What is the pelvic floor? Have you possibly heard someone mention “pelvic floor exercises” or “strengthening your pelvic floor” in conversation? It is indeed a present day concern and I don’t imagine it was the topic of exercise class discussions in the 1940’s and 50’s! Knowledge of your pelvic floor musculature is a progressive form of exercise and health awareness, and as it turns out, a very important concept for all walks of life!
This month OSR presents to you a simple Question and Answer session regarding the pelvic floor to help enhance your understanding of this region in our bodies and ideally to gain knowledge as to why it is important to attend to. This Q&A session is a very typical one that many physical therapists, physicians, and ObGyn specialists have already experienced, so we laid it out in a conversational manner. Enjoy:
Client: What exactly is the “pelvic floor”?
PT (physical therapist): Sure. The pelvic floor muscle group incorporates small pelvic girdle muscles and connective tissue. It extends across the base of the pelvis almost as a screen or a sling, supporting and containing the organs of the reproductive and urinary systems, preventing release from the gravity-oriented orifices. The pelvic floor consists of three layers, the superficial perineal layer, the deep urogenital diaphragm (innervated by the pudendal nerve), and the deep pelvic diaphragm (innervated by the sacral nerve roots S3-S5). The pelvic floor provides support to the pelvic organs. It can also assist in sexual performance, stabilize connecting joints, and serves as a lymphatic pump for the pelvic region.
Client: Why is it important to strengthen and bring awareness to this area?
PT (physical therapist): It is important for all of us to be knowledgeable of the muscles in our body; especially muscles that serve to help with daily functioning such as using the bathroom which involves your pelvic floor region. It is important to know how to isolate and contract the pelvic floor muscles for retraining because you might later be able to prevent urine leakage, bladder issues, or reduce difficulty or pain with sexual activity. Being aware of the pelvic floor will only benefit a patient and improve his or her awareness of their own control and muscular maintenance of bodily functions.
Client: If I have a history of issues with stress incontinence (uncontrollable urges to release urine), is this something I should be aware of… the pelvic floor?
PT (physical therapist): Yes. Research supports that adults with urinary stress incontinence or fecal incontinence have benefitted significantly from re-training pelvic floor muscles. Pelvic floor exercises can help strengthen the small but important muscles surrounding the uterus, bladder, and bowel or large intestine. By creating a safe routine of pelvic floor strength building exercises, a person will gain bladder and bowel control. There are safe and effective documented recommendations to perform pelvic floor strengthening or to understand some of the research behind the pelvic floor, via the internet. A few RESOURCES that we recommend include:
Mayo Clinic:
https://healthletter.mayoclinic.com/editorial/editorial.cfm/i/454/t/Pelvic%20floor%20exercises/
https://www.mayoclinic.org/healthy-lifestyle/womens-health/multimedia/female-pelvic-floor-muscles/img-20006566
Anatomy of the Pelvic Floor:
https://www.beyondbasicsphysicaltherapy.com/pelvic-floor-anatomy
National Institute of Health, Brazil:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664121/
Effects of Pelvic Floor Training:
https://www.bmj.com/content/349/bmj.g7378
The Asian Journal of Sports Medicine:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289190/
International Urogynecology Journal:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057627/
Group-Based Yoga Therapy Intervention for Urinary Incontinence in Women:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310548/
Pelvic Floor and Pilates:
https://www.beyondbasicsphysicaltherapy.com/pilates
The Status of Pelvic Floor Muscle Training:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997838/
————————————-
Client: Who should be doing pelvic floor strengthening on a regular basis?
PT: Again that is a good question. All of us would benefit from pelvic floor awareness and routine safe and mild muscle contractions. If you have an issue with stress incontinence (both men and women), if you are pregnant, if you recently delivered a newborn, and if you underwent abdominal or bladder or even intestinal surgery in your recent past you will most definitely benefit from pelvic floor muscle training. However, everyone will find benefit from being able to locate, isolate and attend to this muscular region.
