Raise your hand if sneezing often equates to peeing your pants.
There are probably a lot of you with hands in the air right now. While incontinence is a thing that happens to a lot of women after carrying and birthing babies, it doesn’t have to be the status quo from there on out. There’s therapy for that. Yes, physical therapy geared specifically toward getting what’s called your pelvic floor functioning like it did before it had to...well, you know.
Funny thing about pelvic floors, though. We all have them and whether you’ve birthed a child or not, are a man or woman, young or old, you can experience issues with your pelvic floor. So what exactly is a pelvic floor, what role does it play in our bodies, and why does it cause issues in some people?
A group of muscles you never knew you’d need therapy for
The pelvic floor is a group of muscles that span across the entire bottom of your pelvis, from the front of your pubic bone to your tailbone. The bladder, uterus, and rectum sit on top of these muscles.
“It’s sort of like they’re sitting in a hammock,” said Jill Ehrmantraut, board-certified women’s health clinical specialist at Apex Physical Therapy and Wellness Center. “These muscles support the organs in the pelvis and abdomen while assisting with bladder and bowel control. They also provide pleasure during sexual activities.”
Ehrmantraut has advanced training in pelvic rehabilitation for females, males and children and notes that there are a variety of reasons anyone can experience pelvic floor issues.
“Pregnancy and childbirth are common causes of pelvic floor disorders,especially if you’re experiencing prolonged labor or delivery, multiples or perineal tears, but there are more general risk factors that can cause the disorder in anyone,” Ehrmantraut said. “I’ve treated kids as young as four, men and individuals as old as 95 years.”
Aging and being overweight are factors that can put anyone in the category of pelvic floor disorders. Those who experience high-anxiety, constipation or have gone through a pelvic or abdominal surgery are also at risk.
When the muscles in our pelvic floor stop functioning appropriately we certainly notice, but many of us may not realize it’s a pelvic floor issue. There are a full range of symptoms beyond incontinence that could point to a dysfunction in this muscle group.
What your pelvic floor may be up to
“There are two different issues that could be going on — either your muscles are weak or overactive,” Ehrmantraut said. “Some symptoms overlap and others are very telling of what your muscles are up to.”
Ehrmantraut explains that when the pelvic floor muscles are weak, they can’t provide enough pressure to “clamp” shut the urethra, the tube that carries urine from the bladder to the outside of the body. This can lead to urine leakage with activities such as coughing, sneezing, laughing, jumping, or running. A weak pelvic floor can also cause a pelvic organ prolapse. This means your muscles can’t support the organs. Women will often feel or see a bulge inside or just at the opening of the vagina, which can cause discomfort during exercise, sitting, or sex.
On the other hand, when the pelvic floor muscles are overactive, they become tense or tight, which typically causes pelvic pain during sex, pelvic exams, sitting, or even exercise. But just like weak pelvic floor muscles, overactive muscles can also increase urinary frequency or urgency and mimic overactive bladder symptoms.
“If you feel like you need to use the bathroom more than every 2 hours or have constant feelings that you need to go, your pelvic floor may be the culprit,” Ehrmantraut said.
In addition, a feeling of heaviness or “falling out” down there, experiencing less than three bowel movements per week, or straining to go are also indicators that it may be a good idea to see a specialist.
But I’m doing kegels
“Kegels are an important exercise in pelvic floor rehab, but we also want to strengthen the other surrounding muscle groups,” Ehrmantraut said. “The pelvic floor muscles work very closely with the muscles of our core, lower back and hips. It’s almost impossible to work just one area and see the best results.”
Pelvic floor physical therapy treatment may include a variety of tactics, including manual therapy, specific exercises to either strengthen or relax the pelvic floor muscle, biofeedback and dry needling in addition to educating the patient.
But not all physical therapists have training in this area. A pelvic floor physical therapist has advanced and specialized training to diagnose and effectively treat patients with pelvic floor disorders.
“Evaluations start with a discussion about the patient’s history and issues they’re currently facing,” Erhmantraut said. “Then we examine the lower back, abdomen and hips and do a pelvic floor assessment, which can be done vaginally or using biofeedback depending on the patient's comfort level.”
The pelvic floor assessment tests muscle tension and pain, muscle coordination and strength, which are all important in determining what type of muscle dysfunction may be occuring. There are also additional tools, such as apps and devices that many women find helpful in conjunction with their physical therapy treatment.
“A pelvic floor physical therapist is going to personalize your kegels to ensure they’re most effective for your body. But apps are great at giving reminders throughout the day,” Erhmantraut said.
Erhmantraut notes that “Squeeze Time” and “Kegel-Pelvic Floor Exercise” are two great apps. Other apps, like Perifit or Elvie, also come along with a device you can insert that will provide more accurate feedback about how you are squeezing your pelvic floor. This can be particularly helpful in ensuring your kegels are done correctly since as many as 50% of women are not doing them right.
“I typically see women for 2 to 6 months,” Erhmantraut said. “But women don’t need to attend physical therapy for the rest of their lives. They should, however, continue with their home exercises, at least to some extent, for as long as possible.”
Pelvic floor therapy is offered by many providers in our area, including Essentia Health and Sanford.
“We’re entering a time when patients are really educating and advocating for themselves,” Erhmantraut said. “If you feel you need to see a pelvic floor PT, let your doctor know. The great thing is you also have the power to choose which provider you want to see.
If you have questions about pelvic floor therapy you can reach out to Jill at firstname.lastname@example.org or call 701-364-2739.