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The Pelvic floor – A term my Yoga and Pilates instructors made up, or an actual, real muscle?


Image: Centrfit


If you have attended a Yoga, or Pilates, class, or have been in a birthing suite, you would be quite familiar with the term ‘pelvic floor’.


But what is the pelvic floor? And why do our instructors keep reminding us to ENGAGE this muscle during class?


For a lot of people, the pelvic floor, and issues related to a misbehaving pelvic floor, are taboo and uncomfortable to talk about.


Today, our aim is to empower you with knowledge and increase your confidence around engaging (verbally and physically) the pelvic floor.



Basic anatomy

Image: The Pelvic Guru, Continence Foundation of Australia


Let’s start by saying – yes, males have a pelvic floor too!


The 'pelvic floor' is the name we use to describe a group of muscles that sit in the bottom of our pelvis, in the pelvic bowl.


The pelvic floor is made up of 2 main muscle groups - the levator ani and the coccygeus muscles.


Just like the rest of the muscles in our body, they contract, move, stretch, and can tear.


What makes the pelvic floor so unique, is that it has an important role in the following:

  • Supports abdominal and pelvic viscera (organs) to counter gravity

  • Supports abdominal and pelvic viscera (organs) during times of raised intra-abdominal pressure e.g. vomiting, sneezing, coughing, laughing, obesity or carrying additional weight, and lifting a heavy object

  • Helps maintain continence of urine and faeces

  • Support during childbirth

  • Assists with breathing, in a similar manner to the abdominal diaphragm


COMMON issues we see with the pelvic floor

To emphasise again, pelvic floor conditions are common. If you have any of the following conditions, there are options that can be explored, to help improve your symptoms, and we are here to help reduce the fear surrounding having the discussion.


Incontinence

Incontinence refers to the involuntary loss of control of urine from the bladder (urine incontinence) or faeces from the bowel (faecal incontinence).


Incontinence is commonly due to a weakness in the pelvic floor muscles, as a result of:

  • Increased pressure on the pelvic floor during pregnancy

  • Increased pressure on the pelvic floor related to obesity

  • Menopause

  • Conditions such as multiple sclerosis, arthritis, diabetes, stroke, respiratory conditions, and prostate problems

  • Surgery eg prostatectomy and hysterectomy

Common symptoms of incontinence include:

  • Leaking when lifting a heavy object, sneezing, coughing, or laughing

  • Rushing to the toilet

  • Feeling as if you haven’t completely emptied your bladder

  • Getting up frequently during the night to go to the toilet

  • Lometimes leaking with exercise or sport

  • Leaking when you change from seated or lying, to standing

If you experience any of the above symptoms, you are not alone! Currently in Australia, 1 in 4 people have incontinence, and only 30% of those people are seeking help. Incontinence can affect males and females, but a staggering 80% of people with incontinence are female.

Hypertonicity

We use the term “hypertonic” to describe any muscle that is essentially, “too tight/tense”. You might think it is strange that a group of muscles that you don’t even feel (or know exist), can become “tight”.


Well, there are a few scenarios that commonly result in a hypertonic pelvic floor, such as:

  • Tension from holding onto/ activating you 'core'

  • High levels of stress, fear or anxiety

  • Trauma from birth or injury

  • Conditions such as endometriosis or IBS

When the pelvic floor muscles are tense, it can cause a variety of different symptoms, including:

  • Pelvic, coccyx, low back and hip pain

  • Urinary incontinence or incomplete emptying of the bladder

  • Urinary urgency and frequency

  • Not being able to feel the pelvic floor contract or release

  • Constipation

  • Painful sex

  • And many more


Low back pain

A very common result of a pelvic floor pathology is low back pain.


The abdominals, pelvic floor and muscles in your lower back, all work together to help maintain posture during activity, and maintain an appropriate intra-abdominal pressure during tasks, such as lifting, sneezing, coughing and laughing, to facilitate movement and prevent injury.


Additionally, any increase in abdominal weight (aka your belly), increases intraabdominal pressure, and places additional stress on both the pelvic floor, abdominal muscles, as well as their relationship with the back.


