by Lisa Perry
I once worked in a building that had a crack in the wall from the top of the doorframe to the ceiling. A handyman was brought in to patch it and make it go away. When he was finished it looked as if the crack had never been there. However, the crack kept coming back. It wasn’t that the handyman didn’t do a proper repair, but the crack in the wall was just a symptom of the building’s cracked foundation. As long as the foundation remained cracked and unstable, the crack in the wall would keep returning. And not only would it return, but when it did it was always a bit worse than the time before.
When most people think about pelvic floor dysfunction (PFD), the fix that comes to mind is kegels. The reasoning follows as such: the pelvic floor is failing, therefore it is weak. Weak muscles obviously need to be strengthened to regain proper function. Kegels activate the pelvic floor musculature, making this the logical answer. However, while kegels might be considered the logical answer, they’re not the complete answer. It is important to understand that the pelvis is not a stand-alone structure. It is dependent on the function of everything below and above it, just as the walls of a building are dependent on the foundation below and the roof above. Only doing kegels may provide a fix for the time being, but unless one addresses the areas above and below the pelvis, PFD will continue to return like the crack in the wall.
Our pelvic floor has great responsibilities. The most obvious is that it keeps contents inside our body, providing support to keep the lower pelvic organs (bladder, uterus/prostate, and rectum) in place. It is constantly yielding to the intra-abdominal pressure created by respiration and abdominal engagement. The pelvic floor must also be able to stretch, pull upward, and push downward during our many different daily functions we have as human beings. If it is functioning properly, we don’t really have to think about what it should be doing because it is reflexive, happening without conscious control. Many are led to believe their PFD is brought on by childbirth and aging. This is a valid belief considering most women start to experience leakage, sneeze pee, or whatever else it might be called after birthing children and/or as they get older. But these are just symptoms of a hidden dysfunction that has been lurking in the body for quite some time, possibly since childhood.
If we go back and compare the body with a building, the feet are the foundation, the pelvis is the wall, and the ribs are the roof. The biggest difference between a body and a building is that all pieces of a body need to move, be strong, and be flexible at any given time. If we look at the structure of our foundation, high arches and flat feet can give a hint of what may be happening inside the pelvis before we even start to notice any symptoms. Our feet are the first point of contact with the ground, and thus provide the brain with essential information about the environment and our place in it. The pelvic floor relies on the information received from the feet to make a reflexive decision as to what it needs to do. If the feet are rigid, weak, or both they will not only send incorrect information regarding the terrain, but will also pull all the structures above them into a less-than-optimal alignment. A pronated foot (flat foot) can pull the shin inward, which rotates the thigh inward (knock knees), allowing the pelvic floor to be more lax. A supinated foot (high arch) can force the shin outward (bow legs) and tuck the pelvis under, creating a more drawn-up pelvic floor. In both scenarios, the pelvis is weak. A lax pelvic floor lacks contractile strength (the ability to contract while shortening), while the drawn-up/tense pelvic floor lacks yielding (stretching) strength (the ability to contract while lengthening). A muscle that is short/tight at rest can be just as weak as a muscle that is long/loose at rest, but both need different strategies to strengthen them.
The pelvic floor needs its variability restored so that it may respond to its many demands, but we first have to address the feet and their contribution to any PFD. Our modern world of supportive shoes, flat surfaces, and automobiles have contributed to our stiff, rigid, and weak feet, thus creating a weakened pelvic floor, even in the most active people. If we incorporate exercises to mobilize and strengthen our feet in conjunction with pelvic floor and whole body exercises, we can finally start working towards a permanent fix to our PFD.