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Getting to Know Your Pelvic Floor

Do you feel a sneeze coming on and immediately cross your legs? 

Avoid laughing too hard because you fear you might leak urine? 

Can’t jump on a trampoline anymore? 

Sound familiar? 

Urinary incontinence is the involuntary loss of urine. Currently, about 13 million Americans suffer from incontinence. Women are more likely than men. 25-40% of women suffer from urinary incontinence. The likelihood of experiencing incontinence increases with age, increases with the number of pregnancies and can also be affected by other medical conditions like cancer, surgery and obesity. As you go through menopause the odds increase that you will experience incontinence. One of the top reasons patients are admitted to an assisted living facility is incontinence. 

If you are experiencing any type of urinary incontinence, THERE IS HELP NOW. If you wait to get help later, the symptoms do not go away, and most likely will worsen. A LARGE percentage of women experiencing urinary incontinence do NOT report it to their primary care physicians. So, these numbers could be even higher. 

There are two types of urinary incontinence:  Stress and Urge. 

Stress Urinary Incontinence (SUI) is the involuntary leakage of urine during efforts or exertion, for example while sneezing or coughing, running or lifting.  

Urge Incontinence (UI) is the leakage of urine immediately following the urge ‘to go.’ This is also known as an overactive bladder.

How can pelvic floor physical therapy help?

The pelvic floor is made up of muscles. These muscles play a role in supporting the contents in the abdominal cavity, assisting with both urination and defecation and facilitating sexual function. The pelvic floor is made up of muscles, and just like other muscles in the body, sometimes these muscles can be too tight. When they are tight they can restrict your ability to contract them effectively. They can also be too weak, also limiting your ability to contract them effectively.   

What happens when a muscle is chronically tight? 

Well, let’s consider another muscle that is often chronically tight? The upper trapezius.  The upper trap connects the base of the head to the spine and the shoulder girdle. Restrictions are frequently found in this very large muscle that leads to chronic head, neck and shoulder pain. 

What happens when a muscle is weak? 

Let’s compare to a group of muscles that are often weak, the rotator cuff muscles. When this group of muscles is weak they are not able to serve their purpose, which is to stabilize the shoulder joint.  This can lead to pain and dysfunction 

Tight or weak muscles elsewhere in the body cause dysfunction, so why not in the pelvic floor? The pelvic floor works the same way. When it is tight or weak, dysfunction occurs and the results can lead to  pelvic pain or incontinence. 

Often times when you leak urine your pelvic floor muscles are weak, but not always. 

Often times when you pelvic floor muscles are too tense, you could be experiencing pain and have difficulty with things like sexual intercourse or inserting a tampon.

Let’s take a closer look at the role the pelvic floor plays.  The pelvic floor musculature is part of a larger group of muscles called the deep core stabilizers. They consist of the transversus abdominis, the multifidi and the abdominal diaphragm. Together these muscles work to stabilize your spine before moving your limbs. If you are experiencing weakness or tightness in any of these muscles you might not be able to effectively stabilize the spine. Considering we are constantly moving our limbs throughout the day, you can easily see how this can lead to problems.  Pelvic floor physical therapy can help you create the stability you need. 

The pelvic floor forms the bottom of the pelvic basin. The pelvic basin is outlined by the following bones:   the two innominates (which are comprised by the pubis, the ilium and ischium) and in the back, the sacrum and coccyx. When you connect the bony landmarks they create a shape resembling a diamond (marked by the teal colored lines). The diagram below depicts only the first layer of muscles, or the most superficial layer, as well as the bony landmarks (as seen from the inferior aspect.)

All together the pelvic floor consists of 3 layers of muscles:

The 1st and 2nd layers play important roles in sexual function as well as the opening and closing of the urethra, the vagina and the anus. 

Also located in this layer is the perineum, which can be damaged during a vaginal delivery by tearing or an episiotomy.

The third layer, or the deepest layer, is also known as the pelvic diaphragm, which plays an important role in supporting the abdominal contents. At this deepest layer the pelvic floor plays an important role in supporting the spine along with the other deep core stabilizers. 

The walls of the pelvic basin are formed by the following two muscles: the piriformis and the obturator internus. Sandwiched in between these two very important muscles is the sciatic nerve. 

How many of you have experienced sciatic nerve pain? Perhaps one of these muscles was the culprit. 

What can you do? 

Seek professional help. Non invasive therapies can help improve urinary incontinence for many patients. 

First, a pelvic floor therapist can help you determine whether your pelvic floor muscles are weak or tight.  Based on your evaluation results, there are many treatment options available. Some treatments may include : keeping a bladder diary and bladder training, pelvic floor and other core exercises, functional training, manual therapy and relaxation techniques, postural education. 

Fascinated by the pelvic floor and want to learn more? Click on the link below and watch my video on The Pelvic Floor and the Diaphragm. 

Pelvic Floor Video:

Have questions? Schedule a FREE 15 minute consultation today. 

The time is NOW. Don’t wait any longer to take the action you need to gain the knowledge that will make you feel more confident and empowered. Telehealth can be a good option for starting your pelvic floor program now at home. 

"Life isn’t about waiting for the storm to pass, it’s about learning to dance without leaking in the rain."

Sara D'Agostino, PT, RYT-200

Co-Owner The R3finery

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