Picture a hammock between two trees. If it’s taut, it’s flat and uncomfortable. If it’s loose, it’s saggy and unstable. Similarly, the pelvic floor is a group of skeletal muscles and connective tissue that support the pelvic organs, including the rectum, the bladder, and a woman’s uterus. “They stretch from sit bone to sit bone and from pubic bone to tailbone,” explains occupational therapist Logan Shuttleworth of Triumph Pelvic Health in Lewes. There are openings for the urethra, the anus, and a woman’s vagina.
Painful, uncomfortable, and potentially embarrassing issues occur when the pelvic floor becomes weak, tight, or a combination of both. While men can have pelvic-floor-related problems, such as pain and urinary incontinence, women are more likely to put off care, says Anne Collins Duch of Physical Therapy for Women in Wilmington. “Early treatment will address the symptoms and help patients break bad habits and build strength.”
Since pregnancy and menopause affect the musculoskeletal system, they can lead to pelvic floor problems. However, previous injuries and diseases that cause hypermobility are other factors. Even the way you breathe or stand can affect the pelvic floor.
“Along with bladder leakage, signs of a pelvic floor imbalance include urinary frequency or urgency; constipation; pain during bowel movements, menstruation, or sex; and the inability to use inserted menstrual protection, such as tampons.
“In this culture, we tend to be belly-grippers,” Duch says. “Women have been told to suck in their gut.” Pulling the belly button up to your spine for prolonged periods puts pressure on the pelvic floor. Athletes with strong core muscles can develop urinary incontinence as early as age 17, she notes.
Along with bladder leakage, signs of a pelvic floor imbalance include urinary frequency or urgency; constipation; pain during bowel movements, menstruation, or sex; and the inability to use inserted menstrual protection, such as tampons. Shuttleworth also treats people with pelvic organ prolapse, which happens when organs drop and bulge into the vagina.
A physician will refer patients to physical therapists for a full-body musculoskeletal exam. Duch recommends making an appointment with a pelvic floor specialist. Treatment might include manual soft tissue and myofascial release, diaphragmatic breathing, visceral mobilizations, stretching and strengthening, and lifestyle modifications, says Alison Walker, a physical therapist specializing in pelvic floor health at Performance Physical Therapy in Hockessin. Duch agrees. Manual manipulation of the abdomen area and organs helps patients learn to control the muscles and can even ease constipation and abdominal pain.
Walker offers postural education and bladder retraining. Children are taught to proactively urinate, even without the urge, and adults are often advised to do the same, she explains. This disrupts the bladder-brain connection. Ideally, the brain should only trigger the need to urinate when the bladder is full. Over time, bladder problems can snowball into other pelvic floor issues, Walker explains.
Surgery is warranted in some instances, but each case is different, Shuttleworth notes. She treated a woman who was in pain a year after giving birth and who had a history of chronic constipation, discomfort with intimacy, and poor breathing mechanics. The cause was pelvic hypermobility and weak core muscles. “The pelvic floor craves stability, and [hers] got really tight, which caused pain,” Shuttleworth explains.
The game plan included improving core strength and hip mobility. Stretches, breathing exercises, and abductor exercises helped create support to take the burden off the pelvis.
To keep your pelvic floor healthy, remember to exhale, even when picking up your grocery bag or a child. It’s a practice Shuttleworth calls “blow as you go.” Avoid clenching the glute and belly muscles for prolonged periods. Like any muscle, the pelvic floor needs to relax.
See your doctor if you experience any of the associated symptoms.
Related: 5 Habits to Reduce Muscle Loss, According to Delaware Experts
