WHAT WE TALK ABOUT WHEN WE TALK ABOUT THE PELVIC FLOOR

What is the pelvic floor?
The pelvic floor is a dome-shaped muscular sheet that separates the pelvic cavity above from the perineal region below. This sheet is part of our deep core and is composed of fascia, connective tissue, and three layers of muscles. The pelvic floor helps control continence (both urinary and fecal), contributes to stability in our hips and pelvis, and aids in sexual arousal.
 
Why would you seek out pelvic floor physical therapy? 

• You are about to or have just had a baby. Being pregnant is a lot of stress on the fascia and muscles of the pelvic floor. 
• You leak urine when you laugh, cough, sneeze, or exercise.
• You have moments when you really, really, really need to use the restroom, but are unable to get there in time.
• You have pain down there.
• You have pain with touching or intercourse.
• You're unable to have a pelvic exam.
• You have tailbone pain or difficulty sitting.
• You are having difficulty getting pregnant.
• You have a "falling out feeling" with standing or other movements.
• You have difficulty starting the flow of urine or fully emptying your bladder.
• You have chronic constipation.

 My doctor told me to do kegels. 
Your doctor may be right or your doctor may be wrong. 

A lot of people have heard of kegels but are not totally sure what they are and most women seem to think just doing kegels will solve all their pelvic floor problems. Pelvic floor PT is not just about kegels. In some cases, yes, strengthening the pelvic floor will help reduce symptoms, but that is definitely not always the case. 
 
A kegel is a contraction of all three layers of the pelvic floor muscles,  accompanied by a closing and lifting sensation in the pelvic floor. Sometimes it feels like your sit bones are being pulled together. The sensation of a close and lift needs to be followed by a relaxation/ dropping back down sensation. We also don’t want to be clenching our butts or thighs while we do the contraction.  
 
When are kegels not appropriate? They are usually not appropriate for someone who is experiencing pain in the pelvic floor or any symptoms of pelvic floor tightness. These symptoms might include the inability to initiate urine flow or might include chronic constipation. Sometimes people actually leak urine when their muscles are tight, not weak. A good example of this is to make a tight fist and then try to squeeze your fist tighter. Not much will happen in that scenario, but if you relax your hand then try and make a tight fist you can squeeze a lot harder. This is what happens with a tight pelvic floor. It's already tight so it cannot contract to help control bladder incontinence.  

Pelvic floor health physical therapists help people who have problems with sexual intercourse, urination, fertility, pregnancy preparedness, pelvic and/or tailbone pain, postpartum recovery, erectile dysfunction,  and other conditions. 

Depending on exam findings, treatment includes manual techniques, specific exercise prescription (a Kegel is not simply a Kegel!), and the use of electrical stimulation and/or biofeedback/stretching tools. 

More confused than ever? Schedule a consult.
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