Pelvic Floor: A Pelvey Tale
Once upon a time there was a lady. She wasn’t a Princess and, just between you and me, she’d long since given up on Prince Charming.
She had received no visits from her Fairy Godmother and turned her attention instead to the arrivals from Amazon whilst, naturally, dreaming of John Lewis
The things is, she had been visited by a Wicked Witch who had left her something: The Menopause
Now, The Menopause is the gift that keeps on giving, and amongst its bountiful gifts was one in particular. The lady experienced a change in her pelvic floor. It started to leak, and we ain’t talking Fairy Dust.
This is where this story starts to get interesting because our plucky heroine started to investigate the marvel that is the human pelvic floor, and how it can be maintained, improved and , with practice, relied upon. In this story there are no gingerbread houses, pumpkins and not a single dwarf but if you were to ask a talking mirror:
Mirror Mirror on the door, tell us about the Pelvic Floor:
- It is an area of the human body which can very often fail to work optimally, causing practical, physical and subsequently emotional problems
- It is affected by weakness elsewhere, constipation, increasing age, dysfunctional breathing, surgery, childbirth, Menopause, certain medication
- Pelvic floor problems are often hidden, not talked about, where people suffer in silence, not realising that many people experience the same symptoms and problems
- There are plenty of ways to intervene, help and improve Pelvic Floor function in both men and women.
What does it look like?
Well pretty darn amazing actually although these pictures don’t really do justice to the complexity, functionality and elegant efficiency of the structures.
The above picture is a female pelvic floor viewed from above (left hand picture) and viewed from underneath (right hand picture). The pubic bone at the front of the pelvis is at the bottom of the picture. It is not completely clear from the picture but there is more than one layer of muscle: three in fact, and they are continuous with the skin, sub cutaneous fat, the fascia that surround each muscle layer and the organs
The picture below is of a male pelvic floor, viewed from below. I’ve turned it upside down so that, as with the female picture, the tail bone at the base of the spine is at the top of the picture. In the middle of the female (right hand side picture) and the male picture is the anal sphincter. In the female pictures is a kind of space/hole for the urethra (leading from the bladder which we pee through) and the vagina. In the male picture is the penis which contains the male urethra. Very much in and amongst all of this is erectile tissue in both females and men: it is continuous with and blends with the pelvic floor. They are mixed up together.
What do the Pelvic Floor Muscles Do?
They support, from underneath, the 3 organs that occupy most of the space within the pelvis: the bladder, the womb (aka uterus) in women, the Rectum (the end of the large bowel). Weakness in the pelvic floor and compromised support can lead to the organs dropping down, a clinical condition known as organ Prolapse.
They have a role in maintaining the shape of the pelvis and can move the pelvic bones, notably the tail bone and the sit bones. Tightness or weakness in the pelvic floor will disturb the shape and function of the pelvis which in turn affects movement: walking, running etc
The outermost layers of the pelvic floor blend with the Labia Majora and Labia Minora in women and errectile tissue in both men and women. The strength, muscle tension and the health of the blood supply to the area contributes to sexual function.
The muscles provide control of bladder and bowel function. There is an interplay here with non conscious activities around the bladder and bowel filling up. Bladder and bowel continence can be disturbed separately and in different ways, depending upon the type of muscle weakness or in some cases damage to the muscles.
Here are 5 things that you should really know about the Pelvic Floor
There are loads of other fascinating and important facts – I’ve really just chosen a few biggies
Constipation causes stress incontinence. If you suffer with constipation and also have an issue with your continence then it is highly advisable to address the constipation first or at the very least, at the same time as strengthening your pelvic floor. This is an absolute must. It is beyond the scope of this article to talk about solutions for constipation but consider fluid intake (plenty of them), diet (plenty of soluble and insoluble fibre), trying not to avoid drinking because of stress incontinence. Whist this is entirely understandable it could worsen the constipation. Medication can really help. Broadly speaking they fall into different categories: stool softeners – to make them easier to pass, stool bulking agents – also to make them easier to pass, medications to stimulate the bowel muscle to move more.
