Pelvic Floor Dysfunction: Common, Not Normal, and Treatable

Deep Dive

Pelvic floor disorders are described as a "silent epidemic," affecting women of all ages with various symptoms. These disorders are common but not normal, serving as information from the body that something is not functioning correctly. The narrative that these issues are a normal part of aging or childbirth is identified as gaslighting, as no amount of leakage or pain is considered normal.

The pelvic floor has multiple crucial roles, including supporting pelvic organs such as the uterus, ovaries, bladder, and bowels. It also contributes to stability, posture, breathing, and spinal support, and is involved in bladder control, bowel function, and sexual function. Dysfunction in these muscles can lead to issues like low back pain, hip pain, tailbone pain, and discomfort during intercourse.

Issues with bladder health, such as urinary leakage with coughing, sneezing, or laughing, overactive bladder, painful bladder syndrome, or difficulty initiating a urine stream, are linked to pelvic floor dysfunction. Similarly, problems with bowel movements, including straining, hemorrhoids, fissures, fecal staining, or urgency, are also associated with the pelvic floor's condition. Sexual health concerns, such as discomfort during intercourse, changes in sensation, weaker or painful orgasms, are also discussed as potential indicators.

The source emphasizes that straining during bowel movements places more pressure on the female pelvic floor than activities like jumping or coughing, and can be a cause of leakage or prolapse. It is suggested that even after prolapse surgery, if straining due to constipation continues, the prolapse may return.

Daily bladder habits that protect pelvic health include only peeing when there is an urge, avoiding "just in case" peeing, which can shrink the bladder over time, and not pushing to pee. Pushing to urinate can lead to incomplete bladder emptying and weaken the ligaments supporting pelvic organs, potentially contributing to prolapse and leakage. Sitting down to pee, leaning forward, and taking deep breaths are recommended to allow the bladder to empty naturally.

When exercising, it is advised to contract the pelvic floor muscles before and during movements, similar to stopping a urine stream or holding in gas. This pre-contraction helps engage the pelvic floor, and it should be maintained while exhaling during the exertion phase of an exercise to avoid holding breath and putting downward pressure on the pelvic floor.

Identifying pelvic floor tension is discussed, with symptoms including vaginal pain, painful bowel movements, tailbone pain, hip pain, or abdominal pain. Straining to start a urine stream, straining during bowel movements, pencil-thin stools, or feeling incomplete emptying can also indicate tension. For those with pelvic floor tension, Kegel exercises (tightening) are discouraged, and the focus shifts to breathing exercises, relaxation techniques, and stretches like child's pose, happy baby pose, and deep squats to help relax the muscles. Massage to the hips, glutes, and internally to the pelvic floor muscles is also suggested for tension relief.

Pelvic floor therapy sessions are described as one-on-one, private, and typically lasting 45 minutes to an hour. They involve a detailed history, external physical assessment of the low back, hips, and glutes, and an internal examination to assess muscle contraction, relaxation, and tenderness. This comprehensive assessment helps determine if there is tension, weakness, or incoordination in the pelvic floor muscles.

The concept of prolapse is defined as the dropping of pelvic organs due to insufficient support from the pelvic floor muscles, often felt as a bulge or heaviness in the vagina. Stage one and two prolapse can be improved with therapy and lifestyle modifications, while stage three and four prolapse, where organs extend past the vaginal opening, typically requires surgical intervention. Therapy is still recommended after surgery to address the root causes.

The importance of pelvic floor education is highlighted, suggesting it should be integrated into life stages from potty training through adulthood, similar to period education or sex education. This education aims to normalize conversations about pelvic health, demystify anatomy, and prevent shame and secrecy around bodily functions and potential issues.

The V-Hive app is introduced as an on-demand pelvic floor fitness platform offering workouts for various life stages and needs, including strengthening and relaxation. The app provides accessible and affordable resources, described as a "pocket pelvic floor therapist," with workouts ranging from 10 to 30 minutes.

It is reiterated that pelvic floor issues are common but not normal, and they are treatable at any age. Simple daily habits and exercises can make a significant impact on pelvic health, and seeking professional help, whether through in-person therapy, telehealth, or resources like books and apps, is encouraged.