What’s Up 
‘Down There’?

The importance of paying attention to your pelvic health

If you think you should be suffering in silence with pelvic pain, incontinence, constipation or painful intercourse…think again.

None of these “down there” issues are normal. And they are often highly treatable and preventable.

Even as women grow older, give birth or exercise, they should not be leaking urine.

But there is help. Pelvic floor physiotherapists work with people facing these kinds of pelvic health challenges.

Carolyn Campbell, a women’s health physiotherapist (another name for this profession) at Comber Physical Therapy in Williamsburg, Virginia, says that she is amazed by how people can improve their pelvic health “with just a little bit of education, postural awareness, core strengthening and a lot of knowledge.”

A mother of four, Campbell is passionate about helping women with pelvic floor health challenges.

And it’s never too late to think about your pelvic health.

Campbell recently saw a 70-year-old woman who had scar tissue from a birth 40 years earlier. After Campbell released the scar tissue, the woman became free of pain for the first time in decades.

“Muscles of the pelvic floor are just muscles and they can hurt just like a muscle anywhere else in the body,” says Campbell.

What Is the Pelvic Floor?

We often associate the pelvic floor with women’s health. But everyone has a pelvic floor, including men. 

The pelvic floor is made up of muscles, nerves, tendons, blood vessels, ligaments and connective tissue. There are actually three layers of muscles. They stretch from the pubic bone to the tailbone and reach out to the bony parts of the pelvis that you sit on.

While often ignored, the pelvic floor does a lot for your health. 

It supports the bladder, bowel and, in women, the uterus. It helps to hold in urine and feces and then releases them when you are ready. It stabilizes your back and pelvic girdle, and it assists in moving blood and lymph back to the center of your body.

The pelvic floor also plays a large role in your sexual health.

Strengthening and Relaxing the Pelvic Floor

Just as some people hold tension in the shoulders, Campbell says that others can hold too much tension in the pelvic floor muscles.

Optimal function of the pelvic floor, though, requires a balance of relaxation and strengthening. One of the most common strengthening exercises for the pelvic floor is kegels.

Often, when people think about the core, they focus on the “six pack” abs. But for pelvic health, you need to strengthen the deep core—also known as the “core four”:

  • diaphragm: the dome-shaped muscle attached to the base of the ribs that moves with respiration
  •  transverse abdominus: the muscles that form a girdle around your midsection and are activated during movement of limbs
  • multifidus: a series of muscles attached to the spinal column
  • pelvic floor

A large part of what pelvic floor physiotherapists do is educate people. 

For example, if a patient is experiencing painful intercourse the physiotherapist will talk about options for lubrication, stretches, relaxation and breathing techniques to practice at home.

They will also teach you other techniques and exercises, including how to do kegels properly.

When it comes to pelvic health, silence is not the answer. Pelvic floor physiotherapists have heard all the questions before. 

A visit to one—sooner, rather than later—is a great gift to your physical and emotional health.

Pelvic Health Challenges

Pelvic floor physiotherapists are trained to help patients with pelvic health challenges. These can affect both your physical health and emotional well-being. Some of the most common ones are:

  • Urinary urgency/frequency
  • Incontinence, both urinary and fecal
  • Constipation
  • Painful intercourse
  • Interstitial cystitis: bladder pain syndrome (BPS)
  • Chronic prostatitis: inflammation of the prostate
  • Issues with pregnancy or postpartum recovery
  • Scar tissue
  • Prolapse of the bladder, bowel or uterus
  • Fertility
  • Back pain
  • Diastasis of the rectus abdominus: separation of the abdominal muscles
Improving Pelvic Health

Maintaining your pelvic health is a lot about being more mindful of how you move and using the ‘Core Four’ to support those movements. Here are some that can help:

  • Improve your posture by keeping a natural curve in your low back and a neutral pelvis while sitting or standing. 
  • Move around more by taking frequent breaks when sitting or standing for long periods.
  • Breathe more fully by expanding your belly on your inhale, and bringing your navel up and back toward the spine as you exhale.
  • Avoid high-impact activities, such as running or jumping jacks, if you are leaking urine.
  • Learn ‘The Knack,’ an isometric contraction of the abdominal muscles, the pelvic floor and the back muscles before lifting or coughing.
  • Visit a pelvic floor physiotherapist if you experience pelvic pain, incontinence or any other pelvic health challenges.
“Muscles of the pelvic floor are just muscles and they can hurt just like a muscle anywhere else in the body.”

About the author

Shannon Crow