What Physical Therapists Wish You Knew About Your Pelvic Floor

To fully appreciate what your body does for you on a daily and hourly basis look no further than between your legs. As a physical therapist I have tended to a spectrum of impairments — from lower back pain to recovery from surgical procedures — but what has moved me the most is treating someone’s pelvis.

The pelvis is made up of many bony and soft tissue components, including pelvic floor muscles. These muscles have been compared to a sling or hammock that cradle the bladder, colon, and uterus. In this way they prevent the descent of the organs as we move against gravity in upright positions. I prefer the image of this type of functional support to a box. When holding precious cargo, the box is only usable if its base is strong — otherwise it would collapse under the weight of its content. In this way the pelvic floor muscles act as the base to your body and preserve its supportive role of keeping your organs in place.

Additionally, the pelvic floor muscles work well to support the body in various positions, working especially well with the core. If you have taken a pilates class, you may be familiar with the concept of the body’s core by these commonly used verbal cues: “Bring the belly button towards the spine,” “Use your breath” or “Engage your pelvic floor.” The core is a system of muscles that are the root of your body’s foundational support, including the diaphragm at the top, the pelvic floor muscles at the bottom, the back musculature from behind, and the deep abdominals along the front. The core compliments your musculoskeletal system and maintains homeostasis. What is considered your “core” is fundamental and best illustrated as a pressurized system that constantly seeks equilibrium.

Which brings us to thermodynamics.

The basis of the first law of thermodynamics is conservation — the idea that the total energy of the universe is constant, like an entire ecosystem. The body is made up of multiple systems working to keep the body in homeostasis. To illustrate how your pelvic floor works its second sphincteric role, consider its connection with the core as well as the respiratory system. In an ideal closed system, the pelvic floor and respiratory system — through the diaphragm — work together to achieve the goal of preserving a pressurized homeostasis environment. Imagine when you inhale your lungs filling with air, decreasing the surface area, and increasing the pressure in your trunk. To accommodate for the decrease in surface area the pressure of your pelvic floor descends just enough to accommodate for the loss of surface area in the trunk to keep the pressurized system in equilibrium.

Now envision the first rule of thermodynamics applied to a non-ideal closed system, like a weak pelvic floor. In such a case the pelvic floor muscles may have developed decreased strength or are not able to coordinate well with the respiratory system due to trauma (think childbirth or hormone imbalance from menopause). When your lungs fill with air, instead of accommodating to the increase of intra-abdominal pressure, the pelvic floor fails. Consequently, this could lead to incontinence (the involuntary loss of urine) during periods of high intra-abdominal pressure (such as coughing, sneezing, laughing, or squatting).

Incontinence is not an unfamiliar symptom in the US today. In fact, it is projected that pelvic floor dysfunction will affect a third of all American women by 2050. Incontinence alone places a significant financial burden on the person affected and the healthcare system, costing an estimated 16-29 billion dollars per year. To see an example of this, look no further than the local pharmacy store that has its own incontinence section in the feminine aisle.

Urinary incontinence is a symptom that reveals a deficiency in an ecosystem in search of homeostasis — one that can be resolved completely with the help of a pelvic floor physical therapist.

At this point you may think that as a physical therapist my role would be to simply prescribe Kegel exercises to women with this problem, which is not exactly true… at least right away. Kegels, in most cases, are improperly prescribed especially when the state of the muscles and surrounding tissues are not properly examined.

Similarly to the practice of yoga, a large component of pelvic floor physical therapy is bringing awareness and body mindfulness into focus. In ancient yoga culture it was believed that the body contained seven centers of spiritual power or chakra. Of the seven, the pelvis was thought to possess its own sacral chakra that ties a person to creativity, sexuality, and various emotions.

To see where you hold your emotions try giving yourself a body scan and assess where you are holding tension. Are you gripping your abdomen; do you grind your teeth; do you carry stress in your shoulders?

One of the most common places people carry their stress is the pelvic floor. When the muscle is too tight its muscle length decreases, preventing it from being able to stretch and optimally contract. In this way, weakness creeps into the system, causing it to fail in its roles to support the reproductive organs and keep you continent and able to enjoy sexual experiences.

Therefore, a prerequisite to Kegels must first be to quiet the system and teach the muscles to lengthen. A pelvic floor therapist can best guide the patient to accurately engage specific muscles so that the patient may have equilibrium in their system again.

In summary, participating in daily life activities requires the pelvic muscles around the pelvis to operate in a number of roles: sphincteric, sexual, and supportive. Seeing a pelvic floor physical therapist is a conservative route to hope and healing and should be the standard of care for anyone experiencing pelvic floor dysfunction. Women traditionally wait approximately seven years before talking to their doctor about bladder control, and only a quarter of women with urinary incontinence symptoms talk with their physician about this issue at all.

However, there is hope and healing for those with pelvic floor dysfunction, so see a pelvic floor physical therapist to find how they can help you find balance and harmony within your body.