Having strong pelvic floor muscles is essential for both men and women. These muscles help control our bladder and bowel movements. But they can become weak during pregnancy or following a surgery. In addition, aging can affect pelvic floor health and lead to incontinence and other health issues.
The good news is that just like other muscles in the body, the pelvic floor responds to exercise. Like athletic trainers who help guide your routine at the gym, a pelvic floor physical or occupational therapist can help patients train these muscles during pelvic floor physical therapy.
UCHealth Physical Therapist Michelle Faris explains the importance of a healthy pelvic floor, what men and women can do if their pelvic floor muscles show signs of tightening or weakening, and how pelvic floor therapy may help.
What is your pelvic floor? And why are strong pelvic floor muscles important?
Your pelvic floor is the area between your tailbone and pubic bone within the pelvis. This area contains pelvic floor muscles that encircle the urethra, vagina and anus. These muscles work with the deep abdominal hip and back muscles and the diaphragm to stabilize and support the spine. They also control the pressure inside your abdomen when lifting or straining.
In men, the pelvic floor muscles support the bladder and bowel. The same is true in women, but they also support the uterus. These muscles are essential in bladder and bowel control, as well as in sexual sensations and functions.
What causes the pelvic floor muscles to become weak?
Many factors create pelvic floor muscle weakness, including pregnancy and childbirth, surgery, childhood bladder issues, trauma, cancer treatment, menopause, smoking, poor bladder habits, and aging. When pelvic floor muscles weaken, you may experience pelvic floor dysfunction.
What is pelvic floor dysfunction?
Pelvic floor dysfunction is a general term used to describe the inability to relax or contract and coordinate your pelvic floor muscles correctly.
“When your pelvic floor muscles don’t relax or contract properly, similar to any other skeletal muscle in the body, it can lead to bladder and bowel dysfunction,” Faris said. “These symptoms include things like incontinence, urgency, frequency, constipation, diarrhea or pain.”
Symptoms of pelvic floor dysfunction include:
- Urinary or bowel incontinence
- Incomplete voiding
- Recurrent UTIs
- Vaginal dryness
- Pelvic pain
- Pain with intercourse
- Sexual dysfunction
- Abdominal or pelvic scar tissue
- Pelvic heaviness or sense of “falling out”
If you are experiencing any of these symptoms or you want to learn what to do to keep your pelvic floor strong and healthy, talk to your doctor to get a referral for pelvic floor therapy, Faris said.
How do I know if my pelvic floor is strong?
Your pelvic floor is strong when you can do all functional activities without leakage, pain or other symptoms. You should be able to hold your urine for 3-4 hours during the day and empty on average one or fewer times per night. You should be able to suppress your bladder and bowel urges to make it to the bathroom on time, and you should be able to empty your bowel and bladder fully when you are using the restroom.
What issues can arise when my pelvic floor muscles weaken?
Weakening of the pelvic floor muscles can result in urinary, fecal or gas incontinence, the loss of bladder control and pelvic organ prolapse, which is where one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. This happens because the pelvic floor muscles are not strong enough to support the surrounding organs and bladder or bowel functions.
“These muscles can not only be weak but have poor coordination as well,” Faris said. “You need both to properly control your bowel and bladder and prevent urgency or frequency.”
What is incontinence and how does it relate to pelvic floor muscles?
There are different types of incontinence. Stress incontinence is when urine leaks when there is pressure on your bladder, such as when you sneeze or laugh. Urge incontinence is when you have a sudden urge to urinate but can’t get to the bathroom in time. Fecal incontinence is when you have accidental stool or gas leakage. Weak pelvic floor muscles can result in incontinence.
How can I prevent and treat pelvic floor weakness or dysfunction?
Your primary care physician, OB-GYN, urologist, or surgeon can refer you to a pelvic floor physical or occupational therapist.
“There is a lot of good research showing that pelvic floor muscle training can help with bowel and bladder dysfunction as opposed to surgery or other more aggressive therapies such as medication management,” Faris said.
Pelvic floor physical or occupational therapists can take a baseline assessment of what your pelvic floor is doing.
“They can test strength, coordination, endurance, and soft tissue tightness or relaxation,” Faris said. “Based on a baseline assessment, a therapist can instruct you on the proper exercise routine to keep your pelvic floor strong and healthy. They may also incorporate core, back, hip, and breathing exercises.”
How early should you treat pelvic floor dysfunction?
The earlier, the better, Faris said.
Typically, it’s helpful to do pelvic floor physical therapy about four to six weeks after an operation or the birth of a newborn.
UCHealth also offers preventive care. Patients can take a proactive approach. Therapists can give patients exercises to strengthen pelvic floor muscles before surgery or childbirth. That can improve your post-operative prognosis.
What is PT like for pelvic floor dysfunction? And how long before I see results?
A pelvic floor physical therapist will evaluate your symptoms and medical history at your first visit. The therapist performs an external exam of the spine, hips and core to determine strength and function.
With patient consent, they can perform an internal pelvic exam. However, depending on the patient’s comfort level, it may not occur during the first visit, Faris said. With an internal exam, the therapist evaluates the perineal area and assesses tissue from the outside. The internal portion of the exam is not typically done with a speculum but with one finger to assess the internal pelvic floor muscles and structures.
“After a comprehensive evaluation, the physical therapist will apply treatment techniques such as manual therapy, exercise, biofeedback, and neuromuscular retraining, to help retrain the muscles and structures of the pelvis, just like physical therapy anywhere else in the body,” Faris said.
The therapist may assign home exercises, stretching, or massage techniques. Patients usually attend six to eight visits, but it all depends on the individual needs.
Are there yoga moves for strengthening my pelvic floor?
Exercises such as yoga can help stretch and strengthen the pelvic floor. But people experiencing pelvic floor dysfunction should seek the expertise of a physical therapist to get individually-tailored exercises and treatment options.
“Some patients need pelvic floor strengthening whereas some people need pelvic floor relaxation or lengthening because the muscle is too tight,” Faris said.
What are Kegel exercises?
Kegel exercises are strength training for your pelvic floor muscles, which support the bladder, rectum and uterus.
“Think of it as the equivalent of a bicep curl but for your pelvic muscle,” Faris said. “It involved the pelvic floor lifting upward and inward to close off the flow of urine/stool, and then relaxing back down to its normal resting position.”
What are the advantages of doing Kegel exercises?
The advantage of a proper Kegel exercise program is that it can keep your pelvis strong, which helps support bowel and bladder function, Faris said. It can also help hip and low back pain because these regions work together.
Faris warns that Kegels do not answer everyone’s pelvic floor problem. For people whose pelvic floor muscles are too tight or have pain, those patients would focus on lengthening or relaxing the pelvic floor using different stretches or massage techniques.
Can men do Kegel exercises? Are they harmful to the prostate?
Men also have pelvic floors with minor differences in anatomy.
Kegels are also effective for men and do not harm the prostate, Faris said.
“But Kegels may not be the type of therapy a person needs,” she said. “A physical therapist can help identify the patient’s needs and provide the appropriate treatment plan.”
Can strengthening the pelvic floor reduce symptoms of erectile dysfunction?
There is no data showing that Kegels, alone, can help with erectile dysfunction, Faris said.
Penile rehabilitation, which men often attend after surgery to remove cancer in the prostate gland, helps a man regain erectile control. Pelvic floor rehab does not typically help with erectile dysfunction, Faris said. Still, men who are seeing a pelvic floor therapist for urgency, frequency, incontinence or pain in the pelvic region may notice, as a secondary benefit, an improvement in their erectile function.