Pelvic Floor HEalth & Dysfunction
By Heather Simmons
Note: The information contained in this post is provided for informational purposes only, and should not be construed as medical advice. We highly recommend you consult with a medical professional if you believe you have a condition that warrants it.
For many, walking into the gym and seeing that the jump rope will be part of the day’s workout leaves them knowing that they’ll be making multiple trips to the bathroom during that class. Maybe the exercise isn’t a jump rope. It could be box jumps. It could be running. The story is the same. Start warming up, even just a little and the need to go to the bathroom arises. Spend a little more time practicing the exercise, doing a practice round or two and while the clock hasn’t even started, you may find that you’re into the bathroom for the second, maybe the third time. The coach starts the clock and you’re off into the workout and by the time you finish the workout, you’re not certain where the sweat on your pants begins and ends. You’re not alone in this experience and it very likely is related to your pelvic floor.
What is pelvic floor? What is dysfunction, and how does it affect everyday life?
The pelvic floor is a group of muscles located within the bottom of the pelvic bone cavity. The pelvic floor muscles (PFM) connect the boney structures such as the pubic bone, the coccyx, and the hip bones, while also creating a “floor” or ‘Hammock” which supports the organs within. Their function is to lengthen and contract as needed, in order to assist in basic bodily functions in conjunction with these organs and structures. Some of the activities of daily life (ADLs) which are made possible with the support of your PFM are; urination, bowel movements, clitoral and penile erection and orgasm, as well as core, hip and back stabilization to name just a few.
Dysfunction of these muscles can occur in various ways due to stress or strain acted upon on them from scenarios including but not limited to; childbirth, trauma, surgery, stress, respiratory problems, and inflammation. Symptoms of dysfunction may present as urinary or bowel incontinence or leakage, pelvic pain, organ prolapse (bulging), and/or sexual dysfunction. The PFMs can be generally categorized as being “overactive” or “under active” in their dysfunction but can present with many of the same symptoms.
Over active pelvic floor muscles are those which are chronically contracted or tight and “high”. A person with tight PFM’s may have pain in the abdomen or pelvic area, have trouble emptying their bladder and/or bowels, or may strain to do so. Sexual dysfunction and/or pain during sex, and tight hips and low back can also be present with over active PFM’s. Possible causes for over active pelvic floor muscles can include; “postural deficits, childbirth, trauma, surgery, muscular guarding, hemorrhoids, and/or pelvic inflammation” (Lewan,2020).
Under active pelvic floor muscles are those which are chronically lengthened or loose and “low”. Individuals with chronically weak PFM’s will find that their muscles do not contract as needed. Symptoms that present may be urinary and/or bowel incontinence or leakage, pelvic organ prolapse or bulging. Numbness or lack of sensation during sex and/or the inability to maintain clitoral or penile erection and orgasm, are also symptoms of low PFM tone. In addition, a person may experience low back pain or core instability. Possible causes for under active PFMs are “childbirth, trauma to the area, surgery, aging, or chronic intrabdominal pressure caused by a history of asthma, cough, heavy lifting or repeated high impact activity” (Lewan,2020).
Most people are aware of the idea of “Kegel” exercises as a treatment for problems in this area. This type of exercise refers to the concentric contraction (intentional tightening) of the group of deep and superficial muscles creating the pelvic “bowl” or “hammock”. The idea is that the area is generally weak, and by doing the repetitions of squeezing and holding, the muscles will become stronger and thus symptoms will lessen or be alleviated. However, individuals with over active PFM will not be served well by this practice as it will only be tightening an already tight and uncomfortable area. In addition, to properly execute these or any type of exercises as an intervention for PFM dysfunction, awareness of the sensations in this area is critical to initiating control. In most, cases individuals may lack the mind body connection or neuromuscular control to actively engage these muscles, and could be performing the exercise ineffectively or inefficiently.
A simple technique to help improve pelvic floor tone and awareness is the practice of diaphragmatic breathing. In addition to the benefits of helping to maintain overall homeostasis in the body via activation of the body’s parasympathetic (calming, restorative) system, diaphragmatic breathing allows us to engage in an intentional and mindful focus on areas of the body which are directly related to and support the success of the breathing process. The pelvic floor muscles, become the bottom of the deep bowl which fills with the breath, and then they become the anchor of the body which is pulled up and presses the breath completely out of the body. Diaphragmatic breathing can be an effective tool in beginning the process of “uptraining” or “down training” this muscle group for better function.
How exactly does one perform a diaphragmatic breath?
“Lie on your back with your knees slightly bent and head supported. Place one hand on your chest and one hand on your abdomen. This little trick will help you know if you are performing the breath correctly.
Breathe slowly through your nose and allow the air to flow from the thoracic cavity down to your abdominopelvic cavity. As you take your deep breath in, the hand on your chest should remain as still as possible, while the hand on your abdomen should rise. It’s important to note that you are not using your abdominal muscles to push out your stomach, but rather, allowing the air to fill the abdomen.
Exhale slowly through your mouth and allow the abdomen to recoil back down to its resting position. The hand on your chest should continue to remain as still as possible.” (pelvicpainrehab.com. Diaphragmatic breathing, pelvic pain, peeing and pooping In Low-Tone Pelvic Floor Dysfunction, Stress Urinary Incontinence by PelvAdmin, March 1, 2017)
While performing this practice, become increasingly aware of the role the PFMs play in the inhale and the exhale, and try and isolate the muscles thoughtfully. When inhaling, intentionally lengthen and relax them, pressing the air down releasing tension, like you’re filling a balloon. On the exhale focus on pulling them up tight, as you press the air from your abdomen and your chest and then wring every last bit of air from the body holding your PFMs and your core active high and tight for a second.
Pro tip- use the bathroom before your breathing practice to avoid an urgent disruption!
Engaging in a thoughtful practice such a diaphragmatic breathing is just the beginning to creating strength in this area of the body in a positive and nonjudgmental way. Dysfunction of the pelvic floor is very common, and so hopefully bringing these issues into the conversation will help alleviate some stress and mystery over our taboos surrounding the area, and its various functions. Creating a routine of emotional and physical self-care can bring us closer to realizing our goals no matter how small or large they are, and can empower us to be proactive about changing our health and the world around us in positive ways.
Special Thanks:
I’d like to thank Bonnie Hull for consulting with me as I wrote this article. Her willingness to share her knowledge and training on this subject is appreciated.
Resources:
1. Lewan,C PT,DPT,CYT,CPI (2020) Functional Pelvic Floor Training: Pelvic floor assessment and exercise planning, Summit Education
2. Padron,I. CPT (2015) Developing mind muscle connection for muscle hypertrophy., DrJohnRusin.com, research and education blog
3. Levac, K. (July 1,2019) Research on Diaphragmatic Breathing, NQA.org, research and education blog
PelvAdmin (March 1,2017) Diaphragmatic Breathing, Pelvic Pain, Peeing and Pooping in low-tone pelvic floor dysfunction, stress and urinary incontinence., PelvicpainRehab.com, research and education blog