Why Your Pelvic Floor Matters?

Written by Katrina Carpenter, PT, DPT

Hello everyone! My name is Katrina Carpenter, PT, DPT and I put together this informational video with the purpose of educating the general public, potential patients and healthcare personnel, on the pelvic floor. I had a few goals throughout this presentation primarily including a discussion on what the pelvic floor is, what issues can involve the pelvic floor, and how we as physical therapists can treat the pelvic floor. I also feel that it is important to break the taboos around the pelvic floor and spread the word that common does not equate to normal and that the pelvic floor can be a treatable issue regardless of gender.

What is the pelvic floor?

The pelvic floor is made up of three layers of muscle and their boney attachments. This acts as a support structure for the abdominal organs and the foundation of our core. Our core is made up of the Abdominals (Rectus, Transversus, and Obliques) around the mid-section, the Diaphragm below the lungs, and the Pelvic Floor at the bottom. All three portions work together to brace the low back, protect the organs, and allow us to take part in our daily activities. If we have weakness in one of these areas, there will be dysfunction. A good example is when the pelvic floor is week and someone sneezes. When we sneeze our whole core should contract together and there should be no issues. However, if our abs kick in as our diaphragm contracts for the sneeze and the pelvic floor does not activate as it should, we may leak.

What issues might involve the pelvic floor?

The short answer is ANYTHING! But more commonly anything in the abdominal or pelvic area. A short list of conditions that pelvic floor physical therapists may treat is as follows:

  •             Prenatal and post-partum
  •             Post-surgical
  •             Erectile Dysfunction
  •             Bowel/Bladder urgency/incontinence
  •             Organ prolapse
  •             Pelvic Pain
  •             Pain with intercourse
  •             Tailbone or low back pain
  •             Many MANY more!

You might hear some people refer to their body as a temple. If it is, then I would say that it changes with time just as any other structure would and may fall into disrepair if not properly maintained. Some things that cause us to fall into disrepair include; age, surgeries, trauma/abuse, mind/psyche (shame, embarrassment, and taboo)

More often than not, compensations that you are doing may lead to injury, OR injuries that you have may lead to compensation. For example, an abdominal surgery that you may have had in the past can have scar tissue growing internally which may negatively impact the mobility of your bowel leading to constipation. Inversely, urinating “just in case” too often can actually change the way your body functions in sending signals to the brain leading to increased frequency and urgency.

Our goal is to treat your body holistically based on your presentation and break these cycles, keeping in mind that the pelvic floor is often overlooked.

How do we treat the pelvic floor?

Everyone is different and different treatment methods and techniques are more beneficial for some people than others. This in mind we really need to do a full assessment in order to determine what is right for you, and even then the treatment is subject to change as you change or as we get to know you, your body, and your condition.

First we will assess your body and determine your functional and structural deficits and go from there. Most of the above list can be categorized into one or any combination of the following: tightness, weakness, and incoordination. We assess with discussion, manual muscle testing, and palpation.

Following the assessment we discuss with you our recommended treatment plan including treatment, duration, frequency, and a home exercise program.

We typically treat with a combination of functional mobilization, neuromuscular reeducation, and motor training.  Functional mobilization is more often hands on but is NOT massage. We typically apply pressure at a specific depth and direction to an area needing attention and incorporate your body’s own movement patterns in order to affect the tissue in that area. This is most often followed by neuromuscular reeducation and motor training which can include specific exercises or activities requiring you to activate certain muscles at a given time with coordinated breathing utilizing your own body weight or other resistances. This portion may also include education on the structure of the body or habit training/breaking techniques.

Our goal with our treatment is to set you up with the tools you need to continue progressing on your own once we bulk up your “tool box”. This includes techniques you may need to manage a flare up or progressions in your home exercise program as the exercises begin to get too easy for you. I feel that a handful of patients improve in a kind of bell curve. It may take a couple sessions to figure out what works best, and then we see a lot of improvement, and then there may be a plateau. During that slow of progression is when it may be more beneficial for you to continue on your own for a period of time.  We form good relationships with our patients but we don’t want to be treating them forever! We want to set them up for success with the knowledge that they can always return if needed.

Common does NOT mean normal!

I need my little soap box here because I can get annoyed at the impact that I feel diaper commercials or frequency of Viagra use as solutions to problems that could be something bigger or could be addressed by Pelvic Floor treatment. I understand that we have some excellent options for people who need aids such as these but I wish they were not the go to as I feel this normalizes issues that are not normal. Don’t ignore your pelvic health!

We as physical therapists are not always the best at marketing, and in turn, Pelvic Floor PT’s are also not great at it. When we do market it seems to be more often towards obstetricians, gynecologists, and urologists when I feel like it could be more. I challenge you to help spread the word! Tell a friend, family member, your doctor, or co-worker: Pelvic Floor Physical Therapy is a thing — for Men and Women!