Pelvic-Forward Thinking: A Critical Component to Health and Well-Being

In a riveting change of pelvic narration, I’ve decided to shift perspective from a bystander-ly third person narrator of pelvic-y rehab to the more forward, vulnerable and candid first person approach.  This seems more real to us, as pelvic health PT is a highly intimate and emotional area for both Beth and I (and all other PTs in our same line of work).  Beth sends in her contributions from afar, as her job for the next week or so is to float her own dear pelvis between the Greek Isles and revel in her time away from the clinic.  (My pelvis is envious, but hey, someone’s got to hold down the pelvic fort in Fort Collins for now).

For those less familiar with the specialty of pelvic health physical therapy, as PTs, we often address highly intimate/personal issues involving the pelvis/spine, pelvic floor muscles, organs and related structures.  This requires an integrated and thorough understanding and evaluation of many systems of the human body. We see patients (men/women/transgender) struggling with issues related to chronic pelvic/abdominal pain, pregnancy/postpartum needs, urinary/fecal incontinence, voiding difficulty, sexual dysfunction/painful intercourse, pelvic organ prolapse, and considerations before/after surgery, etc.  In conjunction, we address frequently related issues of low back and mid-back/rib pain, hip pain, sacroiliac dysfunction, tailbone pain, among others.

Research studies show that pelvic floor issues are more prevalent in women than men, and that pregnancy increases incidence of pelvic floor dysfunction.  However, these issues also occur in women who have never been pregnant.  Studies readily estimate that at least 1 in 4 women in the United States have symptoms of pelvic floor dysfunction.  But men also have pelvic floor symptoms, too.  In reality, these are common issues (but not ‘normal’) that we often shy from discussing with our confidants, family and even partners.  Face it: we as humans pee, poop, have intercourse, move, etc.  We often see this unwelcome ‘hush’ re: normal bodily functions lending itself to more fear, shame, emotional distress and/or adverse effects on daily activities, exercise and relationships.

I thought we’d tackle one inevitable query our patients nearly always ask:  “Why did you get into this kind of PT?”  (Like peculiarly funny clockwork, this often first comes up upon donning of gloves and prepping of lubricant).  Opportunely, just like our patients’ reasons for coming to pelvic PT, Beth and my answers to this intertwine with our deep-seeded motivations/beliefs, insatiable (clinical) curiosities*, vulnerabilities, mental/emotional health and our very real human experience of also owning a pelvis.

In her book Daring Greatly, Brené Brown writes: “Vulnerability sounds like truth and feels like courage.  Truth and courage aren’t always comfortable, but they’re never weakness.”  It’s pretty dang hard to dedicate your professional career to pelvises without thinking of your own, along with the emotional intersections of our own physical and mental health.  And it’s courageous and often feels vulnerable for patients to come forth and address these intimate, dignity-compromising and personal issues in PT.

So, here’s to what we’ll call courageous vulnerability, pelvic edition:

Beth and I agree that we found our way into this specialty because of dire need to bring pelvic health into the mainstream-talk of our overall health.  One driver of our ‘why’ and critical component of our work as PTs is educating and empowering our patients to better understand and develop a better ‘brain map’ connecting the ‘upstairs’ (brain) to the rest of our ‘downstairs.’  Consider this like building a resilient inner map of your intuitive senses navigating how you move through your every days.  We believe once we can better understand our body and challenges to our health, we can better advocate for our needs.  Most of us are highly in-tune with our bodies when troubles arise in our arms, legs, neck, low back — at least enough to seek help — however, when the pelvis starts complaining (ie pain, incontinence, heaviness, difficulty with intercourse, straining, etc), a common angst often arises, in part, I believe, from a relative un-knowning of what’s occurring or how to change it.  I liken this to the feeling of when my higher mileage Volvo’s check engine light deviously flickers before me (Read: I have no idea what’s going on! And can’t fix this myself! And, I’m all alone on this road!).  Adjacently:  Why is my pelvis leaking?! Or why are my insides hanging down?!  I’m a solo struggler right now!  When issues go ‘south’ in the pelvis, enter these commonly-associated negative feelings and struggles.  But why?

I think this angst and un-knowing traces back, in part, to our collective understanding/education and poor exposure to pelvis-talk.  I recall the significant limitations (and near hilarities) in my own anatomical education of our ‘downstairs’ in grade school, high school and college courses — maybe best depicted in gender-distinguishing mathematical equations:

  • Women:
    • Bladder + Bowel + Uterus + Ovaries + Fallopian Tubes + Vagina = Pelvis
    • Urethra + Vagina + Anus = 3 holes
  • Men:
    • Bladder + Bowel + Prostate + Scrotum + Penis = Pelvis
    • Urethra + Anus = 2 holes

No wonder I was pretty good in math.  Thankfully, PT school finally equipped me with a pelvis-epiphany in greater lessons of the mysterious ‘downstairs.’  But why the heck need I reach a doctoral level anatomy class to begin the self-conversation figuring out my own pelvis? Turns out, we’re more than just 2 or 3 holes and a few organs squished into a small, bony space. And it’s certainly not just about kegels, even if we think we can do them correctly (we’ll save this for another day).  Upon finding I had a pelvic floor and its role in many functions of human dignity, and relation of multiple systems in our body, I was downright mad that I had been carrying it around my whole life sans thorough, brain-y recognition.

Gratefully, with ample research in neuroscience and evolving pelvic/PT research on our side, we know that with better understanding of our bodies, we can then appropriately use tools to best navigate the routes necessary for healing and improvement.  With understanding comes empowerment.  The good thing is, the root of a lot of the issues we treat in PT — from incontinence, to prolapse, to pelvic pain — have significant musculoskeletal and neurological components to them, which are highly dynamic and changeable systems.  We’ve got our PT tools of listening ears, experience, research, support of PT colleagues, hands-on skills, biofeedback, therapeutic exercise, education and expertise – and, well, just being human.   We ask that you bring forth your best and committed self so we can help build a personalized roadmap together.

We know it’s emotional —  it’s often emotional for us, too. And sometimes difficult to begin.  You’re learning — but we’re learning with you, too.  We’re addressing a wildly buried area of our body, jam-packed with input to/from our nervous system, musculoskeletal, endocrine and GI systems, organs, emotions, our environment, relationships, among other signals.  However, our jobs as PTs would cease to exist if the human body didn’t have a remarkable ability to change and mend itself.  And, were here to guide and support you in navigating this path.  Our ‘why’ fuses a deep-seeded empathy, persistent curiosity, expertise in the human body and movement with a fierce drive to normalize the conversation and treatment of pelvic health.  Luckily, we no longer have to bury our dignity in embarrassing/vulnerable symptoms or scapegoat hush-hush issues to ‘what my mom also had.’  Instead, courageously use this as fuel for self-learning, empowerment and change.  It’s time to bring our ‘downstairs’ front and center.

So, do your upstairs, downstairs and all related systems a fine, healthy favor:  Strap on your courage shoes and take your pelvis for a walk today.  Or prop it up on your bike and just ride.  Hike it up the hills, ski it down the mountains.  Dance it silly.  Take some deep, rib-expanding and pelvis-moving belly breaths.  Or even swim it across the Greek Isles, ahem, from time to time.

Do what moves you. And we’re here if you need help along the way.


Dr. Gina Yeager and Dr. Beth Dessner are physical therapists at Colorado In Motion

*Thanks to Rudyard Kipling, from his “Elephant’s Child” in his Just So Stories — a perfectly clinically applicable term to the pelvis.

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