Jaw pain and incontinence no way they are related! Right?
I think we can all get on board to the idea that “everything is connected” right? It makes sense because we are all fully connected human beings who experience sensations in all parts of our body. But how far are we willing to stretch to make 2 dots connect? For example something like jaw pain and incontinence? While it might seem like a long reach, I am here to tell you that it is not. Our jaw and our pelvic floor have so much more in common than we would ever expect. It’s not intuitive initially, but once you see it, it all starts to make much more sense.
First let’s talk about what TMJ dysfunction is. TMJ dysfunction is a condition in which the joint that is responsible for opening and closing your mouth becomes unstable and locked up. Instead of the joint being able to slide and glide in its socket the mechanics get derailed leading to pain and restriction. Patients will describe clicking or pain with opening and closing their mouth or feeling like they can’t open their mouth as wide as usual. They will even describe pain with things like chewing hard or tough foods, or pain with chewing gum. Treatment is very targeted towards reinstating that normal glide and slide of the joint as well as muscle activation and retraining.
Now how does this relate at all to your pelvic floor? While the explanation of the dysfunction and treatment looks far different than pelvic floor, the patient population and risk factors look very similar. We will walk through 3 different recurring themes that have shown up in the research time and time again in both disorders that have made us start to think about their relationship.
Women vs. Men
When you look at prevalence, they both are predominantly experienced by women. The pelvic floor makes sense due to the fact that women have anatomy that makes them more susceptible to pelvic floor issues. They have a gaping hole in the bottom of their pelvic floor, also known as vagina. It also can do miraculous things like birth a baby which causes real impact on the tissues of the pelvic floor and is technically a trauma to your pelvic floor. So the fact that women have more pelvic floor issues definitely checks out. Now, TMJ disorders are also predominantly diagnosed in women compared to men, but we don’t have as clear of a picture of why that is exactly like we do with the pelvic floor. In this meta-analysis of TMJ studies, they found that, of the 2500 people experiencing TMJ pain and dysfunction, women were twice as likely to experience TMJ disorders as compared to men.
Location, Location, Location
When thinking about the location of both the pelvic floor and your TMJ, they are positioned on the top and the bottom of your spinal column. They can act like bookends to your spine and both are affected by the position of it. When we say the position of your spine we are thinking in terms of posture, so changes in posture or rather chronic dysfunctions of your posture then affect these 2 book ends. In this study, they found that people who have TMJ disorders often present with a posture of hyperlordosis or too much arch in their back, and their neck in a forward head posture. Coincidentally, these types of spine positions are commonly seen in individuals with pelvic floor dysfunction especially postpartum women. Hyperlordosis is a great example, this type of posture often seen in pregnant women as the make room for a growing baby. What we find is the excessive arched position is that the lumbar spine is in alot of extension and the hips are tilted very far forward creating that excessive arch in their back. Biomechanically, this leaves the pelvic floor in a very inefficient position to be helpful for stability. Similarly forward head posture in sitting usually comes with excessive lumbar flexion in the spine and pelvis that is tucked underneath you. In this study they found that when the spine is in a flexed position in sitting, it decreases the ability of the pelvic floor to contract and limits its effectiveness as a core stabilizer.
Oh I’m stressed!
Lastly, a big correlation that we find with TMJ disorders and pelvic floor disorders is they are both highly linked to stress. Of the people that are experiencing these symptoms it is not uncommon they will also note experiencing high amounts of stress and anxiety. Multiple studies have shown us that within these 2 diagnoses there is a high prevalence of underlying stress and anxiety in addition to their pain. When we experience stress we tend to find tension in the body and both of these disorders have some leave of tension management that has to be addressed in order to make good gains. So when these subconscious patterns start to kick, our jaw and our pelvic floor are parts of our body that we can hold the tension in. In this study they found that of the pelvic health patients they surveyed 50% of the patients had anxiety or depression.
Although the dots may seem far from each other, there are a lot of reasons we need to continue to connect them. While we are not saying that all people with TMJ and jaw pain will have pelvic floor disorders and vis versa but there is value in seeing that it may play a role. It is all about seeing the full picture and find these weird connections is this one way we like to do that.
ReferencesBueno, C. H., Pereira, D. D., Pattussi, M. P., Grossi, P. K., & Grossi, M. L. (2018). Gender differences in temporomandibular disorders in adult population studies: a systematic review and meta-analysis. Journal of oral rehabilitation, 45(9), 720-729. Cortese, S., Mondello, A., Galarza, R., & Biondi, A. (2017). Postural alterations as a risk factor for temporomandibular disorders. Acta odontol latinoam, 30(2), 57-61. Da, V., Ba, B., Nieman, F., van Os, J., Van Koeveringe, G., & Leue, C. (2017). Prevalence of anxiety and affective symptoms and their association with pelvic floor dysfunctions: A cross sectional cohort study at a Pelvic Care Centre. Hyperarousal in the Hospital and what to do about it, 77. Siddiqui, N. Y., Wiseman, J. B., Cella, D., Bradley, C. S., Lai, H. H., Helmuth, M. E., … & LURN. (2018). Mental health, sleep and physical function in treatment seeking women with urinary incontinence. The Journal of urology, 200(4), 848-855. Sapsford, R. R., Richardson, C. A., Maher, C. F., & Hodges, P. W. (2008). Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Archives of physical medicine and rehabilitation, 89(9), 1741-1747.