As we head towards the new year, have you thought about your health and lady bits? Do you know if they are healthy and functioning as they should be? Now, you've probably heard the word 'kegels' floating around since erm, lets say your mid twenties, and the reasons for doing them. But have you taken heed and do you completely understand the importance behind them? Jeanice Mitchell PFPT (Pelvic Floor Physical Therapist) gives an insight into why it is super important to take care of our lady bits.
Where they are
Your pelvis is made up of many structures including bones, muscles, connective tissue, nerves, and blood vessels, and holds and protects 3 organs in females - the bladder, the uterus, and the rectum. Each of these organs has a canal that exits the body. The bladder connects to the urethra or urine exit canal. The uterus connects to the vagina for sex and childbirth. The rectum connects to the rectal exit canal for solid waste and gas.
The pelvic floor muscles are at the base of your pelvis. Imagine that your pelvis is like a bowl - the bones are the outside and the muscles are literally the “floor”. They attach from the pubic bone in the front to the tailbone in the back. They also attach to the sides of the pelvis.
What they do
Support: this “floor” of muscles at the bottom of your pelvis support your organs, kind of like a hammock. Imagine that the pelvic organs are sitting on this hammock of muscles. The hammock needs to stretch and also needs to rebound back up at the right times.
Sphincteric: imagine that your bladder is like a water balloon. The bladder is meant to fill and expand, just like a water balloon. The pelvic floor muscles wrap around the bladder opening or “urine exit canal” to keep it closed. Just like the water balloon, if you don’t close it off, fluid will leak out. And also, just like a water balloon - it has a maximum capacity. It is designed to fill, expand, store, and then empty. The pelvic floor muscles control the urine exit canal, the vaginal canal, and the rectal canal to keep them closed at the right times and to let them open at the right times!
Sexual: the pelvic floor muscles are active during sex and orgasms for all genders. In females, they attach to the clitoris and help with clitoral erection. They wrap around the vagina to provide tone and sensation. They also rhythmically contract during orgasm.
Stability: your “core” is made up of multiple deep muscles that form an internal girdle to keep your spine, pelvis, and pelvic organs strong and stable during activity. The pelvic floor muscles form the bottom or “floor” of this girdle to provide support from below.
How they work
The pelvic floor muscles are voluntary muscles which means they should do what they are told to do. Just like your hand, they should squeeze, close and hold when we tell them to. They should also let go, relax and open when we want them to. Many people think they are performing pelvic floor muscle contractions (aka “kegels”) correctly, when in fact they aren’t!
Here are 4 key elements of healthy pelvic floor muscles:
Correctly contract: a correct pelvic floor muscle contraction includes lifting of the organs upwards toward the head, a slight forward motion towards the pubic bone, closure of the outlets, of the clitoris, and automatic activation when the core is engaged.
Completely let go: a correct pelvic floor release includes dropping of the floor towards the bottom, a slight backward motion towards the tailbone, opening or softening of the outlets, and release of pressure from the clitoris.
Be active at the right times: the pelvic floor is designed to automatically engage with activity to keep your organs supported, your 3 outlets closed, your sex satisfying, and your movements stable.
Be relaxed at the right times: the pelvic floor must also let go or relax to allow urine, solid waste, gas, and babies to exit the body. It also needs to let go to allow penetration during sex. Healthy muscles must have downtime where they turn off.
When things go wrong
Support: if the pelvic floor muscles become weak, strained, and lose their “spring”, the “floor” can start to drop. This lack of support from below may result in collapse of the pelvic organs that are resting on this floor or “hammock”. The bladder, uterus, and rectum can “fall” into or through the vaginal canal. This is called Pelvic Organ Prolapse and affects almost 50% of women that give birth. A “falling bladder” is called a cystocele. A “falling rectum” is called a rectocele. A “falling uterus” is called uterine prolapse.
Sphincteric: if the pelvic floor muscles lack the strength or coordination to close off the exit canals at the right times, this may result in leakage of urine, solid waste, and gas. If the pelvic floor muscles lack the coordination to allow the canals to open at the right times, this can result in pain or difficulty with urination, recurrent UTI’s, post-void leaking, painful penetration, constipation, and incomplete emptying of your bladder and bowels.
Sexual: if the pelvic floor muscles are overstretched and weak, this may result in decreased sensation, tone, satisfaction, and orgasm success. If the pelvic floor muscles are uncoordinated and overactive, this may result in painful penetration, painful sex, decreased orgasm success, and pain with orgasms.
Stability: if the pelvic floor muscles lack the strength or coordination to engage with the other deep core muscles during activity, this may result in leakage, pelvic organ prolapse, pain, or instability in the back, pelvis, hips, and pelvic organs.
Who can help
Just as we have healthcare providers that specialise in taking care of our teeth, skin, eyes, and hearts, we also have experts that specialize in pelvic health. Most of the time, these experts are called “Pelvic Floor Physical Therapists” but there are other healthcare providers that also may be able to help. Most insurances cover pelvic floor physical therapy (PFPT) under the same rules as regular Physical Therapy. Skilled PFPT in the USA is covered by Medicare, Medicaid, Tricare, BCBS, and most other insurances.
PFPT applies the same therapy concepts used in other areas of the body to the pelvic floor muscles. Just like your leg muscles can be trained and strengthened, so can your pelvic floor muscles! Your therapist will work closely with you to determine your current function, your goals, and the treatment interventions that you are most comfortable with. Many therapists have specialized tools like biofeedback or real time ultrasound that allow us to “see” what your muscles are doing on a computer screen. This can be used for evaluation and training.
Learn more about the pelvic floor by watching simple videos on our YouTube channel MyPelvicFloorMuscles and by visiting our Instagram @mypelvicfloormuscles for everday tips.
Schedule a pelvic health appointment today! You can find one on our website myPFM.com