Pelvic floor dysfunction is not gender-specific or age-specific, you don’t have to be pregnant or have given birth to get it and frankly, it is on the rise more than ever before. When it comes to the musculoskeletal component of pelvic floor dysfunction, you should know that the muscles involved are almost all the same type as the rest of your muscles, and voluntarily can be contracted and relaxed. Pelvic floor dysfunction is more than incontinence or painful sex, and more than erectile dysfunction or pain in the penis. For the subtle, and not-so-subtle signs and symptoms of pelvic floor dysfunction, I refer you to my blog, “What are Pelvic Floor Dysfunction Symptoms”.
To best understand why you sitting impacts pelvic floor dysfunction, you should note that everything that involves movement and posture influences your pelvic floor. You ought to understand some basic anatomy of the area to go forward in life, with more mindfulness in how you move and carry yourself. I am not suggesting walking on ice type of living but unless you change the dysfunctional movement that you have because you have pelvic floor dysfunction, you won’t fully overcome this condition.
Where Is The Pelvic Floor?
As explained in my blog, Are pelvic floor exercises the same as Kegels, “The pelvis is the ‘house’ that the pelvic floor is the ‘floor’ of.” This is very important to remember because we seem to be too busy thinking of the ‘floor’ when the ‘house’ is not stable by any means. We will come back to this later on in this blog but keep this in mind for now.
I go on to say, “The pelvis consists of 3 bones: 2 ilium and sacrum with the 2 ilium coming together in the front to form the pubic bone. The pelvis is attached to the spine via the sacrum at the top and connected to the leg bone at the bottom to form the hip joint. In fact, in the hip joint which is a ball and socket joint, the socket is offered by the pelvis.”
If the pelvis was a bowl, the pelvic floor is the floor of the bowl and the walls of the bowl would be the walls of the pelvis. Pelvic floor muscles are the muscles of the floor attached to the wall and work in unison with each other.
Pelvis bones (courtesy of https://orthoinfo.aaos.org/)
How To Sit With Pelvic Floor Dysfunction?
Pelvic floor dysfunction, regardless of any co-morbidities, or conditions that exist that add or feed it, relies heavily on postural stability and functional movement. The less stable the posture and movement are, the more unstable the pelvis will be. The pelvis is the ‘house’ that the pelvic floor is the ‘floor’ of and so no matter what else is happening, it needs to stay stable.
When it comes to sitting, the principles of posture and movement are no different, and what we need to pay attention to are:
Breathing
In the video below, I talk about what needs to happen with proper breathing. What is proper? The type of breathing we all did as babies! What is innate and automatic that we no longer hold. Our breathing is compromised by our injuries and lifestyle and unless we take the time to undo that, we won’t be functional in our movements and posture.
Engagement of the ‘barrel’ with movement
The barrel is what we create with our biological breathing. It consists of the bottom which is the pelvic floor, the top which is the abdominal diaphragm, and the sides which are the oblique muscles. The front is the abdominal muscles and the back is the back muscles. It is the ‘cylinder’ that gives us stability in the torso for better posture and movement.
Awareness of the plumbline with sitting and standing
When it comes to posture, the plumb line is a straight line that goes from the ear hole to the middle of the shoulder to the hip joint, the middle of the knee, and the outside bump of your ankle on a side view. We were born knowing this and resuming this until we started messing things up!! Our lifestyle choices, habits, and injuries started influencing the line. When you do exercises that you compatible with the exercises and moves we all did as babies, (Developmental Kinesiology) this necessary requirement was met and nurtured. When it comes to stability in posture and movement to positively impact the pelvic floor, we need to rehabilitate the same way.
Standing on both feet
As obvious as this seems, most people with pelvic floor dysfunction don’t do it, Why? Because they don’t think about it. But why is standing on one foot more comfortable than both feet? Because there are a series of muscles, bones, and joints that are simply not where they need to be and do what they need to do. This is a clue that some things are off and by standing on both feet, you are doing a little bit of something in the right direction vs pushing it to the more negative position.
Neutral spine and pelvis
Practicing a neutral spine and neutral pelvis is working on positive neuroplasticity. It is working on the right way of moving by intentionally doing it at the beginning until it ‘becomes you’. A neutral spine allows for better breathing, a better plumb line, and better overall balancing. It is the ‘fear’ of the brain for your safety and fall that makes it change the blueprint of movement to then dictate a different way for the body parts to move and to hold. Pelvic floor dysfunction due to pelvic instability is no exception.
Stability of the torso (static and in movement)
Again, this is necessary for balance, postural stability, and functional movement. When the torso, sitting above the pelvis is unstable (breathing biologically works on the stability and conversely, when done incorrectly, incrementally feeds the instability), everything below is impacted. That includes the pelvis, the house that the pelvic floor is the floor of.
Hip mobility
Your hips are connected to the pelvis; they are involved in walking and their lack of mobility, directly impacts how balanced the pelvis is. Hip mobility is often overlooked when it comes to pelvic floor dysfunction.
Lower back and pelvis stability
Once again, the status of the lower back and pelvis play directly into the balance and stability of the pelvis. Even when there are other issues related to let’s say urinary incontinence when the pelvis is unstable, the bladder also receives excess pressure from the pelvis not being balanced, and the nerves to the bladder receive irritation from the lower back (where the nerves exit to go to the bladder). This becomes multiple reasons why pelvic floor dysfunction continues.
When it comes to sitting, we want to be breathing biologically, have a strong barrel, sit preferably on the ground or an exercise ball, walking often throughout the day. Assuring that you are not slouched is crucial as it directly impacts your breathing, the abdominal and pelvic diaphragm, and compression of the spine and your hips that feeds the dysfunction.
If you have pelvic floor dysfunction, you suspect you have it or your treatments have not been to your satisfaction, contact me and let’s talk.
Dr. Shakib
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