What is the pelvic floor?
The pelvic floor musculature is a group of muscles that sits like a sling within the pelvis and plays a vital role in providing stability, support and daily function. The pelvic floor works to provide support for pelvic organs, stability to the low back, hip and pelvis, and controls bladder, bowel and sexual function.
Pelvic floor dysfunction is the inability to control the muscles of your pelvic floor. Coordinated contracting and relaxing of the pelvic floor muscles control bowel and bladder functions – the pelvic floor must relax to allow for urination, bowel movements, and, in women, sexual intercourse. Pelvic floor dysfunction occurs when there is either too much tension on the pelvic floor muscles (high tone) or not enough (low tone) contributing to urinary incontinence, constipation, pain during intercourse or pain in the lower back. It’s also something that can be mistaken for back pain or bring about pelvic and lower back pain.
What’s the link between pelvic floor and back pain?
Research has found correlations between the presence of low back pain and pelvic floor dysfunction. A 2018 study of 182 participants showed that 95% of those who were experiencing lumbopelvic pain also had pelvic floor dysfunction. If the pelvic floor component of low back pain is missed or untreated, there is a chance the back pain will continue. It has also shown that individuals with low back pain have lower pelvic floor muscle function compared to individuals without low back pain. Therefore, it is not always clear which comes first.
Most people think of their core as consisting only of the abdominals. However, the core system is made up of the abdominal muscles, back muscles, diaphragm, and pelvic floor muscles. This system is responsible for managing pressure within the body and creating stability from our centre to support movement. If a component of this system is not working properly, or the entire system does not work well together, it can result in altered movements and pain.
A major role of the pelvic floor is to help stabilize the core and lower back, so when the back is in pain, the pelvic floor muscles may tighten to try and protect the sensitive area. This can overwork the pelvic floor and create additional symptoms. In other cases, the pelvic floor dysfunction may have come first and altered the spine’s mobility and stability, thus triggering low back pain. Either way, there is a feedback loop where low back pain and pelvic floor dysfunction reinforce each other. Both must be addressed for full resolution of symptoms.