What’s Wrong Down There?

At the intersection of where our spine and hips collide, rests our pelvis. Three bones held together by sutures, cartilage, and ligaments; with an artistic weave of muscles and fascia that makes up our pelvic floor, whose job of many, is to support and hold our pelvic organs in place. Speaking on female anatomy, our bladder, uterus, and rectum are suspended in space in our pelvic cavity through these tissues. So, we have a lot moving pieces that need to work together in order to keep the show going.

We hear a lot about our core and pelvic floor and how they are so important for us, but why? Well, our “core” is made up of 4 different muscle groups; diaphragm, transverse abdominals, multifidi, and pelvic floor. The core’s function is to help support many functions in our bodies by providing stability. The pelvic floor is thought to have 5 functions, or the 5 “S”’s: stability, support, sump pump, sexual, and sphincter control. Stability is functioning in level of the core, basically helping all of those structures that attach to the pelvis move in the manner that they should. Support is literally holding our pelvic organs up. Sump pump, helping pump the blood, lymph fluids up from the lower part of our bodies up towards our heart. Sexual includes arousal and orgasms. Sphincter control is helping us not pee or poop on ourselves.

The muscles in our pelvic floor are split into three layers; the first layer is primarily responsible for sexual function/ arousal, and some stability (core) and sump pump help; the second layer is primarily responsible for sphincter control of both bowel and bladder, and some support and stability (core) help; the third layer is primarily responsible for support, stability (core), sump pump, and some sexual functions. The fourth layer is made of a dense fascia network that is primarily responsible for supporting our pelvic organs. When we talk about these tissues being organized in layers, imagine these layers in 3D in the shape of a funnel.

Now, how do things go wrong? Imagine all day, everyday, our pelvic floor muscles and fascia are working behind the scenes, keeping us dry from unwanted pee and allowing us to poop without discomfort and pain. Then boom, you fall on your tailbone! Well, several pelvic floor muscles attach to our tailbones, so trauma there, can cause a response of tensed muscles because they’re scared and don’t know what else to do. So now there is tension in the pelvic floor, specifically in the posterior portion of the pelvis, and this can make it harder to poop. What? How does that work? I eat lots of fiber and drink lots of water, what does tension in my pelvic floor have to do with my poop not wanting to come out? Well- at rest, the rectum has a curve towards the end caused by a pull in the puborectalis muscle, this curve is part of our fail safe system to keep us from pooping ourselves. Normally, when we use the bathroom, we get in a squatting position and that helps us relax the puborectalis muscle, which then allows us to release the poop. Now, in the case of this tailbone injury, the puborectalis is on guard because of this increase in tension, and now even with squatting, it doesn’t want to relax. This means, now we have to push against the muscle in order to allow the poop to come out, ie, straining, which can lead to hemorrhoids.

Tension in other parts of the pelvic floor can lead to pain with penetration, difficulty urinating or increased urge to urinate, pain with menstruation, or difficulty holding in urine or stool. Ok, it makes sense that trauma to the area can cause tension and pain, but how is tension causing incontinence? Well, increased muscle tension over time actually weakens the muscles. Try holding a a gallon of milk with your arm out in front of you for 5 min straight. In the beginning, it may be a little difficult, but you’re strong, you got it. Then the longer you hold that muscle contraction, your arm is going to start to drop down. The muscle hasn’t had any time to recover and that makes it weaker. The same thing in the pelvic floor. If our muscles that support sphincter control are constantly being contracted and held in a shortened position, eventually they’re gonna get tired and fail, causing you to leak urine at the most in-opportune times.

What else can go wrong? Back pain, hip pain, jaw pain, foot pain. The muscles in the pelvic floor share attachment points with muscles in the hips and lower back, so if there is tension in the pelvic floor, there can be tension or compensation in the neighboring structures. The feet and jaw are not neighboring structures to the pelvic floor, why can tension in the pelvic floor lead to pain in those areas? Fascia. Specifically, fascia trains, specifically one that connects the bottom of the feet, to the pelvis, to the jaw. So people who have TMJ pain or frequent plantar fasciitis will also have pelvic floor tension or pain and vice versa.

How can a Pelvic Floor (Health) Physical Therapist help you? We are trained to assess your pelvic floor muscles (internally or externally) in relation to neighboring muscular systems, and the body as whole. We can assess where you have dysfunction and get a better grasp on the potential underlining cause. We can take that information and help educate you on what's going with your body, and help you develop a plan to correct it. With our license to touch, with your permission (written and verbal consent), we can also provide hands on techniques that can help facilitate healing.

So, now that you have a better understanding of your pelvic floor, it’s functions, and some examples of what can go wrong, I hope you feel empowered to make your pelvic floor a priority.