Exercise invigorates the body, sharpens the mind, and uplifts the spirit. Working out regularly is extremely important for our well-being, as it helps protect us from potential diseases. But have you ever imagined a workout that strengthens your core, enhances your confidence, and boosts your overall well-being, all without breaking a sweat? Welcome to the world of pelvic floor therapy!

Pelvic floor therapy, as the name suggests, focuses on the muscles in the pelvic region. It helps strengthen these muscles so they can better support our pelvic organs.

Let’s delve into further details about our pelvic muscles, the various functions they perform, and the ways in which pelvic floor therapy can help strengthen them.

Introduction

Definition of pelvic floor therapy

Pelvic floor therapy is a specialised form of physical therapy focused on rehabilitating the pelvic floor muscles to treat dysfunctions or injuries. The pelvic floor includes the muscles that support the bladder, bowel, and reproductive organs. It is often associated with women’s health as it addresses issues of pelvic trauma due to childbirth. However, licensed physical therapists trained in pelvic floor therapy provide assistance to all individuals, irrespective of their gender or sex.¹ 

Importance of pelvic floor health

Pelvic floor health is a crucial factor in overall well-being and quality of life. The pelvic floor plays a major role in supporting vital pelvic organs and helps maintain urinary and faecal continence. Strong pelvic floor muscles provide core stability, prevent incontinence, and improve sexual health. Maintaining pelvic floor health through exercises, proper posture, and awareness is essential for both men and women to lead a healthy life.²

Anatomy and function of the pelvic floor

Description & functions of the pelvic floor muscles

The pelvic floor muscles are a group of muscles, ligaments, fascia, and other connective tissues that together form a sling or hammock supporting the pelvic organs. The primary muscles of the pelvic floor include:

Levator ani

The levator ani is one of the largest and most significant muscles in the pelvic floor. It actively supports the pelvic organs and consists of three parts:

1. Pubococcygeus muscle: This muscle extends from the pubic bone to the coccyx and helps in maintaining continence. It helps maintain floor tone when the body is in an upright position
2. Puborectalis muscle: This muscle forms a loop around the rectum and creates an angle at the anorectal junction, aiding in faecal continence. It also helps in raising the pelvic floor
3. Iliococcygeus muscle: As the name suggests, this muscle extends from the ilium to the coccyx and supports the pelvic organs. It is responsible for our voluntary control of urination³ 

Coccygeus muscle

The coccygeus muscle, also known as the ischiococcygeus muscle, is triangular in shape and located behind the levator ani muscle. It plays a major role during childbirth by supporting the foetal head.³

Perineal muscles

The perineal muscles are located in the perineum, the area between the genitals and the anus. Also known as the superficial pelvic floor muscles, they include the following:

1. Bulbospongiosus/bulbocavernosus muscle: This muscle surrounds the vaginal opening in women and is located at the base of the penis in men. Hence, it aids in sexual function
2. Ischiocavernosus muscle: This muscle helps maintain erection in men and supports clitoral engorgement in women
3. Superficial transverse perineal muscles: These muscles provide support to the perineal body, which is crucial for pelvic organ support³ 

Urogenital diaphragm

A deep transverse perineal muscle, fascia, and external urethral sphincter muscles form the urogenital diaphragm. This diaphragm contributes to urinary continence.³ 

Types of pelvic floor dysfunction

Urinary incontinence

Urinary incontinence is a condition that involves the involuntary leakage of urine. While this condition typically affects elderly people, it can also occur in young adult males and females. There are five types of urinary incontinence, as listed below:

1. Stress urinary incontinence: This type involves the leakage of urine during physical activities that increase abdominal pressure, such as exercising, coughing, or sneezing
2. Urge urinary incontinence: This type involves a sudden, intense urge to urinate, which is usually accompanied by involuntary leakage of urine
3. Mixed Incontinence: This type is a combination of stress and urge urinary incontinence
4. Overflow urinary incontinence: This occurs due to an inability to completely empty the bladder, leading to frequent dribbling of urine
5. Functional incontinence: This type occurs in cases of certain environmental or physical barriers to toileting⁴ 

Faecal incontinence

Faecal incontinence is the inability to control one’s bowel movements, resulting in the involuntary discharge of stool. While it is common among elderly patients, it can occur in any age group. Causes include weakened pelvic floor muscles, nerve damage, or injuries related to childbirth.⁵

Pelvic organ prolapse

Pelvic organ prolapse (POP) is a gynaecological condition in which pelvic organs, such as the bladder, uterus, or rectum, descend into or outside of the vaginal canal or anus. POP can be further classified into four types, depending on the organ that has prolapsed:

