In the time that I’ve been writing this blog, whatever the topic, there’s one thing that comes up again and again in the comments:  pelvic floor health.

One woman wrote on our blog about pain during sex that: “after a long discovery I found out that a pelvic floor physiotherapist exists! She gave me exercises to help me understand how to control those muscles, and sex is now pain free.”  Another lady noted that, “after a few months of physio I've learned how to relax my muscles down there and what an improvement in all areas of my life!”

But even though jade eggs and kegels and Kundalini Yoga are all things I had heard of (okay, fine, seen on instagram), I realized I didn’t know what pelvic floor muscles actually do, what happens when they aren’t working, and how they can have such a significant impact on our sexual health.

So, I called in Rachel Gelman DPT, owner of Pelvic Wellness & Physical Therapy, to get the lowdown.

She explained to me that the pelvic floor sits between the tailbone and the pubic bone, and supports the bladder, bowel, and all things sexxxxy — basically anything going in or out has to get through the pelvic floor muscles.

“Your pelvic floor is like any other muscle in the body”, says Rachel. “But like any other muscle, it can be too tight or too lax”.

Usually, when we think of pelvic floor problems, we tend to jump straight to urinary incontinence, but the reality is that pelvic floor muscles affect a whollllleee lotta other bodily functions too.

According to Rachel, a common misconception is that pelvic floor dysfunction only causes incontinence or only affects women after having a baby or older woman, or even only affects women at all! (In fact, many of Rachel’s patients are men).

However, a majority of Rachel’s patients are suffering from pelvic pain — “whether that’s pain in the vagina, rectum, clitoris, vulva, or during penetration or thrusting during intercourse. It could be urgency and frequency, pain with bowel movements and abdominal pain, dysmenorrhea (painful periods), any type of urinary dysfunction — feeling like they need to pee or go pee all the time.”  Basically, when your pelvic floor is outta whack, it can throw a lot of stuff off balance.

Many women find their way to pelvic floor specialists like Rachel after a series of frustrating doctor’s visits. For example, some women discover that a UTI they’ve been dealing with for weeks isn’t actually a UTI after all, or the STD symptoms that they’ve been suffering from are still there even after treatment. So, their doctor refers them on to someone like Rachel.

Pelvic floor dysfunction and treatment is still under researched, and not widely accepted by the medical community, and women’s pain, particularly sexual pain, is often misunderstood and not taken seriously. And for many women who suffer from vaginismus (a condition that causes involuntary spasms when something enters your vagina) or vulvodynia (pain of the vulva) — a pelvic floor specialist like Rachel might be the first person they speak to who really understands their experience with pain during sex. 

I thought that pelvic floor pain was caused by weak muscles, because in my experience of dragging myself to gym, muscles + working out  = strong muscles = good? Right? But that’s not generally the case. Rachel mostly finds her patient’s pelvic floor muscles to be “hypertonic (which basically means too much muscle tone), and they develop trigger points in the muscle. It can be harder for blood to flow, oxygen to get in, and the muscles get cranky and cause pain. Nerves can get compressed, and the muscles contract when they should be able be neutral, relaxed, and lengthened — like when you urinate or have a bowel movement…”

So, what is the treatment if your pelvic floor muscles are the cause of your pain or urinary incontinence? Rachel works with her patients with hypertonic muscles to release trigger points and teaches patients how to relax their muscles.

But what else can people be doing to look after their pelvic floor health? Well, Rachel said that a huge factor of overworking your pelvic floor is caused by constipation. “If you’re not having regular bowel movements, it’s going to put a lot of pressure on your vagina and bladder. While this doesn’t go together in people’s minds, they’re very close in the anatomy… I also tell people to drink water, because it’s going to contribute to urinary health! Promoting good bowel habits with a Squatty Potty or step stool under your feet is also great.”

OK, but what about kegels?? Because if you’re a person in the world who has picked up a magazine in the last three years, you’ve been told YOU SHOULD BE DOING KEGELS 24/7 IF NOT MORE!!!! Also TEN REASONS SEX WOULD BE BETTER IF YOU ATE MORE KALE.

Rachel, maybe unsurprisingly, doesn’t quite agree with that. “Kegels have a time and a place, but for a majority of people, especially if a patient has pain with sex and bowel dysfunction — kegels are not usually necessary.” And, if you’re taking your kegel advice from a magazine that’s also telling you how to *burn fat fast without changing your diet* or *get Gwyneth’s abs with these one and a half moves* you may not be doing them correctly or when you don’t need to at all (aka, when your muscles are already too tight) — and that can make things worst.

“I always recommend that if you think you might need to do kegels, you should visit a pelvic floor PT. Even patients with urinary incontinence don’t always need to do kegels because often their muscles are hypertonic —  imagine if your bicep was always contracted and you tried to tone it further, it’s the same with urinary incontinence for hypertonic muscles. Every time you sneeze or laugh you leak because the muscle is too contracted.”

Were pelvic floor muscles the cause of your pain or other symptoms? Did therapy or rehab help? Let me know in the comments!

Did you know our sister brand, Thinx for All Leaks, makes underwear for ladies who leak?

Dr. Rachel Gelman is a clinician, writer and educator. She is the owner and founder of Pelvic Wellness & Physical Therapy in San Francisco, which specializes in treating patients with pelvic floor dysfunction including pelvic pain, bowel, bladder and sexual dysfunction. She is an adjunct instructor at Samuel Merritt University where she teaches the pelvic health curriculum in the Doctor of Physical Therapy program. 

by Mia Abrahams