The pelvic floor is a bowl-shaped group of muscles that live underneath your pelvis, connecting your tailbone to your sit bones and pubic bone. These are extremely helpful muscles as they hold all of your organs up and in your body. They control when you let out urine, gas, or fecal material and allow insertion during sexual activity, tampon use, or exams. They’re also closely related to the abdominals and spine and actually count as one of your “core” muscles, allowing you to lift and move safely and strongly.
When the pelvic floor is not working well, the symptoms can take a toll on a person’s sense of self, activities, and relationships.
These muscles are so important that there’s actually an entire specialty of physical therapy dedicated to them. These physical therapists are professionals that dedicate themselves to this complex area, addressing issues such as urinary leakage, frequency and urgency, constipation, abdominal and pelvic pain, pain with intercourse, prolapse, constipation, scar rehabilitation, and complicated low back pain in people of any age and gender.
In popular culture, the most common way in which the pelvic floor is referenced is with kegel contractions, with some people even calling them “kegel muscles.” Misnomer. Dr. Arnold Kegel was a man who described the contraction of this musculature. And oftentime, the only recommendation out there is to “do your kegels.” However, saying that all you need to do to obtain a healthy floor is to do a bunch of kegels is the equivalent of saying that all you need to do to be healthy is to drink milk.
Pelvic floor contractions such as kegels may be a part of a plan for a healthy pelvic floor, but they are not the only component necessary. In fact, they should not be recommended to people who are experiencing symptoms like pain, bladder urgency, and painful intercourse. Research shows that if people are only verbally instructed how to do a pelvic floor contraction, more than 1/3 of them will actually perform it incorrectly. Next time you read an article in a magazine instructing you to do a kegel, pick up the phone and make an appointment instead. You do not want to make your symptoms worse by doing the exercise incorrectly.
On your first visit, you will likely talk over everything you’re experiencing including any pains, bladder, bowel, and sexual health. All of this information may help your therapist find the root of the problem, so be honest. The therapist will then likely assess your posture, pelvic alignment, and tissues and musculature of your abdomen, back, and legs. Depending on the reason for your visit, you may proceed with a vaginal or rectal exam, per your comfort level. This may also be performed at future visits. The therapist may take time to assess the tissues of your vulva to look for signs indicating skin health or identify scarring. You will likely learn helpful tips to ease symptoms and may be provided with exercises to take home to start improving right away. Future visits could include progressing exercises, manual therapy (the therapist using their hands to address musculature externally or internally), teaching you to perform techniques on your own, and further education, including discussing elements of diet or habits that could be contributing to symptoms.
If you want to know more about how your pelvic floor is functioning or if you’re experiencing some of the symptoms mentioned above, seek care. These symptoms are incredibly frustrating. With the help of a professional and the right therapy, healing is possible.
Christina McGee PT, DPT is a pelvic floor physical therapist at Sullivan Physical Therapy, a pelvic health physical therapy clinic in Austin, Texas.