Pelvic Floor 101

Aw yeah, pelvic floor muscle time! I gotta be honest, during each new patient evaluation there comes a time when we get to talk about the pelvic floor muscles, the anatomy, and how these muscles may be related to the problems the person before me is having. And this is my FAVORITE part. Each time. Without fail. 

Why? Well I love teaching and more so that "AHA" moment when the person sitting next to me realizes that these taboo topics aren't as much of a mystery as they seem. We get potty trained at an early age and we take pee, poop, and sex for granted until something goes wrong. So let me be Mrs. Frizzle for a hot minute, and let's dive right in. 

Where is the pelvic floor?

MaleVSFemalePelvis

The pelvic floor refers to a group of muscles at the bottom of your trunk, which attach the pelvis. The pelvis is a bony ring made of your pubic bones, your sit bones, and the bones around your waist. These bones protect your internal organs including the bladder, rectum, intestines, and reproductive organs. This side by side picture shows the difference between the male and female pelvis. The pelvic bones of women are typically wider and rounder to accommodate for childbirth.

The picture below shows the pelvic floor muscles of women and men. We all have these muscles, otherwise, we wouldn't be able to pee, poop, or have sex! The key takeaway here is that there are more common structures between the genders than there are differences. 

 

This view is from the bottom up with the skin removed, like if you were laying on a table in stirrups.

This view is from the bottom up with the skin removed, like if you were laying on a table in stirrups.

What do the pelvic floor muscles do?

These muscles are strategically positioned to  impact how we pee, poop, and have sex. You can see that these muscles surround all the "exits" of our bodies: the urethra, vagina (for babies and menstrual blood), and rectum.  In babies and infants these muscles respond to reflexes from the spinal cord which tell them to relax so pee and poop can come out. You can't begin to potty train until that little tyke begins to feel urges and use their muscles to override these reflexes.

PelvicFloorMusclesRelax

Now when it is the right time to go, the pelvic floor muscles need to relax. This is the same in both women and men. Pee and poop are propelled from your body by involuntary contractions of the bladder and rectum, respectively, not the pelvic floor muscles. I'm going to say that again for the people in the back; stop trying to force your pee and poop out! That's not how it works!

These muscles also work as a quick close mechanism to prevent leaks when you laugh, cough, sneeze, jump, etc. You may develop problems if these muscles do not contract when they are supposed to (i.e. leaking) or if they do not relax properly (i.e. constipation, incomplete voiding).

The pelvic floor also quite literally supports your internal organs and your low back. Because of this, these muscles are never completely "off." This is referred to as the resting tone of the muscles. When these muscles and the surrounding connective tissues become weaker, the pelvic organs begin to slip from their optimal position, which we call pelvic organ prolapse.

Let's talk about S-E-X

That's right, if I wasn't for these fabulous muscles then sex just wouldn't be as fun! In women these muscles keep the clitoris erect, support the vagina, and contract during orgasm. In men, they maintain erections, assist in ejaculation, and also contract during orgasm.

Baby time

During pregnancy, these muscles help to support the growing baby. If a mother is able and chooses to have a natural birth, then these muscles will help to deliver the baby. As you can imagine, these muscles carry quite a big load (literally) during pregnancy. Hormonal changes during pregnancy result in looser ligaments and connective tissue in order to prepare the body for birth. Although back pain and pelvic floor problems are common in pregnancy, they are not normal. I repeat - you do not need to put up with pelvic floor problems either during or after having your baby. Seek help! 

Close Connections

As if all that wasn't enough, the pelvic floor has overlapping connections with many of the hip, low back, and abdominal muscles. Problems in these areas may present as pain in the pelvic floor muscles, and vice versa. This means that the underlying source of the problem is creating pain in a different area of your body.

Ready to learn about your own anatomy

Check out the 2 part Pelvic Self Exam series!


Resources: 

  • Evidence Based Pelvic Floor Physical Therapy. Bo

  • Women's health in PT. Irion & Irion.