May is Pelvic Pain Awareness Month, in which organizations strive to raise and improve public awareness of issues in the area of chronic pelvic pain. As a physical therapist with a special interest and years of experience in the treatment of patients with pelvic girdle related pain, I hope you find that this blog article increases your knowledge of the role our pelvic floor muscles play in pelvic girdle, pelvic, buttock, low back, and hip pain and stiffness and stress urinary incontinence (urinary leakage).
Men and women have a pelvic floor. It is not really a floor, but a collection of muscles, ligaments, nerves, tendons, blood vessels, fascia, and connective tissue at the bottom of the pelvis. Several layers of muscles make up our pelvic floor muscles (“PFM”). Some of these muscles connect the tailbone to the pubic bone while others spread outward and connect to pelvic bones and the hips. Thoracolumbar fascia connects these muscles to the low back. The deeper layer of muscles supports the vagina, bladder, uterus, and rectum. The outer, or more superficial layer, surrounds the bladder, vagina, and anal openings.
Here is what your pelvic floor muscles look like looking down from above:
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| PelvicGuru.com |
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| PelvicGuru.com |
The pelvic floor muscles have multiple roles. Not only do they provide support for the pelvic organs and help keep them in place, but the muscles also work in synergy with other deep muscles of our inner core to provide muscular stability in the low back, buttocks, pelvis, pelvic girdle, and hips. These same muscles also play a large role in maintaining urinary and bowel continence.
We all strive to have normal functioning muscles, including our pelvic floor muscles. However, many of us have non-optimal pelvic floor muscle function. In fact, a NIH study reported that approximately 25% of women will have pelvic floor problems in their lifetime, with the prevalence increasing with age. Pelvic floor dysfunction can alter the ability of the muscles to fully contract or fully relax, both of which are necessary for normal function. There may also be a problem with the timing of the muscle contraction or poor coordination with its counterpart on the opposite side of the pelvis or with other muscles, such as the abdominal wall.
Symptoms of pelvic floor dysfunction include:
* Urinary problems, such as the urgent need to urinate, incomplete emptying of the bladder, or painful urination.
* Pain or pressure in the vagina or rectum.
* Constipation, including straining or pain during bowel movements.
* Fecal incontinence
* A heavy feeling in the pelvis or a bulge in the vagina or rectum (i.e., organ prolapse).
* Muscle spasms in the pelvis.
* Pelvis, buttock, hip, or low back pain and stiffness.
* Dyspareunia (painful intercourse).
Some of the reasons that we may develop pelvic floor dysfunction include:
* Pregnancy.
* Childbirth.
* Age.
* Trauma and repetitive microtrauma.
* Pelvic surgery.
* Obesity.
* Pain.
* Disease.
* Radiation treatments.
* Behavioral issues.
* Poor toileting practices.
* Poor exercise training principles and techniques.
Our pelvic floor muscles need proper endurance to work for long periods at a time; they also need the ability to contract quickly and strong enough with activities such as coughing, sneezing, running, jumping, and laughing to help keep us from leaking urine. Leakage with physical activities such as these is known as Stress Urinary Incontinence (SUI). When our pelvic floor is healthy and functioning normally, the muscles contract automatically, without mindful activation, just prior to these activities and help keep us continent. When they aren’t functioning normally, urinary or fecal leakage may occur, causing embarrassment and other mental anguish.
Musculoskeletal pain and stiffness in the low back, pelvis, buttocks, and/or hips are common complaints amongst physical therapy patients. Pelvic floor muscle function is often found to be impaired in these clients. It is not unusual for patients to report stress urinary incontinence problems and/or pelvic pain in conjunction with their musculoskeletal pain complaints. Physical therapists often find non-optimal back, pelvis, and/or hip alignment, painful muscle trigger points, muscle tone problems (too tight/short or too loose/long), joint hypo/hypermobility, poor movement strategies and patterns, and muscle coordination, activation, and timing problems in the pelvic floor and other muscles with these patients. This makes sense, as the pelvic floor muscles have direct attachments to the hips, pelvis, sacrum, and tailbone and are connected to the back via the thoracolumbar fascia. Physical therapists therefore frequently incorporate pelvic floor manual therapy treatment techniques, muscle re-education, movement training, and training and strengthening exercises for our patients complaining of pain and stiffness in the back, pelvis, buttocks, and hips who have associated pelvic floor muscle dysfunction. Education regarding our clinical findings and appropriate home care is an important component of our intervention.
If you or someone you know has low back, pelvic, pelvic girdle, buttock, or back pain and stiffness, or has urinary or fecal leakage, please consider referring him or her to a physical therapist trained in pelvic floor evaluation and treatment. Pelvic floor muscle dysfunction may be the missing link in their current treatment program. These problems can have a significant impact on a person’s quality of life and can often be reversed with the proper treatment.
