Pelvic Floor Dysfunction and Lower Back Pain

Could Pelvic Floor Dysfunction be Causing my Low Back Pain?

The pelvic floor is a muscle group that directly influences the hips, pelvis, and lower back. This “sling” of muscles includes over a dozen separate muscles all with a variety of functions. This muscle group acts as the floor of your “core” and works in conjunction with your spinal muscles, abdominals, and diaphragm to stabilize your spine. When one muscle group is under or over performing, it alters the mechanics of the lumbopelvic complex and can result in pain, reduced range of motion, or weakness. Lack of neuromuscular control to pelvic floor muscles can be correlated with trunk instability resulting in low back pain.

Pelvic Floor Dysfunction is More Common in Women

Pelvic floor dysfunction is more common in women than in men due to :

pelvic anatomy
hormonal differences
pregnancy/birth.

Over 25% of women will experience pelvic floor dysfunction at some point in their lives. If you are having a flare up of back pain associated with your menstrual cycle, it could be related to hormonal changes and pelvic floor dysfunction.

If you are having back pain after childbirth there may have been a shift in your pelvic bones that can be corrected with pelvic floor training.

If you are experiencing urinary incontinence when you sneeze, laugh, or jump and also have low back pain, there could be a correlation between your pelvic floor dysfunction and your back pain.

Is Incontinence Common with Low Back Pain?

Statistics show that upwards of 70% of women who attended physical therapy for low back pain also reported urinary incontinence.

Common Signs of Pelvic Floor Dysfunction

Pelvic floor dysfunction is most commonly associated with urinary incontinence, but there are many other symptoms that can be associated with pelvic floor dysfunction. Some of the most common symptoms include:

Chronic constipation
Painful intercourse
Pelvic pain

If you are experiencing these symptoms along with low back pain, there is likely a correlation. These symptoms are not to be confused with those of cauda equina syndrome which can include incontinence as well as changes in sensation to the groin/buttocks and weakness in one or both legs. This can be a serious condition and should be treated as soon as possible.

Surgical Treatment of Pelvic Floor Dysfunction

In some severe cases, pelvic floor dysfunction can require surgical interventions. These interventions can include slings, pelvic prolapse repair, and artificial sphincters. Most pelvic floor dysfunction can be treated with therapy and medications.

Physical Therapy Treatment for Pelvic Floor Dysfunction

With an in depth physical therapy evaluation your therapist will be able to determine if your pelvic floor muscles are properly functioning. Through education and movement patterning your physical therapist can teach you how to properly engage your pelvic floor muscles. This in conjunction with abdominal exercises and hip stabilization can improve your lower spine mechanics and reduce the load on your lumbar spine and SI joints.

Other factors that may be discussed with your physical therapist include

Healthy diet
Controlling body weight
Activity modification
Breathing exercises

Easy Home Exercises to Address Pelvic Floor Dysfunction and Back Pain

Abdominal bracing – Lying face down, gently draw in the lower abdomen away from the surface. Hold 5 seconds and repeat 10X.

Lower trunk rotations – Lying on the back with knees bent, rotate the legs and lower trunk each way 20X.

Piriformis stretches – Lying on the Back with knees bent, cross 1 leg over the other and pull the knee toward the opposite shoulder. Repeat 3x for 30 second holds.

Clamshells – Lying on the side with knees bent, lift the top knee without moving the spine.

Kegels – Pelvic Floor Contraction (See Below)

How Do You Contract the Pelvic Floor?

To perform a Kegel contraction, begin by squeezing your pelvic musculature as if to stop the stream of urine. From there, draw your pelvic floor upward like an elevator. Be sure not to use you buttocks and abdominals to compensate. Start by performing this exercise laying on your back and progress to sitting and eventually standing.

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