Can I just start by saying that I absolutely despise the phrase “Pelvic Floor Dysfunction”?
Yup. I said it.
“Pelvic floor dysfunction,” or PFD is an umbrella phrase that encompasses anything that can go awry with the pelvic floor. Pelvic floor dysfunction can present as: pelvic pain, difficulty urinating or having bowel movements, urinary urgency, urinary or fecal incontinence, pain with intercourse, groin pain, sacroiliac joint (SI joint) pain, etc. There are SO MANY factors involved in pelvic health, and more often than not, the source of the dysfunction is multifactorial. I like to describe PFD like a pie chart, with each individual’s varying factors in their charts. The pelvic floor can become dysfunctional for manyyyyy reasons; anatomical, biomechanical, dietary, and psychosocial (and no that does not mean it’s in your head!). For each individual, their “pie chart” may be made up of other factors, and each factor can vary in percentage from one person to the next.
Everyone has had different life experiences or situations, and even though we all want to have one thing to “point the finger at” as the cause, there is usually not simply ONE cause to dysfunction. Stress, breathing, past sexual/physical/emotional trauma, child birth or surgical trauma, diet, poor bladder habits, foot/spine/hip mechanics, sacrum/coccyx trauma, hormones, anatomy, and scars can all play a role.
In order to create healing and progress you towards your goals, we need to identify which particular factors make up your own “pie chart.” When trying to tease these out, I have found it’s best to start with the most obvious factors first. Yup, the low-hanging fruit, so to say. Patients know their bodies much better than I do. They know what sensations they feel, what their habits are, their past history, and what their diet is. I can only make objective observations about what I currently see. I truly rely on a patient’s input to help guide my evaluation and treatment. During the initial evaluation, I pay close attention to the patient’s history to discover clues to the “low hanging fruit” to try and target first.
Anatomical/Trauma example: A patient came in complaining of pain with intercourse that had gotten worse over the past 4 years and now was experiencing pain with bowel movements. She had never had children, denied past sexual trauma, but did report a fall on her tailbone (coccyx) about 5 years ago. Our internal evaluation found her to be very tender at the deep pelvic floor (layer 3) muscles. We worked on releasing these muscles both internally and externally, coccyx mobilizations internally, and improving her glute activation and strength with great success. Now, did she have some other potential causes for “dysfunction” that I listed above? Of course. But going back to the low hanging fruit, we worked on the items that most stood out during her subjective report, and she was able to have no pain with intercourse and bowel movements after our course of treatment.
Anatomical/Scar tissue example: A patient came in 4 months after the vaginal birth of her first child complaining of left hip pain. She had a slight perineal tear (grade 1) during child birth, and no other complications. During our internal evaluation, I found that her perineal tear had extended inside her vaginal tissue, and she had some scar tissue that extended into layer 2 muscles, which was a larger tear than she had originally thought. When I palpated the scar tissue she said, “That’s my hip pain!” We worked on scar tissue mobilization internally, breath work to improve her pelvic floor muscle relaxation and blood flow, and her hip pain went away.
Psychosocial/bladder habits example: A patient came in with complaints of frequent need to urinate and urinary urge incontinence (could not always make it to the bathroom without leaking). She went to the bathroom 18+ times a day. She mentioned she has frequent long meetings for work and is always scared she won’t be able to hold her urine until the meetings are over. I dove into questions about her bladder habits and mentality surrounding her fears. She reported always going to the bathroom when she doesn’t necessarily have to go “just in case” she doesn’t have time to go later. She also reported not drinking very much water for fear that she would need to go more frequently. We discussed better bladder habits (not going “just in case”), increasing her water intake (concentrated urine can irritate the bladder lining and increase the urge to go more frequently, and urinary urge suppression techniques to decrease her stress and anxiety around urinating. She implemented these changes and was able to decrease her bathroom trips to 10 times a day (8-10 is normal!).
If you are looking to make a change and aren’t sure where to start (it can be overwhelming!), it’s best to have a pelvic floor physical therapist evaluate what’s going on and give you an individualized course of action to help streamline your care.