The female pelvic floor - what it is and why it is important
Your pelvic floor is a group of muscles that span the base of the pelvis.
The red area on this midwives view of the pelvis represents all the muscles of the pelvic floor.
You can see that they cover the whole area between the sitting bones at the sides, coccyx at the back and pubis at the front.
The deep layer of muscles also wraps up inside the pelvis to form a “bowl”.
There are two openings in the pelvic floor muscles. The anus, surrounded by the anal sphincter (still part of the pelvic floor muscles) and the genital hiatus that includes the opening to the vagina and urethra (the tube that urine passes down from the bladder).
This side on view of the pelvis demonstrates the basic relationship of the pelvic organs to the pelvic floor muscles.
The muscles, when functioning well, support the bladder, uterus and bowel, they aide closure of the urethra, vagina and anus, enhance sexual pleasure and are an integral part of core stability.
They help to keep us continent of urine and faeces, maintain pelvic organ position and work together with the deep abdominal and back muscles to support our pelvis and spine.
The pelvic organs are supported, from below, by the pelvic floor muscles and, from the sides and above, by non-stretch tissue called fascia and ligaments. These non-stretch tissues attach the organs to the inside of the pelvis.
If the ligaments and fascia get damaged, the bladder, bowel or uterus can descend (pelvic organ prolapse POP). Typically this results in a sensation of fullness in the vagina or a palpable lump. You may also feel it as a dragging or heavy sensation with or without low back or abdominal pain.
If the pelvic floor muscles are weak, the prolapse may worsen over time as the non-stretch tissues are further loaded and stretched.
Think of this as a boat in a dry dock.
The ligaments and fascia are the ropes holding the boat in place and the water is the pelvic floor muscles.
If the water is low (pelvic floor muscles are weak and lengthened) the full weight of the boat is taken by the ropes. Over time, this will lead to gradual lengthening of the ropes (ligaments and fascia) and cause the pelvic organs to drop.
However, if the water rises again, the load is taken off the ropes and the boat is supported again. This is the same with the pelvic floor muscles – strengthen them and improve their resting tone, and the pelvic organs will get more support.
Everyone has heard someone talking about core stability. Unfortunately, the way it is described is usually not very accurate. “Strengthening your core” and “core stability exercises” more often than not, entail exercises such as The Plank, double leg lifts and medicine ball twists in a V-sitting position. You are encouraged to brace your stomach muscles to make the trunk “rigid”.
It is the coordinated action of the diaphragm, pelvic floor, deep abdominal (transversus) and spinal (multifidus) muscles to form a dynamically stable unit. This supports the trunk and pelvis at all times, not just when it is under heavy load.
If one component of this “unit” is dysfunctional, problems will arise either in the form of pain or discomfort in the back, herniation of, or through, the abdominal muscles, or pelvic organ prolapse/incontinence. It may also lead to more peripheral problems such as shoulder, upper back, hip and lower limb pain and dysfunction.
Intra-abdominal pressure (IAP) is the pressure within the abdominal cavity (think of a balloon). During normal activity the IAP is relatively low. However certain activities significantly increase it (typically traditional “core stability exercises”), for example: lifting, coughing, sneezing, lifting both legs when lain on your back, the Plank, and abdominal exercises in a V-sit position.
Pelvic floor muscles that aren’t coordinated or strong enough to counteract this increase in IAP can result in a ballooning effect as the pressure tries to escape through the weakest link (think of a balloon being squeezed from the top and sides, but not the bottom – it will balloon out further at the bottom).
Not only will this further exacerbate any weakness or lengthening of the muscles but it will also result in significant downward pressure on the pelvic organs. This in turn will exacerbate or lead to pelvic organ prolapse and/or incontinence.
To summarise, your pelvic floor muscles are really important. Not only do they help maintain control of your bladder and bowel, they also help support your pelvic organs, increase your sexual pleasure and form an essential component of core stability. Having a good “core” not only helps you to move more efficiently but also helps to prevent unnecessary injury.