By Rachel Levy PT, DPT, CIMT
The phrase pelvic floor refers to a group of muscles within your pelvis which play an important role in bladder and bowel control, sexual health, pelvic organ support, and posture. Although there are some anatomical differences depending on your sex, everybody has a pelvic floor. Anyone of any age, gender, childbirth history, or fitness level can experience pain or problems stemming from pelvic floor dysfunction.
The pelvic “floor” reflects not just their location at the bottom of the pelvis but also the role they play as the foundation to your core. The strength and coordination of your pelvic floor allows you to stand up from a chair, carry groceries, climb stairs, exercise and perform other daily activities without pain or leakage.
Many of us have heard about Kegel exercises, which refer to contracting your pelvic floor. But when it comes to treating pelvic floor dysfunction one size does NOT fit all. Your pelvic floor *might* be too weak to provide the foundational support for your daily activities, but it could also be overactive. This will cause the muscles to become too fatigued to maintain support in high pressure situations like jumping or running. You could be contracting the pelvic floor incorrectly, bearing down when you think you are drawing the muscles in. A physical therapist can examine your pelvic floor muscle function to determine what’s driving your pain or bladder/bowel control problem.
The pelvic floor is generally divided into three layers from superficial to deeper within the pelvis. The most superficial muscles (or first layer) play an important role in sexual health and function. These muscles include the bulbocavernosus assisting in clitoral erection, the bulbospongiosus assisting in penile erection and the ischiocavernosus helping to maintain either clitoral or penile erection. The first layer also includes the external anal sphincter which typically maintains a certain level of contraction to prevent leakage of stool or gas but which you can also voluntarily contract to exert more closure force. The superficial transverse perineal muscle (along with the deep transverse perineal muscle of the second layer) provides support to the pelvic organs and helps to resist increased intraabdominal pressure that occurs with everyday acts such as sneezing.
Muscles in the second layer contribute to urinary continence, which include the sphincter urethrovaginalis, compressor urethra, and external urethral sphincter.
In the third layer, the levator ani and coccygeus provide support for the pelvic organs, resist intraabdominal pressure, and stabilize the sacroiliac joint.
Although they aren’t technically part of the pelvic floor, a muscular examination of the pelvis would not be complete without evaluating the piriformis and obturator internus muscles. Both of these muscles externally rotate the hip (picture crossing your leg to place your ankle on the opposite knee when putting on socks or shoes) and can cause hip and low back pain when dysfunctional.
To take a closer look at these muscles Ninja Nerd Lectures has a nice guided tour on YouTube. Coming up in the next blog, learn more about the effect of orgasms on your pelvic health, and why you may want having an O part of your daily routine.