If there is an imbalance in any of the above-mentioned muscles, this can add additional stress onto our low backs, which may result in pain (or injury).


Image: Continence Foundation of Australia


Treatment


Self-management

To promote a healthy balance in our pelvic floor, it is important to identify predisposing factors that lead to our pelvic floor imbalances and promote a healthy lifestyle.


A few things you can start doing now include:

  • Exercise – promotes healthy bowel movements and activates our pelvic floor muscles (without us knowing)

  • Healthy diet – A=a well balanced diet that includes fibre to help with bowel movements and reduce straining

  • Keep hydrated – helps with absorption, digestion and bowel movements

  • Pelvic floor exercises – helps with ensuring the muscles are performing at their best. See below for more info

  • Maintain a healthy weight - helps with reducing the pressure placed on your pelvic floor and surrounding musculature


Manual therapy

At Retrain Health, (where appropriate, and with your consent!) our osteopaths will examine your pelvic floor (externally) to look for clinically relevant findings, such as hypertonicity or weakness.


As mentioned earlier, pelvic floor issues can result in pain in your coccyx, hips, pelvic girdle, or low back. Your osteopath will examine all areas to identify any restrictions that may be contributing to your pelvic floor imbalance, or vice versa.


As well as looking at structural restrictions, your osteopath may examine the relationship between your diaphragmatic breathing (chest vs belly breathing), and core muscles, to ensure they are not causing any additional stress on your pelvic floor muscles.


Treatment may include addressing the pelvic floor (externally, and through underwear, or tights), and treating restrictions in surrounding areas such as the coccyx, hips, pelvic girdle, low back and/or diaphragm.


Depending on whether you have a hypertonic or weak pelvic floor, your osteopath may give you exercises to help either reduce the tension in the muscles or strengthen your pelvic floor.


NB: At Retrain Health, your comfort is paramount, and all examinations and treatment of the pelvic floor are performed externally, and through underwear, tights, or whatever you are most comfortable in.


GP

If you are concerned about your pelvic floor, please do not hesitate to contact your local GP. If they are not able to provide a solution, there are specialists trained in addressing pelvic floor dysfunction, for both males and females.


Pelvic floor activation

Your osteopath will direct you to the most appropriate pelvic floor exercises. The choice of exercise will depend on if your muscles have been identified as being weak, or hypertonic (too tight).


Below is a simple exercise to simply ‘activate’ and re-introduce you to your pelvic floor.


Activation:

  1. Sit, lie down or stand – whatever makes you feel most relaxed. NB: If you don’t feel it working with the following steps, reposition yourself, and try again.

  2. Try and relax every muscle in your body – especially those abs!

  3. Slowly, and smoothly, try tightening your pelvic floor muscles by imagining lifting and squeezing in your pelvic floor muscles

  4. Relax the muscles for a few seconds

  5. Once you have figured out the best position for you to engage your muscles, you are ready to start pelvic floor exercises

Tips:

  • An easy way to identify the muscles of the pelvic floor, is to try to stop, or slow down, the flow of urine, when you are halfway through emptying your bladder. Identifying the muscle group will help you when it comes to activating!

  • Remember to breath. If you are holding your breath, or holding your abs, too tight the exercise will not work, and will just cause an increase in abdominal pressure

  • Keep your buttocks and thighs relaxed


Image: Continence Foundation of Australia


If you would like more information, or to book an appointment, please get in contact!


References

https://www.continence.org.au/

http://www.pelvicfloorfirst.org.au/



Retrain Health is based in the Northern Rivers, NSW. From our Byron Bay and Ballina clinics, our team provides a range of quality healthcare services and products.

Retrain Health offers osteopathy, remedial massage and strength and conditioning, and PT sessions, with qualified practitioners.

If you are interested in finding out more information or would like to book an appointment, please contact the clinic by phone (02) 6680 7447, send us an email or click here to book an appointment online.

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Phone: (02) 6680 7447

Email: info@retrainhealth.com
Address: 1/55 Centennial Cct, Byron Bay, NSW, Australia, 2481

ABN: 11 165 987 931