“Why Didn’t Anyone Tell Me This Before?”: 5 Common Myths About The Female Pelvic Floor

By Stephanie Brown, PT

If only I had a dollar for every time someone said to me “Why didn’t anyone tell me this before?” or “I wish I had known this earlier”. I hear comments like this daily so I thought it was time to bust some common myths about the female pelvic floor.

Myth #1: Urinary incontinence is normal, especially after childbirth.

FACT: It is common – but it’s not normal!

Normal means to conform to a standard or accept something as expected. We wouldn’t say it’s normal to hurt your back lifting something heavy. It’s a very common injury but it’s not normal for it to happen. When it does it’s typically due to poor lifting techniques, muscle weakness, or preceding injuries.

“According to the Canadian Continence Foundation approximately 3.5 million Canadians experience some form of incontinence. That’s roughly 1 in 3 women”. How often do you hear women say things like “don’t make me laugh I’ll pee my pants” or“I can’t jump on the trampoline with my kids anymore without peeing”, what about “I can hardly make it in the door without wetting myself.” These are all common complaints but they aren’t normal and it’s a sign of pelvic floor dysfunction. Pelvic floor physiotherapists can help to identify and treat the cause of dysfunction with great results. 

Myth #2: Pelvic pain and pain with intercourse are normal after having a baby. 

FACT: While it is common following childbirth, pain is never normal.

As a society I don’t feel we respect the journey of pregnancy and childbirth. Childbirth should be thought of as a marathon. You wouldn’t just wake up one day and expect your body to run a marathon without training for it. We should prepare and train our body for the “race” of childbirth. We need to appreciate the miraculous changes the female body endures to grow and birth these tiny humans. In the birthing process perineal tears, episiotomies, and stretching of the pelvic floor muscles are common. These are forms of injury that can lead to pain and dysfunction of the pelvic floor. Physiotherapy can help to reduce the pain commonly felt after childbirth and make the transition back to intercourse a little more smooth.

Myth #3: A Cesarean section will prevent problems with my pelvic floor.

FACT: Sorry ladies, not the case.

A Cesarean section is a major abdominal surgery with an incision made through the skin, the underlying fat, and into the abdomen and uterus. Neither a vaginal delivery or Cesarean section will prevent all pelvic floor dysfunction. We must remember that the core is actually made up of the diaphragm (top), the abdominal muscles (middle) and the pelvic floor (bottom). In addition, your pelvic floor just had the weight of a growing baby pushing down on it for the past 9 months. So even if you didn’t physically push a baby out of your vagina, your pelvic floor still helped support that baby in utero and your abdomen was cut open to birth the baby. Therefore, your core support system has been affected and indirectly your pelvic floor. Pelvic floor physiotherapists can help evaluate all aspects of the core to ensure they are working in synchrony.

Myth #4: Pelvic floor problems are caused by weak muscles. 

FACT: Sometimes, but the opposite is also true. 

Typically when we assess the pelvic floor we are looking for hypertonicity (tightness) or hypotonicity (weakness) of the muscles. For a muscle to be functional it must be able to contract and relax (shorten and lengthen). When the muscles are too tight or hypertonic dysfunction can include stress incontinence, difficulty emptying the bladder or bowel, urgency, and pain with intercourse. On the other hand, weak or hypotonic muscles typically present with urinary incontinence or urgency, pelvic organ prolapse, poor control of bowels/gas, and decreased sensation with intercourse. A pelvic floor physiotherapist can assess the muscles of the pelvic floor to determine what treatment and exercises would be most beneficial. 

Myth #5: Kegels will help fix any pelvic floor issues.

FACT: Not always, sometimes they can make things worse.

This answer to this question depends on what we just talked about in Myth #4. In my practice I actually see more women with issues related to tight pelvic floor muscles (hypertonicity). Exercising muscles that are already too tight will not help the problem.

Secondly, “30-40% of women don’t know how to effectively perform a Kegel”. Many people think they are doing a Kegel when in actual fact they are using other muscles like the glutes and adductors. You need to learn how to activate your pelvic floor properly without accessory muscles. It is also important to learn how to use your core muscles (diaphragm, abdominals, and pelvic floor) together to protect your pelvic floor from unnecessary strain and pressures. Just when you thought you were done- you need to be able to add movement and exercise to the equation. It’s not as simple as you think!

So what have we learned?

If you think you might have pelvic floor dysfunction you should be evaluated by a trained healthcare professional. A pelvic floor trained physiotherapist can help to assess, treat, advise and educate on the appropriate treatment plan individualized to your needs. It is normal to feel a little intimidated about a pelvic floor assessment because it typically involves an internal vaginal exam. However, a good physiotherapist will go above and beyond to ensure you are comfortable, informed and respected every step of the way. 

Stephanie Brown PT of Choice Health Centre, Dartmouth, is trained in the Physiotherapy Approach to Female Urinary Incontinence, Physiotherapy Approach for Dyspareunia (painful intercourse), and Physiotherapy for Ano-Rectal Disorders. She is also a certified Core Confidence and Pre/Post Natal Fitness Specialist. Stephanie is a mom to two young children and decided to pursue the Women’s Health field of physiotherapy after personally struggling with her own pelvic health issues postpartum.