Should I be worried about my pelvic floor?

When Kegel exercises just don’t cut it. 

I’m sure that many of us are familiar with TikTok’s Kegel challenge. It’s a call to action typically prompted by a bass-heavy beat and alternating ‘xo’ emojis. “Get to it, ladies, no slacking,” the caption might read. And so we complete our reps and move on with our day, ready to participate in the next exercise, whenever it shall grace our feed. 

The exercise, commonly known as the Kegel, was first described in the early 20th century by Arnold Kegel. He introduced the technique to GPs as a way for women to strengthen their pelvic floor muscles after childbirth. Over time, specialised technology and toys like Goop’s jade vagina egg have emerged to (supposedly) assist us in maintaining this area of our bodies. But how much do we really know about our pelvic floor besides the Kegel?

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Women’s health remains a taboo subject in society, especially when it comes to genitalia and sexual health. Even at the age of 21, I was sure that pelvic floor dysfunction only really concerned seniors or pregnant people. 

Located at the base of the pelvis, the pelvic floor is a hammock of muscles that support our internal organs: the bladder, rectum, uterus and prostate. These muscles also contribute to essential human functions and continence, like urination, bowel movement, posture and sex. And despite the myths, problems with your pelvic floor can vary depending on your sex and age. 

While it’s normal to feel embarrassed about discussing your nether regions, there’s a difference between feeling uncomfortable and living with discomfort or pain. There is such a tremendous gap in public knowledge on the pelvic floor that many consider pelvic pain a symptom of ageing and choose to accept a life of chronic pain. 

In recent years, awareness of pelvic issues like endometriosis, vaginismus and dyspareunia has grown. But it’s rare for general practitioners to recommend pelvic floor physiotherapy as a form of treatment, despite it having great success for these sufferers. To find out more, I spoke with Dr Jessica Teeger, a pelvic physiotherapist and Pilates instructor at the Sydney Pelvic Clinic, to shed some light on this alternative therapy. 

Who can go to pelvic floor physiotherapy? 

Pelvic floor therapy can treat a variety of problems. Just browsing through the Sydney Pelvic Clinic’s website, I’ve learnt more about my health than any sex-ed class has taught me; people can be prone to abdominal separation, endometriosis, faecal or urine incontinence, coccyx pain, prolapse, sexual dysfunction, Peyronie’s disease and more. 

If you’re experiencing discomfort in the lower abdominal region, Dr Teger recommends visiting a pelvic therapist for a consult. “Unfortunately it [pelvic floor dysfunction] has far-reaching impacts on life – we certainly see a lot of people who aren’t achieving, aren’t living their best life.

“Often, people think it’s all in their heads, or something is wrong with them. But very commonly, it’s a mixture of your muscle and nervous systems that needs treatment. And we have great success once people are validated and understand that their problem is normal and can be found in many, many people.” 

Additionally, Dr Teger has helped patients suffering from disabilities that are often overlooked by modern medicine. “With endometriosis, of course, we can’t remove the endo because that’s for a surgeon. But we can certainly treat the pelvic pain that arises due to having monthly terrible period pain or pain throughout their cycle.

“Women who have endo often have pain with urination or pain with sex, and that’s not completely just the endometriosis; it’s very commonly the muscles in the pelvis that have just reacted to the pain and have become tight and sensitised,” she says. 

What happens in a typical session?

Going to the doctor can be daunting, let alone going to a doctor who specialises in examining and exercising the pelvis. Thankfully, Dr Teger has given me some insight into the typical session to help put us at ease.

“It’s always patient-dependent. We will always take a very detailed history to understand how this person has come to find us. And then we know what we need to work on with that person, and that can help direct us whether it will be more physical or educational, depending on what is bothering them,” she explains.

“Then we would often suggest a physical exam which may be an external assessment, looking at how their pelvis moves and what hurts when we press here or there. Or it may include an internal examination where the therapist would use gloves and lubricant and put one finger into the pelvis. Or, we can sometimes use ultrasound.”

Despite experiencing pelvic pain, many people are reluctant to see physiotherapists because of their financial concerns. However, physiotherapy can be covered by both private health insurance and Medicare if your condition is deemed chronic. 

Can you DIY pelvic floor therapy?

Pelvic floor therapy often involves exercising, so it’s likely that your physiotherapist will recommend at-home stretches for your pelvis – roll out the yoga mat and get bending!

Dr Teger says that at-home therapy can differ in combination, but it’s commonly a variation of breath work, stretches and strengthening. “It could be that people use a meditation app, practising mindfulness around their pelvis and allowing tension to leave their pelvis. It might be stretches you see in certain yoga videos.

“It’s also about strengthening certain muscles around the buttocks like the glutes because often the reason that something might be sore or tight is actually when something else might be a little bit weak or not supporting the pelvis that well.”

Deep in my TikTok physiotherapy stalk, I’ve discovered a variety of oddly shaped toys and gadgets. Dr Teger laughs and reminds me that not all toys are meant for pleasure. “We certainly have an array of fun-looking things. There are wands that you use to release your pelvic floor internally, dilators that help to progress penetration, electrical stimulation machines that help with relaxation.

“It’s about prescribing the right thing for the right person at the right time. I wouldn’t recommend that people go out and buy something online and start using it themselves without any direction.”

While you might not have a definitive diagnosis, book an appointment if you suspect pelvic floor therapy could be helpful for you. Whether for education or physical therapy, physiotherapists are keen to restore your form. 

“Physiotherapy is about empowering the patient, giving them self-management strategies, giving them control of the situation. We are not looking for them to come back for lots of treatment. We are looking to guide them along their own treatment journey and to guide them to essentially heal themselves, but with good information and professional guidance.”

This article was originally published on December 9, 2021.

For more information on pelvic floor dysfunction, head here.