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Pelvic Floor Dysfunction (PFD)

Recent Attention Placed On the Pelvic Floor

The pelvic floor is an important health consideration, sometimes being the elusive missing link between various signs and symptoms and their underlying cause.

This spans all sorts of issues, which we'll explore in greater depth a bit later on.

In truth many people are new to learning about this topic, though the Pelvic Floor has received more attention in recent years due to various health practitioners, chiefly Physical Therapists, developing techniques that aim to help their patients, and marketing their systems of healing on social media.

All Women, But Especially Perinatal Women, Are Our Focus

The focus of this page will be PFS women, with a particular focus on perinatal women.

Why is this? It's because we're perinatal therapists and this is the focus of our practice of Therapeutic Massage, in real life.

In actuality, both men and women can experience Pelvic Flor issues, with deleterious effects.

For more information on the pelvic floor, please click this link to visit nih.gov.

For information pertaining specifically to men, this document will not be relevant. Instead, try https://www.pelvicfloorfirst.org.au/pages/men.html

Pelvic Diaphragm or Pelvic Floor?

The Pelvic Floor is like a hammock formed by criss-crossing muscle groups, supporting the vagina, bladder, and rectum.

In women, there are three tubes with sphincters that pass through the pelvic floor for the urinary tract, vagina, and digestive system. (Men only have two.)

Otherwise known as the Pelvic Diaphragm, this complex structure is comprised of various tissues including layers and layers of both skeletal and smooth muscles, ligaments, and sheets of fascia.

The two terms are often used interchangeably, but some authorities in the field do not consider the Pelvic Floor and Pelvic Diaphragm to be the same structures, but rather divide the tissues into two sets, with floor muscles being inclusive of those that make up the Pelvic diaphragm.

The levator ani (pubococcygeus, puborectalis, and iliococcygeus muscles) and coccygeus together comprise the diaphragm, with the Pelvic Floor including these, but also the perineal membrane and what's known as the deep perineal pouch. Or not. It all depends on whom you're asking, really.

What Muscles Comprise the Body's Core?

We have the Pelvic Floor and then there's the body's "core."

The core support the spine and trunk and keeps our internal organs in place, but also permits movement. This includes all the tissues of the pelvic floor and a lot more.

The list of muscles in the body's core includes the pelvic floor muscles, transversus abdominis, multifidus, internal and external obliques, rectus abdominis, erector spinae (sacrospinalis) and especially the longissimus thoracis, and the thoracic diaphragm.

The lumbar muscles, deep aspect of the quadratus Lumborum, deep rotators, as well as cervical muscles, rectus capitus anterior and lateralis, longus coli are sometimes also be considered members of the core group.

Minor core muscles are usually grouped as the latissimus dorsi, gluteus maximus, and trapezius, though most would argue that if we were grading in terms of pain-potential, the trapezius are a major headache!

The Hypertonic Pelvic Floor

Having an assessment and finding that you have signs and symptoms consistent with a Hypertonic Pelvic Floor indicates that your pelvic muscles are in a continuous state of contraction. Symptoms may include Pelvic muscle pain, Constipation, Painful sex, Urgency, Low back pain, Hip pain, Coccyx pain, Vaginismus, Urinary incontinence, and Incomplete emptying of the bladder.

However, this is just what's found most commonly, and every women is different.

Stress, Anxiety, and Emotional Difficulties

A Hypertonic Pelvic Floor can be caused, in part or in whole, from stress, anxiety, and even depression, and of course, Post Traumatic Stress Disorder and Complex Post Traumatic Stress Disorder, among others.

Being the Survivor of Abuse

Longstanding emotional issues such as any of the above mentioned may lead to pelvic floor muscles that do not relax, for the most part, ever. In particular, having survived sexual abuse, or interpersonal abuse and trauma of any kind, can lead to intensely difficult emotions to process, with the result being a tight pelvic floor system.

