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The pelvic floor is a group of muscles that form the base of the core muscles. These muscles work with the deep abdominal and back muscles and the diaphragm to support the spine and control the pressure inside the abdomen. The pelvic floor muscles support the pelvic organs, including the bladder, bowel, and uterus. They also control the release of urine, faeces, and flatus. The pelvic floor is made up of thick skeletal muscles, nearby ligaments, and fascia. It is a triangular or funnel-shaped structure that attaches to the walls of the pelvis, separating the pelvic cavity from the perineum. The pelvic floor muscles can be categorized into superficial and deep muscle layers. The superficial muscle layer includes the external anal sphincter, perineal body, and possibly the puboperineal or transverse perinei muscles. The deep pelvic floor muscles consist of the pubococcygeus, ileococcygeus, coccygeus, and puborectalis muscles.
| Characteristics | Values |
|---|---|
| Shape | Triangular/funnel-shaped |
| Location | Inferior border of the abdominopelvic cavity |
| Composition | Fascia, muscle, ligaments, blood vessels, nerves, fatty connective tissue |
| Functions | Support for pelvic visceral contents, abdominal viscera, and spine; control of pressure inside the abdomen; control of continence and release of urine, faeces, flatus, and ejaculation; sexual function |
| Components | Levator ani (pubococcygeus, puborectalis, iliococcygeus), coccygeus, perineal body, obturator internus, piriformis, external anal sphincter, internal anal sphincter |
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What You'll Learn
Pelvic floor muscles support the pelvic organs
The pelvic floor is a basin-shaped or triangular sheet of muscle that forms the base of the group of muscles commonly called the 'core'. The pelvic floor muscles support the pelvic organs, including the bladder, bowel (large intestine), and internal reproductive organs. In women, the pelvic floor muscles also support the baby during pregnancy, and they need to be relaxed during the birthing process.
The pelvic floor muscles are made up of thick skeletal muscles along with nearby ligaments and their investing fascia. They form a large sheet of skeletal muscle that is thicker in some areas than in others. The pelvic floor muscles are normally firm and thick, and they can be subdivided based on their points of attachment and the pelvic organs with which they are associated. The pelvic floor muscles can be classified into two layers: the superficial muscle layer and the deep muscle layer. The superficial muscle layer includes the external anal sphincter, perineal body, and possibly the puboperineal (or transverse perinei) muscles. The deep muscle layer includes the pubococcygeus, ileococcygeus, coccygeus, and puborectalis muscles. The puborectalis muscle is located between the superficial and deep muscle layers and can be considered a middle muscle layer.
The pelvic floor muscles have two major functions. Firstly, they provide support or act as a "floor" for the pelvic organs. Secondly, they act as a constrictor or continence mechanism for the urethral, anal, and vaginal orifices (in females). The pelvic floor muscles help stabilize the core while assisting with essential bodily functions, such as urination, defecation, and sexual function. They can weaken over time due to injury, trauma, childbirth, surgery, or the normal aging process, leading to conditions like incontinence or pelvic organ prolapse.
Pelvic floor exercises, such as Kegel balls or vaginal weights, can help strengthen the pelvic floor muscles. Physical therapy with a trained specialist can also help coordinate and strengthen the pelvic floor muscles. In cases of pelvic organ prolapse, reconstructive surgery or obliterative procedures may be necessary to secure the pelvic organs in place.
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Pelvic diaphragm and perineal membrane
The perineum is an anatomical region in the pelvis, located between the thighs. It is the most inferior part of the pelvic outlet, separated from the pelvic cavity superiorly by the pelvic floor. The perineum can be divided into an anterior urogenital triangle and a posterior anal triangle. The urogenital triangle of the perineum is further divided into two pouches or spaces by a robust fibrous sheet known as the perineal membrane. This membrane is stretched across the urogenital triangle and is attached laterally to the ischiopubic rami. The perineal membrane is a tough layer of fascia, perforated by the urethra and, in females, the vagina. It provides attachment for the muscles of the external genitalia.
The perineal membrane has two parts: a ventral portion and a dorsal portion. The dorsal portion has a transverse fibrous sheet attached to the perineal body and the lateral wall of the vagina. The ventral portion contains structures that form the sphincter complex of the ureter. The perineal membrane is now used in place of the term "urogenital diaphragm" to refer to the 3-dimensional musculofascial expansion across the urogenital triangle.
The pelvic diaphragm, also known as the levator ani, is a wide but thin muscular layer of tissue that forms the inferior border of the abdominopelvic cavity. It is composed of a broad, funnel-shaped sling of fascia and muscle, extending from the symphysis pubis to the coccyx and from one lateral sidewall to the other. The pelvic diaphragm is external and inferior to the pelvic cavity. The pelvic floor muscles have two major functions: they provide support or act as a "floor" for the abdominal viscera, and they act as a constrictor or continence mechanism for the urethral, anal, and vaginal orifices (in females).
