Diving Deep into Pelvic Floor Dysfunction

Today I have a guest blog from Dr. Brianne Grogan, PT, DPT.I interviewed Brianne a while ago for a Couch Talk podcast focused on Pelvic Health... if you missed that, you can still view it here.

As I have been talking about for a while now, keeping your overall sexual health in optimal shape as you age involves a lot of things...you need to have the right diet and exercise, reduce your stress and nurture your relationship, address dryness and other vaginal atrophy symptoms, and also focus on overall pelvic health.

Brianne Wrote This Wonderful Blog On "Pelvic Floor Dysfunction"... So Important For All Of Us! Enjoy it!

By Dr. Brianne Grogan
Last month, HBO star Zosia Mamet publicly admitted that she had pelvic floor dysfunction (PFD). Zosia's PFD caused her years of sexual difficulties, pain, and problems with urination. She described how she was misdiagnosed, was prescribed medication that made her gain weight and feel depressed, and ultimately, was told that it was all in her head.

What is PFD? And Just How Common Is It?

pelvic bone copyright Brianne

Pelvic Floor Dysfunction (PFD) is a general term that refers to a wide range of symptoms that can occur "down there." Sadly, Zosia's story is not unique. Millions of women (and men) suffer from various forms of PFD and feel just as alone and "crazy" as Zosia describes!

Let's dive a bit deeper into PFD and see how it might apply to you, or to someone you love.

The pelvic floor is a group of muscles located at the base of the pelvis. The pelvic floor muscles act as a support system for your abdominal and pelvic organs. They also help close off the orifices they surround, including the urethra, vagina, and anus in women, and the urethra and anus in men.

In a perfect world, the muscle fibers that comprise your pelvic floor would always have the perfect length-tension relationship to make them "on enough" to support your body throughout the day, and also to be able to quickly and effectively turn "extra on" when needed — such as when you're coughing, sneezing, laughing, or running to catch the bus.

Unfortunately, due to poor posture, sedentary lifestyles, hormonal changes, and childbirth many of us experience dysfunction in our pelvic floor over time. The length-tension relationship in the muscle fibers change, or injuries to the muscle fibers occur, causing all manner of problems related to PFD.

PFD usually presents as weakness or excessive tension in the pelvic floor, and manifests as either a lack of support (causing issues such as pelvic organ prolapse or back pain), or a lack of closure (causing issues such as bladder leakage, fecal incontinence, or unintentional "slips" of wind). Too much closure, or an inability to relax these muscles, can cause painful sex, difficulty initiating the stream of urine, and generalized pelvic pain which is often felt in the buttocks, tailbone, or groin.

It's easy to think that if you're leaking urine, or if you have a prolapsed bladder (for example), that your pelvic floor muscles are weak and overstretched. 

However, that's not always the case. A startling number of cases of PFD are actually a result of overly tense, overly tight pelvic floor muscles that I sometimes refer to as "Hulk Vagina."

With the "Hulk Vagina" version of PFD, the pelvic floor muscles that surround your vaginal canal (and rectum and urethra) are hyperactive. The muscle fibers are firing, but they’re NOT doing their job. They’re simply “on” — overly “on,” in fact — and are unable to turn off so that the pelvic floor muscles can return to that ideal length-tension relationship I mentioned earlier.

hulk pelvic health

Vaginismus is an extreme example of this situation.

Vaginismus is when the muscles that surround the vagina involuntarily or persistently contract when vaginal penetration is attempted. These contractions can prevent sexual intercourse, cause generalized pelvic pain, and make your gynecological exams (and monthly tampon insertion) difficult if not impossible. It’s an incredibly frustrating condition! Thankfully, there is help in the form of pelvic floor physical therapy.

Do You Have a Hulk Vagina?

Even if you don’t have vaginismus, if you have any of the following conditions then you might have overly active pelvic floor muscles:

  • Difficulty with evacuation (bowel movements and urination).

  • Frequency of urination and the sensation that your bladder is always partially full (caused by the pelvic floor muscles being so tense that they don’t allow the bladder to fully release).

  • Generalized pelvic pain/discomfort, including pain with intercourse.

  • The feeling that “no matter how many Kegels I’m doing, it’s not helping my incontinence, prolapse, etc...” (because in actuality, Kegels are exacerbating an already overactive pelvic floor).

