New Year – New Pelvic Floor

As the year unravels, and we all embark on New Year resolutions, perhaps a pelvic health improvement plan should be part of our plan for improved health. Often left behind in anatomy education, medical visits, and overall health awareness and articles, it’s time the pelvic floor muscle was center stage and a part of our daily routine. Understanding this part of our anatomy may be mysterious, daunting, or even just a brand new experience. This article suggests 3 tips to enhance your pelvic health in 2022 after explaining some basics about the muscle, what it does, and where it’s been all our lives. 

What is the pelvic floor? 

Our pelvic floor is the group of muscles that sits at the base of our pelvic bones, between the tailbone and the pubic bone.  It includes the levator ani, coccygeus, and superficial muscles: ischiocavernosus, bulbocavernosus and superficial transverse perineal muscles.  The pelvic floor muscles also attach directly to an internal hip muscle on each side, the obturator internus. Though this is where the labeling of the pelvic muscle architecture may stop, it has important relationships through fascial connections, movement, breathing, and more to the rest of our body.  These muscles are unique in that from left to right in our bodies, they use each other as attachments and are 3-dimensional in form and function.  We are incredibly reliant on the performance of these muscles to be able to do our everyday tasks, bodily activities, and find stability and continence during daily exercise and even basic movements.  Though the pelvic floor muscles are most commonly known to help with bowel and bladder function, urinary activities, and in sexual activity, the capabilities of this muscle group in our everyday lives is far beyond what we can imagine!

What does the pelvic floor do?

The pelvic floor is involved in almost every movement we make, through multiplanar activation, responses to movement, breathing, and helping us manage our bodily processes throughout the day. It makes sense that the pelvic floor is active in every move we make, but research also shows that it contracts and relaxes during every breath we take, as well (Talasz).  So amongst the long list of pelvic functions, it’s being quick to react when we need this (coughing, sneezing, jumping), or holding a baseline stiffness to support our organs, or more endurance based activity. It is dynamic and always adjusting based on what the rest of our body needs.  Imagine walking a dog, or with a friend: when you swing your arm forward, and then backward, your pelvic floor responds.  If you trip on the sidewalk, your pelvic floor responds.  It is there for us whenever we need it, so we need to be there for our pelvic floor muscle, too. 

Feeling confused, and a little frustrated that such an important piece of our anatomy was left out of the basic birds and the bees talk?  Don’t fret, and spread the word.  A recent systematic review demonstrated that the majority of women do not know about the pelvic floor, what risk factors for potential larger problems are, or where to seek help and knowledge (Fante). In fact, this study reviewed eight articles attempting to learn what women know about urinary incontinence and all of them showed that women had a low knowledge. The review also summarized that in a group of female athletes, where a high prevalence (30.2-35.8%) of urinary incontinence existed, less than half of the athletes talked about having this problem.  The problem is not the woman, or the athlete, it’s the drought in information and awareness of the pelvic floor muscle.    

How do I get to know my pelvic floor? 

Meeting your pelvic floor is as simple as learning how to perform a pelvic floor squeeze. Or taking a deep diaphragmatic breath, and feeling the pelvic floor slowly drop with this breath.  Studies have shown that inserting a tampon and using a mirror is successful in training women in how to contract their pelvic floor. If you find it hard to contract this muscle, there are multiple options available, and you’re not alone.  The article  “Breathing with the pelvic floor? Correlation of pelvic floor muscle function and expiratory flows in healthy young nulliparous women” demonstrated that performing a voluntary pelvic floor contraction on demand, or an involuntary contraction forced coughing or breathing wasn’t just difficult:  a high percentage of women could not do it.  But that makes sense.  If you weren’t introduced to your  hamstring muscle and your quadriceps until you were in your adult years, it would not be easy to contract, relax, or use those muscles the way they are meant to be used.  

Understanding what is normal behavior from the pelvic floor and it’s associated activities, and what is not, will also help you raise awareness of the pelvic floor.   For example, leaking urine is not a part of aging, and it can be helped during pregnancy, after or during treatment of prostate problems, and while performing athletic activities.  Chronic pelvic pain, sacral pain, back pain, and hip pain (the list could go on and on) is also something that can be helped and managed.  Sensing the causes of these pains, the relationship of the problems to sex, bladder function, and bowel, can help you identify pelvic floor involvement. 

Friends, colleagues, and clients have also commented on how they can feel that the pelvic floor reacts to stressful times.  It indeed does have a role in anxiety, and the changes in breathing around this, as well as the activation of fight or flight in our body.  Activities throughout the day to “check in” on your pelvic floor, where the muscle is resting, and if it’s tightening, are important to gain awareness.  

