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The pelvic floor is a group of muscles that stretch from the pubic bone to the tailbone, supporting the pelvic organs, including the bladder, urethra, bowel, rectum, anus, vagina, and uterus. Pelvic floor muscles help to control the release of urine, faeces, and flatus, and they assist with sexual function. They can weaken over time due to various factors such as injury, childbirth, surgery, and the ageing process, leading to conditions like incontinence or pelvic organ prolapse. Pelvic floor exercises are designed to strengthen these muscles and improve muscle strength and flexibility.
| Characteristics | Values |
|---|---|
| Location | Between the tailbone (coccyx) and the pubic bone within the pelvis |
| Function | Support the pelvic organs, including the bladder, urethra, bowel, rectum, anus, vagina and uterus in female bodies and the prostate in male bodies |
| Shape | Funnel-shaped |
| Components | Levator ani muscles (largest component), coccygeus muscle, and fascia coverings of the muscles |
| Levator ani components | Pubococcygeus, puborectalis and iliococcygeus |
| Exercises | Squeezing and holding the muscles for 10 seconds, relaxing fully and breathing normally for 5 seconds, repeating 10 times |
| Weakening factors | Pregnancy, childbirth, prostate cancer treatment, obesity, constipation, surgery, heavy lifting, chronic coughing, age, injury, trauma |
| Dysfunction symptoms | Leaking urine, loss of bladder control, anal incontinence, pain during sex, reduced vaginal sensation, deep vaginal aching |
| Treatment | Pelvic floor exercises, physical therapy |
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What You'll Learn
Pelvic floor dysfunction
The exact causes of pelvic floor dysfunction are not well understood, and no specific factor has been identified as the cause of PFD. However, it is associated with conditions or events that weaken the pelvic muscles or tear connective tissue. This includes pregnancy, childbirth, obesity, chronic constipation, prostate cancer treatment, and surgery. Additionally, heavy lifting, high-impact exercises, and ongoing coughing can increase stress on the pelvic floor and contribute to PFD.
Symptoms of pelvic floor dysfunction include urinary issues such as leaking urine when coughing or sneezing, the urge to urinate frequently, and painful urination. It can also lead to bowel problems like anal incontinence, difficulty with bowel movements, and lower back pain. For women, PFD can cause sexual difficulties, reduced vaginal sensation, and pain during intercourse. In some cases, pelvic floor dysfunction can lead to a prolapse, where internal organs slide down into the vagina or anus.
Treatment for pelvic floor dysfunction aims to relax the pelvic floor muscles and improve muscle coordination to facilitate easier bowel movements and provide better control. Therapeutic interventions are tailored to the specific needs of the patient and often involve a multidisciplinary approach. Biofeedback, a technique that allows therapists to monitor muscle activity and provide feedback, is commonly used. Other treatments include medication, such as muscle relaxants, and pelvic floor exercises like Kegel exercises. In severe cases, surgery may be an option to loosen the affected pelvic organs and promote relaxation.
It is important to consult a doctor for a proper diagnosis and to explore various treatment options, including home remedies, before considering medication or surgery.
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Pelvic floor exercises
To identify your pelvic floor muscles, you can try the following:
- Vaginal: Insert one or two fingers into your vagina and try to squeeze them.
- Urethral: Imagine you are passing urine and try to stop the flow midway. It is important to note that you should not do this while actually urinating.
- Anal: Pretend you are trying to stop yourself from passing gas and squeeze tightly.
Once you have identified these muscles, you can perform Kegel exercises to strengthen them. Kegel exercises involve tightening and then releasing the pelvic floor muscles. You can do this by lifting and holding, and then relaxing the muscles. Start with a few Kegels at a time and gradually increase the number and duration of each session.
In addition to Kegel exercises, there are other exercises that can help strengthen the pelvic floor:
- Pelvic tilts: Lie on your back with bent knees and feet flat on the floor. Tighten your abdominal muscles and press your lower back into the floor. Hold for a few seconds, then release. Repeat this movement 10-15 times, increasing the repetitions as you get stronger.
- Bird-dog: Start on your hands and knees with your wrists under your shoulders and knees under your hips. Keep your back straight and engage your core muscles while retracting your shoulder blades down toward your hips. Simultaneously extend and raise your left leg and right arm, maintaining a neutral body position. Hold this pose for a few seconds.
- Bridge pose: Lie on your back with bent knees and feet hip-width apart. Place your arms at your sides, palms facing down. Inhale and lift your hips towards the ceiling, engaging your pelvic floor muscles. Hold for 10-15 seconds, then slowly lower your hips and repeat for 10-15 repetitions.
- Squats: Stand with your feet shoulder-width apart and lower your body as if sitting back in a chair, keeping your chest and back straight. Engage your pelvic floor muscles as you lower and rise. Aim for three sets of 10-15 squats, increasing the intensity as you get stronger.
It is recommended to perform pelvic floor exercises 2-3 times a week for optimal results. Remember to consult a healthcare professional before starting any new exercise regimen, especially if you have pre-existing health conditions.
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Pelvic floor anatomy
The pelvic floor is a dome-shaped muscular sheet that separates the pelvic cavity from the perineal region. The pelvic floor muscles are located between the tailbone (coccyx) and the pubic bone within the pelvis. They support the bowel and bladder, as well as the uterus and vagina in females. The pelvic floor muscles give you the ability to control the release of urine, faeces and flatus (wind) and to delay emptying until it is convenient.
Pelvic floor muscles are also important for sexual function in both men and women. In men, they are important for erectile function and ejaculation. In women, voluntary contractions of the pelvic floor contribute to sexual sensation and arousal. The pelvic floor muscles in women also provide support for the baby during pregnancy and need to be relaxed during the birthing process.
