To most people, pelvic floor dysfunction equates to only the pelvic floor and that is not true. The pelvic floor is the inner lining of the pelvic inlet and the pelvic inlet is the inside part of your pelvis that resembles a bowl shown below.
Pelvic floor muscles are considered to be partly accessible from the outside and then there are parts that can only be accessed from inside. The point to remember is that regardless of what layer of pelvic floor muscles we are talking about, a weakness of any of these muscles impacts all the other muscles as well.
The pelvis is connected to the lower back and hips and itself is comprised of 2 bones, the sacrum and ilium. That means there are quite a few bones and associated muscles that directly influence the muscles of the pelvic floor. Unfortunately, in most pelvic floor therapies, they are ignored as the attention is fully given to the pelvic floor muscles only.
What is Pelvic Floor Dysfunction?
My blog on the very subject explains it in detail and what is important to note is the word dysfunction vs function. All dysfunction when it comes to the musculoskeletal system and movement, with the exception of genetic conditions and certain diseases, have to do with altered movement patterns.
We are all born with a blueprint of movement called homunculus that gets detailed in the first 2 years of our lives. This map gets altered based on our lifestyle and injuries as examples. That is when the functional movements become dysfunctional movements.
Pelvic floor dysfunction is no exception to this which means that alterations in the synchronicity and systematic engagement of joints, muscles, and ligaments, directly and indirectly, impacting the pelvic floor leads to Pelvic Floor Dysfunction.
Is Incontinence the Same as Pelvic Floor Dysfunction?
While all people with incontinence have pelvic floor dysfunction, not every pelvic floor dysfunction cases are with incontinence. Incontinence is unfortunately much more common than ever before and it is now involving people of all ages and genders. We can thank our sedentary lifestyle for that as the pelvic floor and all of our body get to be overused and underused depending on our length of time sitting and our sitting environment.
Why is Pelvic Floor Dysfunction Not Treated Fully?
What it takes to properly treat pelvic floor dysfunction unfortunately in the United States of America turns into a multi-specialty treatment where the specialists don’t even communicate with each other! Let me explain:
If you read the recommended blog above, you will see that pelvic floor dysfunction is a collection of issues most of which have to do with the musculoskeletal system. Then pelvic floor weakness is equated to pelvic floor dysfunction while the hips, lower back, and sacroiliac joints, contributors of the pelvic floor dysfunction, are almost never looked at as the preliminary steps to pelvic floor dysfunction.
We have urologists, urogynecologists, pelvic floor physical therapists, chiropractors, orthopedists, and neurologists to name a few specialists that patients with pelvic floor dysfunction visit, and they all do their own things. If the Medical Doctor is sought first, the likely referral is a pelvic floor therapist which in most cases are physical therapists but also registered nurses and chiropractors. The focus then is to do manual internal work and Kegel exercises it seems. Perhaps occasional muscle work but that is not even the focus of the attention.
In my podcast interview with a pelvic reconstructive surgeon, I tried to dig in to see if there is any conversation among the surgeons, neurologists, and therapists about prevention and the answer was essentially NO!!
What is the Missing Link in the Treatment of Pelvic Floor Dysfunction?
- Pelvic floor muscles are part of the musculoskeletal system and as such react to therapy just as all the other muscles of similar type. That means no matter what the story behind the weakness and the overall tightness is, it should never be treated by itself but the surrounding areas and the attachments to the pelvic inlet have to be addressed as well.
- That means while medications may help alleviate some of the symptoms, no medications ever address the root cause of the problem.
- That means while behavior modification plays a huge role in some of the symptoms and while behavior modification is always part of the solution list to all issues (your behavior about life changes how you do everything in life), it is not going to correct any dysfunction.
- All dysfunctions started as function and if we reverse engineer all musculoskeletal conditions, we go back to the brain and the blueprint of movement. Pelvic floor dysfunction is no exception.
- Even if there is a neurological component to the pelvic floor dysfunction, that does not take away the fact that pelvic floor muscles need to learn how to work with the rest of the body regardless of the nerve issue that might have contributed heavily to its existence.
- Movement is like a concert and the body parts like the musicians; that the musicians not only need to know their part but to know when to chime in and phase out. That means the pelvic and pelvic floor need to know how to ‘play’ with the rest of the body if they are to sustain their strength and integrity. This is what Postural Neurology is all about.
- Common sense says that the most authentic way to move is the way babies move. After all, all babies from all over the world go through the same developmental stages of movement (Developmental Kinesiology) which means that we are hard-wired to move that way. So if the issue is movement-related or supported, then we should see how we compare to the way we moved as babies. All discrepancies are then highlighted and can be corrected through Dynamic Neuromuscular Stabilization (DNS) exercises which are baby movements.
- There are machines like Emsella Chair that do 400 Kegels per minute involving all of the muscles of your pelvic floor and not the ones that you hope to be engaging. Note that Kegel exercises are not for all types of incontinence and pelvic floor muscle issues.
- Do know that no matter what we learn on the internet and social media, authentic breathing is what babies do automatically and that is what we need to do in order to sustain the bottom of the breathing apparatus, the pelvic floor!
I hope this blog shed some light on the many parts of your pelvic floor dysfunction, with or without incontinence, pelvic pain, and sexual dysfunction so you know more than likely what has been done is a partial treatment; all partial treatments produce partial solutions which means the problem is still lingering and on the horizon.
Make sure to read all my other blogs on pelvic floor dysfunction and check out my Youtube channel dedicated to pelvic floor dysfunction. If you have any questions, please contact me.
Dr.Shakib