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In Pelvic Health Physiotherapy, there are 4 major components that contribute to the pelvic floor and pelvic organ systems – the abdominal pressure from above, the pelvic floor response from below, the soft tissue system that holds up the organs, and the nervous system feeding into these structures.  Keep reading to learn more about this system and ways Pelvic Health Physiotherapy can help!

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Abdominal Pressure:

Above the pelvic floor and the pelvic organs is the abdominal cavity. It holds all our abdominal organs and is surrounded by the abdominal muscles in the front (ie transversus abdominis, obliques, and rectus abdominus), the muscles through the back (ie multifidus and the erector spinae), as well as the diaphragm (our breathing muscles), which acts like a lid on top. How these muscles activate and work together contributes to how much pressure is applied down to the bottom of the body through the pelvic organs and the pelvic floor. Constipation with bearing down and chronic coughing or lifting can also be sources of increased abdominal pressure. As a Pelvic Health Physiotherapist, I have extra training to spot muscle patterns through the abdomen that might increase downward pressure through the pelvis, and have exercise options to address this.

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Pelvic Floor Response:

The pelvic floor muscles need to be strong (kegel) AND flexible (reverse kegel/let go) AND coordinated (work automatically with the other muscles) to work effectively. It’s not just about if you can kegel or not – timing and length of the muscles are also important. You have the best function through the legs when your hamstrings are strong AND flexible AND work automatically – same with the pelvic floor. Pelvic Health Physiotherapists address the pelvic floor muscle response directly through an internal exam so you can learn how to recruit these muscles optimally. For more on what is involved in a Pelvic Health Physiotherapy Assessment, click here.

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Soft Tissue Integrity:

We have ligaments and connective tissue/myofascia that holds up the pelvic organs (bladder, vaginal walls, uterus and rectum/bowels). Many people experience episodes of increases in abdominal pressure – for example repetitive coughing or heavy lifting, straining or bearing down with bowel movements or pushing with vaginal child birth. If sustained over time, this increase in downward force can stretch the tissues, leaving the organs with less support. This can present as pelvic organ prolapse. Pelvic Health Physiotherapists can assess this connective tissue integrity and offer alternative support options, ranging from exercise to pessary support.

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Nervous System Input:

The nervous system is the foundational system that runs our whole body. It is signals from the brain and spinal cord that influence muscle tension and response patterns, bladder and bowel function, hormone responses and pain sensations. The nervous system receives chemical, pressure and temperature signals from the body, puts the pieces together in our automatic/subconscious brain, then tells the body how to respond. The brain also takes into account the conscious or cognitive processing aspects of our brain that processes memory, emotion, fear, pain, stress, context, environment, mood etc etc etc. This is why in Pelvic Health Physiotherapy we look beyond the biomechanical components and always try to address other factors that influence the system such as stress, exercise, nutrition and overall health. If tissues are tight or sensitive we can look at local treatment options to sooth the tissues at the site, but also have to address why the tissues are tight, sensitive or unresponsive in the first place. This requires looking at the mind-body connection and the psychosocial factors that feed into this system.

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We hope this gave you a deeper understanding of the factors that can influence your Pelvic Health. If this made things seemed complicated to you, no need to worry, as Pelvic Health Physiotherapists, we are here to guide you in identifying which factors are important for YOUR pelvic health, and what you can do to optimize YOUR system!