Feeling more confused? 

Check out these 3 tips to improve your relationship with your pelvic floor. 

1. Just breathe

Find a quiet place, and lay on your back.  Place one hand on your stomach and one hand on your chest.  Take a deep breath in allowing the hand on your belly to rise toward the ceiling, and attempting for the hand on your chest to remain still.  Repeat this and focus in on the pelvic floor, how it moves when the belly goes up, and how it responds when the belly goes down. Try to connect with it and make it move more.  This is a great technique to perform when you feel the pelvic floor is getting stressed out, and it can also be performed in sitting or standing. Practice this before bed and it can help calm your nervous system.

2. Don’t be afraid to look at your pelvic floor, or feel the muscles.  Getting to know more about where the muscles are will help you move them.  

The pelvic floor gets neglected in several ways throughout life.  It’s not typically a part of anatomy class.  It’s not asked about often at your annual medical visit, unless this is your annual woman’s examination, and sometimes not even then.  Can you imagine preparing and completing a surgery for your back without planning a rehabilitation plan, or undergoing a thorough education about the muscles. No!  So why is this how the pelvic floor muscle is treated?  

What you can do is get to know this muscle.  Using mirrors, palpation of the muscle, or even sitting on soft cushioned surfaces and practice breathing in and dropping the muscle, then contraction and lifting it away, can help build awareness. Using a tampon with a mirror has shown to be effective in pelvic floor muscle training in women with or without pelvic problems (Pintos-Diaz).  Find your comfort level in meeting your pelvic floor, and come up with a plan that works for you!  Try to identify your muscle, and how it is feeling, 5 times each day to gain a more natural awareness.  Do not get discouraged if this is difficult, and if you find you need more help, a pelvic health physical therapist is a great place to go and learn more. 

3. Set up a simple pelvic health program. 

Exercise the pelvic floor like you would any other muscle.  Being creative or using a biofeedback device, such as the Perifit or Elvie, can add more to your program.  If you have pain, urgency, or nerve signs, it would be beneficial to meet with a pelvic floor physical therapist to determine the safest pelvic health program for you.  Otherwise, consider the same basic training concepts as you would when exercising for any other reason.  

Master the Basics

When you squeeze your pelvic floor muscles, it’s as if you are pulling the front pubic bone, toward the back tailbone, and the muscle is moving up toward your head.  Using a variety of cues to get in touch with different parts of the muscle initially, may be useful.  Cues such as “tightening the anus,” in men “shortening the penis,” “trying to imagine stopping the flow of urine (but not practicing this on the toilet!),” “lifting the bladder toward your head” may all be useful in learning about the muscle and how it works.  Try to set your goal at learning to squeeze the whole muscle, front and back, easily and appropriately as you breathe out.  Then try to drop the pelvic floor, and feel it lengthen when you inhale and breathe in.  

Design Something Functional 

Now knowing that the pelvic floor is a part of breathing, abdominal use, shoulder movements, and even just responding to body movements to stabilize our core, find fun activities and work pelvic floor and breathing in.  For example, a standing march with a row will challenge all of these movements and help train your pelvic floor to respond accordingly. Once you feel at ease with the pelvic floor contraction, use it with your exercises, and how you breathe when lifting weights, biking, or running.  Awareness of the muscle will help you build more health in the muscle. 

Consult with a pelvic health physical therapist

I may be biased, but pelvic health physical therapists are talented specialists, passionate about what their work is doing for the world, will listen to what you need, and know the pelvic floor.  Set up an initial consultation just to learn more if you find you are curious and having a difficult time with the pelvic floor. 

During a pelvic floor session you have a safe place to talk about any issues you may be having, whether it’s leaking urine, difficulty having sex, loss of orgasms or pleasure with sex, bowel problems, or pain that you think might be crossing over with pelvic floor causes.  Your pelvic floor therapist will listen to everything you need to say, explain anatomy and physiology of the pelvic floor, and help you relate your concerns to how the muscle works.  With consent, your therapist will also check the health of the pelvic floor muscles, pelvic floor reflexes, integration of pelvic floor into lumbar movements, lower extremity movement, and breathing function, and more.  This might include an external examination, internal examinations, hip screen, low back screen, ankle and foot evaluation, and breathing evaluation, amongst other potential items. The pelvic floor is part of the whole body and depending on your expectations for your visit, may include multi system screening.   You will leave your visit feeling empowered, and knowledgeable about one of the most important parts of your anatomy!


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