Pelvic floor dysfunction (PFD) is a systemic issue, and rarely caused by one event. While it is most common to experience pelvic floor issues after a physical trauma or giving birth, the dysfunction usually comes from an underlying and chronic imbalance that was hiding, unnoticed. Our bodies have the amazing ability to function well in many many alignments, but sometimes adding a bit of extra load (or in the case of a baby – a big extra load) can bring to light an underlying imbalance.
There are many factors that contribute to PFD; what follows are the most common ones.
Posture: How we hold our pelvis determines the shape of the pelvic floor muscles, which determines how well they function. Chronically tucking the pelvis shortens the pelvic floor muscles, making them stiffer and less responsive.
Muscle Imbalance: Our habitual posture and movement patterns can create a muscle imbalance that leads to PFD. Wearing heels and sitting most of the day contributes to this by shortening the muscles in the back of the leg, which influence how our pelvis moves.
Oftentimes people with PFD have a too tight pelvic floor, rather than a too weak one. Kegels are a popular exercise that contract the pelvic floor muscles, much like a bicep curl contracts the biceps. Taking a chronically short, tight muscle and tightening it further only exacerbates the problem. For good pelvic floor health you need supple and responsive muscles.
Short, tight muscles = weak, unresponsive muscles.
Intra-abdominal Pressure: The three chambers of our torso (thorax, abdomen, and pelvis) are connected together, which means that what happens in one chamber influences the mobility of the other two. A preference to belly breath, or initiating the breath by contracting the diaphragm, creates more pressure in our abdomen. While our ribcage is able to expand, the abdomen cannot; it will only squish into different shapes. Extra pressure in our abdomen will leak out somewhere, and for most people with PFD that intra-abdominal pressure is escaping downwards.
Similarly, when we’re doing some heavier work (weight lifting, moving furniture, picking up a tantruming 3 year old) we can temporarily create higher pressure in the abdomen by bearing down. This is a common but non-optimal strategy for stabilizing the core, and is one of the reasons why PFD is so common in weight lifting/CrossFit circles.
Fascia or Connective Tissue issues: Imbalance in our fascia functions much the same way as imbalances in our muscles. If your connective tissue is too tight, it can create a muscle imbalance (and vice versa). If your connective tissue is too loose, such as in those who struggle with hypermobility, it can destabilize the joints which can also create a muscle imbalance.
Myofascial release techniques can help restore balance in our connective tissue and thus improve function.
What to look for in a good PFD program
The key to resolving PFD is to address these underlying imbalances. A good pelvic floor program will include the following components:
*Developing body awareness
Being able to sense what’s going on with your pelvic floor muscles and your alignment in general is an invaluable tool for healing PFD. By developing awareness of intra-abdominal pressure and pelvic floor tone you will learn what movements cause problems and how to change them so that you maintain strength and function.
*Postural Alignment and Corrective Exercises
Corrective exercises help restore balance in your muscles and connective tissue, and working on your whole body alignment sets the stage for the most responsive pelvic floor. You want to look for stretches that allow full hip mobility and strengthening exercises that target your deep hip muscles.
There are a lot of options out there, check out my previous article for a few ideas: Squats for Pelvic Floor Health
If you want individual guidance, I’d recommend attending one of my pelvic floor workshops or schedule a private session with me.
If you’d like a home exercise program, I strongly recommend Restore Your Core.
A pelvic floor physical therapist can use gentle pressure to release tight pelvic floor muscles; for many women this is a key part to healing.
Massage therapists, especially those trained in myofascial release, can help address the muscle and fascia imbalances that create PFD.
Please feel free to email me for my list of recommended practitioners.
Thankfully, as awareness of pelvic floor health increases, there are more and more resources out there for improving pelvic floor health. My hope is that these posts help you navigate some of these resources, and as always, if you have any questions please don’t hesitate to contact me.