Physical Traumas: Surgeries, Accidents, and Pregnancies

Physical trauma, as in injuries to the pelvis, is another leading cause of PFD. Injuries can be incurred during pregnancy and childbirth. Surgery, not even necessarily confined to the pelvis, can also tighten the entire pelvic floor. Lastly, a fall, such as might happen on a cold day when a woman slips on ice and lands square on her buttocks, can also create physical issues with the pelvic floor system.

Postural Issues: How Do You Stand and Sit?

Posture is both a great indicator in the patient of deeper issues that must be addressed, as well as something most woman can change at will, in time, with consistent practice. Poor posture can happen from a woman drawing into herself, pulling her shoulders forward and in.

This can be a response to stress, or even trying to "hide" after being abused. But that's just one possibility; the cause may lie elsewhere, like ergonomics issues at her workstation causing strain. Regardless of the cause, poor posture should be addressed.

Prolonged Sittings

Prolonged sitting, like many women do at work or at their desk at home for remote work, can create muscular dysfunction and ;lead to a hypertonmic Pelvic Floor. If you must sit for hours and hours, get up periodically to stretch. If you're at work, walk around the office and visit the bathroom. And, stay hydrated. Muscles need water to be supple and work properly. At work, many qwoen drink a lot of coffee and no water, as this is a net duiretic effect.

Issues When Walking

Irregular gait can also cause Muscular Dysfunction that creates a situation where the Pelvic Floor is hypertonic. And, of course, we must find out why a woman might be walking irregularly. The cause may be a past injury, compensation because of pain somewhere entirely removed from the pelvic floor, like the foot, or having a joint pain in the knee. And, of course,w those are but a few examples. Your therapist should help determine this during your Intake Session.

Irritation to Pelvic Tissues: IBS, Crohn's, and More

Irritation causes pain, and so many forget that the cause here is irritation, and not the pain. However, there is frequently pain when women experience conditions like irritable bowel syndrome (IBS), Crohn's Disease, endometriosis, vulvodynia, anal fissures, and painful bladder syndrome. This irritation, and ultimately pain, almost invariably leads to pelvic floor hypertony. The nerves will be inflamed, sometimes all the way back to the nerve root at the spine, and the tissues surrounding the inflamed area of the internal pelvic floor may also become inflamed, as the tightness due to inflammation spreads like a fire.

Pregnancy Hormonal Changes: The Roller-coaster Ride

During pregnancy, a woman's hormones oscillate according to a well-studied, predictable path of change. These changes ready the body for each stage ofg the pregnancy, and ultimately, birthing, and the anbility to breastfeed. These hormonal changes during pregnancy can lead to a hypertonic Pelvic Floor as well.

Menopausal Hormonal Changes

At menopause, the hormone profile again shifts, leading to conditions that include a hypertonic Pelvic Floor. Many women choose to stabilize their hormone levels using pharmaceutical preparations, as well as herbal preparations readily available at most stores.

Excessive Exercise/Improper Form

Exercising too frequently, with too much weight, or for too long at one clip can cause Pelvic Floor hypertony, also. Just as significant a factor is exercising without the proper form, which places undue stress on areas the exercise is not meant to.

This is especially significant when lifting weights, but any physical activity or exercise can potentially do more harm than good when done improperly.

Participation in Sports

Participation in organized competitive sports, especially collegiate and higher level, but really, any sports, including the neighborhood softball mixed-sex team, places demands on a women's body that take their toll, and can also lead to PVD.

Too-frequent, too-long practices, the stress of game day, and even the odd postures we must assume for many sports (think being at bat or horseback riding) can cause us to end up with a hypertonic Pelvic Floor.

The Hypotonic (Weakened) Pelvic Floor

Having an assessment and finding that you have signs and symptoms consistent with a Weakened Pelvic Floor indicates that your pelvic muscles and associated tissues, like ligaments and connective tissue, are injured, or otherwise weakened, and no longer functioning optimally.

