– Evelyn Hecht
Y O U R A M A Z I N G P E L V I S
Understanding what your pelvic floor is and all its functions can lower the mystery and misery of ongoing pelvic issues. Knowledge is one of the doorways to healing.
What IS the Pelvic Floor?
The pelvic floor is a group of muscles found in everyone lying at the bottom about a 1/2 inch up inside the pelvis. Like a hammock, the muscle fibers run from the pubic bone in front to the tip of the tailbone at back. The muscles have side attachments onto the fascia of a hip rotator muscle, called obturator internus, so the pelvic floor looks like a diamond-shaped trampoline.
Just like a trampoline, the pelvic floor muscles provide stability as well as elasticity. They support the bladder, rectum and other visceral organs, move with your breath and act as one of the core stabilizers. Their star role is in sexual, bladder and bowel function.
What DOES the Pelvic Floor Do?
Moves with each Breath
The diaphragm is our largest breathing muscle located just under the lungs. When you breathe in, the diaphragm lowers towards the abdomen to allow the lungs to fill with oxygen. Simultaneously, the pelvic floor moves down and gently expands like a gentle ocean swell.
When you breathe out, the diaphragm rises up to push carbon dioxide out of the lungs. The pelvic floor follows the movement of the diaphragm, returning up to its resting position.
Many people with persistent pelvic pain unconsciously tense their abdominals and pelvic floor muscles all day – and probably all night. As a result, the diaphragm doesn’t have much room to move. We breathe about 17,000 times a day. Without good diaphragm movement, the pelvic floor can become “stuck”, and its function disrupted. Many in chronic pain unknowingly breathe using the small neck and shoulder muscles, called accessory breathing muscles. Over time, this creates tension in the neck and shoulder areas and activates the fight/flight sympathetic nervous system (more on this later).
A good diaphragmatic breathing exercise can enhance breathing and move the pelvic floor.
Our core includes muscles of our deepest abdominal muscles, lower spine, pelvic floor and deep fibers of our hip flexors. This group works together to:
1) spare the spine from too much load/pressure
2) transfer forces between lower body to/from upper body
Before you do any large body movements like getting up from a chair, lifting a grocery bag, or climbing stairs, these muscle groups automatically preset and contract together, to stabilize the trunk/spine. Many people with persistent pelvic pain/dysfunction have difficulty activating their pelvic floor muscles because they’re in a continuous guarded state – day and night! This adds more work to the other core muscles and create imbalances of spine and hips, which can be a factor for ongoing lower back/hip pain.
Bladder and Bowel Function
The pelvic floor is integral to bladder and bowel function. When the bladder or colon sends an urge signal to go, nerves send this information to the brain, which signals the pelvic floor muscles to prepare for voiding/elimination. When you’re ready to void/eliminate, the pelvic floor muscles relax, the sphincters open and all flows out easily. If you’re not at the bathroom, the pelvic floor keeps their doors closed, so no leaking occurs, and the sensation of urge subsides.
Your organs, nerves and pelvic muscles communicate or cross talk with each other to work smoothly. If there is disruption with any one of these systems, bladder and bowel function is affected. This explains why ongoing bladder/bowel issues can occur without anything being physically wrong with the internal organs. Rather the pelvic muscles and/or nerves are involved.
Bladder issues can include sudden urges to pee; frequent urination even when your bladder isn’t full; difficulty starting the flow of urine; incomplete voiding.
Bowel issues can include constipation; little or no urge sensation; excessive straining; spending a long time trying to eliminate; leaking; incomplete emptying and abdominal bloating.
Why do you experience ongoing pelvic related symptoms without an infection, inflammation or disease?
A combination of tense pelvic floor muscles, worry/anxiety combined with central sensitization, which is an overly sensitive nervous system, immune system and brain. These naturally protective functions have learned and developed a faulty protective pattern, sending signals of distress, urge, pain, burning to the body as it is getting too many incoming threat messages. The good news is that the brain and nervous system can learn healthier patterns. By doing PelvicSense you’ll gain the knowledge and tools to achieve healthier bladder and bowel function.
