The thought of pelvic floor therapy may make you nervous, especially if you are a man and are told you need pelvic floor therapy done. To put your mind at rest, let me tell you that pelvic floor therapy does not have to include internal manual work; in fact, in almost all cases, we should first stabilize the ‘house’ before doing anything to the ‘floor’.

So, why is internal manual treatment not a must? Let’s see what the pelvic floor is and where it is located first.

Where is the Pelvic Floor?

In my blog, “Where are pelvic floor muscles and why do they get weak”, I explain “You cannot have a pelvic floor issue by itself without the involvement of the pelvic walls. While the pelvic floor is the muscles lining the inside of the pelvic inlet (the inside part of your pelvis where the intestine, bladder, ovaries, and prostate reside), the walls are lined with muscles and the whole pelvis is attached (therefore impacted) by what it is attached to, being the lower back and the hips. Then we have to look at the pelvis itself which consists of two bones called ilium that are attached to the sacrum (the lower tip of which is the tailbone).”

Pelvic Floor group hosted at CPFT

Core Pelvic Floor Therapy hosts PF courses

At the end of the day, with the internal manual treatment what is reached depends on the length of the index finger and the pelvic floor is more than what is reachable that way. Pelvic floor therapists which, by the way, are more than just physical therapists and include chiropractors, occupational therapists, nurses, and physicians all of whom have taken courses on how to assess and treat the pelvic floor. Regardless, all know that the true pelvic floor treatment must include:

  • Breathing
  • Lower back
  • Hips and
  • Posture

The issue is we are accustomed to getting things done by others – being passive in our role as patients and addressing breathing, lower back, hips, posture, and movement requires the active involvement of patients.

There is 100% value to going internal and assessing what is going on but what does not make sense is when we limit the treatment to primarily that portion. If we catch the issues when that initial lower back pain becomes chronic lower back pain, when the hip mobility restriction is not overlooked, when we don’t resort to ‘zappers’ to improve our posture, that is when we truly work on stopping the instability of the ‘house’ that pelvic floor is the ‘floor’ of.

What is the Treatment of Pelvic Floor Dysfunction?

The treatment for pelvic floor dysfunction has to always include the external part and at times may include internal manual work. I say, at times, because many times the symptoms such as frequent urination, painful intercourse, Erectile Dysfunction, lower back pain, tailbone pain, hip and lower extremity pain, frequent UTI, and other ‘chapters’ of the ‘book’ pelvic floor dysfunction are gone. Of course, it never hurts to assess the muscles that are only reached internally to see how well they are doing.

I have done a blog on the anatomy of the pelvic floor that I suggest you review to see what muscles are reachable inside the pelvis when doing internal manual work. I also suggest you visit my YouTube channel to learn about the different manifestations of pelvic floor dysfunction to better educate yourself on what they are and what to do about them.

The treatment of pelvic floor dysfunction regardless of the cause must include:

  • Behavior modification which is always part of the solution list to all issues (your behavior about life changes how you do everything in life), is not going to correct any dysfunction fully, but addresses some of the feeders of the problem.
  • Postural Neurology: Movement is like a concert and the body parts are like the musicians; in that the musicians not only need to know their part but to know when to chime in and phase out. That means the pelvis 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.
  • Functional Movement: 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.
  • Kegels? There are machines like the 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.
  • 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!
  • Internal manual work which ideally should be done to assess the muscles inside the pelvis BUT does not have to be done in all cases.

If you do not wish to have internal manual work done, express your wish to your pelvic floor therapist. If you need help with your pelvic floor dysfunction or want to see if you have pelvic floor dysfunction, contact me.

Dr. Shakib