Getting to Know Your Pelvic Floor // Pelvic Floor Basics
Pelvic floor health is a really important element of women’s health that often gets neglected or swept under the rug when it comes to preparing for and recovering from birth (and just navigating life in general as a woman!). Perhaps I’m a bit naive, but before falling pregnant I had very little awareness about the pelvic floor and its importance. Thankfully there are many amazing resources and professionals out there that helped me prepare for the birth of my little girl, but since it’s outside of my scope of practice I thought that I would get someone more qualified on board to share more about this area of women’s health with us. I’m excited to share a series of blogposts written by Candice Thurston, a Durban-based physiotherapist specialising in the areas of pelvic health and women’s health. In this post, she highlights the basics to help you better understand what the pelvic floor is, what it is supposed to do, and what happens when the pelvic floor doesn’t function as it should.
As women we are ever so blessed with a variety of unique life phases and changes that keep us in tune with all that entails womanhood. Our bodies adjust and flow through puberty, menstruation, pregnancy and menopause yet it seems that it is only when we reach our child bearing years, we begin to develop an invested interest in our nether regions. Understandably so, a few episodes of urinary leaking and planning for child birth is enough to spark a good google search about what happens down below. So let’s put your minds at ease and begin to dive into the basics of your pelvic floor - I assure you that once you have connected with and understand the ‘ins and outs’ of all things pelvis, you will feel a little less overwhelmed!
So what exactly is the job of the pelvic floor?
It allows the passage of urine and faecal matter - You need to have the ability to ‘let go’ and allow waste to flow without pushing (straining) to pass urine or faecal matter.
It is important for maintaining continence (urinary or fecal) - You need to have adequate strength to maintain continence (i.e. be leak free) between toilet breaks. You may have heard of Urge Urinary Incontinence (UUI) (leaking when you have the urge to urinate) OR Stress Urinary Incontinence (SUI) (leaking with an increase in intra abdominal pressure, for example when you cough, sneeze, laugh, jump).
It supports the pelvic organs (bladder, bowel, uterus) - Your pelvic floor prevents the descent of the pelvic organs. A Pelvic Organ Prolapse (POP) may be present following natural chid birth, a hysterectomy, or due to chronic coughing/constipation.
Sexual function - You need the ability to relax to allow for pain free penetration (note: foreplay increases space, relaxation of muscles, natural lubrication) and the strength to reach orgasm. Your pelvic floor plays an important role in these things.
Where and what is the pelvic floor?
Your pelvic floor, whether male or female, is located at the base of your pelvis, where it forms a bowl-like structure comprising of muscle, ligaments, tendons and fascia. This bowl, which can also be thought of as a hammock or trampoline, has holes in it (2 for males and 3 for females) to allow for the likes of ‘pee, poo, and pleasure’. Just like any bodily function there is an element of voluntary and involuntary control over these holes. Think of a function like bending your elbow. If you want to lift a glass, you voluntarily bend your arm to drink. If you touch a hot stove, you involuntarily bend your elbow as a reflex to avoid being burnt. The pelvic floor muscles need to be strong yet flexible to adequately control these holes.
Bringing your attention back to your pelvic floor - when you consider urination, defecation or intercourse, you may be grateful that, without realising, your pelvic floor is responsible for the fact that you can eat and drink without everything passing straight through you (this is a form of involuntary control). You may also now understand that sometimes we need to actively generate tension to close off these holes and ‘keep things in’ (urine, feces) in an emergency, or you may need to relax and let go in order to ‘let things out’ (feces) or even ‘allow things in’ (intercourse) (these are examples of voluntary control)?
The group of muscles that make up your pelvic floor (Levator ani) work in conjunction with surrounding muscles forming what we call a ‘functional unit’. This is comprised of your abdominal wall - Transversus Abdominis (diastasis will be discussed in a follow up post), respiratory diaphragm (deep breathing is underrated!) and multifidus (important for deep spinal stabilisation). The different components of the functional unit compliment one another and work optimally when in sync. This means that rectifying back pain, rectus diastasis, a weak core, cesarean section scars, and poor breathing patterns will all contribute to a healthy and functional pelvic floor!
What does pelvic floor dysfunction entail?
Anything that lies outside of the functions of the pelvic floor that we discussed earlier is regarded as dysfunction. So lets break things down into different areas of concern:
Urination: Any involuntary loss of urine (even if its just a drop), difficulty passing urine or pain associated with urination. Do you strain to push urine out or do you let it flow?
Defecation: Any involuntary loss of faecal matter (even if its just a smear), difficulty passing a stool (Constipated? No pushing please!), or any pain associated with a bowel movement.
Pelvic organs: Any descent of the pelvic organs into the vaginal canal. This may feel like a heaviness/plum between your legs or may be seen as a bulge protruding from the vagina, depending on the stage.
Sexual function: Pain associated with intercourse, whether it results in an inability to penetrate, deep pain during penetration, or pain at the entrance of the vagina. This can also include lack of sensation or a difficulty reaching orgasm.
A number of these symptoms are common, but that doesn't make them normal. If you experiencing any of these symptoms its worth a visit to a pelvic floor physiotherapist also known as a women’s health physio (or a little more to the point a ‘vagina physio’). You may simply need to incorporate your pelvic floor itself or areas of the functional unit into your general exercise program. Whether it is about learning how to relax and ‘let go’ in the case of an overactive and tight pelvic floor, strengthening your low tone levator ani or transverses abdominis, incorporating appropriate breathing techniques into your training regime, or trying a few simple lifestyle hacks, there are many conservative ways of rehabilitating pelvic function. And its never too late to get started.
Candice is a Physiotherapist based in Durban with a special interest in Women's Health and Pelvic Health, a relatively new and growing field of Physiotherapy. In an effort to improve awareness of Pelvic Physio as well as educate and empower women with pelvic health concerns, Candice is known for addressing many of the taboo topics in this area. Rather than ‘brushing it under the rug’ or giggling over pelvic floor symptoms in conversation, she highlights that there are professionals trained in conservative treatment. She has an Instagram page @umhlangaphysioforwomen and ran a series of ‘Wonderful Women’ Events in 2018 which aimed to normalise conversations and address pelvic floor dysfunction in an empowering and engaging setting. These platforms allow women to interact with herself as well as other professionals within the field. When Candice isn't dancing around in front of a crowd explaining the ins and outs of a pelvis she is based at a Physiotherapy practice in Umhlanga, Durban, South Africa. This is where she assesses and treats any patients that may come her way with concerns relating to the pelvis.
You can keep in touch with her work on: