What is pelvic floor therapy you ask? Hell, what even is your pelvic floor?….where even is your pelvic floor?! If you are like most men and women, you have probably ignored your pelvic floor for most of your life. And really, if something ain’t broke, don’t fix it right? Well how do you know if it’s broke?…..And if it were broke…. how would you go about fixing it? All great questions for today’s post where we dive into the who, what, where, how, and WHY of the illusive, the mysterious, the rarely discussed…..PELVIC FLOOR!
Let’s start with what it IS….
Your pelvis is a ring of bone with openings for our genitals and anus. Fwef, not even 200 words in and I dropped an anus bomb. How rude. The urogenital and anus openings are enclosed by a muscular wall known as the pelvic floor. If you are easily impressed by anatomical terms, let me hit you with a few. Most of the pelvic floor is formed by the coccygeus muscle and levator ani referred to jointly as the pelvic diaphragm. Inferior to the pelvic diaphragm we find the perineum. Oooo buzz word for pregnant folks ‘perineum’….more on that in a second. Divided into two triangles, the anterior urogenital triangle contains the external genitalia and the posterior anal triangle contains….pause for dramatic effect….the anal opening! For lady folk, the area in between your vagina and anus is known as the clinical perineum and this is this area that can tear during childbirth (naturally) or via intervention known as episiotomy. Hopefully that was a really impressive anatomical description of the pelvic floor. For those who could care less about the proper terms, your pelvic floor is a hammock slung between bones of your pelvis that supports your internal organs including your bladder, intestines, and uterus (if you’re a lady). In case it isn’t abundantly clear already, your pelvic floor has very a important job. It keeps stuff inside that should be inside and lets it out when it should be let out…
When your pelvic floor isn’t working….
Pelvic floor dysfunction can present as incontinence, pelvic organ prolapse, painful sex, painful urination, constipation and straining with bowel movements, and unexplained pain in low back, pelvic region, hips, genital area, or rectum. Depending on the symptoms you are experiencing it could be that your pelvic floor is too tight (hypertonicity) or too weak (hypotonicity). Well what do you know? Your pelvic floor likes the Goldilocks approach, not too loose, not too tight, must be juuuuuust right for everything to function properly. How can you tell? Likely, you can’t without getting an internal exam. Logically you could hypothesize that if you are leaking urine when you cough, sneeze, jump for joy etc. your pelvic floor isn’t strong enough to keep things in when they should be in. Likewise, if you are having trouble relieving yourself #2 style, it’s possible things are wound up too tight in there. BUT, before you make any clinical diagnoses on yourself, get an expert opinion. Which brings us to….
What is Pelvic Floor Therapy?
Pelvic floor therapists are registered physiotherapists with speciality training in pelvic health. Pelvic floor therapists are trained to conduct internal exams to better examine the tone, strength, and function of your pelvic floor musculature. An internal exam you say? By a physio? Yes. If gloved fingers make you squeamish, skip ahead to the next section. During a pelvic floor assessment, your therapist will insert a gloved (and thankfully lubed) finger into your vagina (if you’re a woman) or your rectum (if you’re a man). I can’t speak for the rectal exam but I have experienced the vaginal internal exam, twice now. Is it weird? Sure. Is it effective? Definitely. Your physio will walk you through exactly what he/she is feeling for and will only do what is comfortable to you. If at any time you feel uncomfortable you can cease the exam but in my experience there is nothing to fear. Perhaps this is part of the pregnancy, I hear after childbirth and the number of people who have seen your watzit up close and personal….you care far less about your modesty.
Here is how the exam went, one gloved finger inserted just inside the opening to your vagina to assess tension and tone, followed by two and then three fingers inside the vagina pressing on the pelvic floor muscles in a North-East-South-West style. During the internal exam there may be some uncomfortable small talk, perhaps you will discuss the weather, maybe the latest episode of Ozark…..no different than the ever awkward pap smear. But THEN the cool part of the assessment starts and your therapist coaches you on breathing techniques to lengthen and contract your pelvic floor. When you finally make the mind-body connection between what you thought your pelvic floor was (if you thought about it at all) and what it actually is, something magical happens. As you breathe in you can feel your pelvic floor drop and the therapists fingers withdraw, as you exhale you can feel the pelvic floor rebound drawing the therapist’s fingers inwards. And for a moment, you forget how strange this whole experience is! In all honesty, it’s not that weird. It’s such an incredible learning experience and it can make SUCH a difference in the health of your pelvic floor that the initial awkwardness of the internal exam is nothing to be afraid of. After the internal exam, your therapist will make an assessment regarding the tonicity of your pelvic floor. You may be prescribed breath work, strengthening exercises, and/or relaxing exercises. Your therapist will provide you with his/her recommendations and a program to perform at home.
