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  • Writer's pictureRachel Richers

Pelvic Floor Physical Therapy

An area of physical therapy that I have become specialized in is Pelvic Floor Physical Therapy. Pelvic health has been historically under treated for reasons such as shame, feelings of being "broken" or embarrassment. Additionally, our culture has often held discussion of "private parts" to be taboo.

Within this post I will discuss what this is and whom it can help.

What is the pelvic floor?

The pelvic floor is a collection of muscles that comprise the inside of our pelvis. It has many responsibilities including:

  • Support: The pelvic floor acts as a hammock to support organs such as your bladder, uterus, rectum, and abdominal organs. Without adequate activation, strength, and control, pelvic organ prolapse can occur.

  • Stability: The pelvic floor muscles help to support your hips, pelvic and low back as an important contributor to our core. Stability in our pelvic floor ensures appropriate force transmission from our back to our legs and vise versa.

  • Sphincter Function: The pelvic floor allows the control of the urethra and anus opening and closing (contraction and relaxation). Without appropriate control of sphincter function, a person may experience incontinence.

  • Sump Pump: The pelvic floor muscles help with circulation and moving lymph and blood through your pelvis back up to your trunk

  • Sexual Function: The pelvic floor muscles assist in sexual arousal

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction can refer to any deviation from a pain free presentation of pelvic structures with appropriate continence, organ stability, sexual arousal and function. There can be an array of symptoms consistent with pelvic floor dysfunction including:

• Incontinence (leaking urine, gas or stool)

• Urgency with urination and defecation

• Pressure/heaviness/bulging sensation

• Organ prolapse

• Pain with intercourse or penetration

• Constipation

• Difficulty or lack of orgasm

********If you experience the above mentioned dysfunctions of the pelvic floor********* you are NOT alone!

  • Urinary Incontinence affects 40% of women under the age of 65 and 60-70% of women over the age of 65 years old - Katarzyna et al 2016.

  • Most women have some degree of Pelvic Organ Prolapse in their lifetime - Katarzyna et al 2016.

  • 1 in 4 women report moderate-severe symptoms of Urinary Incontinence, pelvic organ Prolapse, or fecal incontinence - Nygaard et al 2016

  • 65% of female athletes have stress urinary incontinence and/or urgency Schettino et al 2014

  • 52% of women have pelvic pain - Schelttino et al 2014

  • 18% of community dwelling men will experience urinary incontinence - Assad 2000

  • 11% of Male visits to their primary care provider is for pelvic pain

Frequently Asked Question: If I do Kegels, isn’t that enough?

Although "Kegels" have been the tried and true way to activate your pelvic floor in the past, pelvic floor therapists want you to know two things.

First: Studies have found that women who complete kegels are often found to be performing them incorrectly. Between 24-70% of kegel activations assessed via internal vaginal examination have been found to be either wrong, insufficient, or counter productive in the maintenance of continence.

Second: Kegels have often been the ability to contract the pelvic floor as hard as you can. While it is important to achieve muscle contraction, simple contract and relax is not enough. We want our pelvic floor muscles to be able to actively contract in a graded and controlled manor. We want our pelvic floor muscles to relax on command. And, we want our pelvic muscles to be able to bulge in order to complete a full range of motion.

Pelvic floor muscle examination may assist in providing instruction and feedback for correct activation of pelvic floor muscle activation. This may help improve quality and effectiveness of muscle contractions to assist in controlling symptoms of pelvic floor dysfunction and disorders

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