Pelvic Floor Disorders: What Every Woman Should Know

What They Are and How You Can Prevent Them.

Pelvic floor disorders can manifest in many ways, but once you’ve experienced one, you’ll never forget it. Trust me, I speak from experience on this one. The pain I felt in my lower right abdomen was excruciating. If I hadn’t already had my appendix out, that would have been the first thing I thought of. That’s how bad the pain was. When I finally saw my GYN, and after an ultrasound was done to rule out cysts, she told me she thought I was having pelvic muscle spasms and that there were some yoga-type stretching exercises that I should do. I looked at her as if she was crazy. I, in no way, could see how exercises were going to fix this. I could barely function! But I did follow the exercises exactly, and sure enough, within a week, the pain wasn’t nearly as bad and within a couple of weeks, it was gone entirely.

Unfortunately, these disorders can show up in a variety of ways and each one can feel completely different. That’s why they can be so hard to diagnose. And why, the last thing you might think of as the culprit is your pelvic floor. While pelvic floor disorders aren’t necessarily the most fun topic to talk about, it’s important that you know what they are and how you can prevent them.

Your Pelvic Floor

If you don’t even know what exactly your pelvic floor is, you’re not alone. Most women don’t give this area of their body much thought unless they’re pregnant or there’s a problem. That’s why I asked Lisa Johnstone, physical therapist and director of the Pelvic Floor Program at the Oxford Physical Therapy Centers in Ohio, to help enlighten us. This is her area of specialty. She says the pelvic floor is made up of the muscles at the bottom of the pelvis. They attach “from the pubic bone in the front to the tailbone in the back. It’s kind of like a hammock that fills the entire space at the bottom of the pelvic bowl.” These critical muscles and the associated nerves, tissues and ligaments are your pelvic floor and support the bowels, bladder and uterus.

In her book Heal Pelvic Pain, Amy Stein, M.P.T. calls the pelvic floor “an essential part of your body’s core, the center of gravity in your frame, the place where movement originates – in a sense, the seat of raw power in your body.” She notes that eastern religions see it as “the place where the vital energy of your life force resides,” and that western research confirms that a strong and healthy pelvic floor is essential to overall health and fitness.

Lisa agrees for a number of reasons, especially as we age. Because these muscles affect our bowel and bladder function, “Healthy, strong pelvic floor muscles are able to help you maintain continence and to have easy passage of urine and bowel movements.” They also support pelvic organs in their anatomical position, which is especially important for women because “We’re prone to having prolapse or pelvic organ prolapse.” This can happen if we’ve had children but also with aging in general because our soft tissues can weaken and stretch over time. In addition, Lisa says healthy pelvic floor muscles can affect sexual function since they keep the vaginal tissues healthy and flexible, which is a significant thing that happens to women as we age because menopause and hormone changes impact our vaginal health.

Pelvic Floor Disorders

Pelvic floor disorders can show up in a variety of ways. Lisa sees patients with urinary incontinence, overactive bladder, difficulty emptying their bladder, bladder spasms, pelvic pain, pain with intercourse, bowel incontinence and constipation issues, core muscle weakness, sacroiliac (SI) joint pain (felt in the low back and buttocks), hip pain and low back pain just to name a few. No wonder it can be so hard to diagnose! Lisa says medical professionals may look for other causes when the root cause of the pain or problem may be a dysfunctional pelvic floor muscle that’s either weak or in spasm. In fact, Amy Stein says that “If you’re a woman, you have at least a 5 percent chance of suffering chronic pelvic pain.”

Lisa Johnstone, Physical Therapist and Director of the Pelvic Floor Program at Oxford Physical Therapy Centers

The way the pain and disorders manifest themselves can also vary. Lisa says her patients sometimes describe a feeling of heaviness or pressure in the lower abdomen or pain in the lower part of the pelvis, particularly if the Obturator Internus muscle (which is also a hip rotator) has a spasm or tightness in it. The pain can also radiate, which means that you can press on the pelvic floor and feel it in another location. Lisa has seen firsthand how it really can affect everything from “how you’re able to move, to how you’re able to sit, to how you’re able to walk.”

Causes of Pelvic Floor Disorders

Among the primary causes of pelvic floor disorders, it should come as no surprise that pregnancy ranks right up there. As Lisa points out, “Pregnancy really changes our body. It overstretches our abdominal muscles, it stretches our pelvic floor muscle, and it changes our posture. We get just a full weakness in the core because of the growing body.” Even if you have a normal delivery, there’s still a lot of “soft tissue interruption and stretching. ” If you have a difficult delivery, you can end up susceptible for trigger points, muscle pain, weakness and continence issues when you’re in your 50s or 60s.

Lisa also cites obesity and weight gain (because our pelvic floor can only support so much), aging and normal loss of muscle strength and tone, heavy lifting, high intensity training programs that may be too challenging or difficult, chronic straining with constipation, or joint dysfunction or scoliosis that can throw off pelvic symmetry.

All of this emphasizes the importance of the core because as Lisa says, the pelvic floor is your core’s floor. Some of its muscles overlap with abdominal muscles and they all create “your own muscular girdle.” If one of those groups of muscles isn’t working properly, the way the core has to work can be thrown off.

How to Treat and Prevent Pelvic Floor Disorders

So, what can we do to treat and prevent pelvic floor disorders? For treatment, Lisa suggests that you start with your OB/GYN. If they have any reason to suspect that it might be something other than a pelvic floor disorder, they will almost certainly do an ultrasound to investigate further and will absolutely send you to another specialist if they feel it’s needed. Another type of doctor that would be able to recognize pelvic floor disorders is a urogynecologist. They treat conditions related to the bladder and the reproductive organs.

Physical therapy or specific exercises may be recommended once a diagnosis is made. In my case, my GYN recommended that I follow the exercise plan outlined in chapter three of Amy Stein’s Heal Pelvic Pain, and it worked wonders. Depending on your disorder, you may need to follow the plan in chapter four instead. If those don’t work or if physical therapy is recommended outright, a physical therapist specializing in pelvic floor is going to be your best bet. In many states, a referral isn’t required to see a physical therapist, but you’ll want to find out how it works in your state and what is required by your insurance company.

For prevention, keep your core strong and healthy. Lisa has some patients that have very tight pelvic floor muscles and very weak core muscles. Since strength has to come from somewhere, if your core muscles aren’t strong then your pelvic floor muscles might be squeezing and overworking. Isometric and stabilization exercises will help to strengthen the core, which in turn, will help support the pelvic floor. Lisa also reminds us that if your core muscles are strong, that means the abs, the lower back, the deep hip muscles and the glutes will work correctly and help keep the whole system in balance so that one muscle isn’t overworked.

Since my experience with pelvic pain, I’m a firm believer. I’ve been focusing much more on strengthening my core because I don’t ever want to have that kind of pain again if there’s any way to avoid it. One thing is certain, while any kind of pelvic floor disorder is going to be uncomfortable to talk about, don’t delay in seeking a diagnosis and treatment. There is nothing to be embarrassed about, and you definitely don’t need to suffer.