Pelvic floor anatomy and function are relevant to all of us – everyone has a pelvic floor! Unfortunately, it can be difficult and embarrassing to discuss this area of the body, and for that reason, many people know very little about what to do improve their pelvic floor function.
Pelvic floor problems are highly prevalent for women and men in Canada - research suggests that one in three women and one in nine men will experience incontinence (unwanted urine
leakage) at some point in their lifetime. Despite these numbers, only one in twelve people will seek help for their pelvic health concerns.
What is the Pelvic Floor?
The pelvic floor consists of the muscles, ligaments, nerves and connective tissue at the base of the pelvis. These tissues fill the space between the tailbone at the base of your spine, the sitz bones on either side of the pelvis, and your pubic bone at the front. If you were to cup your hands out in front of you, the pelvic floor is roughly the same size and shape as your hands. Everyone has a pelvic floor, although there are slight anatomical differences between men and women.
Core strength and stability have always been trendy topics in the realm of fitness and rehabilitation. The pelvic floor muscles are part of the intrinsic core that also includes:
Multifidus (muscles of the lower back).
Transverse abdominals (muscles of the abdomen/stomach).
Diaphragm (breathing muscle).
These muscles function together as our inner core.
Function of the Pelvic Floor
Support
Our internal organs, including the bladder, rectum and reproductive organs, rest on top of the pelvic floor muscles. The pelvic floor tissues help to hold the weight of these organs up against gravity within our body. If there is too much mobility (low support), pelvic floor problems such as prolapse, and stress incontinence (leakage) can result. If the support is too rigid, pelvic pain is common.
Sphincters
Pelvic floor muscles have holes for passages. In men, this includes the urethra and the anus. In women, passages include the urethra, anus and the vaginal opening. The muscles of the pelvic floor wrap firmly around these openings to help control the release of feces and urine, giving us some voluntary control over these functions.
Sexual
Pelvic floor muscles provide tone for vaginal and rectal canals and are important for sexual function in both women and men.
Stability
Pelvic floor muscles assist in unloading the spine and have an important role in stabilizing the surrounding joints, including the SI (sacroiliac), hip and pubic symphysis joints.
Symptoms of Pelvic Floor Dysfunction
Most conditions of pelvic floor dysfunction are the result of pelvic floor muscles either being too weak or too tight. Weak pelvic floor muscles are not providing enough support for the bowels, bladder and/or uterus. This can result in symptoms such as:
Urinary incontinence (unwanted leakage of urination).
Pelvic organ prolapse, a condition in which women experience a protrusion (or bulge) at or near the opening of the vagina. This can occur with pelvic pressure or feelings of heaviness, especially towards the end of the day. In men, a pelvic organ prolapse can occur in the rectum, and can result in the sensation that one needs to have a bowel movement but is unable to go.
When the pelvic floor muscles are too tight and have too much tension, they may cause pelvic pain and discomfort. This can result in:
Painful intercourse.
Urgency and frequency in urination.
Constipation or painful bowel movements - you shouldn’t have to strain in order to go to the washroom.
Pelvic pain, such as sensations of burning, itching, numbness or spasm in the pelvic floor or surrounding areas (hips, low back, abdomen and groin).
Nighttime urination. If under the age of 55 years, you should be able to make it through the night without getting up to use the washroom.
Chronic, non-bacterial prostatitis in men. This refers to inflammation of the prostate gland and can result when tissues of the pelvic floor are so tight or strained that they irritate the surrounding nerves and cause radiating pain.
Causes of Pelvic Floor Dysfunction
Common causes of pelvic floor dysfunction include pregnancy, labour and delivery, strenuous exercises, physically strenuous jobs, abdominal and/or gynecological surgery, increased body weight, chronic coughing, aging and neurological insult/injury.
Pelvic Health Physiotherapy
Pelvic floor physiotherapists provide one-on-one assessments and treatments that are focused on pelvic floor tissues. The gold standard for these assessments includes an internal examination (vaginal and/or rectal exam) as this gives the therapist direct access to your pelvic floor. The pelvic floor tissues are assessed for length, tension, strength and coordination to determine if they could be contributing factors to your pain or symptoms.
Anyone could benefit from a pelvic floor assessment. This is especially true if they are experiencing any symptoms of pelvic floor dysfunction. Pelvic floor muscle retraining should always be considered a first line of treatment prior to more invasive options, such as surgery. Benefits of pelvic health physiotherapy include healthier joints, improved sexual function, regular bowel movements, improved bladder control, decreased pelvic, hip and lower back pain, and improved confidence and well-being!
Pelvic floor therapists understand that these issues can be embarrassing and sensitive and we adopt a compassionate approach to your care.
CONTRIBUTED BY: Ellen Incognito - PT, MScPT, BScKin (Honours) Registered Physiotherapist