How to Tell If Your Pelvic Floor is Tight, Weak, or Neither
When people reach out to me regarding a pelvic floor problem, they almost always immediately jump to the assumption that their pelvic floor muscles are weak.
I get it- pelvic floor weakness was the original “dysfunction” that was identified.
Dr. Arnold Kegel even named pelvic floor contractions after himself– the Kegel – which was then used as a treatment for the identified pelvic floor weakness.
But, are all problems in the pelvic floor really “strength vs. weakness” problems? Let’s dive into that today!
What is the pelvic floor?
The pelvic floor muscles are really a functional group of multiple muscles existing in several layers.
They generally attach from the pubic bone in the front of pelvis to the tailbone posteriorly, and attach laterally to the walls of the pelvis (and yes– everybody has a pelvic floor!).
These muscles are intricately involved in visceral function– they play a key role in our bladder, bowel and sexual health.
They are important for childbirth, for posture, for breathing, and even in our stress response. They are skeletal muscles– meaning that at the tissue level, they are the same type of muscle fibers that we have in our biceps, our quads, etc.
They are composed of both type 1 and type 2 fibers – 60% type 1 which are the endurance fibers, and 40% type 2– the quick acting fibers. This makes sense! We need them to activate quickly when we cough to increase closure and pressure around the urethra.
And we need them to contract at small amounts for a long period of time when we are out on a walk.
What makes pelvic floor muscles different than other muscles?
While these muscles are structurally similar to other muscles in the body, there are so many ways that they are actually quite unique.
First, they active in a predominantly automatic nature. That means that you really don’t need to think about them most of the time– they hold back urine without you even asking!
As I mentioned previously– they are also so intricately tied to our visceral function for the bladder, bowels, and sexual health systems.
They also play a key role in fluid management– pumping blood and lymphatic fluid in and out of the pelvis.
So, what happens when the pelvic floor muscles become dysfunctional?
Today, we’ll explore 3 distinct aspects of muscle function that can become problematic: functional strength, tension and mobility, and coordination.
Strength difficulties:
Pelvic floor muscle weakness can occur when the muscles are stretched or damaged from pregnancy or childbirth, from chronic coughing or other strain on the tissues- and from other factors that increase stress on the pelvic floor muscles.
Weakness in the pelvic floor muscles (including the urethral and anal sphincters) can present as bladder or bowel leakage, decreased sexual sensation/arousal, or may co-exist with pelvic organ prolapse or low back pain.
Tension/mobility difficulties:
Tension in the pelvic floor muscles can happen as a stress response, due to chronic constipation, after other pelvic infections or surgeries, and in cases of pelvic pain conditions (ie. endometriosis, prostatitis, IBS, etc).
Sometimes we also see tension happen with no specific known cause or driver. Tension in the pelvic floor muscles can present as pelvic/hip/abdominal/low back pain, painful sex, increased urinary urgency and/or frequency, constipation or difficulty emptying the bowels, and may co-exist with other hip, pelvic or low back pains.
Coordination difficulties:
In this case, the challenge is more related to the ability of the pelvic floor muscles to contract or relax at the right time. So, we can see coordination challenges in cases like stress urinary leakage (when the muscles do not contract against the increased pressure that happens with coughing/sneezing/laughing).
We can also see coordination challenges related to constipation and defecation– basically, the muscles may not be opening when they should for having bowel movements.
We also can see this happen in cases of pelvic or sexual pain– sometimes the muscles may contract in a way that worsens pain symptoms.
What to know about pelvic floor strength, tension, and coordination
The important piece is that each of these difficulties are related to unique functions of the muscles— so they can co-exist together.
We often will see cases where the pelvic floor muscles are not firing at the right times, but also may be tense and tender- contributing to pain.
We sometimes see muscles that are weak and also not coordinating at the right time to respond to pressure changes in the body. This is why individual examination – assessment– and treatment is so critical!
The best path forward is usually the one taking each person’s individual presentation into account, and building the customized plan that addresses those specific needs!
Where to find pelvic floor therapy in marietta and midtown atlanta
At Southern Pelvic Health, we offer comprehensive pelvic therapy care for all genders and we’d love to work with you!
To get started or ask more questions, submit our contact form.
Have a great week!
Warmly,
Dr. Jessica Reale
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