Pelvic Floor 101
The pelvic floor has really made a statement these last several years. More than ever, women are talking about their pelvic floors and are actually seeking treatment for their symptoms!
Compared to other muscle groups, the pelvic floor is very unique. It is layers deep, it is vast, it requires steady endurance, and it performs numerous jobs day in and day out.
To better understand the pelvic floor, we will walk through the anatomy, function, and symptoms that can present.
Anatomy + Muscle Actions
Below is a picture of the pelvic floor anatomy that is most superficial. Take away a thin layer of skin and fascia and this is what you will find.
From front to back:
Clitoris - pleasure center of the vulva
Urethra - where pee comes out
Vaginal opening - where you would insert a tampon
Rectum (anus is the name for the opening, rectum is the “canal”) - where poop comes out
Vulva - names an area of the female genitalia that includes the vaginal opening, labia, clitoris
There are 3 layers to the pelvic floor, this includes muscle, ligament, tendon, blood vessels, and nerves.
This is the 3rd and deepest layer of the pelvic floor.
There are 3 pelvic organs that live inside this “bowl”
bladder (pee)
rectum (poop)
uterus (reproductive organ)
As you can see, there are many muscles that make up your pelvic floor (these are just labeling a handful of them!)
Imagine these muscles like a hammock. When they shorten (contract) they lift upward like you’re pulling a hammock taut on both ends. When they lengthen (bulge) they move downward like someone has sat on the hammock.
When do/should they shorten/contract?
holding in your pee/poop
to avoid leakage when there is an increase in intra-abdominal pressure (think sneezing, coughing, jumping)
when lifting heavy, exercising, exerting yourself
strong exhales
When do/should they lengthen/bulge?
in order to pee/poop
during labor
inhales
Now remember that you are not always going to be shortening and or lengthening. There is a resting muscle tone that allows you to function with normal activities without symptoms. Think of this as the position your muscles are in when you’re just sitting or standing. The hammock resting without any other influences on it.
Think if your legs or your abdomen didn’t have muscle tone, for example, you would collapse immediately. Yet, when your standing or sitting you’re not really having to think about squeezing your muscles, right? That’s resting tone. This tone also keeps your shoulders and hips in their sockets, keeps you looking upright, and allows for balance.
In order to function appropriately your pelvic floor needs to be able to contract fully, lengthen fully, and maintain a normal resting muscle tone.
If your pelvic floor lives in a shortened position you will get symptoms.
If your pelvic floor lives in a lengthened position you will get symptoms.
If your pelvic floor lives in a resting tone, you will get symptoms.
You need fluidity, variety, and responsiveness from your pelvic floor in order to manage every posture, demand, activity.
Function
There are 4 main functions of the pelvic floor (not in any particular order)
Pooping/peeing function
Sexual function
Support pelvic organs
Relax/stretch during labor
Pooping/peeing:
Muscles must relax and lengthen in order for these activities to occur appropriately. If you tense and contract your muscles, over time it will likely lead to muscle tension (keep reading for signs of this!) Think of exhaling and bulging your pelvic floor when pooping vs squeezing as hard as you can. With peeing, just sit and let the pee passively release. You should never be pushing your pee out.
Sexual Function:
A healthy pelvic floor allows for pain-free sex, improved arousal, and better orgasms. No, you’re not reading wrong! Your muscles, nerves, and blood vessels all need to be working appropriately to stimulate pleasure and allow for penetration to occur without symptoms. If you have too much tension, weakness, soft tissue impairment, poor blood flow, or neuralgia (nerve impairment) to name a few, you’ll be quite let down to find sex is not like it is in your favorite romance movie.
Support Pelvic Organs:
As mentioned above, your pelvic organs rest inside of your “pelvic bowl”. From front to back you have your bladder, uterus, and rectum (think pee hole to poop hole.) The muscles, soft tissue, and ligaments of the pelvic floor help to support these organs. If there is an impairment and these structures are either too tight or too weak, there can be excessive motion or too little motion. Think of a circus tent supported by poles, ropes, and stakes. If there is a disruption of one of those things, things go awry.
Labor
During vaginal delivery, your pelvic floors only real job is to get out of the way. Your uterus contracts to move the baby out and your pelvic floor could actually hinder that if not stretching appropriately.
Symptoms
I could write a hundred pages about all of the dysfunctions and symptoms that can arise. Rather than putting you through that, I am going to narrow in on 3 common presentations and symptoms associated with them.
Pelvic Floor Tension
Pelvic floor tension refers to when muscles are in a chronically contracted or shortened position. pelvic pain
pain with sex, inserting tampon, vaginal exam
feeling like you’re hitting a wall with any sort of penetration
butt, jaw, belly clenching
jaw pain
urinary leakage
constipation
incomplete emptying of bowel or bladder
Pelvic Floor Weakness
Pelvic floor weakness refers to muscles not having appropriate strength or power.
urinary leakage
fecal incontinence (can present as smears in your underwear)
unable to hold in farts
tampons won’t stay in
bulging/heaviness
unable to hold your pee
Poor Muscle Coordination
Now this may be a new concept for you, I know it is for a lot of my patients. This refers to our pelvic floors ability to contract and relax appropriately in response to what you’re doing. I think the best example is sneezing. When you sneeze your pelvic floor should reflexively contract to prevent the increased pressure from causing things such as urinary leakage.
If the timing of this contraction is not coordinated appropriately, you will likely have any of the symptoms above particularly when
sneezing
coughing
laughing
jumping
running
lifting weights
picking your child up
grabbing groceries
You get the idea…any activity that requires a response from your pelvic floor (which if you didn’t notice is pretty much everything.")
Conclusion
I hope that you now have a better understanding of your pelvic floor.
I hope that knowing the anatomy helps you better appreciate the intricacy of that region. How those small but mighty muscles work together to create such a harmony will never cease to amaze me!
I hope that learning more about what that region does for you gives you insight into your own body and what optimal looks like.
Lastly, I hope that in recognizing your symptoms, you are able to research and seek out care and educate those around you!
The pelvic floor will continue to make a statement given we talk about it, educate on it, and experience the amazing support that treatment can offer.
