Author: Lisa Cheek, PT, DPT, CLT-LANA
There are 650+ muscles in the human body, but none are shrouded in mystery like the pelvic floor. Most people are aware that the pelvic floor exists, some can point to its location on a diagram, and a very few can explain what the pelvic floor does. There is little talk of the pelvic floor in most anatomy courses, and many people (clinicians included) are unaware of the impact that the pelvic floor can have on bowel, bladder, and sexual function. At N2 Physical Therapy, we think about the pelvic floor all day, every day. We study the anatomy and physiology, and problem solve ways to improve pelvic floor function. In short, we know the pelvic floor…and by the end of this post, you will too!
1. Men and women have very similar anatomy in the pelvic floor.
Men are from Mars and women are from Venus….is that how the saying goes? In the case of the pelvic floor, this isn’t exactly true. There are some obvious differences between the male and female pelvis–the bones of the pelvic girdle are wider, shorter, and have a larger empty space in women. The reproductive system is closed in men, open in women. Beyond these differences, however, the muscles of the pelvic floor are shockingly similar between the two sexes! Both males and females have a first layer of muscles that is involved with sexual functioning, and a deeper layer that aids in stability, support, and continence There are certainly a few differences, but at the end of the day we are more similar than you might think.
2.The pelvic floor can be overactive, underactive, or both!
These muscles can be tight, over-stretched, strong, weak, and everything in between. In the overactive pelvic floor, the muscles are usually tight, tender, may have myofascial trigger points, and might not relax the way they need too. Symptoms of an overactive pelvic floor may include urinary urgency and frequency, constipation, and pelvic pain — including dyspareunia or painful intercourse. On the other end of the spectrum is the underactive pelvic floor. These muscles are typically weak, overstretched, and often uncoordinated. Symptoms of an underactive pelvic floor may include stress incontinence and pelvic organ prolapse. Here’s the kicker: these two categories are not mutually exclusive, and it is entirely possible to have signs of both. Why, you may ask? Put simply, tight muscles are weak muscles, and weak muscles are tight muscles. For example, the pelvic floor may well be tight and tense, but it might also be so weak that it can’t hold the urethra closed in an efficient manner, leading to stress incontinence. The only way to truly get a read on the condition of the pelvic floor is to have it evaluated by a clinician who is an expert in pelvic floor disorders
3. The pelvic floor works with muscles in the abdomen, back, and ribcage.
No muscle is an island. Every muscle in the body has a set of agonists (muscles that help it do its job) and antagonists (muscles that work in the opposite direction to provide stability). The pelvic floor is no different- it works with a group of muscles in the core to provide spinal and pelvic stability, support the abdominal and pelvic organs, and maintain continence of bladder and bowel. These muscles include the diaphragm (the breathing muscle), the transverse abdominis (the weight belt muscle), and the multifidus (the spinal stability muscle). All four of these muscles must work in a coordinated fashion to provide maximum stability to the spine and abdomen during activity. Many people have difficulty coordinating these muscles due to inefficient breathing patterns, i.e. breathing from the upper chest rather than the diaphragm. People tend to breath in a more shallow fashion when stressed or moving quickly, which has implications for all of the muscles of the core. A big part of pelvic floor rehabilitation is learning how to breath properly!
4. The pelvic floor changes both during and after pregnancy- regardless of how you deliver.
Most people are aware of the changes in the pelvic floor that can occur following pregnancy. Vaginal delivery is associated with increased risk of injury to the pelvic floor musculature, and may result in pelvic floor dysfunction. However, the risk is also present for women who deliver via c-section. Studies 1,2 have shown that although risk for injury to the pelvic floor musculature is more prevalent following vaginal delivery, symptoms of incontinence and pelvic organ prolapse may be present in women who have delivered exclusively via c-section. The strength and function of the pelvic floor prior to delivery matters–no matter how the actual delivery pans out. If a patient has an underactive pelvic floor before and during pregnancy, it is likely that these issues will persist following delivery. For this reason, it is helpful to be evaluated for pelvic floor dysfunction prior to delivery!
5. The right type of pelvic floor exercise is different for each person.
By this point, you should recognize that pelvic floor disorders come in all shapes and sizes. Some are caused by overactive pelvic floor muscles, some by underactive, and some by a combination of both! You should also recognize that pelvic floor dysfunction does not exist in isolation–the pelvic floor works with the muscles of the core, hips, back, and elsewhere to provide stability and support. Many pelvic floor disorders can be linked to how a person moves, and how the muscles throughout the body are firing. No two patients are alike, and it is impossible to give blanket recommendations for pelvic floor health. What works for one patient will not necessarily work for another. One person might need to do Kegel exercises, another might need to learn how to relax the pelvic floor, and another might need to strengthen the core alter their posture. The best way to find the right exercise program for your pelvic floor is to see a specialist!
After reading this list, you now know more about the pelvic floor than the average person. Share this page with someone who needs to learn the Pelvic Floor 101, and come see us at any of our four locations to find the right pelvic floor exercise program for you.
1. Memon H, Handa VL. Pelvic floor disorders following vaginal or cesarean delivery. Current opinion in obstetrics & gynecology. 2012;24(5):349-354. doi:10.1097/GCO.0b013e328357628b.
2. Rortveit, Guri et al. Vaginal deliver parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol.