There is a HUGE misunderstanding as to what the pelvic floor is since the whole medical profession seems to look at sexual dysfunction, pain, or leakage as a pelvic floor issue and that is about it!!! The pelvic floor is a part of the pelvis and the floor is almost NEVER with issues without the whole pelvis and what is connected to it being unstable. So the question is should you treat the floor if the house is unstable?!!

Difference Between Pelvic Floor & Pelvic Floor Dysfunction?

The pelvic floor is the muscles and soft tissue laying inside the pelvis itself. It is accessible partly through the anus and/or vagina but it is never an issue by itself! I suggest you read my blog titled: ‘ What is Pelvic Floor Dysfunction’ for details on pelvic floor dysfunction.

While having a weak or tight pelvic floor can cause issues, they can never exist by themselves and THAT is what we need to understand when it comes to the treatment for the issue.

Pelvic floor dysfunction is the name of the book while a weak pelvic floor and tight pelvic floor are 2 of the many chapters of the book. Typically, you get a referral from your physician because of urinary incontinence, pelvic pain, testicular pain, erectile dysfunction, or pain during intercourse but again, these are some of the ‘chapters’ of the book: “Pelvic Floor Dysfunction’. Don’t claim you have read the whole “book” or know about the “book” when you are only aware of a “chapter” or two!!

Who Treats Pelvic Floor Dysfunction?

Almost all pelvic floor therapists who may or may not be physical therapists concentrate on the pelvic floor with a few incorporating some breathing and some exercises in their regimen. While I am happy to see more and more of that happening, I can assure you that working on the floor BEFORE stabilizing the ‘house’ is not going to last!

While all health care providers that treat pelvic floor are trained in the field, not all of them work on the pelvis and the posture before treating and that is the opposite of how I approach pelvic floor and pelvic floor dysfunction issues and this is why:

What to Look For in a Pelvic Floor Therapist?

In today’s day and age, social media, google reviews, and marketing are huge and when played right, they point you in the right direction. Unfortunately, there are ways to also deceive the public when the right experts do the marketing! My advice is to start by searching for the question, then read the website, read the google reviews and if there are not enough of them, don’t assume the therapist is not good. Most people are quick in doing negative google reviews and not so much in the positive ones. I strongly suggest you go down a checklist of questions you have.

• Write down your questions
• Call the office and ask to talk to the pelvic floor therapist
• Look for a youtube channel to see if they provide information on the subject at hand
• See what their treatment entails
• Do they provide resources for the patients to use at home
• See if you connect with the office staff and the provider

Most therapists start with a consultation and examination; the examination may or may not include an internal pelvic exam. Mine almost never do because for instance, if the condition is a prolapse case, I don’t treat those conditions for prolapse but for the stability of the posture and pelvis which play a huge role in how a prolapse case is handled.

A comprehensive exam should include:

• How does the brain dictate posture and movement.
  • This is important because that is the blueprint of your posture and movement.
  • This is what a postural neurology exam is.
• What is the movement pattern like?
  • Is it functional or dysfunctional?
  • Can the main muscles and joints perform their task or is the movement interrupted?
    • This can be very subtle so the Provider’s expertise is important.
  • This is what functional movement and developmental kinesiology are about.
• What are the breathing patterns like?
  • Most often, it is not deep or is interrupted.
  • In severe cases, the breathing and coordination of movement are reversed!
  • Most patients are given the wrong queuing when it comes to breathing.
• What does the road map of treatment look like?
  • This all depends on the findings above and may include rehabilitation of the soft tissue in the joints such as the lower back, pelvis, and hips before any other treatments.
• Having an internal examination is not necessary in assessing almost all pelvic floor dysfunction cases.

When Should I See a Pelvic Floor Therapist?

When you have chronic lower back pain, hip pain, sacroiliac pain (pain in the back part of your pelvis), while pregnant, after childbirth, with incontinence, chronic sciatica, spinal stenosis of the lower back, chronic knee problems, hip and knee replacement surgery, plantar fasciitis, runners, cyclists, weight lifters, active people, athletes, history of prolapse, bladder pain, chronic urinary tract infection, pain at the onset or during intercourse, testicular pain, erectile dysfunction, neurological conditions impacting the posture, poor posture, prolonged sitting lifestyle, hunch back, and tilted forward pelvis all require an assessment to rule out pelvic floor dysfunction. You may or may not have a weak pelvic floor yet but an untreated, or improperly treated pelvic floor dysfunction always leads to a weak pelvic floor.

Check out my blogs and YouTube channel on the subject of the pelvic floor and pelvic floor dysfunction. If you are wondering if you have pelvic floor dysfunction and want to find out, contact me.

Dr. Shakib