The pelvic floor is a dome-like group of muscles that span across the bottom of the pelvis. Both men and women have a pelvic floor. While it is typically associated pregnancy, the pelvic floor also has an important role in bowel and bladder control, sexual function, supporting the internal organs, and joint stability. One of the primary functions of the pelvic floor is to hold up the pelvic organs against gravity and keep them in place when abdominal pressure increases during sneezing, coughing, laughing, or physical exertion. It does this by creating a coordinated movement with the diaphragm and the deep muscles of the pelvis, abdomen, and spine to help stabilize the pelvis and spine during movement. Ideally, this regulation of abdominal pressure and core engagement happens naturally in response to breath and physical challenge or load. During exhalation, the diaphragm relaxes, abdominal pressure increases, and the pelvic floor should engage, or lift up, as the deep core stabilizers contract to support the spine. During inhalation, the opposite should happen. The diaphragm engages, abdominal pressure decreases, and the pelvic floor and deep core stabilizers should relax and stretch.
However, sometimes this process can be disrupted due to pelvic floor weakness and instead of lifting up, the pelvic floor will bear down. Pelvic floor weakness, which is sometimes referred to pelvic floor dysfunction, can manifest as hypo or hypertonicity.
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A hypotonic pelvic floor lacks muscle tone and is unable to contract or lift up in response to movement. Conversely, a hypertonic pelvic floor is when muscles have too much tone and are unable to stretch or relax in response to movement. Even though the muscles are tense, pelvic floor hypertonicity is considered pelvic floor weakness, because the muscles spasm, rather than moving through a contraction and relaxation phase. Both forms of pelvic floor dysfunction will present similar symptoms and problems.
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Some of the more well-known symptoms and problems that can stem from pelvic floor weakness include
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Incontinence or uncontrolled leaking during exercise, sneezing, coughing, or running
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Constipation, pain during urination, or a constant feeling that you need to urinate
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Ongoing pressure and pain around the pelvis - Pain during intercourse (this is experienced by women)
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Pelvic organ prolapse, which is when the pelvic organs droop out of the vagina. This is a more extreme example of pelvic floor dysfunction and typically occurs as a result of carrying and vaginally delivering a child.
Pelvic floor dysfunction is very common. Almost 25% of women in the United States will be affected by a pelvic floor disorder. Additionally, the likelihood of a pelvic floor disorder will increase with age and will affect more than 40 percent of women between the ages of 60 and 79 and 50 percent of women over the age of 80, according to the National Institute of Health (1).
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At this time, it is unknown what specifically causes pelvic floor dysfunction. However, some potential contributors and risk factors include:
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Pregnancy and childbirth: However, because women who have not have children and men can also have pelvic floor problems, the specific relationship between pregnancy and pelvic floor dysfunction is still unknown.
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Being overweight or obese: It is thought that this is because of the increased pressure placed on the pelvic floor. - Advanced age: There is a correlation between aging and an increased likelihood of pelvic floor weakness.
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Genetics: It is thought that some people are born with inherently weaker tissues. For example, women of other races appear to have a higher risk of pelvic organ prolapse than African American women.
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Surgery: Some surgeries, such as a hysterectomy, are associated with an increased risk of pelvic floor dysfunction. If you suspect that you have pelvic floor weakness, or pelvic organ prolapse, it is recommended that you consult your medical provider for diagnosis and treatment.
Additionally, pelvic floor dysfunction can result in compensatory movement patterns and pain, as a result of additional forces being placed on the lower body when the pelvic floor is unable to adequately support the pelvic organs and help stabilize the pelvis and spine. Some lesser known issues that correlate with pelvic floor weakness include pressure, discomfort and pain in the lower back, hips, and knees.
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How Pilates Can Help with Pelvic Floor Weakness
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It has been found that education and body awareness plays an important role in decreasing symptoms and restoring pelvic floor function. One study published in 2015 by the International Urogynecology Journal reported that women who received a combination of pelvic floor exercises and education experienced a significant decrease in pelvic floor dysfunction related symptoms and an increase in quality of life, when compared to the control group (2). It is beyond the scope of practice for a Pilates instructor to diagnose, or treat pelvic floor dysfunction. However, an experienced Pilates instructor can help you with the following: 1) Identify and address compensatory movement, 2) Build awareness around how your pelvic floor works as a system to support your body, 3) Practice diaphragmatic breathing exercises to engage full range of motion and the right muscle pattern, and 4) incorporate exercises to improve pelvic floor strength, mobility, and function based on your individual situation.
The anatomy of the pelvic floor is just like any other part of the body that needs to move through full range of motion. This includes contraction and extension without pain, or limitations. Education and personal awareness are very important to this process. As an Occupational Therapist, I see how McEntire Pilates is helping clients to build awareness and full range of motion to support everyday function and a healthly lifestyle.
-- Timmonica Wilkins, OTR