How Pelvic Floor Dysfunction Connects to Your Whole Body

When you’re dealing with chronic pelvic pain and/or painful penetration, you hear a lot about your pelvic floor muscles. And for good reason! Tight pelvic floor muscles, weak pelvic floor muscles, and other forms of pelvic floor dysfunction can all contribute to chronic pelvic pain and pain with penetration. Medical professionals have probably told you to see a pelvic floor therapist. Doing so can be literally life-changing as these specialists can design a treatment plan specifically aimed at your pelvic floor issues. 

But what if you’ve done everything you’ve been told to do for your pelvic floor dysfunction and you’re still dealing with chronic pain or discomfort? Too often, people treating pelvic floor dysfunction only focus on the pelvic floor muscles. And honestly, that’s understandable! That’s their main scope of practice! 

Unfortunately, the reality is that the impacts of pelvic floor dysfunction rarely stay in their lane. In fact, pelvic floor dysfunction can cause problems in almost any part of the body, and functional problems in other parts of the body can absolutely cause or contribute to pelvic floor dysfunction. 

Let’s take a look at the myriad connections between the pelvic floor muscles and the rest of the body and how dysfunction in one place can create dysfunction in another. 

You’ve probably heard hundreds of times how important your “core” and “core muscles” are to supporting the whole body and powering movement. Well, the pelvic floor muscles are considered the “floor of the core.” So, that gives you an idea how important they are to the stability and function of your body. 

The pelvic floor muscles work together with the core muscles to 

• Facilitate proper breathing
• Support the back and the pelvis
• Power the body’s movement
• Maintain proper posture

When the pelvic floor muscles are too tight or too weak, this throws off the function of all the other muscles in the core. The reverse is true as well – when the core muscles are too tight or too weak, the pelvic floor muscles can’t function properly either. And when the core can’t function properly, it throws off the entire body’s stability and function.

That’s why Casey Baczewski, a physical therapist who frequently works with people dealing with pelvic floor dysfunction, always starts by observing how the people she sees are using their cores, including their pelvic floor muscles, to move their bodies.

“Your pelvic floor is right in the middle of your body, so you need to make sure that's moving well,” she explained. “How you're using your core affects your extremities.” 

Baczewski continued, explaining that when people come in complaining of chronic hip, back, shoulder, or even neck pain that just won’t go away, she actually looks for a cause in the core and the pelvic floor first. Because chances are, pelvic floor dysfunction is at least contributing to the problem.

Lindsey Novakovic, an occupational therapist who specializes in pelvic floor dysfunction, told me, “Breathing is another [thing] that I love to point out to my patients. They're like, what are you talking about? I breathe fine. I don't feel like I'm not getting enough air.

And then I look at the way that they breathe and they're breathing into their abdomen versus breathing into their lungs and expanding 360. I'm like, well, no wonder your pelvic floor is so tight. You're not allowing it to move the way it should be moving.” 

However, Baczewski pointed out that breathing too high in the chest can also be a sign of pelvic floor dysfunction. 

“Often what happens is if your pelvic floor is tight, and especially if you're somebody who's an abdominal gripper… then I can't breathe downwards. So, then the breath comes upwards into the upper chest and then I'm breathing with my upper respiratory muscles, my accessory muscles, so my neck and my neck muscles.”

Poor breathing mechanics don’t just impact cardio and stamina. They can also cause chronic pain throughout the body. A 2022 study of people with chronic back, neck, shoulder, and/or knee pain found that 65% of these people also had issues with their breathing mechanics. This suggests that breathing mechanics play a role in musculoskeletal pain. 

Since the pelvic floor muscles are so crucial to proper breathing mechanics, it follows that pelvic floor dysfunction may also play a role in chronic pain throughout the body. 

So, even though they’re far away from each other, the pelvic floor muscles are directly connected to the neck. 

And anything that happens to any one of those muscles or the surrounding fascia impacts everything else in the line. 

Baczewski envisions these connections as a “pulley system” throughout the body. “If we tighten this pulley here, how does that influence where muscles are attaching somewhere else, which influences their position, which influences how you're going to use the next one. Kind of like in Indiana Jones when they pull something and then it creates this whole Domino effect.” 

To apply the metaphor to the neck and pelvic floor example, if the muscles in the pelvic floor are really tight, it will influence how the muscles in the core, hips, glutes, and back engage and move. 

Having a medical professional like a pelvic floor physical therapist assess your pelvic floor muscles and come up with a treatment plan is most likely a great way to address your chronic pelvic pain and/or pain with penetration. But it’s probably not the only approach you’ll need to feel your best for the long-term. More experts in the field of pelvic health are now recommending a holistic approach to treating pelvic floor dysfunction that approaches the body as an interconnected system leads to long-lasting relief. 

In addition to seeing a pelvic floor physical therapist, you might want to see a physical therapist who, like Baczewski, has a background in providing PT for athletes. Baczewski’s passion for pelvic health led her to work with a lot of pregnant and postpartum athletes experiencing pelvic floor dysfunction, but she started her career like many PTs do – working with injured athletes and movement junkies. Working with them is what initially taught her that pain and dysfunction in one place almost always means dysfunction in another place as well. This is the foundation she works from every time she assesses someone for any issue, including pelvic floor dysfunction, because it allows her to treat the entire body, not just the issues the person wants to resolve. 

Or you might work with an occupational therapist like Novakovic. Because occupational therapists focus on restoring whole body function so you can do whatever you want to do with your body, they also take their focus beyond the pelvic floor. An occupational therapist can work with you on everything from manual therapies like massage and assisted stretches to breathwork, meditation, and increasing body awareness. 

If you’re looking for something you can do on your own to work on not only your pelvic floor muscles, but the surrounding muscles as well, check out the Kiwi. This little handheld massager can help release tension in the muscles all around the pelvic floor, including the lower abdomen, thighs, hips, and glutes. The unique design also allows you to use the Kiwi to release tension in the perineum, which is part of your pelvic floor! 

There are so many options out there to help you get relief from chronic pelvic pain and/or penetrative pain, even if pelvic floor PT didn’t work for you or isn’t an option. You don’t have to suffer in silence or just accept the pain!