Let’s talk about your pelvic floor!

What is your pelvic floor?

The pelvic floor muscles are a group of muscles that span from the tail bone, (the triangular bone at the base of the spine) to the pubic bone (the front bone of the pelvis), and across between left and right sit bones. If you imagine your pelvis as a bowl, then these are the muscles that literally make up the floor of the pelvis- the base of the bowl.

What do they look like?

(Taken from http://www.dailybandha.com)

What do the pelvic floor muscles do?

They have a number of different functions; they support the reproductive and pelvic organs which include the bladder, bowel, and uterus (womb); give support to the digestive system; provide sphincter control for the bladder and rectum which controls continence; and have other roles including in sexual function and childbirth.

What happens when they work well?

As these muscles have different and important jobs, even regardless of pregnancies or births, it’s highly important to keep them functioning as well as possible. This means there will be *less* likelihood of problems in this area during and after pregnancy and birth. The muscles- like any other muscle- need to be able to shorten and lengthen to do their jobs. If they can shorten, or contract, then they are better able to support the contents inside- be it urine, faeces, or the organs themselves. If they can lengthen, or relax, they are better able to pass digestive contents comfortably, and also are less likely to get tight, tired and injured from overuse.

What happens when they go wrong?

The pelvic floor is sometimes compared to a trampoline, as it can stretch in response to weight or activity, and ‘bounce’ back up again.

However, unlike a trampoline, if it bears weight for a long time like it does during pregnancy, the muscles can become overstretched and weak.

The weight and size of your baby itself, plus the increased pressure caused inside your abdomen can place a lot of stress on your pelvic floor muscles, which can lead to weakness before your baby is even born. Your pelvic floor can become weak and stretched from as early as 12 weeks into your pregnancy.

Pregnancy itself, along with childbirth, can also often damage the connective tissue of the pelvic floor and core. This can lead to pelvic floor dysfunctions such as urinary and faecal incontinence, pelvic pain or even pelvic organ prolapse, despite strong muscles.

Having a weak pelvic floor makes it harder for you to squeeze the muscles and sphincters at the bottom of your bladder to prevent urine from escaping. You may accidentally leak urine when you cough, sneeze or exercise. This is known as stress incontinence. It also means that your bowel, bladder and womb aren’t well supported, which can give you a heavy, dragging sensation.

Having an overly tight pelvic floor can lead to you not being able to adequately eliminate urine and stools, or to be able to relax during intercourse and you may find sex uncomfortable and less satisfying. You may also experience incontinence in this situation too, as the muscles are overworked and not functional – so they struggle to hold the contents effectively.

When the pelvic floor is severely irritated and tight, it can also cause urinary frequency, urinary urgency, irritable bowel symptoms, and pelvic, back and abdominal pain.

How can they go wrong?

The system in this area relies on balance to be effective. That is, a balance of pressure- so there’s not too much pressure bearing down on the muscles; a balance of strength- sometimes the left versus right side can be weak/tight which can create a twist or torsion in the pelvis; a balance of tension; for similar reasons, it is important that the connective tissue and deep stabilising system is not very loose in one area, or super tight in another area, as this can cause different forces across the system and prevent it functioning well. These things can be caused by various factors such as trauma (including childbirth), posture, or previous injuries.

How can you keep them functional?

You’ll need to keep your pelvic floor strong for the rest of your life, as hormonal changes after the menopause can make pelvic floor problems more likely. If your vaginal muscles are weak, it’s possible for your uterus, bowel or bladder to sag down and push against the walls of your vagina (prolapse).

Kegels and strengthening exercises for your pelvic floor muscles can help some women, particularly those with weak pelvic floor muscles, from having accidental urine leaks which can be off-putting to those wanting to restart running.

However, you need to make sure that you choose the correct rehabilitation exercises for your needs, as strengthening an already-tight muscle can lead to further problematic symptoms. It might be that you need to release the pelvic floor muscles first. Seeing a women’s health specialist physio will help to determine which route you need to take.