Around 25% of women, girls, and people who have or had the potential to menstruate (WGPPM) in the US experience issues with their pelvic floor.1 Yet, we often shy away from conversations about these issues and deem many dysfunctions as normal passages of life.
The pelvic floor is a compound structure, which closes your bony pelvis at the bottom. It includes three layers of various muscles, which we term pelvic floor muscles. Your rectum, vagina, and urethra pass through the pelvic floor and are surrounded by your pelvic floor muscles. The pelvic floor muscles need to fulfill many functions, such as providing support to your pelvis and organs, sphincteric opening and closing, sexual, and aiding your circulatory and lymphatic system. To fulfill these functions the pelvic floor muscles need to maintain a resting tone, provide quick contractions for continence and sexual function, and be able to relax, so you can empty your bladder and bowls.
Sometimes, the pelvic floor muscles can lose their abilities.
Your pelvic floor muscles might be underactive, overactive, dyssynergic, or have no function. Underactivity is caused by weak pelvic floor muscles and is often linked to incontinence. For example, you may lose urine when you cough or sneeze. Many women and people with the potential to menstruate experience this after vaginal delivery of a baby. However, it is also connected to obesity and having a hysterectomy. Overactivity is caused by tight pelvic floor muscles and is often seen with pelvic pain. This can lead to issue with emptying your bladder or bowls and pain during sex. Dyssynergic means that your pelvic floor muscles are not able to coordinate their contractions, which can often contribute to continence issues. Nonfunctioning pelvic floor muscles are no longer able to contract, which is caused by damage to your nerves. This will lead to complete incontinence.2
Did you know that treatment for pelvic floor dysfunctions is available?
You may have heard of surgical interventions, especially when the pelvic floor muscles are so weak, they can no longer support your organs (pelvic organ prolapse). However, there are also conservative approaches. One of the most successful and widely used is pelvic floor physical therapy (PFPT). PFPT is a robust evidence-based first line treatment for many pelvic floor dysfunctions and is provided by specialty trained pelvic health physical therapists. The physical therapist will evaluate your pelvic floor muscles’ power, endurance, speed of contraction, and ability to relax. This will include an external and internal exam. Based on their findings the physical therapist will provide a plan of care, which often includes specific exercises and activities, lifestyle changes, and manual therapies, but can also include modalities, such as biofeedback, gentle electrical stimulation, or vaginal dilators.3
Did you know your Hemophilia Treatment Center can help you, too?
If you are experiencing any pelvic floor dysfunctions, such as loosing urine when you are coughing or sneezing or having pain during sex, talk to the physical therapist at your HTC. While they may not be able to provide you with the appropriate treatment, they can connect you with somebody in the community, who can. You can also access a pelvic health physical therapist through your primary care provider or OB/GYN as well as directly reaching out to your preferred physical therapy clinic.
Always remember that you do not have to suffer in silence. There are options available to help you.
References
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Wu JM, Vaughan CP, Goode PS, et al.. Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women. Obstetrics & Gynecology. 2014; 123 (1): 141-148. doi: 10.1097/AOG.0000000000000057.
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Mahadevan, V. (2018). Anatomy of the pelvis. Surgery (Oxford), 36(7), 333-338.
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Wallace S, Miller L, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology. 2019; 31 (6): 485-493. doi: 10.1097/GCO.0000000000000584.
