Words by: Dr. Justine Roper PT, DPT (she/her) @doctorjus
Unfortunately, many people have no idea what the pelvic floor is, let alone how it should properly function. If any current adult were to be honest, the most education surrounding pelvic health they may have received was in sexual education class; which included very little about human anatomy and quite a bit of “do’s” and “don’ts”.
This is unfortunate because there is so much more to our pelvic health than the narrow information provided in sex ed, and our lack of education continues to impact us as adults.
For instance, did you know that when you take a deep breath the pelvic floor muscle should instinctually relax or lengthen? In comparison, when you exhale it should gently lift. This area is important as it provides not only a gateway for people with vaginas to perform one of the greatest acts of mankind, childbirth, but it literally is the stabilizing force behind nearly every movement and bodily function that we perform.
In order to better understand the pelvic floor, we must identify its location and functionality. The pelvic floor muscles, aka the levator ani, are located in the pelvic area and stretch, similar to an upside down umbrella, from the tailbone to the pubic bone (Continence Foundation of Australia, 2019). These muscles support our bladder and other pelvic organs. The pelvic floor muscles give you the ability to control the release of urine and feces and to delay emptying until it is appropriate. They are also important for sexual function in all genders. It is important for arousal, sexual sensation, and orgasm. Lastly, because they line the base of the pelvis, nearly every movement that you perform the pelvic floor muscles are either lengthening, shortening, or are at rest (rare occurrence). Simply put, they aid in the performance of nearly all of our movements.
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The pelvic floor muscles are like any other muscle in the body. I personally feel that they are hidden in plain sight. We can touch our biceps very easily, yet to touch our pelvic floor muscles in public in most societies would be inappropriate. On that note, culture has shaped our view on how we interact with the pelvis and the muscles and organs around it.. So much so that we have names for our genitals such as: pocket book, cooch, lady parts etc. Even saying the word “vagina” would make the average person perk up and adjust their posture. From your geographic location to various religious beliefs, it is of no surprise how much we don’t know and how much we have not had access to often due to systemic censorship. Culture may not be the only one to blame. The Western medical model typically doesn’t make much room for education, even in the treatment room itself.
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I would beg to say the most commonly known topic surrounding the pelvic floor would be “Kegels”. You have seen articles in popular magazines encouraging folks to do them religiously. Even medical practitioners tell their patients to perform them after childbirth. If you do not learn anything else from this article, I would beg that you learn that Kegels aren’t for everyone and here’s why. As a pelvic floor physical therapist, I have treated countless cases of urinary incontinence. I can see two people who both have the same complaint of leaking urine while laughing or sneezing. After performing a pelvic exam on both individuals, it may be found that one person may have tight pelvic floor muscles that are causing pressure surrounding the bladder, while the others may have very weak pelvic floor muscles that aid in the lack of control of urine output. So, if I encourage patients who have tight pelvic floor muscles to do Kegels (which many are doing incorrectly because no one has properly trained them…yikes) this could make symptoms worsen. As a skilled clinician, I could scream this next statement from the mountain tops.
“Kegels are not one-size fits all, and will not fix every pelvic issue or condition.”
This applies to painful sex, leakage, diastis recti (abdominal separation), postpartum complaints, and more..
People with vaginas deserve specialized attention, and to be educated with care. Pelvic health is as important as cardiovascular health, mental health, and the health of all other major systems. The pelvic conditions that impact us can be mitigated if we begin to become more educated about our anatomy, function, normal vs abnormal, and how to properly care for such a sacred area.
No, it is not normal to laugh and urinate. No, it is not normal to have pain with penetration. No, it is not normal to feel incapable of doing the activities you desire to do because you feel “unstable down there.” To acknowledge the need for more education, to share proper education when found, and to act on proper education is the embodiment of empowerment. Let us rally together and commit to the betterment of our pelvic and overall health.
Dr. Justine Roper PT, DPT is a certified women’s pelvic floor physical therapist & pelvic health & wellness coach. She has dedicated her life to offering innovative ways to heal her patients’ bodies of pain and other dysfunction through alternative methods. In addition to being a clinician, she is also a speaker who dedicates her time to promoting education and enlightenment on mental health disorders and beginning a journey towards living a life of freedom after experiencing sexual trauma or abuse. As a wellness coach, she offers dynamic one on one training sessions and group classes that include pelvic floor information in order to optimize her client's quality of daily functional living. As a clinician, she treats many pelvic floor conditions that range from pelvic pain to issues related to pregnancy and childbirth. Proudly, she is the founder of InHer Physique Pelvic Floor Physical Therapy located in Pensacola, FL which is the only clinic that offers pelvic floor physical therapy services to all genders and ages, in the Florida Gulf Coast. She is an author as well as an instructor in the biology department at the University of West Florida.
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