat bladder, bowel and sexual functions. If you have a problem falling within one or more of these areas, physical therapy is very likely to be one of the conservative treatment approaches that will be recommended in your care plan.

For anyone unfamiliar with the pelvic anatomy, the pelvic floor is a group of muscles that attaches from the tailbone to the pubic bone. Its main functions are support, stability, sexual function and sphincteric control. Much like the respiratory diaphragm, the pelvic floor is usually performing at least three tasks at once: maintaining static postural support, holding the urinary and anal sphincters closed and firing dynamically to maintain support as we move through space. It is a pretty amazing set of structures.

Admittedly, information about the pelvic floor can be hard to come by. This problem often starts early, when adults demonstrate discomfort naming the body parts that we use to go to the bathroom or to have sex. Unfortunately, this is a social convention that results in teens and adults who don’t have access to quality health information about the pelvic floor in general. Just like any other body region, your habits support your health - knowing how this body region works is critical to keeping it healthy. 

Below are five pelvic health facts that I wish that everyone knew:

1. The female pelvic floor is not inherently “loose” and it does not need to be actively contracted at all times. Constantly holding contraction for one reason or another actually causes dysfunctions including urinary urgency or even incontinence. Just like a tight hamstring can be prohibitively reactive to normal mobility during activity, a tight pelvic floor can be prohibitively reactive to sexual activity, normal bladder filling and even voluntary contraction to hold back urine. If someone tells you to contract your pelvic floor without assessing it first, that person is not someone who can give you informed recommendations about your problem, which may actually result from the fact that your pelvic floor needs to be stretched. Another note – constantly holding your stomach in can also predispose you to an excessively tight pelvic floor.
2. If your neck and shoulders are tight from stress, your pelvic floor is probably also tight. The order of priority in your body’s fight-or-flight response involves two things: holding the sphincters closed and scanning the environment for threats. If you have increased muscle tightness in your neck because your primitive brain is scanning for threats, your pelvic floor is probably also holding more tension at rest than it should be.
3. Pelvic pain is often the result of tight muscles. This pain could be experienced during sex, while inserting a tampon or while undergoing routine health screenings, such as pelvic exams. Chronic muscle restriction, whatever the initial cause, is not great for tissue nutrition. We have all probably had the experience of uncomfortable tightness in our back muscles, which often feels like burning; similar to when the muscle has been overworking. This burning sensation is due to decreased oxygen in the tissue. The feeling is exacerbated by muscles staying partially contracted even at rest, which pushes against the capillary walls and limits blood flow and oxygen to the tissue. If your muscles are chronically tight, they probably are not getting the blood flow and nutrition that they need to maintain tissue health and perform daily tissue repair - pelvic pain understandably follows.
4. Some pelvic floor problems are caused by muscle activation issues. These issues could include decreases in motor control (the ability to turn a muscle on and grade contraction), coordination (the ability to turn a muscle on at the right time in conjunction with its neighboring muscles), strength or endurance. If an individual is experiencing any of these issues, a thorough physical therapy evaluation is helpful in determining which muscles are having issues and whether the problem is due to another associated muscle group slacking off. The lumbar spine, abdominals and hip muscles are all part of the pelvic stabilization picture. Dysfunction in these areas can cause pelvic floor dysfunction, as the body tries to gain stability by any means available.
5. Individuals with male anatomy can also experience pelvic health issues. Constipation, urinary dysfunction due to prostate removal surgery or age-related prostate enlargement, difficulty emptying the bladder or controlling urine and even erectile dysfunction are all issues that can be treated with pelvic floor physical therapy techniques. For men and women alike, it is worth noting that many sports-related muscle strains also involve the pelvic floor.

The pelvic floor is not the most widely discussed body region, and for that reason, it may be hard to know if physical therapy could be helpful for your problem. If any of the above issues sound uncomfortably familiar, talk to your primary care physician, urologist, gynecologist or other care provider to determine whether physical therapy is something that could play a role in your treatment plan.