Beyond Kegels
Ladies, we have all been told to do ur Kegels. Whether it was the first Cosmo we ever read or our friend who ‘swears by them’…it seems Kegels are the secret to a better sex life. But are they? It sounds plausible…..tighten and tone that vagina! And you know what? If you are leaking when you sneeze or cough Kegels could be a very important part of your therapy. But then there is the other half of us who are actually too tense at all times. We are really really good at contracting our pelvic floor….to the point we are experiencing pain during sex, going to the bathroom, or hell…even just walking around! And yet….the messaging from the media is always the same, tighten and tone! Worse than that, a lot of people associate pelvic floor therapy exclusively with Kegels. Learning to properly contract your pelvic floor is just one tool in your kit. Lengthening your pelvic floor is equally important, and it’s often the movement we struggle to connect with. The best thing you can do is to get an assessment and find out where you stand with your pelvic floor health.
Pregnancy
Captain Obvious here with a hot tip, during pregnancy your pelvic floor stretches to accommodate baby (shocking I know). A healthy pelvic floor will adapt to this stressor and still be able to lengthen and contract (letting stuff out and keeping stuff in) when you need it to. Sometimes we place additional strain on our pelvic floor during pregnancy by engaging in high impact activities like running and jumping. There are many women who will happily run throughout their entire pregnancies and those who will do double unders with ease at their CrossFit boxes right up until their due date. Does that mean it’s safe for everyone? No! Just because you were an avid runner/box jumper/pole vaulter pre-pregnancy does NOT mean your body is equipped to handle the increased demands of high impact exercise during pregnancy. The advice to “do whatever you did before pregnancy” is not actually all that great. YOU are not the same as you were pre-pregnancy, not physiologically, not even anatomically. Things have moved, shifted, and loosened to accommodate baby. You need to take precautions exercising when pregnant. I am the BIGGEST advocate for staying active during pregnancy so don’t think I am bad cop here….but perhaps in another post we will get into the nitty gritty of modifying exercise safely for pregnancy. If that is something you’d like to know more about, let me know!
My own experience with pelvic floor therapy
Personally, I sought a pelvic floor therapist during my pregnancy to make sure I was preparing my whatzit for birth and for what I hope to be a smooth recovery. Even though that was my intention, I actually ended up really needing pelvic floor therapy for pain I was experiencing after a run. I have always been a runner though I confess I didn’t run once during my first trimester (too fatigued). Instead, I waited until I had a burst of energy around 22 weeks and went for a glorious run. I took it easy, scaled back the distance and pace from what I would normally do….but the next day I woke up with 9/10 pelvic girdle pain. In fact, since that day I have experienced pain. First plan was to rest the area and avoid aggravators (unilateral exercises….including putting on pants) but the pain persisted (and I couldn’t avoid pants forever). Days and weeks went by and I started to accept that the pain was just related to my pregnancy and the laxity in my pelvic joints. Finally I made an appointment with a pelvic floor therapist and got a proper assessment. It turns out I was holding WAY too much tension in my pelvic floor to the point it was causing me pain on walking! After a few practice breaths (during that extremely valuable internal exam!) it became clear my pelvic floor was far too tight. And all this time I had been practicing Kegels thinking I had to increase tone and tension for my ever stretching pelvic floor! Good grief. My therapist banned me from doing Kegels and instead had me focus on a particular Yoga breath and symmetry sequence to relax my pelvic floor. Literally after one day I felt better. Not perfect, but SO much better. I practice every day now, and the symptoms keep improving. I’m not usually one for anecdotes but I have had such a positive experience with pelvic floor therapy I wanted to share.
If you have any questions I didn’t answer here, please send me a message on Instagram or an email at [email protected] and I’d be happy to answer!
Coach P
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