• Cystocele: The bladder prolapses into the vaginal wall
• Rectocele: The rectum descends into the vaginal wall
• Uterine prolapse: The uterus descends into the vaginal canal
• Enterolapse: The small intestine prolapses into the vaginal wall⁶

Chronic pelvic pain

Chronic pelvic pain is a persistent and disabling pain in the pelvic region, most commonly affecting women. This pain can last for more than six months and may be associated with pelvic floor muscle spasms, interstitial cystitis, endometriosis, or other gynaecological, urological, or gastrointestinal conditions.⁷ 

Sexual dysfunction

Sexual dysfunction typically involves problems with sexual activity due to issues with the pelvic floor muscles. This condition can affect both men and women. In women, it can result in dyspareunia, which causes genital pain before, after, or during sexual intercourse.⁸

Vaginismus is another sexual dysfunction experienced by women that involves involuntary spasms of the vaginal muscles, causing difficulty with penetration during intercourse.⁹ In men, common sexual dysfunctions include erectile dysfunction, premature ejaculation, or pain during ejaculation.¹⁰ These dysfunctions often result from overactive or weak pelvic floor muscles, nerve damage, or psychological factors.

Pelvic floor therapy techniques

Physical exercises

Kegel exercises

Kegel exercises are pelvic floor muscle-strengthening activities designed to improve the tone and function of the pelvic floor. They were first described by Dr. Arnold Kegel in 1948, hence the name Kegel exercises. They involve the repeated contraction and relaxation of the muscles that support the pelvic organs.

The fundamental steps of Kegel exercises include identifying the muscles used to stop or slow urination, contracting these muscles for a few seconds, and then relaxing. Repeating this process several times a day can enhance muscle strength, helping prevent and manage urinary incontinence, pelvic organ prolapse, and improving sexual function. Kegel exercises are beneficial for both men and women.¹¹ 

Squats

Squats are considered one of the most effective exercises for pelvic floor strengthening. By engaging the glutes, quadriceps, and core muscles, squats help support the pelvic organs and enhance muscle coordination. However, maintaining a proper squat form is very important to avoid injury or muscle tear. One should stand with feet shoulder-width apart, lower the body by bending the knees and hips while keeping the back straight, and then return to the starting position.¹² 

Manual therapy

Manual pelvic floor therapy involves hands-on techniques performed by a trained therapist to assess and treat pelvic floor dysfunction. This therapy helps improve blood flow, release tension, and enhance muscle function. Manual therapy primarily involves techniques such as myofascial release, soft tissue mobilisation, and trigger point therapy. Myofascial release (MFR) includes the application of long-duration stretches to the myofascial complex. These techniques help alleviate pain, reduce muscle tightness, and improve coordination.¹³

Biofeedback

Biofeedback is a technique that helps individuals gain awareness and control over their pelvic floor muscles. It involves electrical stimulation using sensors and electrodes placed on the pelvic area or inserted vaginally or anally to measure muscle activity. This feedback is provided in visual or auditory formats, allowing patients to see how their muscles are working in real time. This process aids them in correcting their pelvic muscle movements.¹⁴ 

Benefits of pelvic floor therapy

Pelvic floor therapy offers numerous benefits that improve quality of life and overall well-being. It strengthens the pelvic floor muscles and helps prevent the development of dysfunction in the future. This therapy alleviates chronic pelvic pain, enhances sexual function, and supports postpartum recovery. Tailored exercises and techniques address muscle imbalances, improving bladder and bowel control. Additionally, it promotes better core stability and enhances overall pelvic health.¹⁵ 

FAQs

How do I know if I need pelvic floor therapy?

A: One of the major signs that indicate you may need pelvic floor therapy is the leakage of urine when you sneeze, cough, jump, or get up from your seat.

Do I need to shave for pelvic floor physical therapy?

A: No, shaving is not necessary for your pelvic floor therapy sessions. Your therapist is focused on your treatment, not your personal grooming habits or choices.

How painful is pelvic floor therapy?

A: Pelvic floor therapy is not usually painful. It is designed to help strengthen your pelvic muscles and ease your movements.

Summary

• Pelvic floor therapy is a form of therapy aimed at strengthening the pelvic muscles and addressing dysfunctions
• The pelvic region comprises a group of muscles, each with a distinct role, but collectively functioning to support the pelvic organs
• Common pelvic dysfunctions include urinary and faecal incontinence, pelvic organ prolapse, chronic pelvic pain, and sexual dysfunction
• The main pelvic floor therapy techniques include Kegel exercises, manual therapy, and biofeedback
• These therapies help individuals improve their pelvic health and overall well-being