What is your pelvic floor?
The pelvic floor is the floor of your pelvis. Your pelvis is a group of bones at the center of your body that connect to the bottom of the spine and the hip bones. There are muscles all around the pelvic bones. There are nerves extending into this area. There are blood vessels here. Inside the pelvis sit organs like the bladder, uterus, prostate and rectum. On the outside of this area sit the genitals and the anus. All of this is the pelvic floor. It’s not a good name. The pelvic floor isn’t just the “floor” of the pelvis. It is everything in and around the pelvis.
What is a shiny, happy pelvic floor?
This is when all the contents of the pelvis do what they ought to do. Urine is held as long as you need to hold it. Bowel movements are satisfying and complete. Your brain isn’t constantly being made aware of the presence of your genitals or your anus or your tailbone. A shiny, happy pelvic floor is one that lets you live life unaware of its existence.
What does it mean to have pelvic floor dysfunction?
Pelvic floor dysfunction is when your pelvis and it’s contents are misbehaving. They are being rude and socially inappropriate. They aren’t listening to your requests. You say “pee” and your pelvis refuses. You say “don’t leak” and your pelvis leaks. You say “I do not give consent to this fart!” and your pelvis could care less. You say “I don’t want to be aware of your presence constantly” and your pelvis says “I’m here! I’m here! I’m here! Can you feel me? Huh? Huh? Huh? Can you feel me now?” Pelvic floor dysfunction is when your pelvis needs to learn some manners.
Physiologically, pelvic floor dysfunction is when the muscles, nerves and bones of the pelvic area are not resting or moving as they should. This could be because they are staying too tight or too loose or because they are getting too much movement or not enough movement. The cause of this could be learned patterns that you are contributing to or surgical insult “Like a scalpel told your pelvis that it’s butt looked big in those jeans” or poor circulation.
How can pelvic floor physical therapy help?
The role of the pelvic floor physical therapist is to teach the pelvic floor to know their own role. It’s to slow their role. It’s to whip the pelvic floor into shape and take no prisoners. It’s to say “You’re not the boss!” It’s to command obedience.
And how is this done? Much to people’s surprise, it’s not done over coffee. It’s done on a plinth with a lot of hands on work to the abdomen, legs, genitals, anal area and internally. Yes, internally. The call is usually coming from inside the house so I’d be wasting a lot of time staring at the front door.
If muscles are too lax, then we work on strengthening them. If muscles are too tight, then we work on making them longer. If the pelvis has been insulted by surgery, we work on building up it’s confidence. We tell it stories and remind them that it too is destined for greatness. If the pelvis has poor blood flow and oxygen, we do hands on techniques to encourage more blood flow and oxygen.
But what does this really, really look like? If I were to take a snapshot of a treatment, it would look like this:
Patient is lying on table with a drape over their lower body. I am gloved with my hands working on their abdomen or legs, or any other external body part. Or, I am gloved with a finger working in the vagina or the anus. Yeah, it sounds weird. But, that’s because it is weird. It’s evidence-based medicine, but weird. I get it. Truth be told, most people’s voices raise a few octaves as they ask “So…how exactly did you get into this field?”. That question comes out as I put the gloves on. And, if I don’t hear the question, I’ll offer “Now’s about the time you’re wondering how I got into this work, right?”. I’m always right.
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Contact me at Sara.Sauder@UrologyAustin.com
Written by Sara Sauder, PT, DPT
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