Just like everyone has a diaphragm, everyone has a pelvic floor. It is made up of a number of muscles, and can be considered a component of your “core”.
The role of the pelvic floor (PF) is to support the organs within the pelvis.
Pregnancy and Childbirth
A common misconception is that birth itself is the main cause of weakness in the pelvic floor. This is not completely accurate, and pelvic floor issues can arise after caesarean births too. As mentioned above, these muscles support the pelvic organs, and these include the uterus. The combined weight of the uterus and its contents at full term can be around 3kg before taking the baby into account. Carrying this increasing weight on a sling of muscles for months is a stressor in itself.
Of course, birth itself can indeed injure the pelvic floor. 3rd and 4th degree tears are direct injuries to the PF muscles, as is an episiotomy, albeit a more controlled one. After birth, new mothers should be given information from a women’s health physio about exercising the PF. This is a great start, but is general information that may or may not be relevant to the individual. It is true that a strong muscle can contract and relax easier than a weak one. However, these “kegel” type exercises may encourage patients to hold tension in their muscles, potentially causing new problems.
Relaxing the Pelvic Floor Muscles
If your symptoms are caused by tension in the PF, learning to relax the muscles is the first step to improvement.
- Lie down with your knees bent and feet flat on the bed/floor.
- Breathe into your tummy so you can see that it rises up. You can also place your hands on your tummy to feel it rising. Hold your breath for 4-5 seconds, making sure to keep your shoulders relaxed and your ribcage soft.
- While you are holding your breath, consciously relax your tummy downwards and relax your pelvic floor muscles from front to back (as if you are passing urine and as if opening your bowels). You could also use the image of a flower bud opening, until you feel them soften. Remember you are not aiming to do an active push here – you are trying to ‘let go’ of all the muscles instead.
- Finish with a ‘sigh’ as you breathe out, with your mouth open. This should be completely passive in nature.
Symptoms of a Dysfunctional Pelvic Floor
In both men and women, urinary or faecal incontinence can arise as a result of problems with the PF. Constipation can also be associated, and there is evidence to suggest that manual therapies like osteopathy can help here. Other possible symptoms include:
- Bladder pain
- Urinary urgency
- A feeling of incomplete emptying of the bladder
- Pain or discomfort during sexual intercourse
Sometimes the pelvic floor is tight on one side only. This can potentially interfere with the function of the sphincter muscles, potentially causing leaking on coughing, sneezing, running, and laughing. For women, it can also cause urine to veer off to one side while urinating. If you notice this, do mention it at your appointment as it can help us understand what’s going on.
The male PF can also become dysfunctional, particularly after prostate surgery. There is an amazing factsheet here which focuses specifically on the male experience of PF issues arising from prostate cancer and exercises which may be beneficial.
Back pain can even be related to a problem with the muscles of the pelvic floor. Just like the gluteal muscles can play a role in lower back pain by pulling unevenly on the pelvis, so can the PF. The tailbone attaches to a number of these muscles, and can be the source of very lower back or buttock pain.
If you suspect there is a problem with your pelvic floor, make an appointment with one of our osteopaths here.