Photo by Ketut Subiyanto.

Usually associated with female anatomy and the effects of childbirth and aging, a dysfunctional or weak pelvic floor can have debilitating effects on men as well. In women, organ prolapse, or the protrusion of pelvic organs into the vagina, is the result of weakness or dysfunction in the pelvic floor. In the male anatomy, it is rectal prolapse that can occur when the pelvic floor is not right.

Regardless of sex, maintaining a healthy pelvic floor is vital to healthy bladder and bowel function, as well as to preventing prolapse. Anatomically, the pelvic floor is considered to be the base of what is commonly called the “core”. Along with other core muscle groups, the abdominal muscles, the low back, and the diaphragm, the pelvic floor regulates pressure and provides stability in the lower abdomen in service of protecting the spine and maintaining control of bladder and bowel function. Slung like a hammock inside of the four bony landmarks at the base of the pelvis, the two “sitbones” (ischial tuberosities) on either side, the tailbone behind, and the pubic bone in front, the pelvic floor muscles, when healthy, contract and relax as needed.

Common Causes of weakness and dysfunction

Pregnancy and childbirth are the most common causes of weakness in the female pelvic floor. This weakness can lead to lack of bladder control, anal incontinence (the inability to control the passing of gas), and even fecal incontinence (the inability to control bowel movements).

In both men and women weakness of the pelvic floor can be caused by excessive heavy lifting, obesity, constipation causing straining during bowel movements, excessive high impact exercise, injury or trauma, and nerve damage.

Strengthening and relaxation with Kegels to Yoga

Kegels are performed by contracting the pelvic floor, and then relaxing it.

Addressing pelvic floor weakness in all genders involves both strengthening and developing the ability to relax the area. An exercise called Kegels, named for an American gynecologist, Arnold Kegel, who studied the relationship of pelvic floor tone to various pelvic floor issues during the 1940’s, involve conditioning the muscles of the pelvic floor by contracting and relaxing them.

Not surprisingly, while the exercise was named after Dr. Kegel, his work stood on the shoulders of female English physiotherapist and ballet dancer Margaret Morris who began treating patients with pelvic floor strengtheners in the 1930’s. She is also credited with inventing the perionometer, a now obsolete device that could measure the strength of one’s pelvic floor.

Kegels are performed by contracting the pelvic floor for 3-5 seconds, and then relaxing it. For some the contraction is easier to feel than the relaxation, in which case, the emphasis can be on completely relaxing and improving the ability to do so before contracting again. A set of Kegels might be 10-15 repetitions and can be performed daily. As an adjunct to kegels, toning the inner thighs and glutes can be helpful, as can breathing deeply and guiding the fullness of the inhale into the pelvic floor creating a slight billowing outward and expansion on the inhale, followed by an exhale that draws the pelvic floor back into the body creating a slight contraction.

The ancient practice of Yoga acknowledged the importance of the region’s health.

The ancient practice of Yoga acknowledged the importance of the region’s health as not just a physical structure crucial to the functions of childbirth and elimination of waste, but also a portal into the subtle body for life force, or prana. 

Kegels, when performed throughout pregnancy, help women have easier birth experiences as well as improved healing after delivery. Both the tone and the ability to relax the pelvic floor help a woman control pushing, manage contractions, and in some cases can shorten the second stage of labor. Women are less likely to tear and have fewer instances of vaginal or rectal incontinence after delivery.

For women and men, kegels are prescribed to address pelvic floor issues that can be a prelude to prolapse.

When problems become prolapse

Pelvic floor dysfunction occurs when the area, rather than being weak, is over-engaged, clenched, or “tight”. This can lead to incomplete urination or bowel movements and sexual dysfunction that in women can cause pain during intercourse, and in men can cause erectile dysfunction.

Causes of pelvic floor dysfunction can be stress and anxiety, history of sexual abuse, excessive straining that results from constipation, difficult deliveries, nerve or connective tissue disorders, and aging. Treatment for pelvic floor dysfunction is physical therapy that teaches you how to stretch and relax the area. Biofeedback is often employed alongside PT and helps the patient recognize habitual clenching and learn to release it.

Pelvic floor dysfunction occurs when the area, rather than being weak, is over-engaged.

When therapies for weak or dysfunctional pelvic floor do not relieve the symptoms and restore healthy function, organ prolapse can occur, causing the bladder or rectum to bulge in the vagina or anus in all human bodies, or the bladder or uterus to bulge into the vagina.

Prolapse is staged and treated accordingly, with lifestyle adjustments and exercises useful in earlier stages and surgical options explored in later stages or when quality of life is diminished by symptoms.

Many people put off seeing their provider about pelvic floor issues due to shyness or embarrassment. However, as is often the case, the earlier you address the symptoms you are having, the more likely a non-invasive treatment will fix the problem. 

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.