Pelvic Health 101: What Women Need to Know

Why Should I Care about My Pelvic Floor?  

What Can a Pelvic Health Physical Therapist Do For Me? 

Good questions! Let’s answer these and others right here and now.

While, technically, your pelvic floor is the group of muscles and ligaments in your pelvic region that supports your pelvic floor organs (including the bladder, rectum and uterus), when your doctor talks about pelvic floor dysfunction, there are a whole lot more tissues and issues to consider.  

Image

Common pelvic floor problems include:

• Urinary: painful urination, urine leakage, urgency/frequency or difficulty emptying your bladder.
• Bowel issues: constipation/straining, leaking of stool or gas.
• Pelvic region pain: coccyx (tailbone) pain, pubic symphysis (front of the pelvis, below the bladder) pain, sacroiliac joint (back of the pelvis) pain, vulvar or vaginal pain, rectal pain or lower abdominal pain.
• Pain during or after sex.
• Prolapse: this occurs when pelvic organs or tissues descend below where they belong, leading to pressure, discomfort, bulging organs and sometimes interference with emptying of bowel and bladder.

What causes pelvic floor problems? 

Many factors can contribute to these problems; too many to list. Some common causes of pelvic floor problems include:

• Pregnancy and childbirth can cause damage to muscles, ligaments or pelvic nerves.
• Pelvic and abdominal surgeries can cause a cycle of events leading to problems, such as scar tissue which may impinge on nerves. 
• Cancer and radiation treatments also can cause considerable problems in pelvic organs, muscles and fascia (the connective tissue surrounding organs and muscles).
• Natural processes like menopause, with changing hormone levels, can cause problems with tissue elasticity and dryness, which may impact sexual function.
• Chronic constipation and chronic coughing are also hard on the pelvic floor—creating excessive force loads on tissues which may suffer over the long term, resulting in loss of support of organs with urine leakage, prolapse or muscle spasms, as well as hemorrhoids.

What can a person do to prevent pelvic health problems?

• Practice therapeutic breathing (see below).
• Pressure management (including avoiding constipation and chronic cough).
• Maintain a balanced diet, healthy body weight and adequate fluid intake.
• Embrace an active lifestyle.
• Learn and practice pelvic floor exercises.
• Maintain routine wellness visits and health screenings.

Of course, these will not prevent all pelvic floor issues, but they are an excellent place to start.

Ultimately, pelvic health is about achieving and maintaining the best possible functioning and management of the bladder, bowel, reproductive organs, muscles, nerves and other tissues in the pelvic region to allow for optimal functioning and quality of life. At Overlake, this involves a team approach with many types of providers.

How can a pelvic health physical therapist help when problems occur?

• Therapeutic breathing: Physical therapists (PTs) specializing in pelvic health teach therapeutic breathing, which involves the expansion of the rib cage and abdomen as well as the chest when inhaling, and a nice recoil while exhaling. There is an anatomical connection between the diaphragm and core, with the pelvic floor, so proper breathing is a building block for optimal pelvic floor function. PTs work with patients to master this skill. 
• Muscle, joint and nerve treatment: We work with patients to locate, recruit, train and strengthen the pelvic floor muscles when appropriate. For some patients, this might not be right away. If the pelvic floor muscles are tight, short, tender or otherwise not functioning, the PT may have to treat this first. This is very common in situations involving pelvic pain. Pelvic health PTs are trained in external and internal manual techniques that are safe and effective for pelvic floor muscles and surrounding muscles and joints. Sometimes biofeedback, with internal or external sensors, is also used for muscle training and/or quieting the nervous system.
• Patient education: Our most important contribution is working with each patient to develop an individualized approach for behavioral strategies that will work for them. Bladder training, toileting positioning, lifting techniques, home exercises, dilator training and lubrication recommendations are just a few examples of what therapists provide to help patients achieve their goals and build a happy, healthy quality of life for life.

To learn more about the Overlake's comprehensive women's health services, visit overlakehospital.org/services/womens-health. You can also sign up for one of our Pelvic Floor Wellness classes to learn tips and techniques to improve your pelvic floor health. Classes are led by trained Physical Therapists specializing in Pelvic Health.

Anyone can have pelvic floor issues, including men. If you have any concerns around issues mentioned above, including pelvic pain, talk with your healthcare provider about whether a pelvic health PT referral is right for you.