Pelvic floor issues mostly occur when the pelvic floor muscles are lacking enough tone (hypotonic) or are too “tight” (hypertonic). Some people may experience weak pelvic muscles and core muscles from an early age. Others may not notice problems until after certain stages of life such as pregnancy, childbirth, or menopause.
When pelvic floor dysfunction in women is present, it is typically a result of overly toned, too short pelvic floor muscles. The pelvic floor cannot function in this state. Think of it this way - you can contract muscles and make them shorter (as in a bicep curl) or you can contract it by making it longer (releasing a bicep curl). Strengthening your pelvic floor means loading it long (like a slow, controlled release of a bicep curl).
Overworking these muscles and connective tissues without learning how to properly engage the various muscle groups can keep you from relaxing them fully.
The most common reasons why someone may be suffering from pelvic floor dysfunction are:
- Excessive pelvic floor tension
- Pregnancy and birth
- ongoing constipation and straining to empty the bowels
- being overweight or obese if it contributes to excessive intraabdominal pressure
- heavy lifting (e.g. at work or the gym)
- a chronic cough or sneeze (e.g. due to asthma, smoking or hayfever)
- previous injury to the pelvic region (e.g. a fall, surgery or pelvic radiotherapy)
- growing older
Although it is hidden from view, your pelvic floor muscles can be consciously controlled and therefore trained, much like your arm, leg or abdominal muscles. A pelvic floor that is responsive to the varying loads placed on it keeps your organs functioning as they should--no more leaking pee when you sneeze. All people benefit from learning how to release and engage their pelvic floors, so that the pelvic floor reacts reflexively.
Why is my Pelvic Floor so tight?
As I have mentioned previously, overly tight pelvic floor muscles are what we call hypertonic. In order for our pelvic floor to respond appropriately to our everyday movements, they need to be able to correctly relax and contract. If your muscles are too tight, you may experience continence issues, pain, or discomfort. Some of the more common conditions that may result from a hypertonic pelvic floor include:
Dyspareunia: Dyspareunia is the fancy, medical term to express pain associated with sexual intercourse. This condition is often closely related to surgery or trauma that may have occurred to the pelvic floor muscles. However, this condition can also result from hypertonic, painful pelvic floor muscles.
Vaginismus: Vaginismus is a condition that causes the vaginal muscles to squeeze, spasm, and contract violently when something is inserted in the vaginal canal. This can cause discomfort and pain. If someone has this condition, the increased muscle activity in the pelvic region can cause the muscles to become hypertonic.
Pudendal neuralgia: Pudendal Neuralgia is a condition that results from damage to the lower body and the pudendal nerve. Often damage to this nerve can go hand-in-hand with hypertonic pelvic floor dysfunction. The most common ways that this nerve can become damaged include: birthing, infection, or during exercises that may place strain or pressure under the pelvis
Chronic prostatitis: In men, a hypertonic pelvic floor muscles may be a result from chronic prostatitis (inflammation of the prostate). One of the most common causes of an inflamed prostate actually stems from issues with the pelvic floor muscles. If your pelvic floor muscles are too tight or strained, they can irritate nerves in the area causing radiating pain.
What are the symptoms of tight pelvic floor muscles?
Symptoms vary from person to person. Some of the most common pelvic floor dysfunction symptoms include:
- Stress incontinence in women (sneeze pee)
- Rectal, fecal incontinence
- Incessant need to pee (urge incontinence)
- Difficulty in emptying your bladder or pain during bowel movement
- A prolapse (in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping)
- Pain in your pelvic region, near the pelvic bone
- Pelvic muscles spasms
- Pain during sexual intercourse
Hypertonic pelvic floor muscles can result in painful and embarrassing symptoms. Pelvic pain and incontinence can be uncomfortable and embarrassing at best.. However, there are ways to begin releasing and integrating your pelvic floor muscles in order to gain back control over your body.
What Causes Pelvic Floor Dysfunction?
Pelvic floor dysfunction causes are still being researched. However, there are some common conditions that are linked with PFD and pelvic organ prolapse. Some of the common causes for pelvic organ prolapse and weakened include:
- Childbirth & postpartum related issues
- Delivery trauma
- Multiple pregnancies
- Pelvic surgery, medical history of pelvic organ prolapse
- Pelvic trauma or injuries
- Overuse of the pelvic muscles (i.e.: constipation, improper exercise)
- Damaged nerves
This is not a comprehensive list of pelvic floor dysfunction causes, but helps paint a picture of what may have led or been leading to your weakened pelvic floor. The goal with a pelvic floor treatment plan and exercise is to address the specific and unique symptoms that you may be facing while preventing the need for corrective surgery.
What makes Pelvic Floor Dysfunction worse?
