What is The Pelvic Floor?
The pelvic floor refers to a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum (the large fused bone at the bottom of your spine).
These muscles act like a hammock to provide support to the bladder, intestines, and uterus (in women). Coordinated contracting and relaxing of these muscles controls bowel and bladder functions.RELATED: RECOMMENDED PLANS FOR YOU
What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction effects both men and women and consists of a wide range of problems including but not limited to the following: Bladder Dysfunction that includes Interstitial Cystitis and Urinary Incontinence, Bowel Disorders such as Irritable Bowel Syndrome, Sexual Dysfunction such as Levator Ani Syndrome, Pelvic Pain such as Pudendal Neuralgia, Vulvodynia, and Erectile Dysfunction.
These problems can occur when the muscles of the pelvic floor are weak, tight, or there is an impairment of the sacroiliac joint (triangular bone at the back of the pelvis), low back, coccyx (tailbone) or hip joint.
Infections, pregnancy, childbirth, being overweight, aging, chronic low back or SI joint dysfunction, trauma (such as a bad fall), or surgery can all affect the pelvic floor musculature and create dysfunction.
Most people assume that if you are having a problem with the pelvic floor, that performing Kegel exercises are the all encompassing answer.
Kegel exercises, developed by gynecologist Arnold Henry Kegel are used to strengthen the pelvic floor by squeezing the muscles like when you stop the flow of urine.
Today, Kegels are a primary form of treatment. But what if your pelvic floor is already tight? And how do you go about determining this?
How Do You Know If Kegels Are Right For You?
In actuality, the pelvic floor can actually be both weak and tight. For simplicity and the purpose of this article, “tight” will refer to “strong” as a muscle can be both tight and weak and you never want to stretch an already weakened muscle unless you contract it first.
Signs of a weak pelvic floor are incontinence or difficulty performing sex. But this does not always mean the pelvic floor is always weak, it can actually be strong!
You can think of the pelvic floor as four different quadrants divided front to back and left to right. The front quadrant in woman consists of the labia major and the scrotum in males.
The back quadrant is between the coccyx (tailbone) and ischial tuberosity (bony landmarks on the butt). It is possible for one quadrant of your pelvic floor to be weak and another to be tight.
In this case, a typical Kegel will not be effective and can actually make your situation worse.
For example, if your pelvic floor is going into spasm, the muscles actually need to be relaxed to ease the pain, not strengthened. Here an anti- Kegel exercise would be appropriate (more on these later).
It is key to determine what part of your pelvic floor is weak and what part is strong. And then to either strengthen or release that particular quadrant.
The neuromuscular system can also cause one quadrant of the pelvic floor to prevent the other quadrants from working properly.
The fascia (connective tissue) of one quadrant can pull on the others causing them to overstretch which weakens the muscle as it can no longer re-contract.
The over stretched part of the musculature can therefore not contract and provide the necessary support to the pelvic floor. In this case, the pelvic floor must be brought back into balance to function properly.
To Strengthen a Particular Quadrant
1. You can either perform a squat or come onto all fours in a quadruped position with the knees wide.
2. Sit towards the quadrant that needs to be strengthened as you perform a Kegel. If the front quadrant is weak try to “hold your pee”, if your back quadrant is weak try to “hold your poo” (pardon the expressions). Release and then perform again.
To Release a Particular Quadrant
You can either perform a squat or come onto all fours in a quadruped position with the knees wide.
Sit away from the quadrant that needs to be released so it gets a stretch. Move in and out of the position.
In any pelvic floor issue, it is also important to evaluate the functioning of the diaphragm and rest of the intrinsic core musculature. The pelvic floor and diaphragm are at opposite ends of the thorax and work together in breathing.
The diaphragm is our primary breathing muscle, it is dome-shaped and connects to the lower part of the ribcage.
On an inhale the diaphragm moves downwards pushing on our organs towards the pelvic floor and on the exhale the diaphragm and organs move back up. So on the in breath the pelvic floor stretches and on the exhale it contracts.
Therefore, with every breath our pelvic floor receives some exercise.
When there is breathing dysfunction it can certainly affect the pelvic floor. Often the diaphragm never fully relaxes and it causes the pelvic floor to become weak.
A good diaphragm release and proper training of the breath alongside proper pelvic floor activation can go a long way. Here is my favorite diaphragm release, taught to me by Dr. Kathy Dooley. Make sure to follow up with performing the proper Kegel exercise for you.
Cough and Flick
Hook a finger under the bottom of your ribcage.
Flick the finger out as you cough.
The proper functioning of the pelvic floor and diaphragm can also be affected by poor posture. The transverse abdomens is an intrinsic core muscle that acts as a corset circling our torso and provides lumbar stabilization. It also works during exhalation.
Poor posture weakens the transverse abdomens and can cause the pelvic floor to work overtime to pick up the slack. This can lead to dysfunction and pain.
In this case the pelvic floor needs to be released and the transverse abdomens to be strengthened. The Anti-Kegel is useful in this situation as it does both simultaneously. I learned this exercise from bodyworker Thomas Wells.
To perform the Anti-Kegel:
Lay on your back with legs up in table top position and knees wide with feet together.
Press your hands to your thighs and your thighs to your hands as you breathe deeply.
In order to receive effective treatment and properly rehab the pelvic floor, it is critical to have a thorough evaluation from a physical therapist who specializes in the pelvic floor or someone who can perform neuromuscular testing to determine the relationships and patterns between muscles and view the system as a whole such as a Neurokinetic Therapy Practitioner.