Check-In: Are You Able To Relax Your Pelvic Floor?

Try doing a Kegel. My favorite visualization is to picture your pelvic floor as an elevator. Close the imaginary elevator doors (i.e. squeeze your pelvic floor muscles around your vagina and anus) and then lift the “elevator” up to the third floor. Next, allow the “elevator” to descend (i.e. relax/release your pelvic floor contraction), and then open the “elevator” doors all the way (completely relax the pelvic floor).

Check in with yourself! Were you able to sense a difference between the contraction and relaxation phase? Could your pelvic floor “elevator” go up AND down?

What If You Can't Relax Your Pelvic Floor? What's Next?

Women with vaginismus should NOT do kegel exercises on a regular basis. Rather, they should seek the care of a women’s health physical therapist. Techniques such as manual therapy, EMG biofeedback, and various methods of pelvic floor “down-training” must be done BEFORE beginning any type of “up-training” (or strengthening) program.

Think of strengthening your arm muscles with biceps curls: You wouldn't grab a dumbbell and curl it toward your shoulder over and over without straightening your arm between reps. When working your biceps muscle, you must fully bend your elbow AND fully straighten it to get the most out of the exercise!

It's the same with your pelvic floor muscles. You must be able to completely relax before you can successfully contract. The hard part is that unlike your arm muscles, the pelvic floor muscles are harder to see (and even feel, sometimes) since they are hidden deep inside your pelvis.

Coordination is Key

When re-training your pelvic floor muscles, whether you're working with a physical therapist or on your own, always keep in mind that coordinated, supple, and responsive pelvic floor muscles are the goal (not just “strong”).

You want your pelvic floor to be able to quickly and effectively contract, but also to fully and completely RELEASE after contraction. You want them to be sufficiently relaxed (when at rest) so that they DON’T cause discomfort, muscle fatigue, painful sex, etc. Furthermore, you want to position your body (via good posture) such that your pelvic floor muscles are always at the right level of “on” to SUPPORT your pelvic organs and be able to quickly turn “extra on” when needed, for example:

  • when you’re about to pass gas but you’re not in an area where it’s appropriate…

  • when you really need to pee and you can’t get to the bathroom right away…

  • when you’re about to sneeze, cough, or blow your nose…

  • when you’re jumping on a trampoline…

  • when you’re preparing to lift something heavy…

There’s a FINE BALANCE that needs to be established.

If you feel that your pelvic muscles are overly active and “Hulk-like,” seek help of a women’s health physical therapist. There is HELP!

If you’re looking for a place to start learning how to relax/release on your own, check out the following video:

I also love hip circles and other forms of flowing, multi-planar movement for people with overactive pelvic floor muscles. Hip circles simultaneously stretch AND strengthen… They both lengthen AND tone the muscles of the pelvic floor and the entire hip and core region. I discuss hip circles a bit in my podcast with Dr. Anna... check that out here.

To Sum It Up:

Whether weakness or excess tension is the primary dysfunction in your PFD, a lack of coordination and control of the pelvic floor (and surrounding) muscles is usually the ultimate concern.

If you're dealing with PFD, know that you are not alone, and if you need help with something, speak up! Talk to your healthcare provider, and if he or she doesn’t take you seriously, talk to someone else. There is help out there, and you know your body best… So listen to it if it’s telling you that something is “off.”

For a women's health physical therapist locator, click here: http://www.womenshealthapta. org/pt-locator/

Dr. Brianne

Dr. Brianne Grogan, PT, DPT graduated as a Doctor of Physical Therapy in 2006 and founded FemFusion® Fitness. Today, she teaches and shares her FemFusion “feel-good fitness” philosophy via live and online classes. Dr. Bri is the author of LadyBits: Understand Your Body, Elevate Your Health, and Reclaim Your Spark Naturally, and a certified women’s health and nutrition coach. 

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Dr. Anna Cabeca

Dr. Anna Cabeca

Certified OB/GYN, Anti-Aging and Integrative Medicine expert and founder of The Girlfriend Doctor. During Dr. Anna’s health journey, she turned to research to create products to help thousands of women through menopause, hormones, and sexual health. She is the author of best-selling The Hormone Fix, and Keto-Green 16 and MenuPause.

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