Symptoms of pelvic floor disorder may take months to years to resolve depending of the issues you are facing. Before you begin seeking help for these issues, it may be helpful to understand what may be making your pain worse.
In some cases, pelvic organ prolapse can make your symptoms worse. POP is a condition that occurs when the tissue and muscles of your pelvic floor become too loose and can no longer support all of your organs, which results in them dropping out from their normal position. The organs most commonly affected by this condition include: the vagina, cervix, uterus, bladder, urethra, and rectum.
Constipation or long-term bouts of diarrhea may also make pelvic floor dysfunction worse. It is important to focus on hydration and dietary restrictions if your PFD is associated with bowel complications.
One of the most common issues some of my clients face when confronted with pelvic floor dysfunction is continuing to exercise and contract their pelvic floor when it is hypertonic. Any exercises that increase intra-abdominal pressure or strain the pelvic muscles can cause the symptoms of hypertonic pelvic floor dysfunction to become worse.
How do you treat Pelvic Floor Dysfunction?
It’s a bit inaccurate to characterize a pelvic floor as loose vs. tight. It might be better to talk about how responsive our muscles are to the loads we place on them. However, there are many many people who suffer from a pelvic floor where the muscles are overly active (or “tight”). And there are practical steps you can take toward healing and properly engaging your pelvic floor.
Pelvic Floor Education
One of the most unhelpful kinds of treatment suggested for many women with overactive pelvic floor muscles are Kegels. While Kegel exercises performed correctly can be useful for increasing the tone of the pelvic floor muscles, in the case of hypertonic muscles, you're adding tension to tension, and not actually increasing the responsiveness of the muscles. As a result, doing 100 Kegels a day may actually make your symptoms worse; increasing the tension in the pelvic floor muscles can also make it harder to perceive the movement of the pelvic floor. Instead, your pelvic floor exercise should focus on learning how to release excess tension in the pelvic floor, followed by exercises that help you engage your pelvic floor muscles without gripping. In order to release that tension, you will need to develop deeper bodily awareness. Knowing your pelvic floor leads to a better healing process. That bodily awareness extends beyond the mat to everyday activities and habits. Many adult women tend to struggle at first with changing habits. However, over time and with regular practice, this often changes, and people find they are empowered by their increased knowledge, awareness and sensitivity.
Breathing Mechanics Matter
Breathing mechanic therapy plays a large role in resolving pelvic floor dysfunction. Many, many of my Restore Your Core clients with pelvic dysfunction spend a large portion of our time together relearning proper breathing techniques and being trained in how to eliminate unnecessary pressure in the abdominals.
Without realizing it, many people have become belly breathers. This means that they constantly use their belly as they inhale. Doing this creates a bulge in the core which increases pressure on the pelvic floor muscle groups and the core. The increased pressure exacerbates common symptoms like incontinence. Your pelvic floor was not designed to handle such an increased amount of pressure with each breath.
What I teach my clients in RYC is how to breathe 3-dimensionally. This means that you are using the movement of your ribcage to accommodate air as it comes into your body with your breath. Think of it like this: breathing in air creates a shape change in your body. You can change shape by pushing your belly out and increasing pressure, or you can change shape by allowing your ribcage to expand to make space for your lungs. Doing the latter allows your body to properly engage and respond to the demands of daily life. Believe it or not, but your pelvic floor function is closely related to your core function. So, when I am seeking to resolve any pelvic floor issues with my clients, I am essentially addressing core issues as well. Belly breathing does not only affect the pelvic floor, but also makes having a functional core very difficult--if you’re pushing your abdominal muscles out when you inhale, they aren’t available to engage when you need them.
To learn more about proper breathing mechanics, check out my video discussing the connection between belly breathing and pelvic floor/ core issues and how to begin breathing properly.
Decreasing Abdominal Pressure: Pelvic Alignment Matters
How we use our bodies on a daily basis can greatly affect our core and pelvic floor health as well as our joints, muscles, and bones. When it comes to clients with hypertonic pelvic floor, I always ensure that the integrity of their pelvic alignment is maintained or corrected, depending on their needs. One thing many people do without realizing it is pushing out their hips while in a standing posture. This unintentional shift can increase tension in the muscles of the pelvic floor. In the process of resolving pelvic alignment, we might work on hamstrings, upper back mobility, and more. It requires a whole-body approach, The process of relearning how to allow your bones to support you while you stand takes time, but is well worth the process.
Restorative Exercises for Pelvic Floor and Core Issues
Now that you know a little more about proper breathing techniques, better alignment, and your pelvic floor, you might want to start learning how to integrate that information and feel it in your body.. My 12 Week Program: Restore Your Core offers a step by step approach to developing a strong, healthy, responsive core & pelvic floor system, for the health of your whole body.
To learn more about the various exercises that assist in core strength and resolving core and pelvic floor pain, check out one of my previous blog posts.