Hidden in Plain Sight: Pelvic Floor Dysfunction (Part 1)

This is the first post in a 2-part series on the common core injury: pelvic floor dysfunction (PFD).  In this post, we’ll help you understand the structure and function of the pelvic floor and what constitutes PFD.  Then, in part 2, we’ll help you recognize signs of PFD and provide some simple management strategies. 

A story from our Director of Education, Carolyn Appel…

I hand my 42 year-old client, Anna, the jump rope and tell her we are going to do three, 30-second skipping intervals. Anna replies: “OK, but let me go pee first.”

I didn’t think twice about a client hitting the restroom before a bout of plyometrics because (1) it was relatively common and, (2) I remember having to do the same thing when I was a teenage athlete.

Over a dozen years later, I think back to Anna and the many other clients whom I failed. Not out of malice or neglect, but because I didn’t know any better.  None of the continuing education conferences I dutifully attended ever mentioned Pelvic Floor Dysfunction (PFD), not even the pre and postnatal certification I got as a green, new hire. So, I had no idea that Anna or I were experiencing a classic sign of PFD: the urgent need to pee during impact activities.

Thankfully, discussions about breathing, the diaphragm, and the pelvic floor are beginning to circulate among the mainstream training community. Our clients are truly the ones who will benefit from deeper discussions about these issues.

The Pelvic Floor: Structure & Function

The Pelvic Floor (PF) is comprised of three layers of muscles (14 muscles in total), which form a sling at the bottom of the core (or the “floor of the core”). A well-functioning PF supports the pelvic organs, controls continence, provides core stability, aids in sexual response, and assists in guiding the baby out during delivery. In addition, due to the PF’s lateral attachment points on the proximal ends of the femurs (the ischial tuberosities), it helps to provide stability and strength for any movement involving the lower body.

Pelvic Floor Dysfunction

Now that we know what the PF is supposed to do, we can look at conditions that come from a poorly-functioning PF.  There are two main categories of Pelvic Floor Dysfunction (PFD):

  1. Stress Incontinence: Accidental urine leakage (or a sudden/urgent need to pee) during movements like coughing, laughing, sneezing, or any sort of impact activity in which there is a spike in intra-abdominal pressure. Fecal incontinence can occur as well, triggered by the same conditions as listed above.
  2. Pelvic Organ Prolapse: When one or more of the pelvic organs (bladder, rectum, or uterus) descends lower than its normal position, in some cases protruding through the vaginal or rectal openings. Often, the way it is described as a heavy, “bowling ball” feeling between the legs.

What conditions cause (or contribute to) PFD?

PFD occurs when there is a buildup of excess intra-abdominal pressure that cannot be adequately managed. This is often a factor during pregnancy because the growing belly and uterus place a great deal of excess pressure on the PF muscles. In addition, the following things add even more pressure:

  • Alignment Shifts: The greater the anterior pelvic tilt, the greater the downward pressure on the PF muscles.
  • Breath holding and/or sucking in: Breath holding during exertion (either in exercise or “bearing down” for a bowel movement), sucking in, or chronically drawing in (keeping navel locked in toward spine for an extended period), all shut off the Core Canister pump.  This creates a pressure buildup and often that pressure has nowhere to go except downward.
  • Weak Core Canister muscles: Having weak Core Canister muscles leads to decreased ability to regulate intra-abdominal pressure

Given the causal factors above, you can see that PFD is NOT just an issue with the pre/postnatal population.  We often see PFD in powerlifters, or anyone doing very heavy lifting, due to the use of the Valsalva (breath-holding and bearing down) technique.  It’s also quite common in women because they have more of a tendency than men to chronically suck in their bellies.

By the time a woman gets to delivery, her pelvic floor muscles are already quite stressed (perhaps even compromised).  Then, she must endure the further trauma of delivery.  In a vaginal birth, the PF muscles are responsible for helping to guide the baby out during delivery.  However, if the PF muscles are underactive, or in a weakened and shortened state, this could result in increased tearing.

A C-section also traumatizes the PF muscles.  During the procedure, the abdominal muscles are moved in order to pull the baby out.  Because of how intricately connected the abdominal and pelvic floor muscles are, this major abdominal surgery also impacts the pelvic floor.

So, in summary, pregnancy alone puts a great deal of excess strain on the PF muscles, and that is why PFD is common during pregnancy.  However, delivery certainly adds to it, and that’s why PFD is even more common in the postpartum period.

Now that you have a basic understanding of PFD, PART 2 teaches you how to recognize symptoms of PFD and what to do if you, or a client, has it. Ready?  Let’s go (but not uncontrollably)…