Pelvic Floor Therapy

How does pelvic floor dysfunction present?

• Pain during sex
• Incontinence
• Vaginal dryness
• Painful periods
• Unexplained hip and lower back pain and tightness
• Constipation or straining to pass a bowel movement
• Inability to activate glute muscles
• Abdominal pain when standing on feet for extended periods of time
• Chronic lower belly bloating
• Digestive problems

What can cause this dysfunction?

• Traumatic injury to the pelvic region
• Gripping to compensate for injuries to lower back, hip, knee or ankle that weren't fully rehabilitated
• Pregnancy or childbirth
• Hypermobility
• Histamine intolerance and sensitivity
• Poor posture and postural imbalance
• Poor breathing patterns
• Anxiety or stress
• Obesity 
• Aging 
• Chronic constipation
• Heavy weight lifting
• IBS
• Endometriosis

*This is not an exhaustive list of symptoms and causes; however, it is many of the more common ones we see.

In my own experience with pelvic floor dysfunction I suffered with hip pain, lower back pain, painful periods, abdominal cramping, the feeling of UTI and yeast infection discomfort (while testing negative for any infection whatsoever), pain during sex, painful urination, and inability to wear anything even remotely tight or close to my body. My experience was due to postural imbalance caused by a back injury, as well as pelvic hypermobility and histamine sensitivity, that lead to extreme pelvic floor tightness. 

Whatever your experience is, this guide will give you noninvasive, affordable and simple approaches to recover your pelvic health and improve your quality of life because no one should have to endure pain day in and day out!

The breath is inextricably linked to pelvic floor health. Whether it is due to guarding an injury, wearing restrictive clothing (tight leggings, regular/sports bras, etc), or some other physical or spiritual imbalance we often lose our full breath. Learning to utilize your full diaphragmatic breath can bring a significant amount of relief to pelvic floor pain and discomfort. You may be wondering how and why..

When you inhale, your diaphragm contracts and lowers into your abdominal cavity. At the same time, your pelvic floor drops and lengthens. When you exhale, your diaphragm releases and your pelvic floor shortens, moving back to its resting position. The diaphragm and pelvic floor muscles work together to regulate pressure in the abdomen with each breath. This connection can help you become more aware of your pelvic floor muscles and is what makes this the perfect starting point.

Breath:

• Your respiratory diaphragm and pelvic floor diaphragm are synergistically connected. Relieving the tension in both will help to optimize your breath and pelvic floor connection.

• Diaphragmatic breathing (otherwise known as a “360” breathing) is a slow, steady deep inhale that allows your chest and abdomen to expand and deflate equally, focusing on full expansion of the ribcage.

• Breathe in through your nose like you’re smelling the flowers. During the inhale, feel the air move down and allow the pelvic floor muscles to relax and lengthen down.

• Exhale out through your mouth twice as long like you’re blowing bubbles through a straw. On the exhale you want to engage your deep core/TA (transverse abdominis) by bringing your belly button towards your spine. You should feel a light contraction of your pelvic floor muscles.

• Complete diaphragmatic breathing about 3-5 minutes per day.

** Note: Very often when women are looking to recover their pelvic floor function they are told to do kegels. I urge you to begin first with your breath. This is because women are likely to be suffering from TOO tight of pelvic floor muscles and kegels exacerbate this tightness resulting in an increase of symptoms. While kegels are intended to tighten and strengthen the muscles, breath will RELAX and strengthen with no risk of exacerbated symptoms. 

• It is also worth noting that chronically wearing high waisted pants/skirts, tight sports bras, regular bras, leggings, or any clothes that are tightly fitted will result in restricted blood and lymphatic circulation, as well as restricted breath. A very simple way to relieve discomfort is to be mindful of what you wear. Opt for breathable, clean fabrics like cotton or linen, and styles that are a bit looser and more flowy.
• To read the clinical literature around tight clothing restricting healthy diaphragmatic breath: https://pubmed.ncbi.nlm.nih.gov/1932263/

Once you have consistently practiced and integrated deep belly diaphragmatic breathing into your daily routine and feel comfortable engaging your core in that style of breath, we will start incorporating a few new styles of breath. 

I have found it beneficial to do these breath work practices first thing in the morning and at the end of my day for optimal success through the day and to relax my pelvic floor before going to sleep so that I benefit from recovery during rest. 

Complete 1-2 sets of 10 breaths in each position in addition to your 90-90 diaphragmatic breathing:

• Hands and knees breathing: in cat-cow pose (on all fours) fully let your belly drop on the inhale and then pull your belly button towards your spine on the exhale to engage your deep core/lower abdominals (keeping a neutral spine through the inhale and exhale)

• Side lying breathing (each side): place your hand on the side of your rib cage thats pointed to the ceiling for tactile feedback, breathe into your rib so that it pushes your elbow to the ceiling 

• Full back body expansion: In child's pose breathe in deeply expanding and pushing the back of your ribs up and out 

*See additional resources for video demonstration 

There are three layers to the pelvic floor.

1. Layer one: Urogenital Triangle 

• Bulbocavernosus
• Ischiocavernosus
• Superficial transverse perineal
• External anal sphincter

2. Layer two: Urogenital Diaphragm 

• Urethral sphincter (sphincter urethrae)
• Compressor urethrae
• Sphincter urethral vaginalis
• Deep transverse perineal
• Perineal membrane

3. Layer 3: Pelvic Diaphragm 

• Levator Ani Muscle (pubococcygeus, pubovaginalis, puboanalis, puborectalis, iliococcygeus)
• Coccygeus
• Piriformis
• Obturator internus
• Arcus tendinous of levator ani
• Arcus tendinous fasciae pelvis

TCM can be used to support pelvic floor health in many ways. First and foremost, acupuncture can significantly reduce pain as well as increase blood flow which will allow toxic stagnant blood to be circulated out and fresh, nutrient and oxygen rich blood in.

Herbal remedies can also be formulated to tonify, strengthen, and relieve the pelvic floor. Outside of a practitioner creating an herbal blend tailored to you, there are herbs you can find and use at home. Ginger, a warming plant, can increase circulation and draw energy to the pelvic floor muscles. Calendula and chamomile can be used to address postpartum pain by adding it to a warm bath before bed. For generalized pelvic pain, dong quai, willow, evening primrose, licorice, and raspberry leaf can be supportive. Additional herbal teas for general pelvic health include, but are not limited to, stinging nettle, peppermint, skullcap, hibiscus, and passionfruit.

Hypermobility can significantly affect pelvic floor function.  I personally struggle with my pelvic floor not only due to the injuries I experienced, but also due to having a hypermobile pelvis and hips among other areas of hypermobility. 

While I will not go into detail on hypermobility in this article, I wanted to make a note that during certain phases of our cycle we may have times that we notice an increase or decrease in severity of our hypermobility symptoms.  For example, in the 5 days leading up to menstruation and the first few days of  menstruation an increase in progesterone that exceeds the levels of estrogen results in a worsening of symptoms including joint pain, clumsiness, and an increase in tendency to subluxate.

If you are like me and have a hypermobile pelvis or generalized hypermobility, you may notice that during this window just before and at the start of your period you have a harder time doing these pelvic floor exercises.  It can be more difficult to engage those deep pelvic floor muscles effectively due to the increase in ligament laxity. 

I encourage you to track your cycle as well as how your body feels throughout your cycle in order to find a movement and recovery routine that honors your body where it is at.