​PILLE Physiotherapy I Musculoskeletal and Pelvic Clinic

The bony-ligamentous pelvis is one of the most stable parts of our body, consisting of the two pelvic bones and the sacrum wedged between them. The lower outlet of the pelvis is closed by a muscle-connective tissue network, which is called the pelvic floor. The pelvic floor is between the pubic bone and the coccyx, and is attached to the pelvic bones on both sides. The fibrous-connective tissue plates (fascia) of the pelvic floor pass into the fascia of the muscles and trunk muscles around the pelvis, thus creating a functional connection with each other.

If there is pelvic floor dysfunction (weakening, hyperactivity), not only the pelvic floor itself deserves a thorough examination, but also the lumbar spine, hip joints, and the muscle system connected to them (abdominal muscles, lumbar muscles, muscles around the hips).

Pelvic floor muscles (PFM) perform various functions in the human body:

  • they support our internal pelvic organs (bladder, uterus, rectum)
  • they help the closing function of the urethral and rectal sphincters and
  • they also play a role in experiencing sexuality

If we want our pelvic floor muscles to function well for many years, we need to take care of them in the same way as the other, clearly visible, palpable muscles of our body. These muscles also need to be strengthened and stretched! These muscles also have:

STRENGTH

The pelvic floor muscles must support the pelvic organs, resist coughing, sneezing, jumping, lifting weights, running, etc. caused by the increased pressure in the abdominal cavity, otherwise the urine can easily drip.

ENDURANCE

The muscles of the pelvic floor must have a healthy tone even with advancing age, against the increase in pressure in the bladder (urination). For example, in healthy conditions, you can hold your urine for 1-2 hours running, with normal toned pelvic floor muscles and bladder muscles, adequate fluid intake and distribution, and even without a strong urge to urinate. (Note: if you consume food or drink with a diuretic effect before running – coffee, green tea, asparagus, etc. – you may also experience an urge to urinate sooner.)

FLEXIBILITY

The pelvic floor muscles are capable of stretching and contracting and always return to their resting state. If there is no problem with the nervous system and these muscles are sufficiently flexible, urination and defecation are corresponding, the movements of the pelvis and hip joints will be freer, and the experience of intimacy will be more intense.

COORDINATION

The muscles of the pelvic floor also need to have a coordinated functiation with bowel movements and our breathing, they need to know when it is necessary to contract strongly (e.g. during an unexpected sneeze) and when to relax (e.g. when urinating).

TIMING

In the case of rapid effects, such as sneezing or the rapid, continuous impact of our feet on the ground while running, the pelvic floor muscles must be able to contract and relax to a certain extent in time and in coordination.

PELVIC FLOOR TRAINING

It is recommended to perform pelvic floor training:

  • prevention

It is important for both girls and women to learn pelvic floor training, to educate about intimate health, and to preserve the healthy condition of these muscles. This never happens by only doing Kegel exercises, we treat the whole person holistically.

  • for high-impact, shaking, jumping and hard physical activities (running, aerobics, certain dances, ball sports, etc.)

for high-impact, shaking, jumping and hard physical activities (running, aerobics, certain dances, ball sports, etc.)

  • prevention before pregnancy
  • during pregnancy from the 2nd trimester
  • after birth
  • before pelvic surgeries
  • after pelvic surgeries
  • in case of mild, moderate stress and mixed urinary incontinence as first-line therapy
  • as additional therapy in case of urge urinary incontinence and overactive bladder
  • wind and fecal incontinence
  • in case of uterine prolapse, bladder hernia and rectal hernia
  • to improve sex life

When the goal is prevention or the treatment of mild symptoms, we can also learn the correct pelvic floor training in a group lesson led by a physiotherapist. In case of more complex, moderately severe complaints, choose individual therapy led by a physiotherapist.

Relaxation of the pelvic floor muscles may also be necessary when these muscles are overactive.

What are the symptoms of an overactive, tight pelvic floor?

  • burning pain in the vulva
  • constipation
  • pain during intercourse
  • symptoms typical of a urinary tract infection
  • lower back pain, coccyx pain
  • muscle tension caused by stress and anxiety

When should you contact a urogynecologist or pelvic specialist physiotherapist?

  • symptoms affect daily activities
  • the symptoms affect sexual life
  • the symptoms affect urination and defecation

More information about pelvic floor muscles and pelvic floor training can be found on the website of the International Urogynecological Association:

https://www.yourpelvicfloor.org/media/Pelvic_Floor_Exercises_RV2-1.pdf

Source: https://www.intimaterose.com

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