Building and maintaining a strong pelvic floor is crucial for women of all ages. The pelvic floor is a group of muscles at the bottom of your pelvis that supports the womb, bladder, and bowels. So if these muscles become weak—whether it's due to childbirth, pregnancy, aging, or weight gain—it may be challenging to control your bladder and bowel activity. This is referred to as incontinence, a condition that affects nearly 25 million Americans, 75% to 80% of which are women.
Kelly is a certified Personal Trainer with NASM, a Yoga Alliance Registered Yoga Teacher, and has her B.S. in Kinesiology from San Diego State University. She is co-owner of Roaming Yogi Adventures, a yoga and adventure-based retreat. She believes that having fun and well-rounded exercise is the key to maximizing strength, flexibility, and mental health.
Discussed extensively in Travel and Simon’s two volume series, trigger points are taut (firm) points in the muscle that have a consistent referral pattern (they transmit pain to the another part of the body). Trigger points are not only important because they cause pain, they also can affect how the muscle works. This is one of the main reasons our therapists at Beyond Basics are fastidious about ensuring all trigger points are released in the abdomen, back, legs and pelvic floor before transitioning to any core stabiltiy or strengthening exercises that can re activate a trigger point.
Perform bridges. Kegels are not the only way to strengthen your pelvic floor. There are numerous exercises you can do, and a great one is bridges. Start by laying on your back with your knees bent, keeping your feet about a fist distance apart. Then flex your lower abdominal muscles and lift your hips off the ground slightly. Your buttocks should barely be off of the floor and you should keep your inner core muscles flexed. Hold for 3 seconds and slowly return your hips to the ground.
What sets pelvic floor physical therapists apart is their in depth understanding of the muscles and surrounding structures of the pelvic floor, beyond what was taught in physical therapy graduate school. What that means for a patient who is seeking the help of a pelvic floor physical therapist, is that his or her pelvic floor issues will be examined and treated comprehensively with both internal and external treatment, provide them with lifestyle modifications to help remove any triggers, and receive specific exercises and treatment to help prevent the reoccurrence of pain once he or she has been successfully treated.
If you still do not feel these movements, you can try stopping the flow of urine when you are urinating. Feel the work that goes into that action, lifting muscles near your bladder, and try to mimic this movement when you do the exercises above. This is only recommended to try once as you are learning about the muscles. Do not repeat this as an exercise, or it can actually cause urinary problems.
It is essential that we, as pelvic floor physical therapists, also include other assessments when we are examining our patients for the very first time. We employ the tried and true physical therapy exam practices to determine if there is an underlying condition elsewhere in your body, such as a strength deficit or alignment issue that could be affecting your pelvic floor. It’s wild to think of it, but something as seemingly unrelated as a flat foot or a hip injury can be enough to set off pelvic and abdominal pain!
It’s highly unlikely that someone will head into a therapist’s office for a stand-alone “vaginal massage.” Why not? “It’s one small aspect of the whole therapy,” says Laura Y. Huang, MD, assistant professor of physical medicine and rehabilitation at the University of Miami Miller School of Medicine. She notes that pelvic floor muscle training, biofeedback, soft tissue release, and education are some of the many pelvic floor physical therapy treatments used to relieve pain or retrain muscles. Learning techniques and strategies to manage the condition at home is also part of treatment.
May is Pelvic Pain Awareness Month (#PelvicPainAware), supported by the International Pelvic Pain Society (www.pelvicpain.org). As physical therapists who specialize in abdomino-pelvic pain disorders, one of the toughest parts of the job is meeting men and women who have suffered with pelvic pain for years, only to be told by their doctors/healthcare providers that there is no help for them. It is not uncommon to meet a patient who has suffered for 5- 10 years without help before finding us. Musculoskeletal causes of abdomino-pelvic pain are treatable conditions and often times we can start to improve a patient’s symptoms within just a few visits. We are promoting Pelvic Pain Awareness Month because it is our mission to ensure that people know that help exists so they can start living richer and fuller lives. In honor of Pelvic Pain Awareness Month we want to take some time to explain what we do and how it can help with the symptoms of pelvic pain. Please read on to see how we can help you with your pain.
Myofascial release is a more gentle technique that can be useful in cases where a patient is already experiencing a great deal of pain. The therapist will hold gentle pressure at the barrier of the tissue (the point where resistance is felt) for a short period of time, usually less than 2 minutes until the therapist feels the tissue release on its own. The therapist does not force the barrier.
Neural mobilization as the name implies, involves the restoration of neural structures back to their normal mobility: to glide and slide. Neural structures that cannot move properly can cause pain that can radiate down an extremity or into the trunk and can give the sensation of burning, zinging, and stabbing. Some orthopedic therapists practice this type of mobilization; common examples include the sciatic nerve in the leg and the ulnar nerve in the arm. Pelvic floor PTs focus on these nerves when they cause issues, but they also pay attention to nerves that innervate the perineum and genital region (bicycle seat area), such as the pudendal, iliohypogastric, obturator, ilioinguinal, genitofemoral and the femoral cutaneous nerves. By allowing these nerves to move freely, symptoms such as vulvovaginal, penile, rectal, clitoral and testicular pain, itching and burning can be greatly improved.
With her finger inside me, Christensen mentioned that the three superficial pelvic floor muscles on each side were very tight and tensed when she touched them. I was too tight and in pain for her to check the deepest muscle (the obturator internus). Finally, she checked to see if I could do a Kegel or relax the muscles, and I was unable to do either.
Increases bladder and bowel control. The pelvic floor muscles are directly responsible for controlling urine and bowel movements. If these muscles are weak, you’re more likely to experience constipation, urinary incontinence, struggle to control flatulence, or experience urine leakage from forceful activities like when sneezing, coughing, or laughing (called “stress incontinence”). Strengthening your pelvic floor can improve your bowel and bladder control.