Pelvic floor health is something most of us might not consider until we experience related challenges – like painful sex, leaking urine postpartum, chronic constipation, or pelvic discomfort. But these experiences are very common, and pelvic floor health is a fundamental component of wellbeing. This mighty hammock of muscle supports too many important functions to neglect.
For tips, tricks, and the inside scoop on what our pelvic floor can mean for our health, we spoke to Allison Oswald – a board-certified women’s health doctor of physical therapy, holistic pelvic care specialist, and mom of three, who aims to profoundly improve her clients’ wellbeing by addressing their connection to a part of the body that’s too often overlooked.
Let’s start with the basics - what is the pelvic floor, and is it really a floor?
The pelvic floor refers to the muscles and connective tissue at the base of the pelvis that connect the pubic bone to the tailbone, and one sits bone to the other. In some ways it is like a floor because it is the foundation to our bodies; however it is more accurately described as a bowl or hammock of muscles based on its shape and orientation. This group of muscles works to create stability of the hips and back, support of the pelvic organs, bowel and bladder control, and sexual function.
Why is the pelvic floor important to sexual health? Is it connected to the amount of sexual pleasure you can experience, and the quality of your orgasms?
The pelvic floor is fundamental to sexual health. In order to have penetrative intercourse the muscles of the pelvic floor need to lengthen and stretch to allow for that penetration. This lengthening is also what allows for good blood flow and lubrication to the area. Eventually these muscles provide the rhythmic contraction during climax. Therefore if the pelvic floor muscles can fully lengthen and fully contract, it has been shown that women are more likely to have enjoyable sex. If the pelvic floor muscles are short or too contracted, penetration can be painful, difficult and maybe even impossible. Scar tissue (from childbirth or other injuries/surgeries in the area) can also cause dysfunction and pain that can affect sexual pleasure.
What are some of the things connected to pelvic health that we don’t think about (ie: posture and breathing habits?)
Since the pelvic floor is one part of the core system, it seems to be involved with almost everything. Not to say it is always the cause, but it is very much associated with a multitude of presentations. For example, dysfunction in the pelvic floor can be related to neck pain, ankle issues and even gut health. It is also partially innervated by the autonomic nervous system, so reacts automatically to stress. It will tighten/clench when cortisol increases and will lengthen and relax when we are in a more parasympathetic state. It also moves up and down with breath and intra-abdominal pressure, therefore is a major component of proper breathing mechanics.
What are some of the most important habits people can have in terms of their pelvic and sexual health?
I feel that all people should know to reach out for support if they have pain, pressure, leaking, unenjoyable sex or anything else in the abdomino-pelvic region that is not feeling quite right. For whatever reason, so much of what can be improved in this area is always considered "normal"... but it is absolutely not.
In general I feel that all people should know where their pelvic floor is, how it functions and a few ways to connect with it. I consider this like building a relationship with their bodies so it becomes less elusive. Typically this looks like a breath practice to feel the lengthening and contracting of the muscles, along with some movements to feel the location and function of their pelvic floor.
And some habits that are easy to start right now would be learning proper toileting habits, posture, breath, and functional movements that our pelvic floor contributes to.
What does a pelvic PT do?
A pelvic floor PT always begins with taking a thorough medical history, since very often people are not aware of the multitude of things that can affect pelvic floor function. They also do a musculoskeletal evaluation, assessing range of motion, strength, stability and coordination. Breathing patterns, abdominal tension and core strength are also assessed. And of course the pelvic floor is examined, both externally and internally (vaginally and rectally). These muscles are checked for length, strength, endurance, coordination and function. Based on the findings, a course of treatment is advised which always includes a home practice. And pelvic floor PT's very often work with many other providers to give a multidisciplinary approach, so those conversations are had as well.
Can PTs help with issues that are not necessarily caused by the pelvic floor - like endometriosis and adenomyosis?
Absolutely. PTs do not treat the disease, but we treat the symptoms associated with it. For example, many women with endometriosis and adenomyosis often have pelvic floor pain associated with short/tight pelvic floor muscles. Therefore pelvic floor PTs can help with techniques to relax and lengthen the pelvic floor, such as stretches, manual therapy, use of dilators, breathing practices, bathroom habits and digestive issues.
What are some of the most common issues you see in your practice?
Some of the most common issues I see are urinary incontinence, chronic constipation, painful intercourse and diastasis recti. And though I do often see women postpartum, these issues can just as likely affect women who have never been pregnant.
What about kegels - should everyone do them?
I believe every person should know how to do a kegel, but whether or not they need to do them daily and how many is completely dependent upon their body and their symptoms. Just because a person is leaking urine, does not mean they need more strength. It could actually mean they need more length and then learn proper coordination. So pure strengthening could actually make symptoms worse. An individualized approach is always best!
How do you do a proper kegel?
You start by ensuring the body is stacked up with the ribs over the pelvis. You inhale through your nose and feel the ribcage expand 360 degrees while the pelvic floor lengthens down. Then you exhale through the mouth as the rib cage comes back in, while squeezing the openings of the pelvic floor together and lifting the pelvic floor up (it's a squeeze and lift, like grabbing a blueberry and pulling it inside). This can be done in any position using the same technique.
When do you recommend seeing a pelvic floor PT?
I recommend all women to see a pelvic floor PT. Of course if there are symptoms it is easy to see why, but I also feel that as women we should have a relationship with this part of our bodies that is positive, insightful and empowering. The term "body literacy" comes to mind when thinking about this, because knowledge is power and all women deserve to understand themselves deeper.
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