Pelvis: Foundation of support for the body

Pelvic Floor: A group of muscles, ligaments and tissues that support the organs of the pelvis which include the bladder, urethra, and rectum as well as the uterus and vagina for women and prostate for men

Functions of the Pelvic Floor Muscles

Causes of Pelvic Floor Disorders

  • Imbalanced pelvic floor muscles are either too weak (hypotonic) or too tight (hypertonic)
    • Hypotonic
      • Stress Incontinence, Pelvic Organ Prolapse
    • Hypertonic
      • Urge/Stress Incontinence, Urinary/Fecal Urgency, Dyspareunia, Pudendal Neuralgia, Interstitial Cystitis/Bladder Pain Syndrome, Pelvic Organ Prolapse
  • Stress: The pelvic floor muscles are the first muscles in our body to respond to stressors; tension in the pelvic floor muscles is highly related to chronic stress, anxiety, trauma, fear and shame
  • Childbirth
  • Menopause
  • Prior surgery/pelvic radiation
  • Heavy lifting and straining
  • Obesity
  • Congenitally weak connective tissue
  • Aging

Pelvic Pain

  • Felt in the lowest part of the abdomen and pelvis
  • Often from several causes, including musculoskeletal/gastrointestinal/hormonal/visceral sources and central nervous system changes
  • Musculoskeletal pelvic pain may be chronic, long-standing pain that could be dull or sharp, constant or intermittent and mild, moderate or severe; it can also feel like pressure and mimic the symptoms of a prolapse
  • Often radiates to the lower back, buttocks or thighs
  • Can occur during certain functions ie: when urinating or having sexual intercourse, sitting or other prolonged positions
  • Can be connected to central sensitization, also known as a sensitive nervous system
  • Can arise from muscles and connective tissue (ligaments) in the structures of the pelvic floor
  • Occasionally might be caused by irritation of nerves in the pelvis

Pelvic Floor Dysfunction Symptoms

  • Leakage of urine with coughing, sneezing, laughing and exercise
  • Urgency and feeling like you have to urinate more than 8 times per day
  • Inability to hold urine during strong urges, resulting in urine leakage
  • Difficulty passing stool
  • Difficulty initiating urination
  • Feelings of not emptying the bladder fully after urinating
  • Pain in the vagina/pelvis relating to sexual intercourse
  • Burning/stinging sensation in the pelvis
  • Pain in the vagina, clitoris, rectum, penis or perineum
  • Pain in the tailbone, buttock or pelvic girdle
  • Pain and heavy cramping with menstruation
  • Heaviness/pressure within the pelvic region
  • Protrusion of tissues inside/outside of the vaginal/anal entrance
  • Pain in the pelvis after childbirth (tailbone, low back, pubic bone)

Pelvic Floor Disorder Treatment

  • Education: To ensure you have a clear understanding of your condition, the anatomy and physiology related to your symptoms; the most important component of education is to understand the biology of the sensitive nervous system and how that can be changed
  • Counselling: To modify lifestyle, diet and toileting habits to optimize bladder/bowel and pain control
  • Relaxation Techniques: To engage in mindful movement ie: yoga, meditation, tai chi, qi gong
  • Pelvic Floor Muscle Relaxation and/or Strengthening Exercises: Can include massage, myofascial release, connective tissue manipulation, stretching and joint mobilization to promote relaxation and mobilization/activation of tissues
  • Biofeedback: Involves a small vaginal/anal probe and video to monitor the pelvic floor muscle activity. The feedback enables the therapist to then work with you to improve your muscle coordination
  • Electrical Stimulation: A general electric current is applied to the muscles to enhance the sensation, strength or to control pain
  • Connective Tissue Mobilization: Treatment should never be painful or increase your symptoms afterwards
  • Balloon Training: Improves anorectal control by increasing patient awareness of filling, storage and evacuation manoeuvres in cases of chronic constipation or fecal incontinence
  • Lumbar Spine, Hip, Coccyx and Sacroiliac Joint Mobilization: Central focus on what you can do to increase the mobility of these structures