Many people suffer from pelvic floor dysfunction and yet it is hardly talked about. Most people don’t even know that there are muscles down there, let alone that these muscles have several incredibly important functions! They provide support to your pelvic organs against gravity and any increases in intra-abdominal pressure (ie. coughing, sneezing, laughing, lifting, transferring); prevent urinary and fecal leakage; assist in stabilizing the joints of your spine, pelvis, and hips; help with circulation; and, allow you to enjoy sex.
Unfortunately, there are a lot of things that can happen throughout your lifetime that can cause dysfunction of these pelvic floor muscles. Perhaps, you have had a baby or two – which in itself is traumatic for the pelvic floor. Even more traumatic if there was tearing or an episiotomy, or if forceps or vacuum were used. Maybe you have suffered from chronic constipation or you strain constantly by heavy lifting in your job. Maybe you have chronic prostatitis/chronic pelvic pain syndrome, if you are a man. Perhaps you have had a bad fall in the past on your tailbone and still experience some tenderness with sitting. Or maybe you have already had some form of pelvic surgery. These are just some examples of risk factors that can contribute to pelvic floor dysfunction. We are often led to believe by our physicians and those lovely incontinence product commercials/ads that it is normal to leak after childbirth or as we age, or even that it is normal to have pain with sexual intercourse. Although these conditions are very common, it is a huge misconception to think that there is nothing you can do about them.
Pelvic Floor Physiotherapy has been recommended time and time again in the literature as the first line of management for urinary incontinence and pelvic organ prolapse. It can also help people who suffer from pelvic pain and persistent low back and hip pain. Physiotherapists who have taken special post-graduate training in Pelvic Health can assess if your pelvic floor muscles are hypotonic (weak) or hypertonic (tight), and if they are contributing to your condition. This involves performing both an external and internal assessment. A hypotonic (weak) pelvic floor may contribute to stress or urge incontinence, and pelvic organ prolapse. A hypertonic (tight) pelvic floor may contribute to urinary and fecal urgency, urge incontinence, chronic pelvic pain, painful sexual intercourse, vaginismus, chronic prostatitis, interstitial cystitis, and pudendal neuralgia. Treatment is dependent on the assessment findings and may include external and internal soft tissue release, strength training, self-care education, and education on persistent pain mechanisms. It is important to understand that Kegels are not always helpful for pelvic floor dysfunction, and that they are often not done properly. When Kegels are indicated, internal palpation is the recommended technique for physiotherapists to understand, teach, and give feedback to patients.