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Dancers train to develop a strong core to protect themselves from injury. But even they might not know about the importance of pelvic floor muscles. These muscles not only provide stability to the pelvis and back, they also play a major role in control of bowel, bladder and sexual appreciation. Learn what happens when they¡¯re not functioning properly and what treatments are available. And yes, men have them too.

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My name is Sarah Hwang (she/her). I am the director of Women¡¯s Health Rehabilitation and Pelvic Health Rehabilitation at Shirley Ryan ÌÀÍ·Ìõapp. I treat people who have pelvic pain, pelvic floor dysfunction, bowel and bladder issues, and pain during pregnancy. I work closely with physical therapists and other physicians (such as gynecologists) to provide multidisciplinary care for patients with pelvic floor dysfunction.

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No! Women, men, transgender and nonbinary people all have pelvic floor muscles. Let me say that again¡ªmen have pelvic floor muscles! Pelvic floor dysfunction is more commonly seen in women but can occur in men as well. About 15% of my patients are men.

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To understand what pelvic floor dysfunction is, we first have to talk a little about the normal functions of the pelvic floor. These muscles have five important jobs:

1. Stability: These muscles are part of the core muscles as I mentioned above. The pelvic floor helps to provide stability to the pelvis and low back.

2. Support of internal organs: These muscles support the pelvic organs, including bowel, bladder, and, in females, the uterus and ovaries.

3. Maintaining continence of bowel and bladder: The pelvic floor prevents leakage of bowel and/or bladder. When the time comes to have a bowel movement or urinate, the pelvic floor has to relax to allow this to occur.

4. Circulation: These muscles help to pump lymphatic fluid from the legs back up to the heart.

5. Sexual appreciation: These muscles contract and relax during orgasm.

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This is what we call pelvic floor dysfunction. There are two sides to pelvic floor dysfunction. Some people have high tone pelvic floor dysfunction, which means the muscles are constantly in a state of high tension and unable to relax. When people have this problem, they typically present with pelvic pain, pain during intercourse, chronic constipation, and/or urinary frequency or urgency. The other type of pelvic floor dysfunction happens when the muscles are weak, making contraction difficult. Patients with this problem typically present with incontinence (or leaking) of urine or stool or pelvic organ prolapse. One other important thing to know is pelvic floor dysfunction can result in problems in the hip-pelvic-spine complex.

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The most common treatment we use is pelvic floor physical therapy. We can also use medications or injections to help with high tone pelvic floor dysfunction.

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Dr. Sarah Hwang is the director of Women¡¯s Health Rehabilitation at Shirley Ryan ÌÀÍ·Ìõapp. She is an assistant professor of Physical Medicine and Rehabilitation and Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine. Dr. Hwang completed her Physical Medicine and Rehabilitation Residency at Shirley Ryan ÌÀÍ·Ìõapp (formerly Rehabilitation Institute of Chicago). She served as director of Women¡¯s Health Rehabilitation at University of Missouri in Columbia, Missouri, before joining Shirley Ryan ÌÀÍ·Ìõapp in 2018. Dr. Hwang also serves as the associate program director for the Northwestern PM&R residency program.

Dr. Hwang is an active member of the American Academy of Physical Medicine and Rehabilitation. She serves as a member of the Program Planning Committee and has completed the Future Leaders Program. She is a member of the Association of Academic Physiatrists and serves on the Diversity and Community Engagement Committee. She has completed the Program for Academic Leadership through the Association of Academic Physiatrists and the Early Career Women Faculty Leadership Development Seminar through the AAMC.

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