Explore Your Pelvic Floor
by Courtney Virden
Do you know what your pelvic floor is and why it is so important? While it is becoming a topic more widely talked about it, it is often misunderstood which can impact those needing solutions or wanting optimal pelvic floor health. The pelvic floor is the base of our core and its health impacts everything from our posture to our sex life. For both men and women, our pelvic floor can become a source of problems or a strong foundation our body is built upon. Understanding what our pelvic floor is, how it works, and how to improve the functioning of it is important for all of us to live our life to the max.
Let’s start with the basics. What is your pelvic floor? It is a group of muscles and fascia that support your pelvic organs, aids in hip and spinal stability, improves sexual satisfaction, can impact your ability to orgasm, and so much more. The pelvic floor muscles stretch like a hammock from our coccyx (tailbone) to our pubic bone and between our ischial tuberosity (sitz bones). For women, the pelvic floor holds pelvic organs inside of their bodies. Without it, they would fall out between their legs. It is made up of three layers: the superficial perineal muscles, deep perineal pouch, and the pelvic diaphragm. It contains an abundance of blood vessels, nerves, and acts as a lymphatic pump for the pelvis. Both men and women may begin to have problems if they have an imbalance in the length-tension relationship of the fascia and musculature of the pelvic floor. A healthy pelvic floor is strong, toned, and responsive and one that is overly tight or overly stretched can lead to various problems. While both men and women may experience issues and have pelvic floor dysfunction it is more prevalent in women but with both, the issues stemming from dysfunction can greatly impact one’s quality of life.
There are many issues that come from pelvic floor dysfunction which is a blanket term used to describe a wider variety of symptoms. Some of the most common symptoms of pelvic floor dysfunction are stress incontinence (both urinary and fecal), urge incontinence, low back pain, pelvic organ prolapse, constipation, pain in the pelvis or groin, erectile dysfunction, low libido, painful intercourse for women, and even inability to achieve orgasm. Several conditions can increase your odds of disrupting the length-tension relationship of your pelvic floor including obesity, pregnancy and childbirth, improper lifting, pelvic surgery, nerve damage, radiation to the pelvis, trauma, and even stress. While the symptoms can be devastating, for most there is hope. With proper exercises and sometimes physical therapy, most are able to greatly reduce and even eliminate the issues that have plagued them, sometimes for decades.
Let’s take a look at a pelvic floor holding too much tension, aka hypertonic pelvic floor, and what type of disruption that can cause in the body. Many think that a tight pelvic floor is strong when actually it is most often weak. Think for a moment about someone with a tight hamstring. Does having a tight hamstring mean it is strong? Absolutely not, what is most concerning about a tight hamstring and a tight pelvic floor is that it is holding excessive tension and not functioning well. Our muscles and fascia within our bodies are designed to work together as a unit. They turn on when needed and exactly how much is needed. However, through trauma, poor movement patterns or injury our bodies often become segmented, causing some areas to become too tight and rigid while others are overstretched, leaving our muscles and fascia not working together as they were designed to. When our pelvic floor is not working as it was designed to other muscles start taking over which creates more dysfunction. Misalignment, overuse, and underuse in the muscles and fascia can create problems within our muscular and fascial system as well causing densifications in the fascia that can impact your entire body, not just your pelvic floor. Sometimes the issues are not noticed for years to come and show up elsewhere. Other times the issues are noticed quickly and at the source. Understanding our bodies are a unit and injuries, misalignment, and poor movement patterns create dysfunction throughout our body is important to helping our body function optimally.
Our breathing and emotions can also impact the functioning of our pelvic floor. When we breathe our pelvic floor is designed to move with our diaphragm. Inhaling will slightly descend our pelvic floor and exhaling will cause it to slightly ascend, just like a little trampoline. When someone is a shallow breather, their pelvic floor often doesn’t fully lengthen and relax as it is designed to and can cause it to become overly tight. Many store emotions in their pelvic floor and even watching a scary movie can often cause someone to unknowingly tighten their pelvic floor. Stress can also be a major culprit in excessive tension in our pelvic floor. When stressed many inadvertently tighten their pelvic floor and in chronic periods of stress this is being done far too often and creates excessive tension. Many have been told and believe Kegels are what is needed to help their pelvic floor. A Kegel is a concentric contraction and will often exacerbate issues if they are from excessive tension because they create more tension in the pelvic floor. That is why more and more doctors, and myself, do not recommend Kegels and instead prefer exercises to restore both strength and elasticity in the pelvic floor. There are times that more tension is needed throughout the pelvic floor however doing exercises that train eccentric and concentric strength and elasticity is often ideal. You want your muscles and fascia to be able to shorten and lengthen appropriately and not be too tight or overstretched. Feeling self-conscious, unsafe, a lack of connection to your partner, past sexual trauma, and negative views around sex can also impact your sexual satisfaction and ability to orgasm. These feelings should be addressed and can often be improved by working with a qualified therapist.
