If You Dribble When You Giggle You May Need to See A Pelvic Floor Physical Therapist

By, Gail O’Neill, PFPT

The Pelvic Floor is a hammock shaped group of 14 thin muscles located in the bottom of our bony pelvis intertwined with nerves and surrounded by connective tissue that support the abdominal and reproductive organs while playing a key role in urinary, bowel and sexual function as well as postural support.  When you consider the many ordinary-and EXTRAORDINARY tasks the pelvic floor is responsible for such as, childbirth, sexual appreciation, defecation, urination, continence, lifting, sitting, walking and exercise, it is surprising that this part of our body is not given more attention.

When problems arise with the Pelvic Floor, this can lead to many issues. These deficits can occur when the muscles become weakened as well as tight and in spasm.

The following is a review of how our urinary system functions:

Our bladder stores urine- approximately 10-20 ounces.  The wall of the bladder is a muscle called the Detrusor.  There are stretch receptors within this muscle.  When the bladder fills, these stretch receptors are stimulated. They tell the brain that you are going to need to urinate.  This usually happens when there is 4-5 ounces of urine in the bladder. Normally, you will not need to void with this small amount.  When it fills to 7-15 ounces, the urethral sphincters – both internal and external, begin to contract harder to prevent urine from leaking out.

The pelvic floor’s middle layer of muscle is the external urethral sphincter. The pelvic floor and the bladder muscles work together but opposite of one another. As one contracts, the other is relaxed.  Reflexes are sent between the two muscle groups which are controlled by our brain and nervous system.

As the bladder fills, our pelvic floor muscles are contracted to prevent urine from escaping.  When we sit on the toilet, we consciously relax our pelvic floor.  This sends a reflex to the bladder to let it know that it is time to contract to urinate. Urine fills the urethra, telling the bladder to contract harder.  We do not have to push the urine out – the reflex does this for us. When urine is no longer released, the urethra sends a message to the bladder to relax.  The final message is sent from the bladder to the pelvic floor to contract again.  The entire process starts over. With normal function, this process repeats every 3-4 hours during the day.

Many events can interrupt this reflex and contribute to incontinence both urinary and fecal.  Some include; various disease processes, bearing down with labor, chronic constipation, chronic cough, continuous heavy lifting, and obesity, to name a few.

Stress Incontinence:  This is the involuntary loss of urine when the abdominal pressure is more than the pressure in the bladder.  This may happen when we sneeze, laugh, cough, run and with some forms of exercise such as Cross Fit.  Pelvic Floor muscle weakness and laxity may contribute to this.  This can be caused by pregnancy, delivery, surgery, injury, hormonal changes and some forms of exercise.

Urge Incontinence:  This is the involuntary loss of urine usually accompanied by a strong desire to void. The bladder begins to involuntarily contract before you can get to the bathroom.  We call this “key- in -the -door -syndrome”. This may result from bladder instability, hormonal changes, bladder irritants and medications.  For men, this may be a sign of an enlarged prostate.

Mixed Incontinence:  This is a combination of both Stress and Urge Incontinence.  It usually starts with Stress Incontinence and develops into Urge Incontinence if not treated.

Organ Prolapse:  When the pelvic floor is weak, it does not support the pelvic organs. These organs: the bladder, rectum, uterus, and urethra can fall down or prolapse into the vagina. There are varying measured degrees of organ prolapse.  Depending on the severity, pelvic floor strengthening is often helpful. Education for these patients is key in order to avoid activities that may worsen the prolapse.

Pelvic Pain:   If the muscles of the pelvic floor become too tight, the nerves become inflamed, and/or the connective tissue is restricted, these can all lead to pelvic pain and dysfunction.

This can occur from straining during childbirth, straining when voiding with constipation, prolonged sitting, stress, repetitive stress, activities such as horseback riding, and cycling.

Disease of the urinary, bowel and reproductive system can result in pelvic pain.  These include frequent urinary tract infections (UTI’s), yeast infections, prostatitis and endometriosis.

When the muscles of the pelvic floor are stressed, the fibers may become tight creating trigger points or spasm. Pain may be referred from the organs surrounding the pelvic floor muscles and their response is to tighten.  Blood flow decreases which lessens the amount of oxygen to the tissue, causing pain. A tight muscle then becomes a weak muscle.  So many of the problems associated with weak muscles, such as incontinence, can in fact be caused by tightness and pain in the pelvic floor muscle group.

This is the most common reason why a woman experiences pain with intercourse which is referred to as Dyspareunia.  The pain can also mimic the signs and symptoms that one has with a Urinary Tract infection.  In this case, urinary cultures are negative for the presence of bacteria.

With pelvic pain, we do not want to strengthen these muscles by performing Kegels. Instead, the first priority is to have these muscles relax and return to their previous resting length.