Fafard Physiotherapy About the Pelvic Floor

What is the Pelvic Floor?

The Pelvic floor is a collection of muscles located at the bottom of the pelvis. More precisely the pelvic floor muscles attach between the pubic bone in the front and the coccyx in the back and from side to side from one ischial tuberosity (commonly called sit bone) to the other. Both female and male have a pelvic floor. The main difference is that the muscles of the female pelvic floor surround three openings while the muscles of the male pelvic floor surround two openings.

Both male and female pelvic floor muscles surround the anus and the urethra (gateway for the urine from the bladder). The muscles of the female pelvic floor also surround the vagina. To understand the function of the pelvic floor it is important to understand its location and surrounding.

Above the pelvic floor are the pelvic organs: in the female pelvic floor (from front to back) we find:

• the bladder
• the uterus and vagina
• the rectum.

In the male pelvic floor (from front to back), we find the:

• the bladder and prostate (same vertical plane; bladder on top, prostate under)
• the rectum

Since the pelvic floor surrounds the openings relating to bladder, sexual and bowel function, it plays an essential role regarding these three functions. A healthy pelvic floor can:

• hold urine, gas or stool when necessary; avoiding incontinence episodes.
• allow urine, gas or stool to come out completely when appropriate; preventing constipation or urine rentention.
• allows for comfortable (pain free) and pleasurable intercourse (reaching orgasm).

It is often said that a good pelvic floor can prevent descent or prolapse of the baldder, uterus and bowels. It is true that a good pelvic floor provides support (from under) of these organs, but this is not the primary role of the pelvic floor. All of the pelvic organs have ligaments that hold them in the right position. When a pelvic organ starts coming down, creating a prolapse, it is often due to repetitive strain or downward pressure on the organs; for example straining on the toilet during bowel movements or pushing the urine out to speed up the voiding process.

Other activities that can promote pelvic organ prolapses are: heavy lifting, poor posture, carrying, prolong standing position, forceful or prolonged pushing phase at delivery.

Another role of the pelvic floor is its participation in core stability. Core stability means stabilizing the pelvis and spine. Because of its attachments to the front and back and both sides of the lower part of the pelvis, the pelvic floor is essential to stabilize the pelvis and the lower part of the spine. Good core stability protects the spine, but also the pelvic organs from pressure and repetitive stress.

As with other muscle group in the body, a healthy pelvic floor is strong, flexible and coordinated. It can work with other muscle groups appropriately. For example, with the Transversus Abdominis (deep abdominal muscle) muscles, with emptying of the bladder and bowels; the transversus abdominis should contract while the pelvic floor relaxes. During lifting activities, the pelvic floor and Transversus abdominis should work contract together to increase the stability of the spine and pelvis and protect the pelvic organs from unwanted pressure.

Learning to know your pelvic floor is essential to achieving your full potential with bladder, bowel and sexual health. Learning the exercises to improve your pelvic health demand a high level of concentration and can be challenging for the majority of people. Professional guidance, from a pelvic floor physiotherapist, through the learning phase is highly recommended.

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