Up close & personal with: Your pelvic floor
What’s the pelvic floor? What does it do? And what’s pelvic floor dysfunction?
What comes to mind when you hear the term, ‘pelvic floor?’ Some sort of geometric flooring pattern? Maybe an anatomy class you took (read: slept through) in high school? Or perhaps a mysterious, pelvis-adjacent body part?
If you chose option C, you’re correct. The pelvic floor is, indeed, a part of the body – and a pretty incredible one at that.
The pelvic floor refers to a set of muscles that we use practically all the time. You can thank your pelvic floor for everything from bathroom breaks to sexual pleasure, childbirth, and your ability to stay upright when walking around.
Since these muscles play such a key role in the functioning of our digestive and reproductive systems, it’s not surprising that pelvic floor dysfunction – when your pelvic muscles aren’t quite functioning as they should – is so common, especially in individuals AFAB stands for “assigned female at birth.”.
Pelvic floor dysfunction affects 10% of uterus-havers between ages 20-39, 27% of those aged 40-59, and 37% of those aged 60-79.1
Clearly, this is an issue that is not talked about enough. But that’s changing: We’re incredibly lucky to have discovered the fabulous physical therapists at Origin Physical Therapy, a Los Angeles-based practice that offers physical therapy designed for women and mothers both in person and virtually – and that’s been spreading the word about PFPT since 2007.
We spoke with Dr. Sarah Clampett, PT, DPT, Clinical Director at Origin, who filled us in on all the basics about the pelvic floor and what sort of issues can be addressed with pelvic floor physical therapy.
What is the pelvic floor?
As you may have gathered by looking at the diagram above, the pelvic floor consists of several muscles with long, tough-to-pronounce names: pubococcygeus, puborectalis (not pictured), and iliococcygeus.
“The pelvic floor is a group of muscles that sit at the base of your pelvis like a bowl, quite literally like a floor,” explains Dr. Clampett. “It consists of three layers that work together to perform five major functions.” They are:
1. Support. It directly supports your pelvic organs, which include your bladder, bowel, and uterus. It also supports your abdominal organs against gravity and combats other pressures created in your belly (like a sneeze).
2. Continence. Your pelvic floor keeps you continent, meaning it keeps your sphincters tight and your urine and feces inside you until you are ready to void.
3. Stability. Your pelvic muscles help stabilize your low back, hips, and pelvis, keeping your core strong and supported.
4. Sexual function. Your pelvic floor muscles are responsible for your sexual function and pleasure.
5. Circulation. Your pelvic floor muscles are known as a sump pump, meaning as they contract they pull fluid out of your abdomen and pelvis and send it back into your circulatory system, which decreases swelling and bloating in the pelvic and abdominal area.
What’s pelvic floor dysfunction (PFD)? And what causes it?
Pelvic floor dysfunction is a condition that’s diagnosed based on your pelvic floor not performing any one or more of the duties listed above.
“It can occur for many reasons, but most pelvic floor dysfunction is caused by the pelvic floor muscles being too tight, too weak, or a combination of both,” Dr. Clampett tells us.
Both tightness and weakness of the pelvic muscles tend to occur after childbirth or trauma to the region; these are two especially common causes of PFD. Other common causes include:
- Chronic constipation
- Hormonal changes (i.e. during puberty/menopause)
- Stress (!!!)
- Illness (particularly those with respiratory symptoms like coughing)
- Overtraining, especially high impact exercise
- Injury to the surrounding joints or body parts (i.e. abdominal surgery or a hip injury)
What are the symptoms of pelvic floor dysfunction?
Pelvic floor dysfunction symptoms can present in many ways – it all depends on your unique history and the mechanism of the injury. However, the most common symptoms are:
- Pelvic heaviness or pelvic organ prolapse
- Urinary or fecal incontinence
- Urinary urgency or overactive bladder
- Painful sex
- Perineal and/or pelvic pain
Pain due to PFD can be intense and may feel like it stretches all the way from your vulva up to your lower abdomen. Burning, stabbing, aching, or even shooting pain are often experienced alongside incontinence issues.
Pelvic floor dysfunction is also commonly seen in patients diagnosed with Interstitial Cystitis, a condition characterized by chronic bladder pain and pain with urination.2
“More often than not, people with PFD will present with more than one symptom – i.e. painful sex and a feeling of pelvic heaviness,” says Dr. Clampett.
If you’re experiencing any of these symptoms, even if it’s just one, don’t ignore them. Talk to your provider and consider reaching out to a pelvic floor specialist. Your doctor may also be able to send over a referral.
Treating pelvic floor dysfunction
If you’re wondering what the treatment options are and whether PFD can ever be fully resolved, we have good news: With correct and consistent treatment, PFD is curable.
