Pelvic Health: Let’s Talk About It

The pelvic region is very personal and the social custom – or expected behavior – of respecting this privacy is essential. However, this customary politeness can verge on making “down-there” a taboo, even in conversations with medical professionals! Our social habits exist to strengthen communities, but this particular practice is not helpful when it causes one to ignore – or not even acknowledge – something important.

Pelvic dysfunction can be swept under the rug as “normal,” and individuals can be told to, or feel that they must, “just deal with it.” For some, the sacrifice of changing one’s lifestyle to accommodate pelvic dysfunction may not bother them, but for others it can be life-altering if unable to do the things that once brought joy and satisfaction. Over time, this can drastically affect self-esteem and relationships, sometimes changing the course of one’s life. Yes, pelvic dysfunction can be that impactful.

I am not saying this should be a topic of conversation at the grocery store, but if someone happens to mention that they leak when they sneeze or lift, cannot wear tight clothing because it’s irritating to their genital skin, have painful intimate relations, or miss work because of incapacitating pelvic pain, don’t allow them to accept those things as “normal” – strongly encourage them to see a medical doctor and follow up with them later to see if they made an appointment! This simple act of compassion and helping someone to be accountable may be all someone needs to take the issue seriously and get on the road to recovery, which could be life-changing.
When I mention the pelvic floor to my orthopedic patients with back or hip pain, there is always an initial surprise, but one by one I see faces light up with interest and curiosity. It didn’t take long for me to realize that this was an essential conversation that people really do want to know about! Whether or not they have pelvic floor concerns, I want them to hear the words and at least think about this area of their body. The pelvic floor and its functions are so often taken for granted, I just want to instill an awareness. Those who do have issues are so appreciative that I can offer them hope and simple techniques or exercises they could start right away.
After awareness, knowledge is next. We need more of that up front so that individuals can make informed lifestyle choices for prevention and optimal functioning. This might mean wearing a pessary during high impact activities for extra support, knowing how to integrate pelvic floor activation into a regular exercise routine, understanding the impact of constipation on the pelvic floor, and/or how to stretch and relax the pelvic floor (which is equally important as activation).

As a pelvic floor physical therapist we can offer suggestions specific to a condition and relevant to one’s body and lifestyle. I recall one patient who, when I started talking about how posture can affect the pelvic floor, said to me quite confidently “Oh, I don’t have one of those. I pee every time I sneeze.” I quickly assured her that she in fact does have a pelvic floor! This led to a discussion about pressure management and basic pelvic floor activation coordinated with her breathing cycle so that she could start being proactive. Although she had been resigned to accept her stress incontinence, she was very happy to hear that it could be changed – a little knowledge and encouragement motivated her to take it seriously!

Optimal pelvic floor functioning – urination, defecation, sexual function, organ support – is so vital to every human being’s daily life, yet it is taken for granted soon after our body figures things out with potty training.

Although as a clinician it’s important to start the conversation, we may actually have more opportunity to NOT STOP the conversation in other environments with friends and family. If we don’t shy away from the conversation when someone makes a flippant remark about something related to their pelvic health, perhaps we can start to break the taboo and squash any shame or embarrassment associated with genital functioning and pelvic health.

Author: Diane Kottakis, PT, DPT | 2023 Scholarship Recipient