The pelvic floor muscles are made up of layers of muscle and other tissue. These layers stretch like a hammock from the pubic bone at the front to the coccyx (tailbone) at the back, and from one ischial tuberosity (sitting bone) to the other (side to side). Several pelvic floor muscles intertwine to form a single sheet of layered muscle with openings for the anus, urethra, and vagina. The pelvic floor muscles are normally firm and thick.
The levator ani composes the bulk of the pelvic floor muscles and consists of three separate muscle components: pubococcygeus, puborectalis, and iliococcygeus. The levator ani wraps around the entirety of the pelvis. The coccygeus is the smaller muscle component and is located towards the back of the pelvis.
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Pelvic floor disorders
Pelvic floor muscles are located between the tailbone (coccyx) and the pubic bone within the pelvis. They support the bowel and bladder, as well as the uterus and vagina in females. Pelvic floor muscles are also important for sexual function in both men and women. Pelvic floor disorders (PFDs) occur when the muscles or connective tissues of the pelvic area weaken or are injured. PFDs are more common among older women. At least one in three women will experience a pelvic floor disorder in her lifetime, and one in four women over 20 suffers from pelvic floor symptoms.
PFDs are a group of conditions that affect the pelvic floor, which includes the muscles, ligaments, and connective tissue that support the pelvic organs (bladder, uterus, vagina, and bowel). Pelvic floor disorders include urinary incontinence, anal (fecal) incontinence, and pelvic organ prolapse. Urinary incontinence can manifest as leaking urine when coughing, sneezing, laughing, or running, or a frequent urge to urinate. Pelvic organ prolapse can cause a feeling of heaviness in the vagina, and a distinct bulge in the vagina is a common symptom.
The pelvic floor muscles can be weakened by pregnancy, childbirth, prostate cancer treatment, obesity, and the straining of chronic constipation. Evidence suggests that weak pelvic floor problems can start during pregnancy, not just after birth. Women who have had multiple births, assisted births, third and fourth-degree perineal tearing, or large babies are at greater risk of pelvic floor muscle damage. Reduced oestrogen levels can also cause the pelvic floor muscles to weaken.
PFDs can be treated with pelvic floor muscle training, lifestyle changes, nerve stimulation, and surgical procedures. Pelvic floor exercises are designed to strengthen the muscles and can be done lying down, sitting, or standing. Each section (vaginal, urethral, anal) can be exercised.
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Pelvic floor and pregnancy
Pregnancy and childbirth are life-changing experiences for a woman's body, affecting it in numerous ways. One of the areas that may be impacted is the pelvic floor, which is the diaphragm of the pelvis. The pelvic floor muscles support the uterus, bladder, large intestine, and rectum. These muscles may be affected by pregnancy and childbirth, altering some of their critical functions, such as fecal and urinary continence and supporting the vaginal walls and uterus.
During pregnancy, the pelvic floor stretches to accommodate the growing fetus. Over time, the muscles weaken from bearing the additional weight. Instead of returning to their original position, they may remain stretched, resulting in reduced bladder control. This is because weakened pelvic floor muscles struggle to contract sufficiently to prevent urine from escaping the bladder. Additionally, the weight gain associated with pregnancy, including the weight of the placenta, increased blood volume, and enlarged uterus, places increased strain on the pelvic floor muscles, further elevating the risk of urinary incontinence.
Constipation is another common issue during pregnancy, especially in the third trimester. The weight of the growing uterus and hormonal changes can impact digestion, leading to infrequent or challenging bowel movements. Straining during constipation can further weaken the pelvic floor muscles and nerves. Hormonal changes during pregnancy, such as the placenta secreting the hormone relaxin, also contribute to the impact on the pelvic floor. Relaxin increases the flexibility of ligaments in the pelvis and softens the cervix, preparing the body for childbirth. However, this increased flexibility can result in instability and a looser connection between the pelvis bones.
To maintain pelvic floor health during pregnancy, it is essential to exercise these muscles regularly before and during pregnancy. Pelvic floor exercises, such as Kegels, can be performed in any comfortable position. These exercises help to prevent bladder and bowel leakage and reduce the risk of prolapse. Additionally, maintaining a healthy body weight and avoiding exercises that exert excess pressure on the abdomen during pregnancy can help protect pelvic floor health.
After giving birth, it is crucial to allow time for recovery and continue strengthening the pelvic floor muscles. Pelvic floor exercises performed after childbirth are different from those done during pregnancy, and a physiotherapist can help design an individualized program based on factors such as the state of the perineum and the length of the second stage of labor. Seeking guidance from a pelvic floor physiotherapist can ensure women are performing these exercises correctly, as doing them incorrectly can be detrimental.
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Frequently asked questions
The pelvic floor is a group of muscles stretching from the pubic bone to the tailbone, supporting the pelvic organs including the bladder, urethra, bowel, rectum, anus, vagina and uterus in female bodies, and the prostate in male bodies.
Pelvic floor muscles help stabilise your core and secure your organs. They also work with the deep abdominal (tummy) and back muscles, and the diaphragm to support the spine and control pressure inside the abdomen.
Weak pelvic floor muscles can lead to incontinence, or pelvic organ prolapse. They can also cause sexual difficulties such as reduced vaginal sensation and pain during sex.
Pelvic floor muscles can weaken over time due to injury, trauma, childbirth, surgery, radiation treatment, chemotherapy, and the aging process.
Pelvic floor exercises are designed to strengthen the muscles. You can do these exercises lying down, sitting or standing. Each section (vaginal, urethral, anal) can be exercised.
