The pelvic floor is the core of the human body – it is there and working from crawling, to walking, to experiencing sexual pleasure, and giving birth to children. The pelvic floor is the root of the body, running deep and interweaving, making a hammock that gently sways and supports the digestive and reproductive organs. So why don’t we don’t talk about the pelvic floor? Because it is also the sexual part of our body, and social norms don’t allow public discourse about sex. In some countries, like France, people are immediately referred to a pelvic floor physical therapist right after childbirth to address obstetric trauma and prevent pelvic floor disorders.
When we think of the pelvic floor and conditions that hinder its function, we usually talk about uterine or bladder prolapse and incontinence - but there is so much more. The world of pelvic floor conditions is vast, ranging from a hyper toned pelvic floor that causes painful sexual intercourse to a prolapsed bladder that causes incontinence. According to the National Institute of Health, Pelvic floor dysfunction affects women more frequently than men - 1 in 3 women are affected by a pelvic floor condition during their life.
Pelvic floor physical therapy is a holistic medical treatment that, for years, was rarely used in the United States. These days, especially in places with progressive medical care, pelvic floor physical therapy is becoming more well known. Pelvic floor physical therapists use therapies like breath work, diet, stress reduction, and manual manipulation of the body and tissues. This essay provides an overview of what pelvic floor dysfunction is, with a focus on over-active pelvic floors; what therapies are used to address it; and which herbs may be used in addition to other therapies. As much as possible, this essay uses gender-neutral terms, except when referring to published clinical studies.
So what is the pelvic floor?
The pelvic floor is located at the base of the pelvis. It is made up of nerves, muscles, and ligaments; the nerves control the muscles and the fascia, which connect everything together. The muscles act like a hammock to support the reproductive organs, urinary tract, prostate, and digestive tract. When these muscles aren’t working effectively, the impact can be huge. People who have pelvic floor dysfunction may also suffer from interstitial cystitis, IBS, and endometriosis.
During pregnancy, pelvic floor dysfunction can cause hip, back, and deep groin pain, and, it may make vaginal delivery difficult and more painful. Aggressive forms of interventions during childbirth like forceps, directive pushing, birth trauma, and episiotomies can cause structural damage, and - C-sections can also cause pelvic floor dysfunctions.
Other root causes of pelvic floor dysfunction are:
Misalignment of the pelvis, due to trauma and poor posture
Sitting for to long on a daily basis
Working out improperly
A previous or existing infection, including yeast infections and urinary tract infections.
Surgery such as a hysterectomy
Menopause due to the loss of estrogen, and lubrication.
Endometriosis that causes tightening of the pelvic floor due to chronic pain.
Tight hip flexors
Leep Procedure (trauma)
Cone Biopsy (shortening of the cervix which affects the surrounding connective tissue and structure)
Range of muscular mechanisms not communicating properly.
There may not be an identifiable trigger to pelvic floor dysfunction
As mentioned above, the pelvic floor acts as a “hammock” for the reproductive and digestive organs. Another element that is very structurally important to the pelvic floor (and the body as a whole) is called fascia. Fascia is a long band of fibrous connective tissue that attaches, stabilizes, and separates muscles and internal organs. Fascia runs from head to toe, covering every muscle, every organ, and every nerve, all the way down to the cellular level. Fascia also produces fluid that provides support and mobility throughout the body. This fluid medium, the extracellular matrix facilitates cell- to- cell communication. When fascia becomes shortened due to accidents, injury, and, daily repetitive stress, it can become dehydrated and lose its fluid medium. This manifests as tightness, tension, and pain throughout the body. The mobility and resilience of the body’s structures are now compromised, and cellular communication is altered - which can affect the pelvic floor. So why not just drink water to rehydrate? Physical therapist Jody Hendryx compares dehydrated fascia to a root-bound plant: "If you have a root-bound plant and you pour water in it, the water will just run through without hydrating the dry, brittle roots. You have to give those roots space so they can absorb water. The same thing applies to our body." Because fascia is such an important structure in the body, and also so neglected, people can end up with a lot of pain related disorders that health care professionals and patients struggle to treat. Finding a body worker who specifically works on facial release, psoas muscle release, and trigger points can be extremely beneficial for people who have a pelvic floor disorder.