Client: What form of exercise might help to bring my attention to developing strength of the pelvic floor? Is there anything in particular?
PT: Why yes. We recommend looking into some written resources, to openly discuss this topic with your physician, ObGyn doctor, or hey, even us physical therapists here at OSR. We recommend you feel comfortable about asking about it. It’s a normal every day function and knowing how to enhance it can only improve your routine and control.
Furthermore, we recommend considering a local Pilates class and there are also many forms of yoga therapy that integrate awareness and focus on the pelvic region. One class that is specific and worth considering is prenatal yoga, or if you’re not so pregnant, possibly a restorative yoga.
If you have further questions in this area, you can most definitely contact one of the physical therapists working at OSR! We am certain they would happily provide a suggestion or two and maybe even help you to develop individualized strengthening exercise program that fit your needs.
Client: Wow thank you therapist. Any recommendations you think I could try out tonight just out of my own curiosity?
PT: I can most certainly make a few suggestions.
Relaxation and slow, deep breathing is important for all of us. If you can add-in to your current routine some slow, closed eyed, lying on your back, quiet breath work… then you just might find the extra bit of time to integrate pelvic floor exercises. Consider elevating your pelvis at the end of a long day if you experienced stress. Lay on the floor with your legs up the wall and your pelvis positioned on and supported by a wedge, a couch pillow, or a rolled up beach towel (eh brah, I have one of those!). Take a moment in this position to integrate the deep breathing exercise, focus your attention on relaxing any joint tension, like maybe you’re clenching your teeth (holding your jaw tight) or retaining tension in the shoulder region.
Just take this break in the evening to relax yourself and release any physically stored muscle and neural tension. Bring your attention then, after several breaths, to your pelvic muscles. Try and tighten the muscles you would squeeze if you were trying to hold back urine. Do not over contract your gluteal (buttox) or your abdominal muscles. No, this is separate. It’s fairly subtle, the pelvic floor contraction, and it takes a few trials to find the right muscle group. Try not to clench tightly. Try lightly and slowly activating these muscles (again thinking you’re trying to stop yourself from urinating). Squeeze there and then hold for a count of five seconds. See if you are able to combine this muscle contracting with your deep breathing exercise.
If you desire more detail and clarification, don’t hesitate to contact a physical therapist trained in this department. We hope these ideas and responses were helpful and we hope you have gained further insight into what you, yourself are capable of in terms of strengthening and muscle control in a fairly important region of your body, the pelvic floor!
Written by: Jana Andrus, RYT, graduate of a doctoral physical therapy program.
Resources
Stein, Amy, DPT. Healing Pelvic Pain
Articles referenced from the Internet:
Title: Why it Hurts Down There
https://www.prevention.com/sex/understanding-pelvic-floor-dysfunction
Mayo Clinic – Womens Health:
https://healthletter.mayoclinic.com/editorial/editorial.cfm/i/454/t/Pelvic%20floor%20exercises/
https://www.mayoclinic.org/healthy-lifestyle/womens-health/multimedia/female-pelvic-floor-muscles/img-20006566
Anatomy of the Pelvic Floor:
https://www.beyondbasicsphysicaltherapy.com/pelvic-floor-anatomy
National Institute of Health, Brazil:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664121/
Effects of Pelvic Floor Training:
https://www.bmj.com/content/349/bmj.g7378
The Asian Journal of Sports Medicine:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289190/
International Urogynecology Journal:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057627/
Group-Based Yoga Therapy Intervention for Urinary Incontinence in Women:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310548/
Pelvic Floor and Pilates:
https://www.beyondbasicsphysicaltherapy.com/pilates
The Status of Pelvic Floor Muscle Training:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997838/
Images and Video Reference:
https://www.healingpelvicandabdominalpain.com/
https://www.beyondbasicsphysicaltherapy.com/pelvic-floor-anatomy
Dr OZ: Healing Pelvic Pain, Stein, Amy DPT
https://www.doctoroz.com/episode/dr-oz-takes-down-scammers-using-his-name-dupe-you?video_id=3520306619001
