Complaints & connections · borters.ch
Four walls, one pressure vessel — without the floor the spine loses its support from within.
Also known as: pelvic floor · pelvic floor weakness · core stability · abdominal pressure · Kegel exercises
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The pelvic floor is the lower wall of the pressure vessel the trunk forms — diaphragm above, deep abdominal muscles in front and at the sides, small back muscles behind, pelvic floor below. If all four tighten together, the pressure in the belly rises and supports the spine from within. From this follows the connection that explains both directions: in persistent back pain the anticipatory tightening of these walls is delayed, and with pelvic floor trouble one of the walls is missing — which is why back pain and stress incontinence appear together more often than chance would lead one to expect. For training something practical follows: pelvic floor exercises work together with breathing and the deep abdominal muscles, not as isolated squeezing. And exercises that strongly raise the abdominal pressure without the floor joining in work against the goal.
The pelvic floor lifts by itself with the out-breath. Putting the tightening onto the out-breath — when standing up, lifting, coughing — works with the diaphragm instead of against it. That is the difference between an exercise that carries and a squeezing that tires.
Pelvic floor training has one of the best evidence bases there is for stress incontinence — but the studies run over three months and more, with guided execution. After two weeks nothing is decided yet, and the commonest cause of failure is a wrongly performed exercise.
Chronic coughing, stubborn constipation with straining and heavy lifting without breathing out repeatedly raise the abdominal pressure against the floor. Working on those three often brings more than any additional exercise — and they are rarely connected with the pelvic floor.
First breathing and pelvic floor, then deep abdominal muscles, only after that loading with weight. Exercises that strongly dome the belly forward belong at the end and not at the beginning — with the join of the straight abdominal muscles still soft they work against the healing.
Less strength on stairs, a thigh gone soft, slower healing. In older age the most common silent deficiency — and the one posture shows first.
Not as a cause but as a consequence: bleeding more because of a prolapse or eating less because of complaints loses iron. Tiredness is then blamed on the pelvic floor although it comes from the blood count.
The pelvic floor is oestrogen-sensitive. After menopause the tissue thins and loses elasticity — which is why complaints often become noticeable then for the first time, although nothing in the statics has changed.
How well the pelvic floor works shows on palpation and on contracting to command — not in blood. Many tighten the belly or the buttocks instead of the pelvic floor; that is exactly the finding that matters.
The counterpart of calcium at the muscle fibre: calcium contracts, magnesium releases. With tension and night cramps it is therefore the first thing asked about — the studies are mixed, the mechanism at the muscle is not.
Every hard strain on the toilet loads the pelvic floor from within. Soft stool is therefore not a side note but the most easily changed part of the whole thing.
Pelvic floor training has one of the best evidence bases there is for stress incontinence — and no capsule comes near that size of effect. The studies run over three months with guided execution; the commonest cause of failure is a wrongly performed exercise and not a missing nutrient.
The indirect but measurable route: persistent constipation with straining repeatedly raises the abdominal pressure against the pelvic floor. Soft stool takes exactly that load out. Psyllium works in both directions and needs enough fluid, otherwise the effect reverses.
In observational studies a low level was more often linked with pelvic floor complaints in women. Whether replacement changes anything is not shown — the connection runs most likely via muscle strength in general, and that is the point of attack here.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
Pregnancy and birth are the single greatest load the pelvic floor meets. What comes back afterwards is decided in the first months — and can still be trained years later.
After menopause the tissue in the pelvis thins and loses elasticity. Complaints often become noticeable then for the first time, although the cause lies decades back.
Every hard strain presses on the pelvic floor. Fibre, enough drinking and no long sessions on the toilet are therefore the quietest and most effective part of the whole thing.
It is not the session that works but what continues at home afterwards. After four to six appointments you can judge whether anything is moving.
For everything to do with statics, the method with the most data. What matters is not the kind but that it happens at all, and regularly — the back holds what it does daily.