“The pelvic floor wasn’t really on my radar before having my first child, but I started to see the significance in understanding it more after seeing patients with pelvic pain that they struggled to pin down. Working away from the symptomatic area only got me so far, and I knew that strengthening the pelvic floor was often the opposite of what was needed, so I looked into further training.
I am now competent in vaginal assessment of the pelvic floor, but this is not the first step for any patient, and it’s certainly not obligatory. It may provide useful information when combined with the verbal history and general examination, and can be a useful way to treat when appropriate.”
Pregnancy puts a long term strain on the tissues of the abdominal walls and pelvic floor. Birth, whether vaginal or caesarean, asks the tissues to do even more. Internal and external injuries are far from uncommon, but may go undiagnosed for decades.
The body is resilient, but it can still benefit from some help in the right direction. Postpartum assessments, with or without the internal assessment, aim to identify these potential issues and their impact on the rest of the body.
Deep or superficial pain in the pelvic area can follow increased demand and strain (pregnancy and birth), hormonal changes (menopause), or traumatic experiences (personally or through medical interventions). Pain is rarely one dimensional, but may be associated with tissue damage, nerve irritation, or protective spasm with a link to psychological trauma. Often the pain is down to more than one of these factors.
Like everywhere else, osteopaths are interested in the connection between the painful area within the pelvis and other nearby structures. The lower back and hips are often associated along with their local musculature. Treating all affected areas is our usual strategy, with the aim to restore function and minimise compensatory patterns.
As oestrogen levels drop, the tissues around the pelvic floor change. Internally and externally, tissues become thinner and lose some structure. This allows for pre-existing issues that might not even have been symptomatic before, to become significant. Pelvic organ prolapse may develop decades after a minor birth injury, causing pain or other problems when going to the loo. Weakness or tension might also appear in the pelvic floor, leading to those symptoms you might struggle to describe well, and might prefer to ignore.
Don’t be led to believe that leakage is “normal” after a certain age, or that it’s something you have to suffer with in silence. Losing oestrogen changes things physiologically, and in terms of pain processing, but we do have strategies to counteract the effects. The “one size fits all” advice to do your kegels isn’t any good for a tense pelvic floor- you need a proper investigation and personalised plan.