Keep Them Coming: Not just kegels: Why pelvic floor health matters for everyone

Kristen Thomas. // Photo by Nicole Bissey

Imagine being a young athlete in overall good health, but you’re worried something is very wrong, and you’re too embarrassed to seek treatment. For Dr. Amanda Fisher, PT, DPT of Empower Your Pelvis, that’s how her story as a pelvic floor therapist began.

“I started having pelvic floor issues when I was 21,” Fisher says. “I started running a lot of half marathons and started peeing my pants while running and then having pain with intercourse. I had never had kids. I thought I was broken and felt guilty for my pain. When I realized my profession could improve my symptoms, I knew as soon as I felt better, I wanted to help more people like me. 

“Then, fast forward to having 3 c-sections and developing a few more pelvic floor issues (pain with intercourse again, pelvic pressure, issues with c-section scar tissue), I had more ways I could relate to my patients and found more ways I wanted to help women online heal as well,” Fisher says.

Many people who’ve given birth have experienced bladder leakage to the point it’s labeled a normal experience to pee when you cough or sneeze. Same with painful postpartum intercourse. Neither condition only occurs after you’ve had children, and while these issues may be common, they are not normal nor should it be normalized. There are treatments available—You’re not stuck with these issues.

Everyone has a pelvic floor—the group of muscles and ligaments that support your lower organs. Therefore, everyone—regardless of gender—can be affected by pelvic floor weakness or tightness, leading to some sort of malady, and not all of them are below the belt.

“Pelvic floor therapy is looking at the pelvis, obviously, but then everything that’s also connected to the pelvis. Think about the pelvis as being the cornerstone of your body and that it can affect up and down the chain. Really what we’re looking at is how does the pelvis affect the rest of your body?” says Jenn Cumming, PT, MSPT, CLT, WCS, who is with Foundational Concepts. “ It’s like any other physical therapy (PT)—It’s just a more intimate type of PT. We are not embarrassed to talk about poop and pee and sex.”

An estimated 32% of women and 16% of men in the U.S. could have some form of pelvic floor issue. “Pelvic floor dysfunction (PFD) refers to a broad constellation of symptoms and anatomic changes related to abnormal function of the pelvic floor musculature. The clinical aspects of PFD can be urologic, gynecologic, or colorectal and are often interrelated.” (Grimes & Stratton, 2022)

Childbirth, cancer, surgeries, and trauma are some of the causes of these issues. Stress has been found to be a leading factor for PFD. For many of us, when we experience prolonged periods of stress, there is a cascading effect on our bodies that starts in our hypothalamus, leading to consistent cortisol overproduction, and this creates a wide array of pelvic issues. Most people with pelvic pain and disorders have been found to have low cortisol because their bodies have become depleted from chronic overproduction. 

According to an article published in Physiopedia, “It is evident that individuals with pelvic pain have factors that disrupt the usual cortisol cycle.” 

So, what conditions does PFT help treat? “Anything from pelvic or abdominal pain, pain with intimacy, bladder or bowel leakage, and/or pelvic pressure,” Fisher says. 

“Pain putting in a tampon, pain after delivery, especially pain with getting back to the gym after delivery,” Cumming adds. “Also, that lifetime change of perimenopause and menopause, that could be prolapse leaking. As in, ‘I don’t feel like I’m emptying when I go to the bathroom.’ For men, it’s looking at penile pain, testicular pain, pain with intercourse, then, after prostate cancer, if they’re having leaking or feeling like they’re not having the libido they want to have.” Some of this work may also be done in collaboration with the patient’s urologist. 

Some people might hesitate to take action when they experience sexual issues, thinking it will pass, or it’s part of aging. Many don’t realize that not only could there be a physiological reason for their dysfunction, but that it’s worth it to seek treatment. “Sex is a quality of life issue, for sure,” Cumming says.

Fisher, who has made a name for herself via educational content on Instagram, says “I wish people knew there is hope for their symptoms. Most of our clients find us after years of searching for answers or dealing with their symptoms.”

Because we live in a society that levies taboo upon bodily functions below the belt, misconceptions abound. “I think the common misconception is that we’re just gonna be like, up in your business, and we’re not. Sometimes we need to do a dilator or there’s some soft tissue work you’ll do yourself. But, most of the time, it’s about ‘How do we get the rest of your body to work off of your pelvis?’” Cumming says.

Awareness of the industry is growing, and there has been a 3 to 5% increase in practitioners in the field over the last few years, yet every pelvic floor physical therapist will tell you they wish people knew they even existed. There’s only a tiny percentage of practitioners who are men, despite there being no shortage of urologists or OB/GYNs that are men. Could this be keeping men from seeking treatment? 

Many people have been experiencing pain for over six months, yet it can take years for a patient to try pelvic floor therapy. “A lot of the men that we see, especially from the pain route, have had pain for sometimes decades,” Cumming says. “They’ve been on every medication, they’ve seen every doctor, they’ve had every test. So they have some medical trauma. It’s like they don’t really trust the doctors because they’ve been like, ‘Well, I took these antibiotics for 30 years for my prostatitis and it didn’t do anything for me.’ And I’ve had patients like that. I’m like, ‘No, this is a musculoskeletal issue.’”

Devices that can help in your pelvic alignment journey include dilators, pelvic wands, or a TENS machine, which delivers low-voltage electrical stimulation. Your physical therapist will help you select what device works for your particular case, if any.

Regardless of the treatment plan you and your practitioner develop, you have to follow through with the stretches and exercises. “Consistency is needed to see results in anything, but especially in improving your pelvic floor symptoms,” Fisher says. Set calendar reminders, alarms, or whatever else you need to continue the recommended regimen. 

You don’t need a referral to see a pelvic floor therapist—All 50 states have direct access, so if you’re struggling with anything you think could be related to your pelvic floor, care is available quickly and cost-effectively in most cases. If your insurance requires a referral, the PFT office will let you know when you call to make an appointment. 

Pelvic pain, constipation, or incontinence are not something you need to learn to live with. Seek treatment, the earlier the better.

You can find Kristen @OpenTheDoorsKC on Twitter or openthedoorscoaching.com. Check out her podcast Keep Them Coming.