Symptoms of a Hypotonic Pelvic Floor may include Urinary incontinence, Loss of bladder control, especially at night, Fecal incontinence: Inability to control the passage of gas or stool, Constipation: Straining, hard, or thin stools, or a feeling of incomplete elimination, Pain in the lower back, pelvis, genitals, or rectum, or pain during intercourse, and Pelvic muscle spasms.

However, this is just what's found most commonly, and every women is different.

Pregnancy

Pregnancy can severely weaken the pelvic floor, especially if it wasn't toned before pregnancy. The weight of the growing baby that's placed on the pelvic floor can cause strain.

Childbirth

And, childbirth can result in an over-stretching of the Pelvic Floor muscles. Third and Fourth degree perennial tears are considered to be significant risks to a weakened pelvic floor, though any break in the integrity of the tissues, as happens in even a slight tear, can cause issues. The risk of pelvic floor damage is also increased with multiple births, in cases where an assisted birth is necessary, as well as when birthing especially large babies.

Age-associated Changes

Muscles wekaen over time without use, and as women age, many find that they've become sedentary. That, coupled with the fact that muscles naturally seem to weaken in many older women, creates the perfect storm for PFD in older women.

Menopause

A marked decline in estrogen, as usually happens at menopause, can have the effect of weakening the connective tissues that support the pelvic floor.

Obesity

The pressure and weight bearing down on the Pelvic Floor when a woman becomes overweight to the point of being clinically obese, can weaken the entire PF system to a great degree.

Intestinal Tract Inflammation

Likewise, conditions that cause intestinal swelling may cause enough pressure to cause Pelvic Floor conditions, as well as diastasis recti.

Chronic Constipation

You shouldn't ever have to strain to go to the bathroom! Psyllium fiber, or other natural fiber, can help with this. The straining can really cause harm, including intestinal or inguinal hernias, as well as PFD.

Chronic Coughing

Coughing really hard, or coughing all the time, can result in the pelvic floor becoming weakened. Regardless of the cause, whether from smoking or anything else, coughing definitely can lead to a woman suffering from a weakened Pelvic Floor. While some of these activities seem to activate the Pelvic Floor muscles, it's not healthy activation like exercises and stretching provide, but rather a cough or constipation pushing create both acute overexertion and straining and chronic strain.

Pelvic Surgery

Pelvic surgeries, including hysterectomies, can weaken the Pelvic Foor as well.

Traumatic Injuries

Injuries to the pelvis, perenium, or hips, like can happen in a car accident or a fall from a horse while riding, can lead to an injured and weakened pelvic floor.

Connective Tissue Disorders

Medical conditions like Ehlers-Danlos syndrome, Marfan syndrome, and joint hyper-mobility syndromes can also weaken the Pelvic Floor.

Family History

You may have red hair. Your sister may have black. It's random. But it's also not. It's genetic. Likewise, a weak pelvic floor, and even pelvic-floor-related conditions, can be inherited genetically.

Family History

You may have red hair. Your sister may have black. It's random. But it's also not. It's genetic. Likewise, a weak pelvic floor, and even pelvic-floor-related conditions, can be inherited genetically.

Radiotherapy Treatment

Radiotherapy Treatment may also weaken the pelvic floor, as the radiation may damage the muscles and other tissues in the pelvic region, leading to fibrotic scarring, which severely impedes muscles' ability to perform their jobs. Nerves can also be damaged, further increasing the difficulties that Radiotherapy Treatment can cause in the Pelvic Floor region.

Heavy Lifting

Lifting a too-heavy bag of groceries can actually injure the pelvic floor and cause weakening through a strain of the muscles. Of course, the same goes for lifting even your kids!

From My Bottom to My Head, Neck, And Shoulders: All I Feel Is Stress-Pain!

What do the pelvic floor and trapezius have in common? They're the lower and upper boundaries of the body's core, and both seem to tighten and contract toward the body's center, shortening the body. Like turtles, we draw our heads close, but women's bodies also draw the vagina upward and inward.

The body is literally squeezing itself shut, just the opposite of when we're relaxed and our spine is lengthening and we're at ease.

A negative mental, and more importantly, emotional, stressor also tightens the core and the PF, and the now-tightened core and PF helps keep that feeling of initial tension, or subjective experience of stress, going far longer than the initial stimulus provided.

We work on our shoulders and feel better when the tension is gone, but we ignore the pelvic floor, and other muscles of the body's core that likewise become activated in a disordered way in these circumstances.

Pelvic Organ Prolapse

The Pelvic Floor may lose its integrity, and various organs may end up where they shouldn't.

The Pelvic Floor can weaken to such an extent that it is no longer a continuous barrier, keeping the internal organs precisely in place.

Pelvic Organ Prolapse occurs in women with diverse backgrounds, with factors like pregnancy history, body type, age, obesity, hormonal profile, and family history all playing a role. Chronic coughing, heavy lifting, and the strained pushing that also often accompanies constipation, can also cause Pelvic Organ Prolapse.

Postpartum Women Have A Greater Chance Than Not For PFDs

Upwards of sixty percent (60%) of postpartum women experience PFD, and about twenty-five percent (25%) of that population continue to experience issues more than a year later.

While it's great that a little less than half the women who had recently given birth are symptom-free at one year, the remaining half that continue to suffer should be of concern to us.

We can ask what they did differently, if anything. We can try to find out why some women improved, while others did not.

Of course, the various therapies and modalities that are practiced by a range of health care professionals working on the Pelvic Floor can improve outcomes, for sure.

Who Gets PFD? Many Factors Seem To Play A Role

Prior pelvic surgery, including C-section, as well as some connective tissue and musculoskeletal disorders, and even neurological conditions, can all play a role.

There's anterior and posterior vaginal wall prolapse, and apical vaginal prolapse, each involving various other body parts like the bladder, urethra, small intestine, rectum, and even uterus to intrude into the space of the vagina.

Advanced prolapse should be looked at by your Ob-Gyn. Surgery may be the only answer.

This may, in fact, be a serious issues which can easily be addressed, but is obviously well beyond the scope of Pelvic Floor Therapy we provide, advising you to consider stretching, as well as mindfulness exercises with a physical component. Doing so can strengthen the Pelvic Floor over time.

My Core Is Frozen. Wait. What's My Core?

The "emotional core" is mentioned in all sorts of philosophies and therapies.

For years, I had known I probably had a "frozen core," without knowing that this corresponds to actual muscles in the pelvis.

I thought it was a purely figurative term referring to "stuck emotions," not a literal core in my physical body!

The Pelvic Floor, and the more inclusive Pelvic Core, are connected to our emotions, and automatically responds to all kinds of emotional stimuli by tightening or releasing.

A chronically contracted PF is synonymous with a "frozen emotional core," and may result from trauma of all types, including sexual and emotional.

A healthy rhythm of contraction and release is expected, as the uterus floats in the lower abdomen tethered by the various ligaments, and simply breathing sets off wave after wave of motion in the pelvic core.

We Ignore the Pelvic Floor

The pelvic floor is one of the most ignored areas of the human body. Why? Mostly, we don't even know it's there! That is, unless it's paining us!

A primary goal of Pelvic Floor therapy is the elimination of unhealthy patterns of tightening in the pelvic floor that can create all kinds of symptoms, both physical and emotional.

Of course, these are mostly unconscious patterns of holding the body, the result of past trauma and stress of all types, including pregnancy and the birthing process.

We learn to hold our bodies in ways that help to mitigate pain, whether emotional or physical.

When any one, or combination of multiple, muscles that comprise the Pelvic Floor are stuck in a state of contraction or spasm, painful conditions, as well as functional issues, often arise.

Chronically contracted muscles no longer work properly. Elimination of the spasms may help all sorts of other issues.

Likewise, a laxity of the Pelvic Floor can also cause many issues and so a second goal of Pelvic Floor Therapy is to work on strengthening the Pelvic Floor muscles over time.

A third goal of Pelvic Floor Therapy is to develop interoceptive awareness of your pelvic floor and surrounding tissues. This can lead to more fulfilling experience of living as an integrated consciousness.

Studies even show that developing experiencing interoceptive awareness results in greater sensuality and even improved sexual experience. https://www.mdpi.com/2076-3425/14/12/1236

While it's true that women ignore this part of the body and sometimes completely disassociate from feeling the pelvis unless feeling pain, developing awareness of the Pelvic Floor and Pelvic Core has benefits.

The Pelvic Floor: Our Mind-Body Is One

Our bodies reflect our mental and emotional states, both chronic and acute.

The goal of many mental health modalities and therapies is to release unprocessed emotions, and deal with underlying troubling thoughts, memories, and perceptions.

However, without the corresponding work on the physical body including the Pelvic Core, this may be more difficult to successfully accomplish. Muscles do store memories, and even emotional states.

We're all familiar with a person who violates our boundaries so frequently and with such recklessness that we tense us up so much that we get pains in the back of the neck, as well as the upper back, like the trapezius muscles and the underlying muscles as well.

Because the pelvic floor is part of our physical body, the pelvic floor if greatly affected by pregnancy, as well as a vaginal birth.

The ANS and Sympathetic Nervous System

The autonomic system (ANS) is involved in our core and pelvic floor.

A woman experiencing a great deal of stress or anxiety can end up with an overactive vagus nerve, which can definitely result in a tight pelvic floor, and associated symptoms.

As the jaw is also innervated by the autonomic nervous system, specifically through both the sympathetic and parasympathetic branches, our mental and emotional state is also reflected as jaw muscle tension, as well pelvic tension.

This can result in a woman having pain, literally, from her vagina to the top of her head.

The Pelvic Floor and the Flight or Flight Responses

The Sympathetic Nervous System is activated during stress to produce the Fight or Flight responses.

The pelvic floor responds to this activation by tightening. This keeps a woman from accidentally defecating and urinating, closes the uterine cervix, and thereby also prevents menstrual blood flow. (https://pmc.ncbi.nlm.nih.gov/articles/PMC8500855/)

Imagine what chronic stress, either residual tension from C-PTSD or even ongoing stress, can do to a woman's life experience?

All this pain and discomfort can create an endless loop of self-feeding symptomatology including headaches, muscle tension, and anxiety. Unresolved, this can lead to depression. https://pmc.ncbi.nlm.nih.gov/articles/PMC2811866/

Experiencing pain can lead to decreased serotonin levels, which can further sensitive the patient to pain perception! Pain causes the body to release inflammatory biochemicals that interfere with serotinon production and uptake. https://pmc.ncbi.nlm.nih.gov/articles/PMC2811866/ This can lead to headaches, among other symptoms.

Pelvic Floor Issues: Urinary, Genital, and Bowel

Pelvic Floor Dysfunction can cause urinary symptoms, bowel symptoms, genital symptoms, and pelvic organ prolapse.

Urinary symptoms may also include frequent urge to urinate (urgency), frequent urination, leaking urine, difficulty emptying the bladder, and a marked difficulty starting or stopping urination.

Symptoms involving the bowels include constipation, incomplete bowel movements, challenges and pain associated with passing gas, fecal incontinence, and rectal pain and pressure.

Genital Symptoms include vaginal heaviness or bulging, a feeling of heaviness in the vagina, difficulty inserting tampons, vaginal spasm, pain during and after intercourse, and difficulty experiencing orgasm. This may also include a sense of disassociation from this part of the body, and can also include difficulty feeling the vagina, in an integrrated way.

The clitoris may also be affected in PFD, either through the mechanism of muscle tension, nerve compression, and even referred pain. The pudendal nerve can be irritated or compressed, or the muscles surrounding the clitoris can be tight due to constant pelvic floor contraction.

PFD and Vaginal Discharge: A Confusing Indicator

Increased vaginal discharge, clear or milky, can occur due to inflammation or irritation caused by a prolapse.

Just to make matters more confusing, a pelvic floor prolapse can also lead to decreased vaginal secretions; a weak pelvic floor can cause vaginal compression, adverswely impacting the function glands responsible for lubrication production.

This can be further exacerbated by menopause, a history of sexual trauma, or even feeling disconnected to your vagina.

And so, this is a poor indicator, in and of itself.

Pelvic Floor Issues Cause Far-Reaching Problems

Other, more random symptoms include lower back pain, and even mid-back or upper-back pain, as these muscles work together as your body's core, permitting movement and constant postural adjustment.

In fact, pain from pelvic floor issues can lead to a modified posture that may reduce pain in the PF, but then bring on pain elsewhere. An especially-tight pelvic floor can pull on other surrounding muscles, and can refer pain to the upper back as well, in this case not directly involving these muscles.

Chronic upper back pain, tightness in the hips or lower back, and pain that worsen with certain postures, movements, and activities, can also be symptoms of PFD.

Pelvic muscle spasms and pressure in the abdomen can also occur, causing pain.

Tight pelvic floor muscles can cause tension in the neck, shoulders, and jaw. This can lead to headaches and neck pain.

Weak pelvic floor muscles can cause other postural core muscles to overcompensate. This can also lead to neck pain, headaches, and tension in the upper body.

Pelvic Floor Dysfunction may be chiefly a physical issue, or Pelvic Floor Dysfunction may also involve personal recovery from trauma for the sufferer, depending upon the details of the individual's history.

That means recovery may well involve mental, emotional, and Spiritual healing, besides the positive changes associated with the tissues of the pelvis, hips, and abdomen.

Our Approach to the Pelvic Floor

Our approach to the Pelvic Floor is a holistic one; we seek to help the whole person, honoring their journey toward healing.

A woman's Pelvic Floor issues often extend to the muscles, ligaments, and tendons of the pelvis, hips, abdomen, and even upper back and neck.

As LMTs, we address the entire body without over-focusing on your Pelvic Floor issues, understanding that the various muscles groups work in tandem to foster posture and movement, and dysfunction is often spread among many muscles.

We fully appreciate the significant role of the Pelvic Floor in many health issues, some of which make perfect sense like urinary incontinence, but others that may not seem so clearly connected, like neck pain and headaches, or even anxiety.

Our approach to the Pelvic Floor as women's prenatal and postnatal massage therapists is a noninvasive modality, totally within our own Scope of Practice.

Our program for dealing with Pelvic Floor issues is based on our specialized training in the Pelvic Floor, covering musculature, conditions, and treatment, as well as our own innovations we've integrated that are based on the latest science, coupled with mindfulness techniques and breathing exercises that lend a Spiritual element to the session.

Why Might Pelvic Floor Exercises I've Done In The Past Felt Like Super-Spasms And Only Hurt More Afterwards?

Whether you were doing the Pelvic Floor exercises yourself, guided by a book or video created by a qualified health care professional, or you were seeking help with a licensed Physical Therapist specializing in the pelvic floor, the answer usually stems from a women having extremely tight pelvic floor muscles, and going too far, too fast, overworking muscles that no longer work, really.

The pelvic floor may be tight and constricted, and that's how you walk around every day, working, sleeping, playing, taking care of the kids, every minute of your life, basically. That pattern must be interrupted as the first goal, before anything else.

Without first learning how to relax the Pelvic Floor completely, too-strenuous squeezing exercises that activate the PF musculature can result in painful sessions where you're seeing stars, suffering from massive pelvic core spasms, and later feeling worse, with a tighter lower pelvic core.

These muscles have become weak from constant over-straining. Being activated all the time do not make a muscle strong, anywhere in the body. They need slow and steady care, in order to recover, not an abrupt jump into an intense pelvic floor recovery program.

Some people have pelvic floor muscles that are too tight and cannot relax. This can be made worse by doing squeezing exercises and overworking the muscles without learning how to relax first. Our holistic approach makes sure that you become connected to your Pelvic Floor muscles, and learn to feel what's happening.

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