5 Things I Wish I Knew About My Pelvic Floor
The pelvic floor, what exactly is it? What does it do? And, why should I care? The pelvic floor is a bowl-shaped group of muscles that sits inside of your hip bones. It is responsible for many things, including but not limited to: supporting the abdominal contents, allowing for the passage of waste, allowing for the passage of babies, sexual function, support of the skeletal system, posture, connecting the “core” to the lower body and the “core” to the upper body. The 5 things I discuss today are not an exhaustive list of what I wish I would have known about my pelvic floor but it’s a good place to start!
1. The Pelvic Floor Does Not Work Alone. The pelvic floor is part of a deep system of support. This system, the deep lower core, is made of the diaphragm (the main muscle for breathing), the transverse abdominis (the deepest abdominal muscle), the multifidi (the deepest layer of back muscles) and the pelvic floor. It creates a cylindrical shape: diaphragm on top, pelvic floor on the bottom, the transverse abdominis wraps around the sides to the front and the multifidi creates the back. When we use this system to its fullest potential, we create the most efficient and effective way to gain actual stability within our body. Think of the deep lower core as the base in which your outer system (arms, legs, head) moves upon. The stronger the base, the more freely we can move. Because it is the base of our support, it is also one of the most important components of our posture. Your pelvic floor literally holds up your head! Your pelvic floor and diaphragm are essentially (in ideal posture) stacked in line with one another; your diaphragm is stacked over your pelvic floor and your head then stacks on top of the diaphragm. We cannot achieve ideal posture without addressing the function of the pelvic floor and its relationship to the rest of the body.
2. It Moves. Wait, what moves? Your pelvis forms an oval shape, the pelvic ring, and within that ring there are 5 joints. There are two joints in the front formed by the two pubic bones and the pubic symphesis. Your sacroiliac joints (or SI joints) create two joints on the back side of the pelvis. The final joint is found at the bottom of the sacrum, where it connects to the tailbone, or coccyx. While there is movement in all 5 joints in the pelvis, the tiny little joint made of the coccyx and sacrum is the most mobile of the 5. (If you’re questioning whether the pelvis moves, place your hands on the back side of your pelvis and squat down. The backside of the pelvis widens as you squat and narrows as you stand- the only way this can happen is if there is something happening within the pelvic ring). The reason the coccyx is the most mobile part is related to where the muscles in the pelvic floor attach. Not all of them have a direct attachment on the coccyx, but many of them do and the ones who don’t are still connected fascially. A healthy pelvic floor is able to lengthen as well as shorten, which happens as the joints move. If the pelvic floor is not involved in movement, the coccyx can fuse to the sacrum, creating a significant amount of dysfunction, including incontinence (bowel and/or bladder), difficulty during childbirth, sexual dysfunction, pelvic organ prolapse, postural dysfunction and many others.
3. The Common Dysfunctions of the Pelvic Floor ARE NOT NORMAL This. Is. Important. Our society is very good at giving us the impression that as we age, we naturally lose control of our bowel and bladder. We are told that because we had a baby, or 5 babies, that we will no longer be able to jump, laugh, cough or sneeze without leaking. We are told that sex is sometimes painful for certain women and that we need to somehow figure out how to enjoy it more. And we are told that there are products, and surgeries, out there to help us and that’s the best we can get. NO. Just, no. If you have weakness or tightness in your ankle, the first step is rarely surgery. (This is not to say that surgery is never the appropriate treatment.) The pelvic floor should be treated no differently. Even though these symptoms are common in our culture, they are not normal, and you never need to “just live with them”.
4. The Pelvic Floor is Directly Related to Sexual Function Yep, it is. Intercourse, as mentioned above, can be painful for some women. The amount of discomfort can change, and we may have more discomfort during some stages of life than others. Because our pelvic floor is a group of muscles, it too can develop restrictions or become weak. The causes of the restrictions and weakness vary however they are always going to create dysfunction. We need the pelvic floor to be able to contract while it shortens and to contract while it lengthens to allow for intercourse without pain. The right and left side of the pelvic floor typically do not have the same restriction/dysfunction which means each side needs different forms of treatment. (This is why doing Kegels can be very detrimental to the pelvic floor. A complete pelvic floor evaluation should be completed by a professional prior to beginning any form of “Kegel” program.) We also need a functioning pelvic floor for improved sensation during intercourse.
5. You Can Improve Its Function This is something I want you to always, always, always remember! You have all the components within you to find improved function within the pelvic floor. If you are experiencing any of the symptoms discussed above, you do not have to live with them. Please don’t live with them. One of the best parts of addressing these symptoms (besides learning how to laugh without leaking, of course) is discovering how empowering it is to facilitate a relationship with this part of our body. It holds so much more than physical strength, it helps to give us life-literally and figuratively.
So, now what should you do? Get in touch with me! If you aren’t in my area, search for a Pelvic Health Physical Therapist (may be listed as a Women’s Health Physical Therapist). If you need help finding one, reach out to me. And talk to your friends, talk to your family, talk to your doctor. Talk. Pelvic health is important, and we all deserve to know about it.