The pelvic floor is primarily made up of thick skeletal muscles, along with nearby ligaments and their investing fascia. It is a basin-shaped muscular diaphragm that helps to support the visceral contents of the pelvis. The pelvic floor muscles are collectively referred to as the levator ani and coccygeus muscles. They form a large sheet of skeletal muscle that varies in thickness across different areas. The levator ani is made up of the puborectalis, pubococcygeus, and iliococcygeus muscles. The coccygeus muscle is sometimes considered part of the levator ani complex, but it is a separate entity situated at the most posterosuperior aspect of the muscle complex.
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Pelvic floor muscle layers
The pelvic floor is a basin-shaped or triangular muscular diaphragm that helps to support the visceral contents of the pelvis. It is also known as the pelvic diaphragm. The pelvic floor muscles stretch from the pubic bone in the front of the body to the tailbone (coccyx) in the back. The pelvic floor muscles can be organised into superficial and deep muscle layers.
The superficial muscle layer includes the external anal sphincter, perineal body, and possibly the puboperineal (or transverse perinei) muscles. The deep pelvic floor muscles consist of the pubococcygeus, ileococcygeus, coccygeus, and puborectalis muscles. The puborectalis muscle is located in between the superficial and deep muscle layers and can be viewed as the middle muscle layer of the pelvic floor.
The levator ani is made up of the puborectalis, pubococcygeus, and iliococcygeus muscles. The levator ani composes the bulk of the pelvic floor muscles and wraps around the entirety of the pelvis. The coccygeus is the smaller muscle component in the pelvic floor muscles and is located towards the back of the pelvis.
The pelvic floor muscles have two major functions: they provide support or act as a "floor" for the abdominal viscera, including the rectum, and they act as a constrictor or continence mechanism to the urethral, anal, and vaginal orifices (in females).
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Pelvic floor muscle functions
Pelvic floor muscles are a group of muscles, tendons, and ligaments that sit at the base of the pelvis. They are internal and not visible externally. They are essential for bladder and bowel control, as well as sexual function in both men and women.
When contracted, the pelvic floor muscles lift the internal organs of the pelvis and tighten the openings of the vagina, anus, and urethra. Relaxing these muscles allows the passage of urine and faeces. Pelvic floor muscles also support the uterus during pregnancy and need to be relaxed during the birthing process.
Weakened pelvic floor muscles can lead to difficulties in controlling the release of urine, faeces, or wind. They can also cause pelvic organ prolapse, where the organs fall into the vagina or anus. Pelvic floor muscles can be strengthened through specific exercises and lifestyle choices, such as diet, exercise, and maintaining a healthy weight.
Pelvic floor physiotherapy is a specialised field that assesses the function of these muscles and develops treatment programs to optimise their function. Techniques such as perineometry, surface electromyography, and ultrasound imaging are used to assess pelvic floor muscle function and identify any dysfunctions.
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Pelvic floor muscle problems
Pelvic floor muscles are a basin-shaped muscular diaphragm that supports the pelvic organs, including the bladder and bowel, and the uterus and vagina in females. They are located between the tailbone (coccyx) and the pubic bone within the pelvis. Pelvic floor muscles have two major functions: they provide support and act as a "floor" for the abdominal viscera, including the rectum, and they act as a constrictor or continence mechanism to the urethral, anal, and vaginal orifices (in females).
On the other hand, pelvic floor muscles can sometimes become overly tight, making intercourse difficult or impossible. Pain is often the trigger for this protective tightening of the muscles. As the pelvic floor is not easily visible, such issues can remain undiagnosed for extended periods. Seeking advice from a specialised physiotherapist is recommended in such cases.
Pelvic floor exercises are a common treatment option designed to improve muscle tone and prevent the need for corrective surgery. These exercises help strengthen the muscles and enhance the brain's connection to them. Additionally, lifestyle changes, such as limiting bladder-stimulating foods and drinks and increasing fibre intake for certain bowel problems, can help manage pelvic floor disorders. In some cases, surgery may be necessary to repair damaged anal sphincter muscles or implant stimulators for nerve control of bowel function.
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Frequently asked questions
Pelvic floor muscles are a group of muscles that form the base of the 'core' muscles. They work with the deep abdominal and back muscles and the diaphragm to support the spine and control pressure inside the abdomen.
Pelvic floor muscles help control the release of urine, faeces, and flatus. They also support the bladder, bowel, and uterus. In men, they are important for erectile function and ejaculation. In women, they contribute to sexual sensation and arousal and provide support for the baby during pregnancy.
The pelvic floor is composed of superficial and deep muscle layers. The superficial layer includes the external anal sphincter, perineal body, and possibly the puboperineal or transverse perinei muscles. The deep pelvic floor muscles consist of the pubococcygeus, ileococcygeus, coccygeus, and puborectalis muscles.
