“I was out for a run and noticed that my hamstring was starting to bother me. I’m going to schedule an appointment with my physical therapist.”  “I was out for a run and noticed that I was having some urinary leakage. I’m going to schedule an appointment with my physical therapist.” Is either of these statements surprising? The first statement seemingly makes a lot of sense. A physical therapist specializes in injury prevention, muscle strengthening, neuromuscular education, pain management, and education. A nagging hamstring certainly falls into that classification, right?  But what about the pelvic floor? Can a physical therapist reduce the risk of injury, strengthen, provide neuromuscular education, and manage pain specific to the pelvic floor? You betcha. Let’s break down what the pelvic floor is, how to know if it is working properly, the importance of pelvic floor exercises, and how a physical therapist with specialty training in the pelvic floor can be a great addition to your healthcare team. 

 

What Is The Pelvic Floor?

The pelvic floor is a grouping of muscles that supports the organs of urination, defecation, and sexual function. This group of muscles sits in between the two pelvic bones and can be visualized as a sling that works intimately with the hip muscles, spine, and core to create a dynamic yet stable support system. Beyond support, the muscles of the pelvic floor also assist in controlling intraabdominal pressure by communicating with the diaphragm. Believe it or not, this group of muscles helps to manage to change pressures during walking, lifting, running, or any activity that requires movements of the trunk and limbs.

Wait for a second…suddenly it seems that the pelvic floor is extremely instrumental in the way our bodies move and function. And the truth is…it is!

The diaphragm, pelvic floor, and abdominal muscles all work together in an effort to control changes in intraabdominal pressure. When the diaphragm fills with air, the pelvic floor muscles should be relaxed to allow the diaphragm to move downward while also maintaining enough control to support the internal organs. The pelvic floor muscles should then contract together with the abdominal muscles during a breath out to allow the diaphragm to move upward. The pelvic floor really does it all! It’s supportive to vital organs, dynamic during frequent changes in pressure, and flexible during activities as profound as childbirth. So how do we know if this “jack of all trades” group of muscles is getting the job done? Let’s find out.

 

Take Control of Your Core Health!

The outcome of a great core program is NOT a 6-pack but it if does happen we are sure you wouldn’t be upset! The core should be thought of as both a dynamic suitcase and an energy transfer center. The goal is to build a rock-solid suitcase for each aspect of the core and to improve its ability to transfer energy to and from the legs and arms.

 

Is Your Pelvic Floor Working? Not Working? How Do You Know?

Like any other group of muscle, the pelvic floor can certainly become injured, painful, weak, hypotonic or hypertonic. Some commons signs and symptoms that may warrant a visit to a physical therapist with specific training in treating the pelvic floor may be:

• Difficult urination
• Pelvic organ prolapse (bulging or feelings of heaviness)
• Pain with sexual intercourse
• Constipation
• Pelvic pain
• Urinary incontinence

 

Let’s break down some of these signs and symptoms to determine HOW the above conditions are related to the pelvic floor. 

 

Learn How Oblique Sling Exercise Can Strengthen Your Core!

 

Pelvic Organ Prolapse

Pelvic organ prolapse (POP), defined as a protrusion of the pelvic organs through the vaginal wall and pelvic floor, is often thought to only affect those in a postpartum status. However, 50% of women having symptomatic POP are 80 years or older, with women 50-59 years accounting for 31% of symptomatic POP and 6% of 20-29-year-olds with complicating POP. Weakness in the connective tissue that supports the pelvic floor is the main factor that contributes to pelvic organ prolapse, and this can be influenced by several risk factors including obesity, genetic predisposition, menopause, and obstetrical and gynecological history. The largest contribution from childbirth was the number of children had and the type of delivery. It is understood that vaginal deliveries play a role in the eventual development of POP. 

 

Urinary Incontinence

And what about urinary incontinence? Another prevalent but often silent sign of pelvic floor dysfunction. The International Continence Society defines urinary incontinence as “the complaint of any involuntary leakage of urine”. Urinary incontinence is often divided into stress incontinence or urge incontinence, with mixed urinary incontinence being a combination of the two. Stress incontinence occurs with an increase in intra-abdominal pressure such as running, jumping, sneezing, or coughing. If the increase in intra-abdominal pressure overcomes the strength of the pelvic floor, urine leakage may occur. Urge incontinence occurs when the bladder uncontrollably contracts to create the impression of needing to void. This is often a result of poor communication between the brain and the bladder in which the bladder begins to signal the need to urinate without the actual need creating an increased frequency of voiding. 

Now, let’s spend some time clarifying…if you’ve had two vaginal deliveries does that mean that you are sentenced to years of pelvic organ prolapse symptoms? Or that your third glass of water during the day will always send you rushing to the bathroom every 30 minutes? NO! Physical therapists with specialty training in the pelvic floor are ready to guide you to keep you and your pelvic floor happy. 

LISTEN: HOW TO MANAGE SCIATIC SYMPTOMS DURING PREGNANCY

 

Physical Therapy and Your Pelvic Floor

The biggest takeaway from this blog should be…(drumroll)… there are exercises beyond Kegels to treat the pelvic floor! Really? Yes, absolutely! And should you be doing them? YES, ABSOLUTELY! Let’s remember that a pelvic floor is a group of muscles. And like any other grouping of muscles, they can be strengthened, lengthened, and retrained to work for the needs of your body. Consider the fact that when you go to the gym for “leg day”, you don’t simply do hamstring curls for 60 minutes. You incorporate squats, single-leg deadlifts, a plyometric series, and maybe some hip stretches. The same rule applies to the pelvic floor! You need to train this group of muscles in varying ways with different kinds of exercises. 

