I often times get asked what the pelvic floor has to do with anything. Many individuals assume that they are not susceptible to pelvic floor issues because they are neither pregnant nor female, or they believe that their issues related to bowel and bladder dysfunction are due to other factors.
As a pelvic floor therapist, my work deals with the “6 P’s”:
Pee, Poop, Pain, Preconception, Pregnancy and Postpartum. Most people assume that pelvic floor intervention is only required if there is “weakness” such as after pregnancy but sometimes the issue is that these muscles are overly active or hypertonic and that can lend itself to a host of symptoms.
The pelvic floor is a group of muscles that lie within the pelvic cavity. There are three layers and their functions include:
1. Support of the pelvic organs,
2. Stabilizing the pelvis to allow the trunk and lower limbs to move,
3. Sexual Appreciation
4. Sphincteric Function (in other words keeping you dry and in control of pee and poop) and
5. Assisting with circulation or the lymphatics of the region.
A hypertonic (overactive) pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Think along the lines of a perpetual “charlie- horse”. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain . This inability to relax can also affect other neighboring muscles such as the glutes, hamstrings, adductors, lumbar paraspinals and cause symptoms to be felt elsewhere.
Some of the causes of such overactivity can include: stress, poor toileting habits, holding urine or feces due to habit or even occupation, constipation, trauma or injury, surgery, scar tissue, visceral pain (IBS, endometriosis, IC), postural or gait abnormalities . This often times will result in symptoms including:
1. Pain including persistent back pain or hip pain
2. Sexual dysfunction including pain with vaginal penetration, or even after intercourse and erectile dysfunction (acquiring or maintaining an erection).
3. Voiding dysfunction (related to urination and defecation) including difficulty having a bowel movement, straining, constipation, bloating, incomplete emptying, difficulty starting a urine stream, feeling of incomplete emptying with urination, urgency, bladder pain, pain with urination.
What then is the solution? As a pelvic floor PT I highly recommend pelvic floor therapy. Often times individuals may go to a physician for pain and the connection regarding the pelvic floor may be missed. Similarly an overactive pelvic floor might not be suspected with complaints of urinary or bowel issues by all physicians. A pelvic floor physical therapist is able to thoroughly assess your history, as correlation of symptoms helps to confirm the diagnosis and provide the necessary strategies and education to address these issues including, breathing and relaxation strategies, proper habits or techniques for toileting, manual therapies and more.
So the answer to our original question, “Is your pelvic floor doing too much?” is that it very well could be and that overactivity can be the root of your symptoms.
1. Continence Foundation of Australia
2. Stephanie S. Faubion, Lynne T. Shuster, Adil E. Bharucha Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction.