Getting Down and Dirty with the Pelvic Floor

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What do runners, weight lifters, crossfitters, and women who have given birth all have in common? Pelvic floor disorders. Both men and women have a pelvic floor and you can think of it as a sling made of muscles, ligaments, nerves and connective tissue that support the vagina (obviously not in men), rectum, bladder and other pelvic organs. When something is going haywire with your pelvic floor you can imagine it can cause a whole host of issues; many that come on so slowly you don’t even notice the change unless it begins to drastically effect your life.

Women are more likely to have pelvic floor issues, but men get them too so don’t stop reading just because you have a dangling participle! People who are also highly active are more likely to develop pelvic floor disorders. At their worst, people who suffer from pelvic floor disorders can suffer from urinary incontinence, fecal incontinence or pelvic organ prolapse. Pelvic organ prolapse is literally when your bladder, bowel or uterus are no longer supported and drop onto the vagina causing it to pop out. Fret not, these are all worst case scenarios, but you can see how important the pelvic floor is and how taking care of the pelvic floor is incredibly important.

What to look for if you think you might have issues with your pelvic floor:

  • Urinary problems (peeing too often or not often enough)
  • Constipation
  • Pain or pressure in the vagina or rectum
  • A heavy feeling of the pelvis or bulge in the vagina or rectum
  • Muscle spasms in the pelvis
  • Pain during intercourse

Many people associate the pelvic floor with the exercise kegels which are typically prescribed to someone who has low-tone pelvic floor disorder. What most people don’t know is that you are just as likely to have high-tone pelvic floor disorder where the muscles there are too tight, especially if you’re an athlete or exercise regularly. When you see an olympic lifter literally shit their pants during a lift or you pee during a crossfit workout this is the pelvic floor giving out. You have exercised it to the point where it can no longer provide its necessary function and overtime this continued assault can cause long term damage.

Why does this happen? As a sufferer of high-tone pelvic floor disorder I’ve asked myself that question countless times and after a lot of research the answer is that we just don’t know yet. We don’t know why one person can train and run the marathon and be just fine while the other is left with a lingering abdominal pain that won’t quit. We don’t know why one woman can give birth and be fine afterwards while another ends up with a prolapsed vagina. The jury is still out on this one, but there are things that can be done to prevent and help pelvic floor disorder!

How are you diagnosed with a pelvic floor disorder? You are typically diagnosed with a pelvic floor disorder after a physical exam, but doctors and physical therapists also can look at your symptoms and determine pelvic floor disorder as a likely culprit. There’s also a handful of tests that can be done to help point towards pelvic floor disorder being the issue, but often times the tests are invasive, expensive and can also be painful so it’s sometimes just easier to treat the patient first and see if they get better before putting them through any of that.

What are the treatments for pelvic floor disorder? I’m sure you can tell by now, but I personally prefer trying pelvic physical therapy before anything else. It’s the most holistic treatment and has been a lifesaver for me. Biofeedback is also a good option and has the patient use sensors and video so the physical therapist can help cue to the patient improve their muscle coordination by giving them feedback during pelvic exercises.

Muscle relaxants may be prescribed by a doctor to help ease the spasming and surgery is used as a last option, especially since surgery can cause scar tissue which can just lead to further issues. 

Medication has a place in health, but try pelvic physical therapy before relying on medication. Most people don’t receive relief with medications prescribed for PFD and if they do it’s only short-term. However, some medications like valium suppositories can help PTs treat patients who would otherwise be in too much pain.

How can you prevent pelvic floor problems? If you’re pregnant, seeing a PT specializing in pelvic floor health before you give birth to get you in prime pelvic shape can do a world of good to help prevent any pelvic floor disorders from cropping up. Seeing a PT after birth is a necessity too so please speak with your doctor about how long they think you should wait to see a PT for pelvic physical therapy after you’ve given birth.

Also, it’s good not to assume that you have a weak pelvic floor just because kegels are mentioned in every Cosmo. If you have any of the above symptoms don’t diagnose yourself! Please seek out the help of a PT that is qualified to deal with pelvic floor issues. The best thing you can do for yourself if you feel like you may have pelvic floor issues is to get help as soon as possible because having to get up during the night to pee constantly or feeling pelvic cramping is not normal. Pain is not normal.

What should you expect when seeing a pelvic floor specialist or pelvic floor physical therapist for the first time? There’s usually a long questionnaire you have to fill out that asks you questions about your pain, issues with your bladder, etc. It covers the full gambit and may make you feel a little shy. It’s incredibly important that you answer honestly and fully so that the PT can put all the pieces together. You’ll then meet with your PT and they’ll probably ask you the same questions you just answered on the questionnaire because 1) it’s helpful to them to hear it from you and 2) they may have further questions. 

Typically, they’ll then ask you to disrobe from the waist down so that they can have access to your pelvic area like you would at the gyno’s office and for men this may be a new experience. Don’t be shy! The pelvic floor is a body part like any other and PTs work on hundreds of patients. Once your undressed you’ll climb under the sheet. Some places have stirrups for your feet and some don’t. I just lay around as comfortably as possible until the PT comes in. They then palpate your stomach and pelvic area externally. They pull it every which way in a seemingly haphazard way, but I promise it all has purpose! Just seeing the way I twist my upper body can show my PT if something is pulling at my pelvic area the wrong way and allows her to figure out what to treat! 

They will also do an internal examination which will involve cuing you to contract and release your pelvic muscles to see what type of command you have over them. They will look for internal knots, muscle spasms, weaknesses or areas that are too tight. They will move your legs around to see if your hips are moving properly because tight hips can also be related to pelvic floor issues. Men, you are not left out of this internal examination just because you don’t have a vagina! Often times the specialist will do what I described above, but rectally. I know this sounds scary and invasive, but it’s a necessary part of diagnosing and treating pelvic floor disorder since a lot of the pain can be coming from internal sources.

You’ll then be left to get dressed and the PT can give you their feedback on whether or not you have pelvic floor disorder, where they think your main issues are coming from and what treatment plan they advise. Personally, my PT recommended therapy twice a week and did external work for almost 1.5 months before we worked internally because we had to treat those restrictions before we could treat into deeper layers. I also had a bunch of exercises to help release the tension and retrain my pelvic floor muscles. They’re time consuming, but oh so helpful and I treat myself with a nice epsom salt bath afterwards.

The stretches and exercises given to you by your PT are very important to do on the days you don’t have treatment. It helps cement the work they did during your last treatment and strengthens areas that might be weak. It’s normal for your stretches and exercises to change often as new issues are addressed.


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Pelvic physical therapy has been a lifesaver for me and my life would still be very painful without it. I’m thankful everyday that during my research on Endometriosis that I learned about pelvic floor disorder so knew to ask my doctor about getting a diagnosis and treatment. After two months of physical therapy I’m actually able to run 30 minutes for the first time in over two years! So if you’re pregnant, given birth, very athletic or having any of the above symptoms go get yourself checked out!

If you have any questions about what it’s like to suffer from a pelvic floor disorder as an athlete or in general please don’t hesitate to ask!



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