READ: THE INTEGRATION OF THE PELVIC FLOOR AND CORE

 

It is extremely important to remember that not all pelvic floors require strengthening, and in fact, a lot of times they need the exact opposite! If there is a pain in the pelvis or hips, difficulty with urination, pain with intercourse, or an increased need to urinate, this may be telling that the pelvic floor needs to work on relaxing and carrying less tension. As mentioned before, the diaphragm and pelvic floor work in sync. As the diaphragm drops and fills with air, the pelvic floor should also naturally lengthen and relax through inhalation. Focusing on diaphragmatic breathing with coordination of the pelvic floor muscles is an excellent way to assess the ability to relax the pelvic floor! This can be done in varying positions and with varying cues to best accomplish pelvic floor relaxation. A pelvic floor physical therapist can guide you through varying exercises to support pelvic floor relaxation. 

Hook Lying Diaphragmatic Breathing

Did you know that the diaphragm plays an integral role in your core? It for sure should not be overlooked when implementing pelvic floor exercises!

 

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Pelvic Floor Strengthening

For some, pelvic floor strengthening is absolutely appropriate! It is crucial that if strengthening is needed, that isolation of the pelvic floor occurs. Pelvic floor strengthening may be appropriate for pelvic organ prolapse or urinary incontinence, dependent on what the root cause of each diagnosis is. The muscles of the pelvic floor are made up of both fast twist and slow-twitch fibers and it is important to train both fiber types to optimize the function of these muscles. The slow-twitch fibers are recruited first during muscle contraction and are instrumental to pelvic floor endurance during everyday activities such as sitting or standing for prolonged periods, as well as higher impact activities including walking and running. The fast-twitch fibers can be trained to allow for quick contraction prior to jumping, sneezing, coughing, etc. If pelvic floor strengthening is appropriate, a combination of endurance holds and quick contractions should be incorporated into an exercise program. A physical therapist with specialty training in the pelvic floor can determine the best exercise program for your pelvic floor.

*Physical therapists who treat the pelvic floor have gone through a series of courses and tests, beyond their clinical doctorate, to acquire a skill set that allows for internal examination if needed. The internal examination should not be performed by a physical therapist that has not undergone coursework specific to the pelvic floor. 

Isometric Bridge – Isometric Adduction

This is an example of a movement that you may incorporate into your pelvic floor exercises routine. Performing a bridge exercise while also squeezing your thighs can help if you are having difficulty activating your pelvic floor. 

 

Closing Thoughts

The pelvic floor is an extremely important grouping of muscles that are supportive and dynamic through everyday activities such as sneezing and urinating to more irregular and demanding activities such as running a marathon or childbirth. Like any other muscle in the human body, the muscles of the pelvic floor can be strengthened, relaxed, lengthened, overused, underused, hypotonic, or hypertonic. A physical therapist with specialty training in the pelvic floor can assist you in determining what exercises are most appropriate for your pelvic floor! Urinary leakage during a run should be treated no differently than that nagging hamstring strain. Remember that.  Find a pelvic floor physical therapist and add them to your healthcare team. Your body will thank you. Be on the lookout for more content related to pelvic floor exercises, women’s health, and more to come soon! 

 

In Need Of A Stronger Core and Pelvic Floor?

This [P]rehab Core Program will teach you everything there is to know about the core, the importance of training it, and how to utilize your core the right way. The pelvic floor is an often missed piece with core programming. Click HERE to not only learn how to train your core but also build it to become more resilient than ever!

 

References

1. Eickmeyer SM. Anatomy and Physiology of the Pelvic Floor. Phys Med Rehabil Clin N Am. 2017;28(3):455-460. doi:10.1016/j.pmr.2017.03.003
2. Gowda SN, Bordoni B. Anatomy, Abdomen and Pelvis, Levator Ani Muscle. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 11, 2021.
3. Park H, Han D. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. J Phys Ther Sci. 2015;27(7):2113-2115. doi:10.1589/jpts.27.2113
4. Grimes WR, Stratton M. Pelvic Floor Dysfunction. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 1, 2021.
5. Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol. 2020;46(1):5-14. doi:10.1590/S1677-5538.IBJU.2018.058.
6. Abrams P, Cardozo L, Fall M, et al. The standardization of have shown to be effective in preventing leakage terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 167-78

 

About The Author

Lyndsay Provencio, PT, DPT

[P]rehab Writer & Content Creator

Dr. Lyndsay Provencio graduated from Colorado State University with a BS in Health and Exercise Science and a concentration in Sports Medicine. After multiple personal sports-related injuries and discovering a passion for healing through movement, Lyndsay attended Creighton University to receive her Doctorate of Physical Therapy. An avid runner herself, she has a particular interest in working with high school, recreational and elite endurance athletes and has undergone specialty training in pelvic floor rehabilitation to better serve her clientele. Additionally, Lyndsay is BSPTS C2 certified in scoliosis-specific exercise and has found a niche working with adolescents with scoliosis to improve overall spinal health.

No, you’re not seeing double! Lyndsay is an identical twin to Lauren Lynass, one of our [P]rehab rockstars. A native of Colorado, Lyndsay is an adventure seeker who loves to hike, camp and race her twin sister on the mountain trails. When the Portland rain hits, you can find her curled up with a good book and a cup of tea.

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.