For the longest time pelvic health was equated with kegels. But what most people don’t understand is that there is a lot to know about the pelvic floor especially when they have symptoms relating to it. The purpose of this article is to understand what the pelvic floor is and how it can affect you. 

The pelvic floor is made up of muscles (ligaments, nerves and fascia) attaching from the pubic bone to the tailbone, also known as the coccyx. The pelvic floor acts like a hammock or bowl within the pelvis holding up the uterus/prostate, bladder and rectum. The pelvic floor should be strong to support these organs and prevent downward pressure. The pelvic floor is also considered a core muscle which stabilizes the pelvis and back. Since the bladder sits above, the urethra runs through and allows urine to flow as well as feces to exit out of the rectum playing a major role in bowel and urinary function.  It also plays a huge role in sexual function as these muscles are used during penetration and orgasm. 

Now like any other muscle in the body, a muscle can be overused causing spasms and tightness, which can feel painful at many points called trigger points. Tightness does not equal strong, in fact it is weak. And on the opposite end, if a muscle is underused it feels loose and weak, and lacking the ability to do a contraction. Both of these scenarios have a weak pelvic floor that lacks the strength to do a contraction. Pelvic floor dysfunction is simply stating that something is wrong with the pelvic floor, whether overactive or underactive. 

 Stereotypically it is thought that a newly postpartum mother of three children may be unable to control her urine flow when she jumps, as someone who has a loose pelvic floor or a grandmother who wears diapers because she has urinary incontinence. But as a pelvic pain sports medicine doctor, I see all genders presenting with pelvic pain as a result of either tight, overactive/hypertonic muscles or loose, hypotonic muscles and sometimes even a combination of both. 

Unfortunately generalizing people into categories does not always help patients. For instance, without an exam, if a pregnant postpartum women came in describing urinary leakage, one might suggest to her to start a kegel regimen. But without further examination, and history taking, one might not realize she may actually have hypertonic muscles that is also causing painful intercourse postpartum and that starting kegels can make her muscles more tight and increase her pain.  Many factors including the way the baby sat in the abdomen, the labor and of course her recovery play a role in how the pelvic floor can present. It is also important to take into account what activities one does, any recent falls, mental health and any sexual history/trauma to further understand how one’s pelvic floor may present. 

If there is a question about whether one should start kegel exercise, a pelvic floor examination should be done prior to starting exercises. Assuming that one is hypotonic or hypertonic, can be detrimental and can make symptoms worse. Finding an experienced pelvic physical therapist or a physician specializing in pelvic pain is a great place to start when it comes to your pelvic health journey.



Written by:

Tayyaba Ahmed, board-certified Physical Medicine and Rehabilitation physician and member of  the International Pelvic Pain Society.

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