Where is my pelvic floor and its function?

It is the region where the vagina is located as well as the anus and tailbone. It is made up of bones, ligaments and muscles. The main bones are the ilium (pelvic bone), femoral or hip bone, sacrum, coccyx (tailbone), and the inner and outer openings to connect the inside to the outside. Ligaments are strong, bendable connective tissue, which hold all these above structures together creating a pelvic rim around the lower spine. The muscles create a sling from the pubic area to the tailbone. You have muscles that are superficial, which make up the vulva and deeper muscles that make up the vagina and rectum. The brain can control muscles automatically and by you through behavior training. This makes treatment of this area quite successful because we can help strengthen the muscles of the pelvic floor.

 The three main functions of the pelvic floor are:

1. Supportive- it acts like a shelf or sling of support for the lower abdominal organs like the colon or the bladder. The muscles help to take up forces so the internal organs are more protected. The amazing thing is this pelvic floor area acts like a cork in a bottle most of the time, always supporting what is inside. When a women gives birth, this then becomes open allowing childbirth.
2. Sphincteric- it helps keep the anus and the urethra (where we urinate from) closed and ensures we are continent or dry throughout the day and not leaking bodily wastes.
3. Sexual- the most outer muscles (the vulva) are the most intimately involved in sexual intercourse. They can stretch or tighten which can directly affect sexual functioning.

Pelvic Floor Dysfunction

• The pelvic floor muscles and other muscles within the pelvis and abdomen often tighten in reaction to pain and can become lax after child rearing and normal aging. Over time, tight muscles can become weak and, as a result, not function properly.

• Activities such as walking, sitting, recreation and normal activities of daily living can be affected.

• Men can have difficulty urinating with prostate enlargement and urinary leakage post prostatectomy surgery.

Physical therapy is a key component for those who have pelvic pain. The pelvic floor muscles and other muscles within the pelvis and abdomen often tighten in reaction to the pain. Over time, tight muscles can become weak and, as a result, not function properly. This cycle can limit sexual intercourse, and even activities such as walking, sitting, recreation, and normal activities of daily living.

Physical therapists evaluate these muscles and develop an individual program that may include external and internal pelvic floor massage, relaxation training, biofeedback, strengthening, electrical stimulation, bladder retraining, and home exercises. We teach you strategies to manage flare-ups and give you the tools to create a healing environment for your body.

Common Causes of Pelvic or Sexual Pain

• Pelvic and Coccyx Fractures- secondary to a fall or high velocity injury
• Childbirth
• Episiotomy
• Pelvic Floor Tension Myalgia Syndrome- muscle imbalances
• Sexual Abuse/Rape
• Fibromyalgia
• Pelvic Inflammatory Disease
• Interstitial Cystitis
• Urinary Incontinence
• Incontinence of Bowel
• Constipation/Irritable Bowel Syndrome
• General Infections
• Hamstring or Groin Pull or Tear
• Pelvic/Hip/Low Back Muscle Imbalances
• Other Soft Tissue Trauma- post-radiation burns, breast and vaginal reconstruction
• Dysfunction in the Sacro-iliac or Lumbar Spine
• Hemorrhoids
• Rectal Pain- spasms of the anus
• Fistulas between the rectum and the vagina
• Prolapse-vagina, rectum, bladder
• Inguinal/Abdominal Hernias
• Scarring of the pelvic region after abdominal surgery
• Posture/Holding Patterns - pain with sitting, standing, walking
• Inability to engage in intercourse
• Hysterectomy
• Endometriosis
  
  Common Signs and Symptoms of Pelvic Pain Dysfunctions:
• Poorly localized vaginal, rectal, lower abdominal and tailbone pain. It can be sharp, dull, radiating or nauseating
• Referred pain to the low back
• Thigh pain down the front, back, or side
• Pain in the vagina or anus
• Lack of sexual orgasm
• Frequent bladder infections
• Frequent yeast infections
• Vulvar or clitoral burning/itching
• Sense of heaviness of the vagina, bladder and anus
• Pain with intercourse- both deep and superficial penetration with sex
• Pain with urination
• A feeling of having to urinate to relieve pressure in the pelvic region
• Constipation- difficulty having bowel movements
• Lower abdominal pain
• Pain with tampon insertion
• Painful sitting
• Pain with prolonged standing