This is one of my favorite videos on fascia. It shows how interconnected our fascia is to our whole body.
There are several symptoms of pelvic floor dysfunction. Some symptoms are shared between pelvic floor dysfunction and other conditions, so going to a general physician to get an exam is important. There are medications that can cause symptoms of pelvic floor dysfunction, so patients should be sure to review their medications with a doctor. Patients may need to advocate for themselves to get referred to a physical therapist.
Symptoms of pelvic floor dysfunction include:
Pain during intercourse, including sharp and ongoing pain in the clitoris, vulva, or rectum. Pain during sex is not normal. Besides pelvic floor dysfunction, pain during sex may be due to one or more parties’ unwillingness to engage in sexual activity, insufficient lubrication, or infection.
Pain in the pelvic floor when sitting
Pain during a vaginal exam
Not being able to fully empty your bladder
Pain in the lower back and hips that can’t be explained by other causes
Painful urination. (This includes people who have had recurring urinary tract infections and people whose urine screening tests were negative).
Vulvodynia (chronic pain or irritation of the vulva)
Vaginismus (involuntary contraction of vaginal muscles, often painful)
A frequent need to urinate
Irritable bowel syndrome
Constipation or incomplete bowel movements
Interstitial cystitis (inflammation of the bladder)
Polycystic ovarian syndrome
Rectal spasming and pain
Lower back pain
What is pelvic floor physical therapy? How long does it take to see results? Pelvic floor physical therapy can look like a lot of different things, depending on the individual and what the therapist thinks will help. The physical therapist will usually conduct an evaluation by looking at the patient’s posture, the pelvis, hips, spine, and sacrum, and flexibility and mobility of muscles. An internal exam may also be conducted. This may be vaginal or, anal, and the therapist may use manual palpitation or biofeedback technology. This kind of internal exam usually looks a lot different from a conventional gynecological exam. There usually aren’t any speculums or stir-rups. During the exam, the therapist will use their hand or a dilator to put gentle pressure on tender spots along the vaginal walls until tension is released. Biofeedback techniques using computer imaging can help therapists evaluate pelvic floor muscles and retrain them to address dysfunction. In some cases, such as when vaginal or anal penetration is too painful for the patient, physical therapists will only do external therapy. External pelvic floor trigger points, also known as myofascial points, can feel like a lump or nodule in the muscles. In addition to external and internal work, therapists work on exercises to build muscles, core strength, and mobility. Physical therapy may include 6 to 12 weekly visits, or more depending on the individual. There are different institutions that offer pelvic floor physical therapy, including some hospitals, and also free- standing physical therapy offices.
Physical therapy is not cheap in the United States, and it is also time consuming; I will discuss other therapies below. These are two directories that can help you find a pelvic floor physical therapist ( https://pelvicguru.com/2016/02/13/find-a-pelvic-health-professional/), (http://aptaapps.apta.org/findapt/default.aspx?navID=10737422525&UniqueKey=).
Physical manipulation: dilators
Pelvic floor physical therapy puts health care back into the client’s hands with a series of self-applied routines. There are tools that can be inserted vaginally or rectally to release trigger points. Hands are always an option, but for deeper trigger points that are hard to reach, or if you just don’t want to use your hands, many people use dilators. The best dilator on the market is called TheraWand (https://www.therawand.com or on Amazon). There are two different sizes; the smaller size can be used anally to relieve prostate, anal, and lower back pain or for when the larger size isn't tolerated because of painful vaginal penetration. Never force anything inside your anus or vagina if it is too painful. A pelvic floor physical therapist can show you how to use a dilator properly, but if you can’t see a physical therapist, there are instructional videos available on TheraWands website. When using a dilator for pelvic floor dysfunction, the dilator is inserted into the vagina and used to put gentle pressure on each tender site until there is release or a sense of relief. This is repeated on all sides of the vaginal wall. If using a dilator causes too much pain, take it slow, and take breaks. It can take time. There are lots of other non-invasive techniques to release tension in the pelvic floor including; pelvic floor release stretches, at home hip adjustments with certain motions, strengthening the core, and lots of other techniques.