Pelvic Floor Dysfunction Series #1 – Introduction

Welcome! This is the introductory post for the Pelvic Floor Health blog series. In this post, we will be discussing the Pelvic Floor – what it is, what dysfunction in the pelvic floor looks like, what the symptoms are, and the anatomy behind the dysfunction.

I am an Occupational Therapist (OT) and a Certified Low Pressure Fitness Instructor.  I completed continuing education and training through The Core Recovery Institute. The Low Pressure Fitness protocol I am trained in addresses Pelvic Floor Dysfunction (PFD) with the use of hypopressive exercises as treatment (intervention). If this topic interests you, be on the look-out for follow-up blogs in the upcoming months!

Introduction to Pelvic Floor Dysfunction

What is the pelvic floor?

The pelvic floor is a group of muscles and tissues that have many, many, MANY jobs. Some of those jobs/functions include:

  • postural control
  • support of organs
  • support for the hips
  • support of the spine
  • support of respiration (breathing)
  • lymphatic drainage
  • sexual function
  • control of sphincters that control urine and stool

For my fellow healthcare practicioners — the pelvic floor consists of three muscle layers:
(1)The Superficial perineal layer: innervated by the pudendal nerve. Bulbocavernosus, Ischiocavernosus, Superficial transverse perineal, External anal sphincter (EAS) (2) Deep urogenital diaphragm layer: innervated by pudendal nerve.  Compressor urethra, Uretrovaginal sphincter, and the Deep transverse perineal. (3) Pelvic diaphragm: innervated by sacral nerve roots. Levator ani: pubococcygeus (pubovaginalis, puborectalis), iliococcygeus, Coccygeus/ischiococcygeus, Piriformis, and Obturator internus.

Why does Pelvic Floor Dysfunction occur?

Pelvic Floor Dysfunction can have many causes — but the underlying cause of PFD is increased intraabdominal pressure. Intraabdominal pressure is the amount of pressure that is in your abdomen/torso (the area between your ribs and your hips).

Naturally, there is always some pressure in your abdomen — if there were not, our organs wouldn’t be contained! Typical intraabdominal pressure at rest is 5mmHG. Certain activities and events increase this pressure.

These activities can be anything from:

  • coughing (90mmHG)
  • sneezing
  • valsalva — (bearing down) during child birth (60mmHG) or during defecating (35mmHG)
  • constant poor posture
  • running (34mmHG)
  • laughing
  • abdominal/core exercises like crunches (50mmHG!), bicycle crunches, leg lifts, etc. 

**any activity that compresses the abdomen will, in turn, increase your intraabdominal pressure**

When intraabdominal pressure is increased on a consistent or repetitive basis, this is what happens within your body (anatomically):

  • The organs are pushed down and move out to the sides and out to the front (the occurs due to Pascal’s Law) Pascal’s Law states that when pressure is applied to an enclosed system, that system will then disperse that pressure equally in all directions within that system. Think of squuezing a balloonwhen you squeeze and apply pressure, the pressure tries to escape through the areas that are not being squeezed by your hand. pascal baloon.jpg
  • The pelvic floor is already naturally heavily weighted by our movement and organs; it reacts to this weight by contracting. When muscles contract they shorten, and when they are always contracting they can permanently shorten and become what is called, ”hypertonic.”
  • The pressure also causes blood flow to decrease to the pelvic floor muscles, and when muscles are not receiving proper blood flow, function is impaired. This impairment may look like leaking urine or an organ prolapse.

Another metaphor…

In my training at The Core Recovery Institute, the instructors explained it this way; ‘You can think of your pelvic floor like an elevator – it job is to be move freely betweeen floors (body stuctures) to stop or start an action (hold urine or release urine). Our pelvic floor is meant to be healthy enough to be so mobile it can go to where it is needed as soon as it is needed. When our pelvic floor is dysfunctional it does not make it in time to where it needs to be, or it is not working at all.’

Symptoms of Pelvic Floor Dysfunction

Possible symptoms of Pelvis Floor Dysfunction include:

  • Incontinence (urine leakage) with exertion, coughing, laughing, etc.
  • Dysmenstria (irregular or painful menstration)
  • Organ Prolapse (seen as uterus, bladder, rectum poking through vagina in females and hernias in males)
  • Frequent urination (more than every 2-3 hours or 6-8 trips to restroom a day)
  • Trouble releasing urine (needing to push or strain to begin stream)
  • Irregular bowel movements (1-3 times a day is typical)

Impact on Occupational Performance

As an OT, I have to break down why this impacts our lives from an occupational standpoint. It seems a bit obvious to some, but I think what struck me the most, is how many individuals are willing to live with these symptoms and allow them to interfere with their daily lives and occupations.

There is a general consensus that if you are a runner or a mother than you just will have problems holding your urine — that it comes with the territory. It may come with the territory if our pelvic floors are not healthy, but it does not have to be an accepted norm!

Pelvic Floor Dysfucntion can interfere with so many occupations; toileting and toilet hygiene, dressing (needing to change or wear extra items to manage in continence), fucntional mobility (standing or sitting a particualt way to prevent leaking), personal hygiene and grooming, sexual activity, care of others (child rearing or petcare), home establishment and maintenance, religious activities and expression, shopping, sleep ppreparation and participation, formal education particpation, job performance, employment, volunteer particpation and retirement preparation for our senior cilents, play particpation and social particpation with loved ones or peers. Just to name a few!

As you can see, this is a real issue for our human population. In the following posts in this series,  I will address evaluation and treatment options for this population. Please comment below or email me with your feedback, thoughts, or if you have expereince in this area — I would love to hear from you!

Information within this blog is based on education and training in Low Pressure Fitness through The Core Recovery Institute and within the following articles; Thompson & O’Sullivan (2003). Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross sectional study and review. Int Urogynecol J, 12, 84–8. Sugrue M. (1995). Intraabdominal Pressure. Clin Intensive Care. 6,76-79

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