Pelvic Floor Dysfunction is the inability to properly coordinate pelvic floor muscle activation and relaxation. It is an umbrella term that encompasses a wide variety of disorders that occur when structures (muscle, fascia, nerve, tendon, ligaments) in the pelvic floor are not functioning optimally. Although symptoms present differently, pelvic floor dysfunction can occur in both females and males.
In order to understand dysfunction, we must first understand simple anatomy and how a normal/optimized core functions. This can be made simpler by comparing the core to a house. In this analogy, the pelvic floor is as it is aptly named is the floor of our house, the walls are the transversus abdominus muscle and the roof our diaphragm muscle. Together, they work to stabilize our spine and promote effective load transmission during movement and breathing.
A normally functioning pelvic floor can perform the following:
- Contract on command to maintain urinary and fecal continence,
- Relax to allowing for sexual function (penetration, orgasm, maintain erection), urination and defecation,
- Stabilize the pelvis and low back,
- Provide support to the organs in the pelvis (bladder, rectum, uterus in women),
- Prevent blood pooling in the pelvis, which presents as hemorrhoids.
Dysfunction is experienced when the pelvic floor muscles are either too tight (hypertonicity) or too loose (hypotonicity). A helpful way to envision this is to think of your pelvic floor as a trampoline. If the coils are too rigid, we do not get the required movement to get a good bounce. Whereas if they are stretched out, we are left straining to jump on a floppy trampoline.
In both cases, we are not optimizing our bouncing and therefore can start to experience undesired symptoms. Pelvic floor hypertonicity typically presents clinically as pain with sex, pain with tampon insertion, severe cramping with periods, increased urgency, difficulty voiding urine and constipation. Pelvic floor hypotonicity is often associated with “sneeze pees” (stress incontinence), and pelvic organ prolapse.
During a pelvic floor exam, your healthcare practitioner is trying to determine if there is too much tension in the muscles or tissue laxity. In the case of too much tension, the focus of treatment will be on relaxation, reverse Kegels, hip openers, and diaphragmatic (“belly”) breathing. In that of a laxity and decrease activation, emphasis will be placed on strengthening and enhancing muscle recruitment. Depending on your assessment, your pelvic physiotherapist will modify your strengthening parameters to address your specific deficits (strength, timing, and endurance).
If you are experiencing any of the above symptoms, it is worthwhile to have an internal assessment to address your specific concerns.
Liseanne Nelson, Physiotherapist
Liseanne graduated from McGill University in 2014 with a Bachelor of Science in Kinesiology and then returned home to complete her Masters in Physical Therapy at the University of Toronto in 2016. She then practiced in Canada for two years, gaining a wide variety of experience in both the hospital and private practice setting. Her experience includes outpatient amputee rehabilitation, pulmonary rehabilitation, complex continuing care, and outpatient orthopedics. Looking to challenge herself further, Liseanne completed her licensing exam for the United States in 2017 where she spent a year working at a sports medicine clinic in Manhattan.
Now back in Toronto, Liseanne is thrilled to join the Body Co team! Her treatment approach consists of a combination of manual therapy, patient education, therapeutic exercise, kinesiotaping and modalities for pain management. Liseanne has additional training in Pelvic Floor Physiotherapy and is able to treat a wide variety of conditions including diastasis recti, incontinence, pelvic organ prolapse, and pelvic pain. Liseanne is constantly taking new courses to improve patient outcomes and to stay up to date with current best practices.
In her spare time, Liseanne enjoys skiing, hiking, yoga, running, and playing fetch with her dogs Morgan and Charlie!