Pelvis ligament courtesy of drlaurenkeller.com

When it comes to pelvic floor dysfunction, it sure seems that we are quick to do primarily internal manual work, which helps btw, but not enough. Yes, that means even if you have urinary incontinence as a result of let’s say a nerve issue to your bladder, internal manual work is only going to help you to some degree and is not the complete treatment by itself.

If pelvic floor dysfunction was the name of a book, urinary incontinence, fecal incontinence, pelvic pain, tailbone pain, pain during intercourse, pain at the onset of intercourse, testicular pain, erectile dysfunction, weak pelvic floor, hip pain, lower back pain, sacroiliac pain, and poor posture would be the chapters of it. THAT is the key concept to remember and where we fail when it comes to the treatment of pelvic floor dysfunction.

While most pelvic floor therapists are physical therapists who are trained in the pelvic floor, there are other providers such as chiropractors, occupational therapists, nurses, and physicians who get additional training and treat the pelvic floor. While the training involves assessment of the posture, breathing, and muscles of the pelvic floor, it seems that most therapists are quick in focusing on the internal manual work primarily. This becomes a disservice to the patient because the condition does not fully resolve or the resolution does not last because a partial treatment only provides a partial solution!

So then who do you see that looks at you as a whole and makes sure nothing is missed? This video explains it in detail.

Telltale Signs of Pelvic Floor Dysfunction

Would you work on improving your kitchen floor if the walls were unsteady? Hope you said no because working on the internal part of the pelvic floor when the pelvis itself is not stable is going to bring some improvement but it is not going to last!

So then the next question is how to tell if the pelvis is unstable, right? One of the things I do when it comes to treating patients with pelvic floor issues is to assess their pelvis and you can do that yourself too! Does your pelvis tilt forward or backward? Do you arch your back (so you stick your gluts out) or sort of collapse your back (like hunching)? Do you lock your knees? Do you have forward shoulders (which force your pelvis to collapse backward) or arch your chest out like in a military posture?

These all mean that your pelvis is not leveled which means the floor itself cannot be leveled. Remember, the pelvic floor itself is the collection of muscles that line the inside of your pelvis so the floor is more than the muscles, but includes:

• The pelvic bones
• Tendons
• Ligaments
• Nerves
• Connective tissue
• And of course, whatever is connected to the pelvis (lower back and hips) that directly influences the stability of the pelvis.

Look at your pelvis like a bowl sitting on 2 legs; if the legs are unstable or one pulls more than the other, the whole bowl becomes shaky. Internal work on the pelvis through the vagina and/or anus in an attempt to relax or strengthen the muscles that line the pelvis becomes a waste of time when those muscles get tight and weak because they are compensating and trying to adjust to what makes the pelvis shaky and unstable. Do you see the correlation?

How to Start Treatment for Pelvic Floor Dysfunction?

You may be getting a referral from your physician treating you for whatever ‘chapter’ of the ‘book’, “Pelvic Floor Dysfunction” you may be experiencing and that referral does not necessarily mean you are going to a therapist with a thorough approach in assessing your pelvic floor dysfunction. This might have not been what you thought but it is the truth; your physician knows pelvic floor treatment is not their forte and refers you to a pelvic floor therapist whom they may know directly or indirectly.

The best way to know if you are being treated by the most thorough pelvic floor therapist is to talk to them before your appointment and ask what their exam entails. Then read their reviews to get a feel of what they are about; see if they have a youtube channel to then see if they are about all ‘chapters’ of the book or they only focus on one of the ‘chapters’! Social media is a great resource to learn from so use that to your advantage.

Now that you are ready to start your treatment, go in prepared with the questions you have and do not think that your questions are too basic or silly; there is no such a thing and you have to be an active participant in your own treatment. I have written a blog on the proper treatment for pelvic floor dysfunction that I strongly recommend you read. If you have any questions or need help with your pelvic floor dysfunction, contact me.

Dr. Shakib