At least once a week I get asked why I got into the very unique physiotherapy practice of pelvic health. Most pelvic health therapists confess we transition to it because we have issues with our own pelvic floors.  

I have experienced a rectus diastasis, bladder prolapse, urge and stress incontinence, bowel urgency, persistent low back and hip pain due to the privilege of birthing my four children. For too many years I put up with these issues because I didn’t do something about it. 

I now work in pelvic health to help other people take control of their pelvic floor!

The pelvic floor: forgotten or ignored?

The pelvic floor is the often forgotten sling of muscles between the pubic bone and the tailbone. They interact with the other core muscles such as the diaphragm, abdominal and back to stabilize the trunk and extremities during movement.  

These pelvic muscles can determine if we are able to have sex. They are greatly influenced by our hormones. They give sphincteric support to our bladder and bowels. And, I would add, they are the seat of our emotions. When we are frightened, they are the first to contract.

When it’s working correctly, we hardly give our pelvic floor a second thought. But when something goes wrong, these little muscles can alter our lives.

The pelvic floor: too tight or too loose?

Over-recruitment or hypertonicity (high tone) of these muscles can be a result of trauma, pain, infection, stress, anxiety, depression or a change in hormones. Sadly, they are often subject to abuse and shame.

All these factors can cause tightness in the myofascial system of the pelvis. It can lead to urgency, frequency, overactive bladder, bladder pain, mimic a urinary tract infection, cause stress or urge incontinence, constipation, painful periods and painful sex.  Persistent low back, sacral-iliac, tailbone and hip pain can result from the pelvic floor being too tight.

When the pelvic floor is hypotonic (lo tone), stress incontinence, fecal incontinence or prolapse of the pelvic organs can occur.  Prostate removal surgery can cause erectile dysfunction and leaking. Increasing the tone and strength of the pelvic floor in these instances is crucial to function.

The pelvic floor: are kegels the answer?

Most people think that pelvic floor physiotherapy involves teaching women how to do a Kegel properly after childbirth. I often explain to clients that if the pelvic floor is already hypertonic that doing a pelvic floor contraction (Kegel) is only going to increase that tension.

Kegels are not a one-size fits all solution. The issue is proper recruitment of the pelvic muscles.

It is crucial to balance the intra-abdominal pressure against the pelvic floor. Breathe and proper core use accomplishes that. Myofascial release and lengthening of the muscles need to occur before teaching the appropriate recruitment and coordination of the pelvic floor.

The brain’s influence over the pelvic floor is integral to resolving these issues. Very often people try to ignore or put up with the symptoms hoping they will go away. Listening to and knowing our own bodies helps solve the sometimes unclear messages they give us.   

The pelvic floor: friend or foe?

Are you going to the bathroom every hour? Do you get up at night to void? Do you leak when you cough, sneeze or run? Do suffer with constipation? Is it painful to use a tampon? Do you have tailbone pain or back pain that won’t go away? Hip pain that wakes you up at night? Pre or postpartum issues? Do you live with pressure in your pelvis? Do you have post-surgical pain or weakness in the abdomen or pelvis?

These problems can occur at any time in our lives and are not an acceptable process of ageing.

Stop putting up with it and take back the floor! Much can be done to help resolve these issues.