Written by Maya Moody, PT, DPT
August is Pelvic Floor Dysfunction Awareness Month, making it the perfect time to talk openly about a topic that is often overlooked, misunderstood, or simply normalized.
In pelvic health physical therapy, many new patients arrive with symptoms they have experienced for months or even years. Often, one of the first things discussed during an evaluation is the difference between something being common and something being normal. Symptoms such as leaking urine during exercise, constipation, urinary urgency or frequency, pain with intercourse, difficulty with bowel or bladder control, delayed potty training in children, erectile dysfunction in men, and pelvic pressure or heaviness are common, but that does not mean they are something that have to be accepted as a normal part of life.
Pelvic Floor Dysfunction Can Look Different for Everyone
The pelvic floor is a group of muscles that sits at the bottom of the pelvis and plays an important role in bladder and bowel control, sexual function, pelvic organ support, breathing and pressure management, and movement. When these muscles are not coordinating properly, pelvic floor dysfunction can develop. Pelvic floor dysfunction does not always mean that the muscles are simply “weak.” The pelvic floor can be too tight or overactive, weak or lacking endurance, poorly coordinated, unable to relax when needed, or unable to generate enough force when needed. Sometimes the pelvic floor works too hard to compensate for other muscles that are not doing their share of the work.This is why pelvic floor physical therapy is individualized. Treatment should be based on the specific symptoms, impairments, and goals of each person.
Pelvic Floor Dysfunction and Low Back Pain
One of the most important connections to understand is the relationship between the pelvic floor and the rest of the body, particularly the low back. Research has found a significant overlap between pelvic floor dysfunction and low back pain. A systematic review and meta-analysis published in Physical Therapy found that women with low back pain had a higher prevalence of pelvic floor disorders compared with women without low back pain.This connection makes sense when considering how the pelvic floor works as part of the body’s core system. The pelvic floor works together with the diaphragm, abdominal muscles, and spinal muscles to manage pressure and provide stability during movement.
When one part of this system is not functioning optimally, other areas may compensate. This means that someone seeking physical therapy for low back pain may also benefit from having the pelvic floor assessed, particularly if symptoms such as urinary leakage, urgency, constipation, pelvic pressure, or painful intercourse are present. The reverse is also true. Someone seeking care for pelvic floor symptoms may have contributing impairments in the hips, glutes, abdomen, or low back that need to be addressed.
So, How Is Pelvic Floor Dysfunction Treated?
There is no single treatment that works for every pelvic floor condition. Effective pelvic floor physical therapy may include several different approaches depending on the individual’s presentation.
Manual Therapy
Pelvic floor physical therapists can use skilled manual therapy to address muscles and connective tissues that are contributing to pain, tension, or poor movement.
This may include skilled internal pelvic floor muscle release, when appropriate and with the patient’s consent. Internal work can help identify areas of increased muscle tension or tenderness and address restrictions that may be contributing to symptoms.
Manual therapy can also be performed externally on surrounding muscles, including the hips, adductors, glutes, abdomen, and low back.
Dry Needling
Dry needling may also be incorporated into treatment when appropriate. Pelvic floor muscles and supporting muscles such as the adductors, glutes, and low back may be treated with dry needling to address muscular tension and dysfunction.
As with all treatment techniques, dry needling is selected based on the individual’s specific
presentation and goals.
Breathing and Pressure Management
Breathing is another important component of pelvic floor rehabilitation.
The diaphragm and pelvic floor work together as part of the body’s pressure management system. Learning how to coordinate breathing with pelvic floor movement can help improve muscle coordination and reduce unnecessary tension.
A pelvic floor physical therapist can teach strategies for managing pressure during activities such as lifting, coughing, running, jumping, strength training, getting up from a chair, bowel movements, and other everyday activities.
Better pressure management can help the pelvic floor respond appropriately rather than constantly working harder than necessary.
Core and Glute Strengthening
Sometimes the pelvic floor is asked to do more work than it should.
The pelvic floor does not function in isolation. The abdominal muscles, diaphragm, spinal muscles, hips, and glutes all contribute to the body’s ability to stabilize and manage load.
Strengthening the core and glute muscles can help distribute forces more effectively throughout the body. This can be especially important for individuals who experience symptoms with running, jumping, lifting, or other higher-impact activities.
The goal is not always to make the pelvic floor stronger. Sometimes the goal is to help the entire system work better together.
Let’s Stop Normalizing Pelvic Floor Symptoms
Pelvic floor dysfunction can be uncomfortable to talk about. Bladder leakage, bowel symptoms, pelvic pain, and sexual health can feel personal or embarrassing, but avoiding these conversations does not make the symptoms go away. Pelvic floor symptoms are real, but they are treatable.
Pelvic Floor Dysfunction Awareness Starts With Talking About It
Pelvic Floor Dysfunction Awareness Month is an opportunity to start conversations that may have been avoided for far too long, and the first step toward treatment is recognizing that a symptom is worth discussing.If pelvic floor dysfunction is affecting daily activities, exercise, bowel or bladder function, sexual health, pregnancy or postpartum recovery, or overall quality of life, Reborn Pelvic Health and Wellness is here to help. An individualized pelvic floor physical therapy evaluation can help identify what may be contributing to symptoms and create a treatment plan designed specifically for each person’s needs and goals.
Common does not have to mean normal, and living with pelvic floor symptoms does not have to be the only option.
Happy August from Reborn Pelvic Health and Wellness!