The Five S’s Functions of the Pelvic Floor

Support: It acts like a hammock and supports your pelvic organs. For women it holds up the bladder, rectum, and uterus. For men the bladder, prostate, and rectum. If this function isn’t working well you may have prolapse of the bladder, uterus, or rectum. This may feel like heaviness or weakness in your pelvis. You may have trouble lifting/carrying your kids, groceries, or even the car seat. This can also play a factor in your hip or low back pain as well as difficulty with urine or fecal leakage (also called incontinence).

Sex: you may have pain with intimacy and even the inability to enjoy it the way you used to (whether you are a male or female). Some females can even have trouble using a tampon or menstrual cup due to the same issue.

Sphincter Control: It controls both your anus for bowel AND your Urethral sphincter for urination. If it is having trouble with your anal sphincter, you may have trouble with constipation, bloating, diarrhea, and a combination of all three as well as painful bowel movements. If the pelvic floor muscles that aide with urination are an issue, you may notice: trouble emptying your bladder, frequent urination (normal is every 2-3 hours), and even urine leakage. Incontinence (urine leakage) can present as stress incontinence that occurs when there is more stress or pressure on your system. This can occur with sneezing, coughing, laughing, jumping, and running. While this is very common with many people, it is NOT normal and can be fixed! Urge incontinence occurs when you experience a sudden spasm of the pelvic floor muscles and you have the sudden urge to go NOW. Sometimes you may not be able to make it to the bathroom in time.

Stabilization: It stabilizes the whole spine from tailbone to neck! This means that chronic low back pain, hip pain, SI joint pain or even neck pain may be coming from your pelvic floor not working as it should. 

Sump Pump: It aides the lymphatic circulation throughout your whole body but especially the abdominal, pelvic, and legs. What you think is bloating in your lower abdomen and pelvis may actually be fluid. The great thing is, the more you know about what your pelvic floor SHOULD be doing, the better you can seek help if you are having trouble. 

Who should you see if you are having trouble with your pelvic floor? A pelvic floor physical therapist is my first recommendation. They will let you know if you need to see an MD as well. Sometimes they will refer you to see your primary MD but most times the referral is to see an OBGYN, a urologist or a urogynecologist. Unless you have government insurance such as Medicare, Tricare, VA, or Medicaid you do NOT need a referral to see a pelvic floor physical therapist. There is even a free pelvic floor clinic at Wingate University if finances are a constraint. 

What does a pelvic floor Physical Therapist do?

Well, they will do a thorough exam of your hip joints and spine as well as your overall muscle flexibility and strength. They’ll even check your posture and balance as well! (It’s all connected!) Then with your permission, they’ll perform an external and internal evaluation to see if your pelvic floor musculature is too tight, weak, or not coordinating well with your abdominal muscles and diaphragm. After the evaluation, they’ll begin treatment the first session.

Treatment, oh you mean lots of Kegels, right?  Actually, no….. Kegels should ONLY be given if the pelvic floor muscles are weak and need strengthening. Many times, the pelvic floor muscles stay contracted and get very tight…. Those pelvic floor muscles need to learn how to relax or down train. If you have pain with intimacy, trouble emptying your bladder, and urge incontinence it usually means your pelvic floor muscles are too tight and always working. Kegels can make tight pelvic floors worse. Believe or not, most pelvic floor dysfunction comes from pelvic floor muscles that are too tight, NOT too weak. 

Well how do I know if I should focus on Kegel type exercises or learning how to (relax) my pelvic floor? Ah, now you are understanding the importance of seeing a pelvic floor therapist!