what is a pelvic floor?
The pelvic floor is an often overlooked and underestimated region of the body despite its significance in maintaining various bodily functions for both men and women. It can be described as a complex network of muscles, connective tissues, nerves and blood vessels that form a hammock-like structure at the base of the pelvis, spanning the area between the pubic bone at the front and the tailbone at the back and can be summarised as important in the functions of;
Support and stability to the pelvic organs, pelvis, hips and lower back
Toileting and continence
Sexual experience including pelvic pain, vaginal tone and orgasmic response
Pregnancy and childbirth, including vaginal and caeserean sections
Core strength and flexibility
Just like another region of the body, the pelvic floor can sustain injuries, become overactive or lack strength which can lead to changes in bladder and bowel habits, pelvic organ prolapse, pelvic pain and poor sexual wellness. However, it is also important to note that these changes in pelvic health, or other medical conditions, can also be the cause of pelvic floor muscular and connective tissue changes, rather than the effect. A pelvic health physiotherapist is able to assess your pelvic floor and pelvic health to determine the most likely cause of your symptoms, prior to creating and implementing an effective treatment plan to get you back to optimal functioning.
There are two distinct muscular layers that contract and relax in harmony to maintain good pelvic health. The superficial layer consists of circular and oblique shaped muscles that wrap around the openings to the body (the external urethral meatus, vagina (in females) and anus) and perform a squeezing action whilst the deep layer is shaped like a collection of slings that helps to stabilise the pelvis and support the pelvic organs (the bladder at the front, uterus at the top (in females) and rectum at the back) by performing a lifting action. We want these muscles to be able to contract AND relax, as they can become tense, tender and non- responsive (pelvic floor overactivity) or lax, weak and non- responsive (pelvic floor underactivity) with variances in lifestyle, health conditions, pregnancy and childbirth and general ageing. You can read about the different signs and symptoms of pelvic floor overactivity or underactivity here.
There is also a series of connective tissue within the pelvic floor, which play an important role in stabilising the pelvic floor muscles and providing integrity to the vaginal walls which border and support the pelvic organs. You can think of the connective tissue of the pelvic floor as similar to the ligaments that you might overstretch when you roll an ankle, they too can become damaged from repetitive straining or during pregnancy and vaginal childbirth, which most commonly leads to pelvic organ prolapse. The pelvic floor is richly innervated by nerves and supplied by blood vessels due to it’s multimodal and important bodily functions, but these too can occasionally become irritated or damaged by chronic pelvic pain or vaginal childbirth.
As the pelvic floor sits at the base of the pelvis, it also works in conjunction with the diaphragm, abdominal muscles and lower back muscles to provide three dimensional core stability. Core stability can be defined as the ability to stabilise the spine and pelvis against gravity and additional load (strength) and also perform all movements of the spine in all directions (flexibility). Indeed, the pelvic floor muscles co- contract with our deep abdominal muscles, move in time with the diaphragm and often compensate for changes that occur in lower back or hip pain.
Thus, although we cannot see our pelvic floor muscles and it is difficult to feel the pelvic floor muscles contract and relax it is not a reason to forget about them. Instead, we encourage all women to have a pelvic floor assessment with a pelvic floor physio to learn more about their pelvic health and how to correctly activate the muscles. Doing this ahead of time, helps prevent pelvic health changes and equips you with the skills to train these muscles just like you would any other muscle group. It can be as simple as doing 5-10 minutes of pelvic floor exercises 3x/ week in conjunction with other activities you may be doing- but these do need to be individualised to ensure that you don’t exacerbate any underlying overactivity or underactivity. To get started on your journey towards optimal pelvic health, contact us or book an initial appointment here.
Author: Jessica Adams 2024