Pregnancy and childbirth are stressful for a women’s pelvic floor. As early as 6 weeks the fetus’s weight puts excessive pressure on the pelvic floor. As the baby continues to grow and the mother gains weight necessary for pregnancy her pelvic floor experiences more and more pressure and often without the strength and tone to support it. During vaginal childbirth, a women’s pelvic floor stretches and realigns to allow for the passage of the fetus. While some women’s pelvic floor functions well after birth many women are left with pelvic floor issues and often for the first time. Common issues after pregnancy include urinary/fecal stress incontinence (peeing when sneezing, coughing, jumping, running), low back pain, diastasis recti (connected to our diaphragm and pelvic floor), painful intercourse, low libido, and trouble achieving orgasm. While these issues are common, they are not normal. Our bodies are not designed to have these issues and many can heal themselves at home with a good pelvic floor program while some will need to see a physical therapist for internal fascial work as well.
Remember when I said our pelvic floor has an optimal length-tension relationship? This means there is an appropriate tone and tension throughout the pelvic floor. Besides a pelvic floor that is too tight throughout we can also have too little tension throughout the pelvic floor or parts of it. When a pelvic floor is overstretched it is weak and not as strong or responsive as it is designed to be. This can also lead to pelvic floor issues such as pelvic organ prolapse, vaginal flatulence, low back pain, difficulty orgasming, and more. Some of the issues people experience commonly such as incontinence and pain can be from a pelvic floor that is too tight, overstretched or a combination of the two. That is another reason Kegels are not ideal for many since so many men and women already have a pelvic floor holding excessive tension, whether it is too tense throughout or just a portion that is too tight and rigid. If someone would like to be doing Kegels, I recommend seeing a pelvic floor physical therapist first to determine if they are appropriate for that individual.
Our pelvic floor health also plays an important role in our sexual satisfaction. Low libido, vaginal dryness, erectile dysfunction, trouble orgasming, and reduced sensations can all stem from pelvic floor issues. Without optimal blood flow and nerve function arousal can be impeded which can significantly reduce sexual satisfaction. The ability to orgasm and the intensity of our orgasms can also be impacted by the health of our pelvic floor. Orgasms are pleasurable rhythmic contractions of the pelvic floor muscles. If the muscles are weak, overstretched, too rigid or not responsive and elastic, our orgasms may not be as strong or pleasurable or we may not be orgasming at all. Having a strong, toned, and responsive pelvic floor can intensify the strength of your orgasms and improve your ability to have them. Awareness of your pelvic floor and being able to feel it is important for sexual satisfaction and orgasms. Some have little to no sensation in their pelvic floor which can greatly reduce sensations during sex. Most women have the ability to experience internal orgasms yet few do without clitoral stimulation. Lack of awareness, decreased nerve sensations and blood flow, and a pelvic floor that has muscles that are weak and have an altered length-tension relationship can be reasons why so many women have difficulty achieving orgasm, especially G-spot orgasms. Men with erectile dysfunction can benefit greatly from pelvic floor exercises to improve the strength of their pelvic floor.
Pelvic floor exercises are for both women and men and can help take your sex life to another level. Our pelvic floor muscles are strong and work well when we use them, much like the rest of our muscles. Since we do not visually see the muscles of the pelvic floor they often get overlooked until someone is experiencing issues and is at a point they are ready to do something about it. Make pelvic floor training a regular part of your life, whether you have issues or not, so you can reap the rewards of a strong and high functioning pelvic floor. By training the pelvic floor you can experience improved posture, more confidence, enhanced movement patterns, and better sex.