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5 things you didn't know about your pelvic floor

It seems like everyone is talking about the pelvic floor these days...but do you know what your pelvic floor actually is? Let’s lay down the foundation and go over what our pelvic floor is and some of the important things it does for us day in and day out.

Your pelvic floor is made up of a set of muscles and tissue that sit at the bottom of your pelvis, forming a “bowl” shape. It supports your spine and pelvis through movement, supports the weight of your pelvic organs (bladder/rectum/uterus), contracts to keep things in, relaxes to let things out, plays a huge role in sexual function, and makes up part of our inner core unit. These muscles sit on the inside of our body and can be felt internally (aka through the vagina or the anus). Healthy and functional pelvic floor muscles need to be able to fully relax, strongly contract, and do both of those things when we want. They also need to work without us thinking of them - to anticipate movement or moments of increased intra-abdominal pressure (ie: sneezes/coughs), and to allow daily activities such as emptying our bladders and bowels. Let me be honest - that was an oversimplified explanation of this amazing muscle group - I could go on and on about this, but I want to get to the juicy part of this article.

Here are 5 things you didn’t know about your pelvic floor - the magical group of muscles that we often take for granted:

1. Your orgasm is a contraction of all of your pelvic floor muscles.

Seriously, if you didn’t appreciate this muscle group before, I sure hope you do now! Healthy pelvic floor muscles are able to relax completely and contract strongly - both voluntarily and involuntarily. An orgasm is an involuntary co-contraction of all the pelvic floor muscles that is brought on by sexual arousal or stimulation (solo or with a partner; with or without penetration). The clitoris is the female sex organ and behaves like a little penis - it swells and becomes erect when aroused and is filled with THOUSANDS of nerve endings! Having muscles that are able to move throughout the full range of motion and are strong can actually lead to better and stronger orgasms. Sign. Me. Up.

2. Kegels aren’t always the “fix” for leaks.

1 in 3 women experience some form of urinary incontinence, or leaks, in their lifetime. Oftentimes, the well-intentioned advice from friends, other medical providers, and strangers on the internet is to “just do your kegels” [kegels are pelvic floor muscle contractions]. Here’s the problem with this advice: we don’t leak just because our pelvic floor muscles are too weak to hold the pee in. There are many reasons why so many women experience leaks, and weakness is just one of them; tightness of the muscles and/or poor co-ordination of the muscles are a couple of other reasons. The truth is that leaks often have a little to do with your pelvic floor muscles, a little to do with your posture, a little to do with your breathing, and a little to do with a dozen other things; it’s not always a simple cause and therefore never a simple solution. So do you see what I mean? You can kegel all the live long day and still may leak if weakness isn’t the root cause of your leaks. I always recommend a one-on-one consult with a pelvic health physiotherapist to get the bottom of why you’re leaking in order to get the right treatment, exercises, and strategies to fix the problem. The right kind of pelvic floor muscle training can cure and improve incontinence symptoms - there is high quality research to back this up. If you leak, please know that this can be addressed. Just because leaking is common, it doesn’t mean that you need to accept that it’s forever.

3. Your pelvic floor muscles don’t “push” the baby out during labour.

Yup, it’s true - how strong your pelvic floor muscles are has nothing to do with how “easy” it will be for you to push out your baby in a vaginal birth. Why is that? Well, your pelvic floor muscles actually need to relax, lengthen, and get out of the way to make room for baby! The muscle that does all the hard work is the uterus - it contracts to push the baby down towards the birth canal; then, combined with increased pressure in your abdomen from when you “push”, helps the baby make his/her way through the birth canal and eventually into your arms! In the last couple of months of pregnancy, it’s very helpful to focus on connecting to your pelvic floor muscles and relaxing them, learning how to lengthen them in different positions, and learning how to effectively push and generate pressure while keeping your pelvic floor muscles relaxed.

4. Massaging and stretching your pelvic floor is associated with less severe perineum tears during childbirth.

The perineum is the space between your vagina and your anus; it is the place that is commonly torn during vaginal birth. Evidence shows that stretching and massaging this area starting around week 34 of pregnancy can help decrease the severity of tears. Using lubricant or oil, gently stretching and massaging for 3 to 5 minute most days of the week is what I typically recommend. This combined with some of the tips from point 3 (learning how to connect to and relax your pelvic floor muscles) is crucial work every mother should do to prepare for birth.

5. Pelvic floor muscle dysfunction can be the cause of many common problems.

Tight or short pelvic floor muscles are ones that have difficulty relaxing or lengthening; these are muscles that are not necessarily strong (tight doesn’t equal strong in this case), and are certainly not capable of moving through a full range of motion. Many of us have tight or short pelvic floor muscles but have no idea...but what we might have include really common issues such as chronic low back or pelvic pain, tailbone pain that isn’t related to a fall or injury, painful penetrative sex (either just at the start of penetration, or with deeper thrusting), difficuly inserting a tampon or menstrual cup, constipation, or leaks. You see, tight or short muscles make it tricky to get things in OR out. Tight or short muscles also can create an imbalance in the muscles of the pelvis, hips, or low back, leading to deep and unrelenting pain that doesn’t improve with massages or traditional physiotherapy exercises. Do you find yourself clenching your bum, inner thighs, or pelvic floor? Pay attention to this...and if you find that you are a clencher, channel your inner Elsa and just “let it goooooo”. I recommend hip and low back mobility and stretches to almost every person I talk to about pelvic health as I believe it is just as (if not more) beneficial to all of us than kegels. So, get your stretch on, ladies!

There you have it - 5 things you didn’t know about your magical pelvic floor. Ps: here is a bonus fact for you - men have pelvic floors, too!

Aliya Dhalla, Pelvic Health Physiotherapist

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