The pelvic floor muscles are involved in all phases of sexual function.
In women, the muscles relax to allow more blood flow to the genital region, provide clitoral erection and prepare the vagina for intercourse. The pelvic floor muscles rhythmically contract during orgasm and add to the intensity of orgasm. Sexual dysfunction includes vulvar/vaginal pain with penetration, decreased lubrication, inability to achieve orgasm and/or lowered intensity of orgasm. Hormone imbalances of estrogen, progesterone and/or testosterone in women can also make sex painful, result in low sex drive and interfere with production of lubrication. It’s important to check hormonal issues as a possible component for sexual dysfunction. A great source to find providers for sexual medicine is www.ISSWSH.org
Sexual challenges can happen to anyone due to emotional issues, daily stresses and/or health issues. Sex is meant to be fun and to connect with your partner. If you find yourself avoiding sexual connection after 3-6 months past a healing timeline from a surgery or injury, be sure to see a specialist versus continuing to avoid intimacy. A great source to find providers of sex therapy is www.AASECT.org. PelvicSense teaches how to lower fear of penetration, guides in use of dilators, achieve intimacy with ease and reverse burning and pain symptoms.
Persistent pelvic pain/distress is similar to chronic pain in other parts of the body, like migraine or lower back pain, due to a sensitive nervous system, an overactive immune system and a hypervigilant “helicopter parent” brain.
Persistent pelvic pain is different compared to pain in other parts of the body due to the shame/embarrassment associated with the pelvis. Shame may prevent many women from addressing their concerns early and prior years of the medical community’s non-focus on women’s pelvic health issues, which is changing for the better. The word pudendal, the name of the largest nerve that innervates the pelvic floor, has its Latin root meaning: to be ashamed. How many times at a social gathering do you hear conversations comparing symptoms of neck/back pain or physical therapy for a running injury, but zippity-doo-da about the pelvis?
Religious views about the body, cultural influences, plus society’s taboo to openly talk about bladder, bowel and sexual function has delayed good research and effective treatment. The reluctance, even from some doctors who may not ask questions about bladder, bowel or sexual function, cause people with pelvic issues to think that they are the only ones who suffer from their condition.
Pelvic pain issues are usually misdiagnosed and don’t get appropriate treatment right away, often taking 6 months to a year to receive a diagnosis. Many women think it’s normal to leak urine, be constipated and have pain with sex. When they finally talk to their doctor and learn that their medical tests are normal, treatments haven’t solved their issue, this sets them up to develop worry, fear, anxiety – which can lead to central sensitization. Often hearing conflicting medical experts’ explanations for symptoms, it’s no wonder many with pelvic issues have long-standing pain, frustration and feelings of isolation.
Pelvic floor is connected to our state of mind
The pelvic floor is intimately connected to our feeling of safety and danger. Any time we feel anxious or nervous, the pelvic floor immediately tightens, preparing your body to fight, flee or freeze as part of activating your sympathetic nervous system. Many people with pelvic issues report they had childhood emotional or physical trauma, some experiencing sexual abuse. Pelvic pain or long standing pelvic floor distress issues can stem from a history of painful periods, issues around toileting, high levels of family stress and medical diagnoses such as endometriosis, IC, IBS. It’s important to see a specialist to make sure your pain isn’t purely stemming from a biomedical tissue issue.
PelvicSense helps you understand some of the why’s for persistent pelvic pain/distress and teaches skills to regain healthy function. There are more wonderful pelvic practitioners than ever before, so a combination of your medical team and practice of this self-care program can make a big difference.
YOUR AMAZING PELVIS
- Understanding the role of the pelvic floor, getting an accurate, early diagnosis can prevent the build-up of worry, fear and sense of isolation with pelvic pain
- Tense, weak pelvic floor muscles and/or a sensitive nervous system can cause a variety of bladder, bowel and sexual dysfunctions.
- Societal and religious taboos about the pelvic region prevents open discussion about personal and embarrassing issues.
- PelvicSense offers a road map of self-healing skills and resources for healing.
Evelyn Hecht, PT can be reached by email: firstname.lastname@example.org
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