A great proportion of the people I help suffer from pelvic floor dysfunction. Over the years of my practice I've found that most people admit that they are not sure what the pelvic floor is and if they are doing pelvic floor exercises correctly. What they do know is what it feels like when it isn’t working. That’s a good start, but we want to go further.
So here I’m going to talk about the pelvic floor. What is the pelvic floor? Why is it important? By understanding the anatomy and function of the pelvic floor we can better recruit it during active therapy as well as during everyday activities.
What is the pelvic floor?
The pelvic floor is a group of muscles that span across the bottom opening of the bony pelvis. This spans from the area between the pubic bone at the front to the base of the spine at the back and out to either sitting bone on each side. For simplicity, it can be divided into two layers: the levator ani and a superficial group of muscles.
Why is the pelvic floor important?
The levator ani forms a functional hammock-like structure for organ support and continence. There is a “U” shaped muscle in the levator ani that originates on either side of the pubic bone and slings around the openings that pass through the pelvic floor (i.e. urethra, vagina, anus). This U-shaped muscle compresses and closes off the openings of the urethra, vagina and anus when contracted, and conversely releases and opens the openings when relaxed.
The superficial layer of the pelvic floor include two sphincter muscles (external urethral and external anal sphincter) as well as muscles that run into the perineum, labia and clitoris (or perineum, base of penis and testicles in men).
The two layers of the pelvic floor work together as a team – it is impossible to separate a contraction of the deep layer from the superficial layer, and it is impossible to separate a contraction of the front of the pelvic floor from the back of the pelvic floor. It is possible to bias a contraction to be more at the front of the pelvic floor that at the back, but you cannot completely separatethe layers, front/back, or side to side.
The roles of the pelvic floor include bowel and bladder control, organ support, reflex detrusor inhibition (to calm a bladder urge), sexual function, and contribute toward lumbopelvic stability.
What is a healthy pelvic floor?
In a healthy individual, the pelvic floor works as a team with other muscles in the body, including the Transversus Abdominis also known as the “core” abdominals.