By Stephanie A. Prendergast, MPT, Cofounder, PHRC Los Angeles
To start, there are various functions we can thank our pelvic floor, but let’s get into the MAIN functions:
Part of core muscles
The pelvic floor supports your core muscles: transversus abdominis, rectus abdominis, and the external oblique muscles. The PFM tends to act reflexively when we’re using our core under normal circumstances.
Supports pelvic organs
The pelvic floor muscles run from your pubic bone back to your tailbone. They support your pelvic organs and are also responsible for urinary bowel and sexual function.
Urinary and bowel control and comfort
As your bladder fills, the pelvic floor muscles will tighten so you don’t leak urine. As gas or stool enters the rectum, the pelvic floor muscles tighten so you don’t lose control of your bowels. When you go to use the restroom you naturally relax the muscles to initiate your urine stream.
Involved with sexual function and pleasure
When vulva owners, start to enter the arousal phase, muscles of this part the anterior pelvic floor start to contract and that allows blood flow to enter the clitoris and result in clitoral engorgement, as well as facilitating lubrication from our glands in the vestibule.
For those with a penis, most people can relate to the muscles also getting tight and they help to keep blood flow in the penis, which results in erection. As one goes through the sexual response, they start to get closer to orgasm, and when people have an orgasm the muscles of the pelvic floors are rapidly contracting to result in ejaculation for some, and sexual pleasure for all.
Fun fact: During an orgasm, the pelvic floor muscles contract up to 64 times in a minute!
A common misconception about the pelvic floor is that it works in isolation. However, the pelvic floor works with the back, the abdomen and the hips, and is reliant on healthy joints above and below to function at its maximum capacity.
The pelvic floor is a DYNAMIC stabilizer and is the first set of muscles to turn on when we initiate any movement. This helps to keep us upright and to keep us from falling over. Therefore, a complete pelvic floor assessment will almost always involve analyzing your functional movement patterns at some point in the process.
We need our pelvic floor when we are walking, squating, balancing etc.!
Many people may have symptoms that occur in the pelvic floor. But as we often see, sometimes the pelvic floor muscles actually are functioning very well! It’s that the individual’s back, hips, knees, ankles . . . sometimes even their toes, do not support the body in the way that they should, which leads to compensatory movement patterns.
Having a biomechanical assessment can help us identify the root cause of your symptoms! Drop your questions in the comments below!
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Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
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FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.