A Pelvic Floor Primer

A 2019 study of women seeking primary care found that most respondents lacked information about pelvic floor disorders, indicating a knowledge gap among patients that may prevent them from addressing their own pelvic floor concerns.

UT Health Austin pelvic floor physical Uchenna Ossai, PT, DPT, WCS, CLT, in Women’s Health, a clinical partnership between UT Health Austin and Ascension Seton, attributes this knowledge gap partially to the stigma surrounding topics related to sexual health. “We’re not necessarily taught about the pelvic floor because of the location of it,” explains Ossai. “A lot of times people associate it solely with sexual activity.”

What is the pelvic floor?

“The pelvic floor is a group of muscles at the bottom of your pelvis,” says Ossai. “These muscles provide support for internal organs including the bladder, bowels, and uterus. The pelvic floor also pumps blood back up to the heart and is involved with lymphatic drainage. People of all sexes have a pelvic floor but may not share the same pelvic floor concerns.”

What does the pelvic floor do?

While this structure may be best known for its role in sexual activity, the pelvic floor helps regulate many other functions.

Functions affected by the pelvic floor may include:

• Childbirth
• Circulation
• Defecation
• Immunity
• Posture
• Respiration
• Urination

What health conditions result from pelvic floor dysfunction?

Pelvic floor dysfunction leading to sexual, urinary, or bowel issues may require medical attention.

Conditions associated with pelvic health problems may include:

• Constipation
• Fecal incontinence
• Pain, including vulvodynia
• Pelvic organ prolapse
• Sexual dysfunction
• Urinary incontinence, which may include:

• Stress incontinence: Involuntary bladder leakage during exertion
• Urge incontinence: Leakage preceded by a sense of urgency
• Mixed incontinence: Urinary leakage with characteristics of both stress and urge incontinence

What factors can make one more likely to experience pelvic health conditions?

<br>Age

“Age is a factor with all of our muscle function, not just the pelvic floor,” notes Ossai. “As you age, you want to make sure you have a regimented exercise routine and that you’re engaging your pelvic floor on a very regular basis. People going through menopause are also more susceptible to pelvic floor concerns.”

Cancer

“For patients in active cancer treatment, and particularly for cancer survivors, it’s very important to include pelvic health as part of a broader care plan,” stresses Ossai. “Usually when you’re going through cancer treatment, you’re just trying to get rid of the cancer. You’re not really thinking about your pelvic floor, but you start to think about it once you’re past that hump.”

Lifestyle

“Female athletes, especially young female athletes, are at high risk because of the female athlete triad,” explains Ossai. “The female athlete triad describes three conditions—disordered eating, low bone density, and menstrual dysfunction—that often occur together in teenage and young adult female athletes.”

Pregnancy and Childbirth

“People who are pregnant or postpartum are at a higher risk for pelvic floor dysfunction,” shares Ossai. “As many as 50% of people who have given birth experience some sort of pelvic floor dysfunction.”

How can I keep my pelvic floor healthy?

“Pelvic health advice is not one-size-fits-all, and instructions that help one person may exacerbate the problem for someone else,” cautions Ossai. “If a patient presented with urinary incontinence, people assume that it’s a weakness problem. It might very well be, but it also could be a tightness problem, a postural problem, or a hip and spine problem.”

How can I promote general pelvic health?

<br>Diet

“Regular water consumption, a high-fiber diet, and eating foods that don’t anger your body, which can mean different things for different people, are important for your general pelvic health,” says Ossai.

Education and Awareness

“Proprioception is part of a broader awareness of one’s pelvic floor that can be promoted through activities focused on identifying tension throughout the body,” shares Ossai. “A lot of people hold their tension in their pelvic floor, and participating in a regular practice of autonomic quieting, such as yoga, diaphragmatic breathing, or meditation, is actually very good for your pelvic floor integrity. Furthering your awareness by educating yourself about the pelvic floor also allows for a baseline understanding of what is vital for your pelvic health.”

Physical Activity

“Having a healthy, active lifestyle, and participating in abdominal and pelvic floor exercises as part of your exercise routine is great, but some pelvic floor exercises may not improve outcomes for all patients,” warns Ossai. “We see patients who say, ‘I’ve been doing Kegels for years and it hasn’t done anything.’ It’s not that Kegels aren’t effective. It’s that we’re not getting to the root of the problem.”

Posture

“Your spinal posture, your pelvic alignment, your gait—all of those things can influence how you load your pelvic floor, how you recruit your pelvic floor, and ultimately it’s strength and coordination,” shares Dr. Ossai. “Posture can also affect one’s proprioception, or sense of spatial awareness, related to the pelvic floor. A lot of times people are unaware. If you tell them to relax their pelvic floor, they don’t understand what you mean because they don’t recognize that they’re clenching their pelvic floor too much.”

Sexual Activity

“Regular sexual activity is important for blood flow and tissue integrity,” says Dr. Ossai, “and partnered activity is not the only way to reap benefits to the pelvic floor. Masturbation is actually very good.”

What should I avoid to optimize my pelvic health?

“Cigarettes have a really negative impact on your pelvic floor function,” says Ossai. “I also don’t recommend people put crystals inside their vagina and hold it in there for hours or days on end, because that can cause a whole heap of issues, especially if you’re a person that’s prone to UTIs or yeast infections.”

While these preventative measures can help avoid pelvic floor conditions in the future, current issues likely require professional attention. “If you are noticing changes in your pelvic floor function, you want to immediately seek out a healthcare provider who specializes in pelvic floor dysfunction,” recommends Ossai.

How do I find the pelvic health specialist who’s right for me?

“It’s common for some pelvic health providers may see patients of any sex or gender, while others may focus only on certain genders and conditions,” explains Ossai. “It’s important that when seeking pelvic care, you contact a clinic and ask which practitioner would best treat your symptoms.”

Clinicians from the following specialties may be involved in treating your pelvic health concern:

• Pelvic floor physical therapists: Treat pelvic floor and abdominal conditions
• Urologists: Treat the urinary tract and related genital conditions (e.g., urinary incontinence and pelvic organ prolapse)
• Urogynecologists: Treat patients who have primary gynecologic issues in addition to the pelvic floor issues
• Obstetrician-gynecologists: Treat issues pertaining to the female reproductive system, (e.g., menopause and sexual health concerns)
• Colorectal specialists: Treat pelvic floor dysfunction affecting the bowel (e.g., fecal incontinence)

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