I Have A What?! What is Pelvic Floor?
Updated: Aug 14
May 16, 2023
Erin MS Warner
There’s a lot of talk about the pelvic floor going around. Sounds personal, doesn’t it? Well, you’re right – it is personal. The pelvic floor is an anatomical region of the body, everyone’s body, that is at the base of your pelvis (A.K.A. floor), and helps to support structures above it, notably your internal organs. Now, that sounds important but boring…. Of course, it becomes interesting because this is also the place where all our personal, private matters happen: pooping, peeing, and sex.
So, why is the pelvic floor so important? How your pelvic floor works, or doesn’t work, affects your whole person. Pelvic floor physical therapy, more commonly known as PFPT, relies on elements of typical orthopedic physical therapy (think total knee replacements, low back pain, etc.), and fine-tunes them to improve pelvic floor issues. PFPT views this base of your pelvis largely like how orthopedic physical therapists would look at any musculoskeletal structures (that being bones, muscles, ligaments, and tendons). If you have a weak muscle, it’s not as supportive or strong. If you have an overused tendon, its tone is too stiff and not flexible. If a bone has arthritis, this will affect how the surrounding ligaments will move.
Well duh, I hear you say, so what? Well, just like if a tight bicep prevents us from straightening (or lengthening) our arm, then we can’t use our arm in its full range of motion. Now imagine trying to use that arm to lift a box, carry a baby, or scratch the top of your head. Without the ability to lengthen the bicep fully, you cannot flex the bicep fully. If you only continue to flex your bicep a short range, you become fatigued. Though the pelvic floor muscles, tendons, etc. are smaller, they still need to be strong and flexible, otherwise a lot of other muscles or structures start to compensate when we move. In this region, movement, strengthening and lengthening, helps us poop, pee, and have sex. (So all of you thinking, all I need to do are a ton of Kegels, think again.)
Keeping this in mind, now we can link how these compensations and limitations can be treated with physical therapy. In any physical therapy clinic, a Physical Therapist (PT) initially assesses what is the limitation, and both a PT and/or a PTA (Physical Therapist Assistant) works towards improving it to your personal previous functional level. Basically, the goal of treatment is to get you back to what works better, more efficiently for you. Because the structures are smaller in nature in your pelvic floor, there’s a bit more nuanced treatment to help improve whatever limitation there is.
Let’s think about what a limitation to your pelvic floor might be. In a therapist’s POV, wow did we just open up a Pandora’s Box! Let’s break it down to a few common issues. (Note: Common does not mean normal. We’ll definitely come back to this frame of mind often.)
You may have noticed that a little pee comes out when you sneeze, or you rush to get into your house to use the bathroom after doing an errand. That’s urgency, commonly thought of as leakage.
Maybe you have a kind-of leakage posteriorly – a little stool comes out when you cough. That’s incontinence. Or, reversely, you only poop once every three or four days, or once every week. That’s constipation. (Disclosure: General reference for “normal bowel movements” is anywhere between four BM’s per day up to one BM every four days. What! That is a BIG difference for “normal.” So don’t compare yourself. Everyone’s body is going to be different.)
Maybe as a woman, penetration hurts at all when having sex, or as a man you have erectile dysfunction: this is often a pelvic floor issue.
Of course medications or other medical issues or complications, what we call comorbidities, must be taken into account. But we therapists start to look at, okay, what is your posture like when you’re pooping? Are you holding your breath to pee? Are you holding your breath when you lift something, especially if it’s heavy? What stressors affect how you feel when you’re having, or trying to have sex? Have your low abs been numb for the past twenty years since having your last child via C-section, who just so happens to be turning twenty this year? All of these things matter.
Want to know more? First and foremost, we suggest taking some time to check-in with your own body. How often do you urinate? How about the frequency of your bowel movements? How does your body feel when you try having intercourse, and how does that affect the rest of you, including your emotional side? Is touching just below your belly button such a weird feeling that you avoid it? Once you do that, then consider if this is tolerable, or, maybe, if it’s time to be seen by your doctor. Or – shameless plus – a pelvic floor physical therapist?
It’s okay to not be okay. It’s not okay to stay not okay.
I know I won’t make any friends with this, but here I go: I hate the phrase, “It is what it is.” To me, that feels like you’ve given up, you’re giving in, and you aren’t willing to try improving your life. Yes, the first step to emotional healing is acknowledgement…but there are more steps after that, and physical healing takes time and consistent effort. Your body is the only body you’ll ever have. Don’t “it is what it is” it! Take action. Find out more.
Thanks for reading.
Erin MS Warner is a Physical Therapist Assistant and a Pilates Instructor and has been trying to help people feel more like themselves for the last seven years.