February 13, 2023
Wellness Trend Du Jour
The pelvic floor is definitely having its moment. It’s about time that the conversation about pelvic and abdominal health is normalized. I’ve just completed my last pelvic floor therapy (PFT) session with a highly skilled, intuitive pelvic floor physical therapist. More on this in a moment.
Did you know that PFT is one of the quickest growing specialties of the physical therapy profession—with no ceiling in sight? This indicates how many are seeking this valuable and potentially life-changing therapy. The Today Show, The Washington Post, New York Magazine, Harper’s Bazaar, amongst others have featured this topic at length. Renowned medical institutions, like Northwestern Medicine to Johns Hopkins to the Cleveland Clinic, have fully integrated PFT into their OBGYN divisions. Venture funding for women’s health platforms providing expert care for pelvic floor dysfunction like Origin and Luna is enabling awareness and expansive growth in this sector—offering in-clinic, in-home and virtual PFT, education and resources.
This therapy’s exponential growth is even touted as a “trend” in certain circles and has gone viral on platforms such as TikTok and Instagram. (A word of caution here: Do due diligence and only take advice from individuals who are highly trained in pelvic health.)
Pelvic floor health is but one aspect of the conversation around all things menopause (especially as related to bladder control and sexual health), which I addressed in an earlier article “ Menopause Moonshot ”.
To be clear, everyone has a pelvic floor—man, woman and child. And pelvic floor dysfunction can occur for anyone when pelvic floor muscles don’t work properly, leading to a range of symptoms and conditions. In the interest of our readership and space, I’ll address it as pertains to women.
First Some Statistics
Every year, 40 million women and individuals with vaginal anatomy suffer from issues related to maternity, menopause and sexual health—issues that PFT can treat and heal. A reported 33% of women will experience a pelvic floor disorder in her lifetime, while 16% of men have a pelvic floor disorder. One in three women experience incontinence. One in two women suffer from vaginal atrophy.* And one in five women experience chronic painful sex. This no longer needs to be the case with skilled pelvic floor treatment.
* Recently, the term vaginal atrophy has been replaced with the newer term, genitourinary syndrome of menopause (GSM). This new term helps describe not just the vaginal, but also the urinary symptoms that can be accompanied by the effects of low estrogen.
Pelvic Floor Dysfunction
Pelvic floor dysfunction (PFD) means your pelvic floor is not optimally performing all of its functions: support and stability, bladder/bowel continence, sexual wellness and circulation. Most dysfunction occurs because the pelvic floor muscles are too tight and tense (hypertonic), too weak and loose (hypotonic) or a combination of both. Excessive strain or tears in connective tissue and musculoskeletal imbalances can also have an impact.
Pelvic floor therapists can provide the latest evidence-based physical therapy services to everyone from childbearing women, to peri-menopausal and menopausal women, to men with incontinence or other pelvic health concerns, to young athletes as well as children.
What Exactly is the Pelvic Floor?
The pelvic floor refers to a complex group of muscles, connective tissue and nerves that form a sling or hammock stretching from the pubic bone to the tailbone and between the sit bones (your butt bones). The pelvic floor is actually the base of the group of muscles referred to as your “core.” These different muscle groups connect into the pelvis from the spine and hip area.
Pelvic Floor Functions
These muscles and surrounding tissues support and hold the pelvic organs in place so they can function correctly. The pelvic organs include your bladder, vagina, uterus, urethra, intestines and rectum.
Importantly, pelvic floor muscles work harder during pregnancy, supporting the growing baby. They are also softened by the effects of pregnancy hormones. Whether vaginal delivery or caesarean, pelvic floor muscles can be impacted.
Bottom line, if pelvic floor muscles are too weak, things can literally start to go south (including pelvic organ prolapse).
Your core muscles including pelvic floor, deep abdominals and deep back muscles along with diaphragm, work together to support and stabilize your spine/torso. Postural alignment is absolutely essential for spinal health, thus neurological balance/functioning* as well as optimal breathing. Both can have a major impact on pelvic floor health.
A strong, flexible and coordinated pelvic floor prevents bladder and bowel leaks (incontinence), ensuring urinary continence and optimal bowel function. It also helps with urinary urgency, also called urge incontinence.
For sexual health and satisfaction, your pelvic floor needs to be able to both contract and relax to optimize comfort, sensation and pleasure. Pelvic floor muscles that are in a constant state of spasm or contraction can create pain during sex or in general.
The pelvic floor also acts like a pump, maintaining circulation of blood/lymphatic fluids (why diaphragmatic breathing is so essential) through abdominal and pelvic areas, helping reduce pelvic edema, swelling and bloating in this area.
As you can see, your pelvic floor is busy! Yet pelvic floor health can often be ignored—especially in conventional fitness classes. This is typically not the case in yoga and Pilates classes where the mind-body connection is of utmost importance (including the energetic impact of how the pelvic floor correlates to the chakra system).
* Because nerves play a part in proper functioning of the pelvic floor, some conditions of the brain or nerves, such as Multiple Sclerosis, Parkinson’s Disease or a stroke, can cause issues with bladder activity, bowel regulation and sexual dysfunction.
I saw an urogynecologist who upon examination and other diagnostics referred me to an excellent therapist— Bernadette Kamin, PT, MSPT, WCS, of Kamin Physical Therapy. It was obvious from the first visit her high level of expertise and intuitive skill.
In our initial meeting my physical therapist did a complete exam—both external and internal. She performed a thorough musculoskeletal evaluation of the pelvis, spine and hips (where pelvic asymmetry and muscle imbalances are often found and contribute to PFD) and evaluated things like posture, abdominal strength and general physical fitness.
The PT may also do an internal exam through your vagina (and/or rectum) to systematically palpate the pelvic floor muscles from the inside. By gently applying pressure on various pelvic floor muscles, she can determine strength, tone, sensation, tenderness, scarring and any other abnormalities. She feels for contractions and inflammation of not only the muscles but the connective tissue as well. Through this, she may also identify specific, isolated tender spots, known as trigger points. The PT will evaluate overall muscle strength and coordination by having you squeeze your pelvic muscles—a maneuver you do when performing Kegels.
Importantly, irregularities the PT finds may not be where they originate. For example, tight hip flexor muscles tilt the pelvis and cause tension in the pelvic floor muscles, which contributes, in turn, to pelvic dysfunction and/or pain.
Pelvic Floor Treatment
Once a source of dysfunction is identified, the PT uses several modalities both external and internal for treatment, including techniques such as myofascial (tissue) release and joint mobilization. Muscle spasms are eliminated using manual soft tissue work and trigger point release directly on the pelvic floor muscles. Biofeedback, dry needling, ultrasound also may be utilized. The initial evaluation determines your specific needs so the PT can build a customized program of physical therapy and recovery—including therapeutic exercise, coordination and flexibility training, neuromuscular re-education, postural and proper body mechanics education, bladder retraining, relaxation and breathing techniques, and more.
Consider visiting the Kamin Physical Therapy website for detailed info re: what pelvic conditions physical therapy can treat for women, men and children and what treatment involves. kaminpt.com
Remember that your women’s health care professional—an OB-GYN and/or urogynecologist—can refer you to a pelvic floor therapist.
Academy of Pelvic Health Physical Therapy
This community is devoted to the field of pelvic and abdominal health. Patients can locate pelvic therapy certified professionals in their locale. Professionals and patients can access tools, education and resources here. aptapelvichealth.org/