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.

Uchenna Ossai, PT, DPT, who serves as a pelvic floor physical therapist at Women’s Health, a 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. A lot of times people associate it solely with sexual activity.”

Here, Dr. Ossai breaks down the pelvic floor basics and offers advice for seeking pelvic health treatment.

What is the pelvic floor?

“The pelvic floor is a group of muscles at the bottom of your pelvis,” says Dr. 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, Dr. Ossai says the pelvic floor helps regulate many other functions, including the following:

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

What health conditions result from pelvic floor dysfunction?

According to Dr. Ossai, pelvic floor dysfunction leading to sexual, urinary or bowel issues may require medical attention. Some conditions associated with pelvic health problems include:

• Sexual dysfunction
• Pain, including vulvodynia
• Pelvic organ prolapse
• Constipation
• Fecal incontinence
• Urinary incontinence
  • Stress incontinence- involuntary bladder leakage during exertion
  • Urge incontinence- leakage preceded by a sense of urgenc
  • Mixed incontinence- urinary leakage with characteristics of both stress and urge incontinence

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

Age

“Age is a factor with all of our muscle function, not just the pelvic floor,” notes Dr. 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.” She warns that people going through menopause are also more susceptible to pelvic floor concerns.

Pregnancy and childbirth

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

Cancer

Dr. Ossai emphasizes that 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. “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,” says Dr. 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.

How can I keep my pelvic floor healthy?

Dr. Ossai cautions that pelvic health advice is not one-size-fits-all; instructions that help one person may exacerbate the problem for someone else. “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.”While specialized care is needed for specific pelvic floor concerns, she provides several suggestions to promote general pelvic health.

Physical activity

“Having a healthy, active lifestyle, doing abdominal and pelvic floor exercises as part of your exercise routine is great,” Dr. Ossai says. Still, she warns that certain pelvic floor exercises may not improve outcomes for all patients. “We see people 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.”

Diet

Dr. Ossai recommends regular water consumption, a high-fiber diet, and “eating foods that don’t anger your body,” noting that this means different things for different people.

Sexual activity

“Regular sexual activity is important for blood flow and tissue integrity,” she says. “Masturbation is actually very good.”

Posture

“Your spinal posture, your pelvic alignment, your gait, all those things can influence how you load your pelvic floor, how you recruit your pelvic floor, and ultimately it’s strength and coordination,” says Dr. Ossai. Posture can also affect one’s proprioception (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.”

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. “A lot of people hold their tension in their pelvic floor,” suggests Dr. Ossai. “Having a regular practice of autonomic quieting, like yoga, diaphragmatic breathing, or meditation is actually very good for your pelvic floor integrity.”She adds that furthering awareness by educating oneself about the pelvic floor allows people a “baseline understanding” of the topic that is vital for their pelvic health.

What to avoid

“Cigarettes have a really negative impact on your pelvic floor function,” says Dr. Ossai. Additionally, jade eggs should be used for decoration, not healthcare. “I 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, immediately go to a healthcare provider who’s a specialist in pelvic floor dysfunction,” says Dr. Ossai.

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

Pelvic health providers may see patients of any sex or gender, but many doctors may focus only on certain genders and conditions. Dr. Ossai recommends that people seeking pelvic care contact a clinic and ask which practitioner would best treat their symptoms. Clinicians from many different specialties, including those summarized below, may treat pelvic health concerns.

Pelvic floor physical therapists

Like Dr. Ossai, many physical therapists receive specialized training to treat pelvic floor and abdominal conditions.

Urologists

Urologists are physicians that treat the urinary tract and related genital conditions. Pelvic health issues that can be treated by a urologist include urinary incontinence and pelvic organ prolapse.

Urogynecologists

While there is significant overlap between urology and urogynecology, urogynecologists receive more training in obstetrics and gynecology. Both specialties are “very skilled surgically to manage prolapse and incontinence,” says Dr. Ossai, “but if you have primary gynecological issues in addition to the pelvic floor issues, then I would go to the urogynecologist.”

Obstetrician-gynecologists

OB-GYN or gynecological specialists are doctors equipped to address issues pertaining to the female reproductive system such as menopause or sexual health concerns.

Colorectal specialists

A colorectal specialist can treat conditions such as fecal incontinence that involve the pelvic floor.

The team at Women’s Health includes obstetrician-gynecologists, urogynecologists, pelvic floor physical therapists, and more. For more information, click here.