So you have a pelvic floor issue or at least you are told you have it, you have to do what is the customary treatment for the pelvic floor but your pelvic floor pain, incontinence, or pelvic floor weakness still exists. What are you to do now?

First, let’s get the most important fact straight and that is that a pelvic floor issue is never an issue by itself and comes in different shapes and forms. If pelvic floor dysfunction was the name of a book, the chapters of that book would be the different forms of the dysfunction.

The different chapters may be pelvic floor weakness, urinary incontinence (and its many types), fecal incontinence, uterine prolapse, bladder prolapse, rectal prolapse, Pudendal neuralgia, lower back pain, knee pain, hip pain, pelvic pain, tailbone or coccyx pain, poor posture, difficulty with proper breathing, and hemorrhoid to name a few.

You may be very familiar with one or more of these, or maybe told that because you are of this and that gender, it is expected, as if that will solve the problem!!!

Enough is enough so let’s explore what you ought to do if what you have done for your supposed pelvic floor issue has not worked!

Your Treatment Was Not the Full Answer

That is right, the right answer only happens when all aspects of pelvic floor issues are assessed to see what your story is and then all that was out of the norm are addressed. That is more than an internal manual exam, that is more than a couple of exercises off of YouTube and Instagram, and is more than the good o’l Kegel exercise.

I strongly suggest you read my blogs on What Kegel exercise is and if it works and exercises for pelvic floor muscles. You will learn that no matter what ‘chapter’ of the book, ‘ Pelvic Floor Dysfunction’ you read, there are a set of items that need to be checked and unfortunately, they are not. Not every face of the pelvic floor issue is the same to receive the same treatment.

The answer to pelvic floor dysfunction is not always internal manual work; that is like you think the answer to every back pain is a massage! Does massage help? Sure, but does that resolve the issue? No! Everyone is not a square peg to fit the square hole.

Your Pelvic Floor Issue is Still Present Because..

More than likely the treatment you received was not the first thing that needed to be addressed. You see, the most common treatment for the pelvic floor is internal manual work and that is as if you work on putting furniture in a room with walls that are not steady and the integrity of the ‘house’ is questionable.

It simply does not make sense to jump in and work on the muscles of the pelvic floor when the structure these muscles line is not strong or the joints between the hips and the lower back to the pelvis are questionable. Frankly, the pelvis itself is comprised of 2 bones (ilium) attached to the sacrum in the back and to each other in the front forming the pubic bone, and most often in my assessment of pelvic floor dysfunction, I find fundamental ‘tweaking’ of these joints.

Pelvis bones

Pelvis bones (courtesy of https://orthoinfo.aaos.org/)

We need to look at the whole picture and understand that some of the causes of pelvic floor dysfunction date back to childhood and injuries that we never took seriously. What needs to be looked into are:

  • The pelvis, pelvic joints, and what is attached to the pelvis (which are the lower back and hips)

    Pelvis ligaments front side

    Pelvis ligaments front side

  • How those joints move together and how they respond in movement.
  • The connective tissue that keeps the joints together which are pictured below.
Pelvis ligaments Back side

Pelvis ligaments Back side













  • The nerves that exit the lower back to go to the muscles of the pelvis and the connectors to thepelvis (hip and lower back).
  • The muscles that line the pelvis itself as well as the muscles that are attached to the pelvis.


muscles of the lower back to pelvis

Lower back, pelvis and hip muscles involved in pelvic floor


  • The Breathing and if it engages the abdominal diaphragm and pelvic diaphragm to form a ‘barrel’ correctly (see this video to understand what that means)


  • If the overall moving around is functional or dysfunctional. In short, think about how all babies around the world, regardless of the difference follow the same patterns of movement; that is because we are born with the software that dictates that and there is no coaching or training involved. We do it automatically. Injuries, lifestyle, and habits can change the software and so the movement becomes altered. For instance, a person with a broken thumb in a cast learns to hold a spoon with the index and middle finger; the cast comes off but they continue using the index and middle finger without realizing it. That is because the map got altered based on the need. This is how movement changes from functional to dysfunctional and using Dynamic Neuromuscular Stabilization we revert the dysfunction to function. You can learn more about it to better understand how that is done and you can read the blog that talks about how this is done for pelvic floor dysfunction in general.
  • Doing Kegel exercises to strengthen the muscles of the pelvic inlet, which are not always problematic from lack of work but weak from being overworked. In a case in which the muscles of the pelvic floor are spastic Kegel should not be done. At our office, we use the¬†Emsella Chair to do the kegel exercises correctly and uniformly.
  • Lifestyle and habits such as too much sitting or using digital devices negatively impact the health of the pelvic floor, and posture affecting the breathing and dysfunctional movement. To undo the negative impact on the brain and its command to move properly, at our clinic we use Postural Neurology since if the brain gives the command to be upright for instance, the body has a better chance of staying upright, vs a device zapping you to sit upright does. Here is an example of positive neuroplasticity to activate the part of the brain (PMRF) with the upright command.

Bottom line is that while some damages are not reversible, they can still get worse so any effort to improve all aspects of pelvic floor dysfunction needs to be done in order to assure a better quality of life. If you have any questions, don’t hesitate to contact me.