Pelvic Floor 101
What is the pelvic floor?
The pelvic floor is a group of muscles, ligaments, and connective tissues that help regulate urinary and bowel function, support your pelvic organs, and stabilize your core. Pelvic floor muscles are organized into three layers:
- The superficial layer, or first layer, are the pelvic floor muscles that are closest to the skin. Muscles in this layer include the bulbocavernosus, ischiocavernosus, and perineal muscles. The first layer of pelvic floor muscles is important for both sexual and urinary function.
- The middle layer of the pelvic floor is just beneath the superficial layer. The second layer includes the external urethral sphincter, which allows us to control urine flow, and the puborectalis muscle, which is crucial for healthy bowel function. An overly active puborectalis muscle can contribute to constipation, while a weak puborectalis muscle might contribute to fecal incontinence.
- The deepest layer of pelvic floor muscles includes the levator ani muscles (pubococcygeus, puborectalis, and iliococcygeus) and the coccygeus muscle. These muscles are crucial for passage into and out of the pelvis, as well as for supporting pelvic organs, such as the bladder, bowel, and uterus.
What happens when things go wrong?
Pelvic floor muscles are skeletal muscles, just like your quadriceps muscles and biceps muscles. Just like any other muscles, pelvic floor muscles can be weak, or overly active. Weak pelvic floor muscles can lead to urinary leakage, prolapse (for women), lower back pain, and decreased sexual sensation/difficulty achieving orgasm. Overly active pelvic floor muscles can contribute to pain with intercourse, constipation, difficulty emptying the bladder, and general pelvic pain.
How can pelvic floor physical therapy help me?
Further Pelvic floor physical therapy addresses muscle imbalances, improving coordination, and restoring healthy function.
- Strengthening a weak pelvic floor- weak pelvic floor muscles contribute to urinary leakage, prolapse symptoms, lower back pain, and poor core stability. Increasing pelvic floor strength goes far beyond kegels- it also addresses abdominal, hip, and back strengthening and mobility work. While doing kegels at home can be a good place to start, skilled pelvic floor physical therapy can ensure that pelvic floor muscles are contracting properly, fully relaxing, and coordinating with other muscles to best support you.
- Relaxing a tight pelvic floor- overly active pelvic floor muscles drive sexual pain, constipation, difficulty voiding urine, and incontinence (if muscles are already tight, they struggle to further contract to hold back urine). Pelvic floor physical therapy down-trains pelvic floor muscles while encouraging abdominal and hip muscles to be more active. Once the pelvic floor muscles have released excessive tension, we work on helping them re-engage at a healthier level, while maintaining their ability to relax.
- Improving bladder and bowel control- bladder and bowel control goes far beyond leakage. Urgency (the strong desire, usually accompanied by intense physical sensations) to immediately void is often accompanied by frequent, disruptive trips to the bathroom. Conversely, constipation, which involves incomplete bowel emptying, can also contribute to abdominal discomfort and bloating, as well as urinary incontinence. Pelvic floor PT improves muscle coordination and addresses nervous system factors to increase confidence in bladder and bowel function.
- Supporting pregnancy and postpartum recovery- pelvic floor physical therapy can help pregnant women safely stay active, manage discomfort, and improve pelvic floor physical flexibility to reduce tearing during labor. Post-partum, pelvic floor physical therapy helps women re-connect to their bodies, regain continence and bowel regularity, address diastasis recti and back pain, improve scar mobility, restore sexual function, and get back to feeling like themselves again.