The Piriformis is another muscle found in the pelvis. I have written about it in a separate article and please do click this to find out more. It helps to keep the pelvis stable when we walk and it also makes the leg turn out (that is, rotate outwards away from the middle of the body). Up until now the talk is of the Pelvic floor. Consider the Piriformis to make up part of the Pelvic Wall. It is not directly involved in controlling bowel and urine flow, but there is a close relationship between pelvic floor and Piriformis. If the Piriformis is tight, and/or over worked and/or dysfunctional then it can disturb pelvic floor. It can pull the pelvic floor muscles out of alignment and disturb them. If you have buttock or pelvic pain or continence issues Piriformis might play a role in the problem and the solution
Let’s talk about sex
Many of us recognise the problems with continence as a consequence of problems with the pelvic floor but how many people realise that pelvic floor problems can cause a range of sexual dysfunctions?
Both weakness and tight overactive muscles can cause problems with arousal, or achieving orgasm in both men and women.
In women there may be pain during intercourse. In men there may be erectile dysfunction. It is important that we know this. Some sexual dysfunction in both women and men has a physiological origin that can be solved. Nor is it an inevitable consequence of the menopause, or ageing in general.
The Vital importance of Breathing
Breathing is almost a kind of missing link in our day to day awareness. Of course we all breathe but we don’t really grasp the significance of it. It isn’t just for getting Oxygen into our body although that is the bottom line. The act of breathing stabilises and energises the whole body. The muscles of breathing form an inner unit of stability. When the Diaphragm contracts, reciprocally the pelvic floor (and abdominal muscles) relax and vice versa: when the diaphragm relaxes the pelvic floor (and abdominal muscles) contract.
A tendency to breathe from the upper chest, to breath hold during exercise, to tend to suck in the belly or over grip the pelvic floor all disrupt breathing. The body is adaptable and will maladapt to poor breathing technique, but not without consequences. One of them can be a disruption to the pelvic floor tone and function. Any plan to work on improved pelvic floor strength with a view to helping, for example, stress incontinence, has to start with paying attention to the breath.
Tight vs Weak Pelvic Floor
I think it is safe to say that most of us, when we consider incontinence, assume that the origin of that is weakness in muscles that need to be strengthened. However a small proportion of people with issues with the pelvic floor have a problem where the muscles don’t work properly because they are too tight. This can be for all sorts of reasons including poorly executed Kegel exercises. The tightness can cause disruption and also pelvic pain.
Does this tale have a happy ending?
As I write complete this article it is January 1st 2020. Of all the days eh! I think that we should make the dawn of this new decade of 2020, our opportunity for new beginnings with our own pelvic floor health. The last years of the previous decade are notable for how we are more prepared to talk about and address our mental health. One can only wonder about unmet need and problems with the pelvic floor: weakness, pelvic pain, sexual problems. We need to put the word out: There are solutions. Things you can do that go beyond inco pads and avoiding activities like exercise because it causes incontinence or limiting fluids when you are out an about. Quite frankly we all have enough crap to deal – we don’t want this to be another problem
We need to be empowered by knowledge – firstly knowing that we are not alone in experiencing these difficulties. It is other men and women too. Secondly in knowing our body, how it works and what we can do to improve PF function. Again, outside the scope of this article, but the third thing to know is, if exercise, breathing retraining, strength training, mobility exercise don’t work or not don’t fully solve the problems, then visit the GP for a referral to specialist physio or for consideration for surgery. There is more help available from skilled Professionals within the NHS.
So what does Improving Pelvic Floor Function actually mean in practice?
With a suitably qualified Exercise Instructor or Physio, determine whether your pelvic floor is weak or whether the problems have arisen due to a tight, over active pelvic floor. The latter affects a a small but significant proportion of people with PF dysfunction and needs a partially different approach
Kegel Exercises: Learn how to do these exercises PROPERLY and then practice them regularly. However, Kegels are not enough on their own. We need to go beyond Kegels into the brave new world of KegelPlus.
By KegelPlus I mean that we need to add Kegels to exercises that also maintain or add to strength in the big muscles of the legs and buttocks. It is not just strength here that matters though: tightness can destabilise the pelvis and affect PF function. We need to stretch and keep supple by keeping moving. Finally this suppleness needs to be in the bones too: We need to keep the pelvis, spine and leg bones mobile and free.
If you have constipation, try to get it under control. with regular medication if necessary.
Pay attention to the way you sit. It helps the pelvic floor if you sit with a neutral pelvis, resting on the bones, not the muscles.
Is There a Happy Ending?
For everyone? It’s too early to tell but let’s hope so.
And for our heroine? Well, someone once told her that she needed to tend her lady garden as well as the garden.
So there you have it: she lived happily ever after amongst the Fuchsias and Ferns with a movement diet rich in Kegels, lunges, squats and dancing.