“Just like any other muscle group, the pelvic floor can be strengthened if it is weak or lengthened if it is tight. Furthermore, pelvic floor dysfunction CAN be fully resolved, but it is important that you know what is going on with your pelvic floor and that you are doing the correct exercises,” Dr. Clampett explains.
“If you do the wrong thing, meaning you are kegeling when your pelvic floor is too tight, it can make your symptoms worse and make it seem like pelvic floor exercises don’t work.”
It’s important to remember that, while you might (for example) leak urine or feel pelvic pressure, you don’t necessarily have a weak pelvic floor. When the pelvic muscles are too tight, it actually decreases their range of motion, leading to difficulty with contraction and coordination. It’s this lack of coordination that could be causing your incontinence and/or pelvic prolapse or heaviness. So, in that case, doing kegel exercises to strengthen your pelvic floor might not be necessarily recommended.
Here’s a helpful analogy: Imagine your calf cramps up during a run and you suddenly feel unstable on your ankle. Doing heel raises to build strength will not help. To alleviate your discomfort, it may be helpful to stretch your calf muscles.
When should you consider pelvic floor physical therapy?
Pain, incontinence, and unusual sensations in your pelvic region are never normal. Unfortunately, too many people tend to ignore the signs of pelvic floor dysfunction or are simply unaware that it’s treatable.
If you EVER feel like something is off in your pelvic floor, talk to your provider or consider seeing a pelvic floor physical therapist. Just because it is common doesn’t mean you should suffer through it.
“Something as major as childbirth or as minor as a cold can cause pelvic floor dysfunction,” Dr. Clampett adds. “With proper education and support, it can be improved and even resolved completely. Waiting to see if it will ‘go away on its own’ is never the answer.”
What’s the relationship between your pelvic floor and period pain?
Period pain is often the result of overactivity and poor coordination of your pelvic floor and abdominal muscles. During your period, you shed the lining of your uterus (the endometrium), resulting in cramping and bleeding. Cramps and some discomfort are common and normal, but severe pain is not.
Pelvic floor PT can help to decrease the tone (tightness) and increase the coordination of your pelvic muscles, providing some relief during menstruation.
PFPT can also make it easier to use certain period products that are worn internally, like tampons, menstrual cups, and menstrual discs. Why? Because you’ll be more easily able to relax your pelvic floor muscles during insertion, helping you get your product of choice properly placed inside your vaginal canal.
Same goes for removal: Especially with period products you remove with a finger, like the menstrual disc, having more familiarity with (and control over) your pelvic floor equals a simpler, less-messy removal process.
Can pelvic floor PT improve painful sex?
Painful sex is often the result of overactivity and poor coordination of your pelvic muscles. It can also occur after direct trauma, i.e. having a baby with or without a perineal tear.
If overactivity is the problem, the pelvic floor muscles can make sex painful because they’re simply too tight and inflexible. More pain leads to even more tightness, and it quickly becomes a vicious cycle in which deep and prolonged penetration is more or less impossible.
If trauma is the root cause, overactivity is often the longer-term side effect. Thankfully, pelvic floor PT can address the overactivity and poor coordination of the pelvic floor. While it’s not a “quick fix” and the timeline to healing varies from person to person, PFPT can be a game changer, improving the quality of life for those suffering from painful sex.
“By creating length and mobility in the pelvic floor muscles, insertion and penetration can be pain-free,” Dr. Clampett notes. “Furthermore, in order to have an organism, your pelvic floor must contract and then relax. If you have difficulty with either, it can make sex less pleasurable and make orgasming difficult.”
If you’re experiencing any pain or discomfort during penetrative sex or you’ve had difficulting climaxing, your pelvic floor could be to blame. Talk to your doctor or reach out to a pelvic floor physical therapist to find out more.
About Origin Physical Therapy
Founded in Los Angeles, California, Origin is an in-person and virtual physical therapy platform that bridges the care gap for women throughout their lives. Origin is setting the new standard for pelvic healthcare, combating gender bias in medicine, and helping the more than 40M women with pelvic floor disorders get physical therapy, eliminating unnecessary surgeries and medical procedures.
At Origin, success is rooted in the belief that treating women requires a safe space and a whole body approach (that means your vagina and pelvic floor, too). Movement is medicine and so each clinician’s work is centered around the patient’s unique goals and needs, and includes expert guidance, targeted exercise, and strengthening.
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- UChicago Medicine. (n.d.). Pelvic floor disorders. https://www.uchicagomedicine.org/conditions-services/pelvic-health/pelvic-floor-disorders
- Interstitial Cystitis Association. (2020, April 28). Pelvic floor dysfunction. https://www.ichelp.org/about-ic/associated-conditions/pelvic-floor-dysfunction/