Most people think about the pelvic floor when it comes to childbirth, incontinence, endometriosis, and/or prostate issues. When they have issues that take them to their medical doctors, they may learn that they need to see a pelvic floor therapist for painful intercourse, perhaps tears or trauma during childbirth, incontinence, or issues related to sexual activity pain, or dysfunction. That means that even the majority of the medical doctors seeing patients don’t do proper referrals when it is indicated because unfortunately, the health care system is myopic in its assessment of patients. This is a matter of close vs broad viewing of patients’ presentations, therefore not having a holistic approach to health.

If pelvic floor dysfunction was a book, all those signs and symptoms mentioned above and more are chapters of the book; I recommend you read the many blogs I have written, exploring pelvic floor dysfunction and its’ related, mostly missed in diagnosis, causes.

What is Pelvic Floor Dysfunction?

As explored in my blog on Pelvic Floor Dysfunction, pelvic floor dysfunction has to do with the pelvic floor which is comprised of muscles, tendons, and connective tissue that line the pelvic inlet, the ‘bowl’ that your thighs and spine are attached to. 

The dysfunction also includes the walls of the ‘bowl’ which include the bones of the pelvis and the muscles that line it. We are talking about the ileum, sacrum, spine, both hips, and the joints that are formed by any two of these bones that come together. These include the sacroiliac joints, lumbosacral joint, hip joint, and pubic symphysis in the front of the pelvis right at the pubic area. All muscles that are in any way connected to any parts mentioned here are directly involved, therefore influencing, the health of the pelvis and its’ floor. 

Lack of coordination of movement among all of these parts leads to pelvic floor dysfunction presented by its many faces.

What Causes Pelvic Floor Dysfunction?

Since we are talking about the part of your body that is the base of your torso and spine, then imagine what activities and factors do NOT include it!! When it comes to movement, your pelvis is 100% involved no matter what. While some people may lose the function of one or more lower extremities, they still have their pelvis which is the base of their torso. You can live without your legs but can’t live without your torso and yet, we hardly ever give any thought to preventative care to the pelvis and pelvic area!

Our lifestyle, habits, and injuries throughout our lives impact the pelvic region and that means from birth to death. However, almost no one thinks twice about things like those childhood falls when riding a bike, playing soccer and getting hurt, the unsuccessful splits, the headstand attempts we all have done to name a few.

Do You Know If You Have Pelvic Floor Dysfunction?

A bold answer is YES. If you live in a first-class society, your sedentary lifestyle is constantly feeding your dysfunction. If you think you work out every day so your lifestyle is not sedentary, think again!! Unless your job does not take you to more than 2 hours of sitting per day, you have pelvic floor dysfunction; the 2 hours includes driving more than 30 minutes at any given time. Why do you think we now have standing/sitting desks? I started recommending that (there were no combination desks back then) almost 2 decades ago and it has taken us this long to catch up in the making of these desks.

How Can a Child Have Pelvic Floor Issues?

In my blog on Pelvic Floor Dysfunction, I have talked about the many potential causes of it and to answer the question here, I want to remind you that almost all possible causes of pelvic floor dysfunction are applied to children as well as adults. For instance, childbirth trauma is not applicable to children, and frankly not every childbirth is traumatic to the pelvic floor.

The stories that lead to the dysfunction may vary while there are only a handful of paths that can go wrong. When it comes to children, any injuries related to a fall, blunt trauma to the crotch area such as falling on the front bar of the bicycle or falling on a stair railing, competitive one-sided sports, hockey, soccer, water polo, skating, gymnastics, and the many dancing classes that all fall under this category.

Anything that tweaks the pelvis sets it up for future pelvic floor dysfunction and yet unless the parents or adults think a bone is broken or concussion needs to be ruled out, children are hardly looked at for pelvic floor dysfunction after an injury. Of course, this applies to adults too – how many times do we hear how everything is good because no bones are broken?

Soft tissue injuries are much more difficult and problematic than broken bones.

How is a Child Evaluated for Pelvic Floor Dysfunction?

Children never receive an internal manual exam (though vagina and/or anus) as a part of their initial evaluation and hardly ever receive internal manual treatment as their course of action. Their exam includes all the external manifestations of the pelvic floor dysfunction and as always the consultation time, the time the health care provider hears their story, plays a huge role in the discovery phases. It is the combination of the history taking and external exam that determine the treatment plan.

Who Treats Children for Pelvic Floor Dysfunction?

While pediatricians are the doctors that children typically visit for their sickness assessment, they are not the health care professionals that treat pelvic floor dysfunction. While most pelvic floor therapists are physical therapists, chiropractors, occupational therapists, and nurses who are trained for pelvic floor issues are all great resources.

The key is then to find the practitioner who has a comprehensive knowledge not only about the pelvic floor but the orthopedic aspects and presentation of the pelvic floor dysfunction.

Holistic Treatment of Pelvic Floor Dysfunction

Postural Neurology Exam

This is an exam with a focus on the parts of the brain that are involved in balancing and posture. There is a map of movement and sensation that we are all born with which gets detailed most during the first couple years of life.  If movement was a concert, the brain is the conductor and the map of movement is the musical note. If the notes read a modified song, the concert will pay that modified song. To understand more about how and why this map gets modified, read here.

Functional Movement Assessment

This is to see how functional or dysfunctional you move. Just because you move does not mean you are moving based on the ‘pre-set’ movements that you are born with! All babies go through the same movement patterns of development so we must be wired to do so and the reason why no infant to toddler gets coached on how to move or uses weights/ bands to strengthen. It is important to use what we know now to see where you stand compared to that.

Active Release Technique (ART)

This is what I call the cleaning process. Through dysfunction and deviation in movement from the innate designed way, our movements change, and not only do our joints get restricted but the synchrony and order that our muscles do their jobs changes. Through ART, some order is restored so the retraining process can have a better chance of restoring function.


We are all breathing but chances are no one is breathing correctly. What is correct breathing? The kind of breathing we all did as babies which we now know is the reason why all babies have a big proportion of girth around their belly area. This video explains it all.

Dynamic Neuromuscular Stabilization Exercises (DNS)

This is the actual exercises we do with all of our patients, pelvic floor dysfunction or not, to restore functional mobility and get rid of pains and associated issues. I suggest you read about DNS for all musculoskeletal issues. 

Emsella Chair Treatment

This only applies if there is a weakness of the pelvic floor muscles and while the machine is FDA-approved for incontinence, it is the 400 Kegel per minute capability that makes it attractive for many pelvic floor dysfunction treatment cases.

Hobby/ Sport Review and Modification

This varies from sport to sport but the DNS principles apply no matter what.

Sleeping Assessment and Modification

Schooling Ergonomics

The same concepts and applications as work ergonomics apply here. Use this checklist to see how well you score on the schooling ergonomics.

Nutrition Review

Last but not least is how well your nutrition supports tissue repair. Generally speaking, we need a good amount of Vitamin D3, Vitamin C, Magnesium, and protein for our muscles to heal and that goes for children as well as adults.

If you have questions or wish to be evaluated for pelvic floor dysfunction, contact my office.

DR. Shakib