Header Image

Pelvic floor

The missing piece of the puzzle – your pelvic floor

Lori Forner, BScH, MPhtySt (Physiotherapist), APAM, CWH committee member

www.loriforner.com

Today we are going to talk about the pelvic floor. The pelvic what?

Many people know more about their house or their phone than they do their own body. Do you know where your elbow is? Can you find your patella? Okay, for some that may be trickier…it’s your kneecap. But do you know the basic details about what’s under your pelvis? Women in particular are less aware and knowledgeable when it comes to naming and finding parts of their genitals. Many women feel awkward saying “pelvic floor”, let alone the “V” word…”vagina”…shhh.

So why is the pelvic floor so important? For one, it is a part of YOUR body. You really should know what things look like, where things are and what your “normal” is, that way if things go astray, you are aware and can seek help early. Men look at their….shhh….penis….everyday. They touch it everyday, they probably show their friends most days, and if not, they talk about it often. If things are not right, they know. This makes fixing things a whole lot easier because their brain knows it exists (but this brain talk is a whole discussion for another day).

Pelvic floor, pelvic
               organs and supporting muscles
Source: http://www.continence.org.au

So let’s just discuss some few basic things about down under, concentrating for now on the pelvic floor complex, inside. We can get into the nitty-gritty outside girly bits later.

This is you, from the side, missing a lot of things (skin, fat, muscles … clothes). Your pelvic floor (PF) is a group of muscles and connective tissue/fascia located at the bottom of your pelvis. They have very important functions:

Orange depicting the role of fascia

Embedded within these muscular layers are many sheets of connective tissue, called fascia. These layers are involved in supporting your pelvic organs and contract with your PF muscles. Different layers of fascia run in between your pelvic organs quite like an orange with all the segments and white stuff separating them yet connecting them.

The PF complex works in conjunction with everything connected to it. Your diaphragm (the big umbrella muscle that you breathe with), your deep back muscles (multifidus) and your deepest abdominal layer (transversus abdominis, or TA) as well as the other outer abdominal layers. I can keep going…your deep hip muscles, your glutes (butt), adductors (inner thighs)...everything works together in optimal conditions. Muscles work, work a bit more, work a bit less, rest, whatever is needed to perform the task at hand. And this is all meant to happen without you having to think about it.

But in reality, how you stand, sit, brush your teeth, work, lift or carry your kids, exercise and even breathe all affect how well this entire system works automatically.

Deep core, transversus abdominus,
               diaphragm, multifidus, spine
Source: http://www.legacytherapystl.com

So what can cause the system to fail? The pelvic floor system can become dysfunctional for a variety of reasons such as:

When the system fails, many issues can arise such as incontinence, prolapse, bladder/bowel problems, pain, problems affecting intercourse, hip pain, back pain, neck pain, I could go on. Once again, a story for another day.

The PF may become weak, stretched, tight, short, scared, confused, lazy and even angry. It may lose coordination with your breathing, brain or other surrounding muscles. And most of all not everyone needs to strengthen it.

Pelvic floor rehab is very specific to the individual! Everyone is different. Some people need to learn how to turn them on, some people need to learn how to let them relax, and everyone needs to learn how to coordinate them with the rest of the body.

People can fall into the trap of only ever contracting their pelvic floor. Whether their doctor, friend or fitness instructor has told them to do it, many people are blissfully unaware of how the body works and the balance that is required. If you contract something, you should also know how to relax it. And as I have briefly stated, not everyone needs to “strengthen” their pelvic floor. Pain, trauma, stress, anxiety and exercise can all contribute to a pelvic floor over-working or over-protecting. In this case, “strengthening” tends to make it worse.

So now you know a little bit more. Go get the mirror, have a look, have a touch – it is yours.


References:

Ashton-Miller JA, Howard D, DeLancey JOL 2001 The functional anatomy of the female pelvic floor and stress continence control system. Scandinavian Journal of Urology and Nephrology Supplement 207.

FitzGerald MF, Kotarinos R. Rehabilitation of the short pelvic floor 1: Background and patient education. Int Urogynecol J. 2003;14:261-268.

Hodges P, Sapsford R, Pengel L 2007 Postural and respiratory functions of the pelvic floor muscles. Neurology and Urodynamics 26, 362.

Lee DG, Lee LJ 2004 The Pelvic Girdle; An Integration of Clinical Expertise and Research, 4th end.

Lee DG, Lee LJ, McLaughlin L 2008 Stability, continence and breathing: The role of fascia following pregnancy and delivery. Journal of Bodywork and Movement Therapies.