Your pelvic floor consists of nerves, muscles, and fascia (connective tissue). Your pelvic floor muscles are a sling of muscles that sit like a bowl on the bottom of your pelvis. These muscles attach from your pubic bone to tailbone (coccyx) and sits bone to the other sits bone (ischial tuberosity). They serve several important functions, including support of our internal organs, keeping us continent (no leakage), sexual pleasure, the birth of a baby, lymphatic drainage/flow, and stability of our “core”.
During physical assessment of the pelvic floor, I am determining if the muscles are tight (hypertonic), and/or weak (hypotonic). Most often I find a combination of the two. If a muscle is tight, it may contribute to pain, but it may also contract sub optimally leading to weakness. I almost always teach clients pelvic floor awareness and relaxation prior to initiating a strengthening program.
Common conditions associated with pelvic floor weakness include, incontinence (bladder/bowel leakage) and pelvic organ prolapse. The Cochrane Collaboration 2010 concluded that Physiotherapists with specialized training in pelvic floor rehabilitation (using internal examination to teach the exercises) should be the first line of defense, before surgical consultation, for stress, urge and mixed incontinence in women.
Common conditions associated with pelvic floor tightness include, pain with intercourse/tampon/pap, persistent pelvic/hip/low back pain, interstitial cystitis or bladder pain syndrome, overactive bladder (urgency/frequency), and constipation.
Frequently when people think about the pelvic floor they think about kegels. Kegels are a pelvic floor muscle contraction named after Arnold Kegel, an American gynecologist, who coined the term when he recognized a pelvic floor contraction or “squeeze”. Kegels are commonly known about and they act to strengthen the pelvic floor. Although kegels can be very useful, they are not for everyone. Some clients perform a kegel incorrectly, and there are many individuals with tight/tense pelvic floor muscles, that could potentially get worse with a strengthening program. When a muscle is already tight why are we trying to contract it more? A tight muscle is not going to function optimally so the goal is to normalize its tension by performing a reverse kegel, or pelvic floor muscle relaxation. This may require some bodywork or hands-on manual therapy to assist in the the release or relaxation of these muscles, and pelvic opening stretches may also be prescribed.
If you have concerns that your pelvic floor may be weak or tight then book now to help you regain back your function and your life!
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