Written by Lannie Sullivan

Lannie Sullivan is a Professional Dancer turned Certified Personal Trainer. She lives in Tucson, Arizona where she works as the Training Director of Prestige Fitness. Her primary interests are postmenopausal demographics and pelvic floor wellness.  

Pelvic Floor Health

Structures cannot be built on unstable foundations and expect to maintain integrity and function. There may be some initial success, but eventually the compromised foundation will become problematic. Failing to account for  pelvic floor weakness and injury is a recurring issue in the health and wellness space.

Often new exercise enthusiasts (or seasoned athletes) embark on fitness programs that neglect to account for the medical history of their pelvic floor. This oversight in program preparation comes at the cost of the athlete. This cost may not be immediately apparent, but just like a house built on an unstable foundation, it will inevitably make itself known. While the importance of incorporating thorough, focused screening questions for people with internal genitalia cannot be overstated, this article will instead serve as a general introduction to the pelvic floor and include ways to incorporate daily lifestyle practices to serve pelvic floor wellbeing. This is not a diagnostic tool or prescription for treatment.

It is worth clarifying that pelvic floor health is integral for every human, regardless of their gender identity or physical ability. However, it disproportionately affects those with internal genitals/reproductive organs. In the United States an estimated one third of women will experience pelvic floor dysfunction in their lives – a statistic which fails to fully account for the array of affected populations due to language restrictions.

Defining the Pelvic Floor

So what is the pelvic floor? ‘Pelvic floor’ is a summation term that refers to the muscles attaching anteriorly at the pubic bone and posteriorly at the coccyx (tailbone), and sideways to link the ischial tuberosities (sitting bones). Together these muscles form a trampoline-like structure that supports the uterus, bladder, and bowel of persons with internal reproductive organs.

This extraordinary muscle grouping allows urinary and fecal continence, prevents organ prolapse, aids in sexual function, and plays a vital role in the overall wellness of the body’s core musculature. This means that the pelvic floor is a major player along with the muscles of the abdominal, back, and diaphragm in supporting the spine and regulating pressure within the abdomen. As far as muscles go, the pelvic floor is at worst overlooked and at the least underappreciated.

Hypertonic & Hypotonic Dysfunctions

Common dysfunctions are often attributed to the pelvic floor’s muscular state: hypertonic or hypotonic.  Hypertonic muscles are overactive, they are tight and unable to achieve resting length (relaxation). Frequent symptoms of a hypertonic pelvic floor are:

  • Urinary incontinence/incomplete bladder voiding
  • Frequent or urgent urination
  • Vaginismus/pain during penetration
  • Pelvic pain
  • Low back pain
  • Constipation/difficulty emptying bowels

On the other hand, hypotonic muscles are too weak.  They often cannot sufficiently support the bowels, bladder, or uterus.  Frequent symptoms of a hypotonic pelvic floor are:

  • Decreased sexual sensation
  • Passing gas when bending or lifting
  • Urinary or fecal leaking
  • Leaking when coughing, sneezing, or laughing
  • Bulging or falling sensations in the vagina

While the potential symptom list of pelvic floor dysfunction is vast, many of these symptoms are excused as common. They’re shrugged off as the inevitabilities of aging, childbirth, menopause, or repercussions of surgery. However, common is not normal.  Disuse is not aging. Dysfunctions of the pelvic floor are not inevitabilities without recourse, but rather treatable and manageable.

A physical therapist should be consulted if any of these pelvic floor dysfunctions are suspected. With their guidance a plan of action can be developed and be relayed to the client’s healthcare professionals or athletic coaches. That said, there are lifestyle habits that may encourage more optimal pelvic floor health when adopted consistently.

Lifestyle Changes / Habits for Pelvic Floor Support

Voiding Posture

One of the simplest changes one can make begins in the restroom. Modern toilet seats do not provide the most ergonomic position for the body to void. Elevating the feet to bring the hips flexed beyond 90 degrees allows for ideal colorectal posture, allowing stool to pass without strain or undo pelvic floor tension. It also gives the bladder a chance to fully expel urine. Remember the Squatty Potty? Same concept, only instead of buying a toilet stool a couple unused books or yoga blocks will serve just as well.

Sitting and Neutral Spine

Modern convenience walks hand in hand with sedentary behaviors. We sit more than ever, and we sit atop our pelvic floor, so it’s crucial that the spine stays as neutral as possible. Low back slouching and upper back curvature (kyphosis) increase coccyx pressure which often results in pain. And over-erect posture can hold too much tension in the pelvic floor. The best option is to keep the spine as neutral as possible when sitting is required.  To achieve this, both feet should be firmly planted on the floor.  Imagine sitting with the ribcage directly over the hips and making a point to maintain deep, even breaths.

Tummy Breathing

It is astounding how much unintentional stress is placed on the pelvic floor through seemingly benign actions. Too often individuals “suck in” their stomachs or try to keep their core “engaged” throughout their daily activities. This forces the pelvic floor to remain tense for extended periods of time, exacerbating or creating dysfunction. Rather than attempting to hold the tummy close, allow it to fully relax and sit naturally on the body.

These principles apply to clothing as well. Tight fitted pants or restrictive bottoms with high waist bands can encourage poor tummy habits. Aggressive pressure on the stomach can contribute to dysfunction and prolapse over time. Select clothes that allow the body to exist in a natural state without restriction or limitation. No fashion or label size is worth more than wellness.

Takeaways

The pelvic floor is an unsung hero of so many vital bodily functions, and with the help of a few simple lifestyle modifications it can be treated with the care it deserves.  Little habits snowball into big changes, and bringing awareness to an ignored part of the body can illuminate potential dysfunctions. Common is not normal. At no age, size, or starting point is it ever too late to address internal wellness and improve the quality of your pelvic health.

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