What is Pelvic Health? Updated!
Welcome, BESTIE!
Most of my friends have, at some point, asked me “What actually IS pelvic health?” and then following my explanation, they respond with “You do what for a living?” Welcome, Bestie—I am so glad you’re here. If you’ve ever wondered anything about pelvic health, or if you just want to get to know your own body better, you’re in the right place. Here is a space where no question is a weird question, anyone and everyone is welcome, and the only thing we don’t have time for is being judgy. It’s a space to lift up those among us who have pelvises (wait….so all of us? YES). Why don’t we all settle into our most comfy chairs, grab ourselves a heaping cup of yum, and chat about pelvic health. Let’s start off with the bare basics about pelvic health today.
Some of the questions I get all the time include “What is pelvic health?,” “How is that different than women’s health?,” and “Did you say public health?”
I love that folks all over are starting to ask these questions. Twenty years ago, it was a very different story and I feel lucky to live and practice in a time where topics such as these are getting attention and piquing curiosity. If you’ve ever asked yourself one of these questions, or a similar question, you are in the right place! Let’s dive right in.
What is pelvic health?
Pelvic health refers to the health of the tissues and structures of the pelvis. This includes the bladder, the bowel, reproductive organs, and pelvic muscles. Common issues that arise when one of the above structures is dysfunctional include urinary incontinence, bowel dysfunction such as constipation, or various forms of pelvic pain.
There are many types of medical professionals that can be involved in pelvic health. These could be gynecologists, urologists, therapists, physical therapists, dietitians, specialty-trained nurses, and more — the list really goes on!
Pelvic floor and pelvic organ health is essential for some of the most basic bodily functions including urinating, defecating, and having sex. Pelvic health is a multifaceted topic that plays a role not only in physical health, but in mental and social wellbeing, as well. Finally, pelvic health applies to anyone and everyone with a pelvis. This includes folks of all genders.
How is women’s health different than pelvic health?
Women’s health is still commonly used to refer to pelvic health issues. However, it is a bit of an outdated term and encompasses a slightly different group of topics compared to pelvic health. Women’s health specifically involves issues that are more likely to affect women* throughout their lifetimes. I have added an asterisk to women* here because there are some problems with this term. It is unclear whether the use of this term refers to people with uteruses, people who were assigned female at birth (AFAB), or just people who identify as women. I believe this term makes most sense when we assume it is referring to people who were AFAB (because people post-hysterectomy may still face women’s health issues, as can trans-men), so let’s maintain that assumption through the rest of this chat.
With that being said, common Women’s* Health issues include pelvic floor dysfunction, but also branch out to things like osteoporosis, relative energy deficiency in sport syndrome (RED-S), lymphedema, breast cancer, heart disease, and more. In fact, the US Public Health Service considers a disease or condition to be a “women’s health” condition when the following criteria are met: the disease must be unique, more prevalent in females than males, more serious in females than males, have different risk factors in females than males, or require interventions that are different for females (1). While all of the above-mentioned diseases are also things men can experience, they are more commonly seen in the female population, and are therefore identified as “women’s health issues.”
As you can see, the term “women’s health” is outdated and doesn’t accurately describe pelvic health. It also, in my opinion, fails to appropriately address social determinants of health and how social context can affect the health of a woman. For example, purity culture is highly linked to pelvic pain; we will dip into this in a future discussion, but for now, consider how the environment you grew up in affected the way you think about your body. From here on out, we’ll refer to these topics as “pelvic health topics” when they apply broadly to those of us with pelvises.
What is the history of pelvic health physical therapy?
The history of pelvic health physical therapy goes back to women’s health physical therapy, which originated in the early 20th century in Britain, where physiotherapists (“physios”) worked in obstetrics (2). By the mid-20th century, physios were advocating for many of the same things we are advocating for today, including working on exercises and techniques to help with preparation for birth, as well as exercises for improving recovery after delivery (2).
In the United States, women’s health physical therapy wasn’t really recognized as a subdivision of physical therapy until the 1970s, and even then it still only focused on childbirth education and pregnant women (2). It wasn’t until the 1990s that the Section on Obstetrics and Gynecology was changed to the Section on Women’s Health within physical therapy, demonstrating the broadening of the role of physical therapists within such topics. Also in the 1990s, therapists worked toward expanding post-professional education by developing residencies and clinical specializations within women’s health (2).
Finally, in 2019, the Section on Women’s Health voted to change their name to the Academy of Pelvic Health, representing the start of a new and more inclusive era of pelvic physical therapy (3).
Women’s or pelvic health are often considered a “niche” within physical therapy. Why do you think that is? Why would this category of physical therapy be considered so specialized and specific, when giving birth is an incredibly common event? In fact, everyone in the world was, at some point, birthed. This is such a complex question, with a multifaceted answer that we will delve into in a future chat, but I think it is important to start thinking about why pelvic health physical therapy is only now stepping into the lime light, when humans have been giving birth since the beginning of the human race.
This has just been the tip of the iceberg when it comes to pelvic health. I cannot wait to get into it with you all and dive deep into all sorts of topics, from periods to painful intercourse to constipation to prostatectomy to absolutely everything in between. Our pelvises are one of the most intimate parts of our bodies, but they don’t have to be taboo (and they can actually be pretty awesome)!
Let’s catch up soon!
XOXO,
Your Pelvic Bestie
References:
1. Women's health. Report of the Public Health Service Task Force on Women's Health Issues. Public Health Rep. 1985 Jan-Feb;100(1):73-106. PMID: 3918328; PMCID: PMC1424718.
2. Irion Jean M. and Glenn Irion. 2010. Women's Health in Physical Therapy. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
3. https://www.aptapelvichealth.org/about
