Your Pelvic Floor. That mysterious thing that you know is down there and you know is important. What is it actually? What does it do? And why does everyone talk about it?

Okay, so what is the pelvic floor?

Your pelvic floor is a group of muscles that create a sling from your pubic bone to your tailbone, lying in-between your two sitz bones. There are three layers:

1) The Superficial Perineal Layer is made up of three muscles that create a triangle between your two sitz bones and your pubic bone, and a 4th muscle called your external anal sphincter.

2) The Deep Urogenital Diaphragm Layer has three muscles. Two that control the urethra: the compressor urethra and the uretrovaginal sphincter. And a third, the deep transverse perineal, that crosses from one sitz bone to the other, running through the perineum.

3) The Pelvic Diaphragm is the deepest layer. There are three muscles that form the Levator Ani, which creates a U-shape with the two ends attaching to the two sides of the pubic bone, and the curve attaching to the tailbone. Then, there are three other muscles in this layer that connect further up into the pelvis.

What does the pelvic floor do?

When working well, those three awesome layers of muscle support your pelvic organs, allow for urinary and fecal continence, help with sexual performance, stabilize the pelvic joints, and serve as a pump for blood and lymph.

…And so why is everyone talking about it?

Your pelvic floor, just like any muscle group, is ideally able to contract or relax in response to loads placed on it. Take your bicep, for example: You don’t just walk around clenching your bicep. Instead, it engages when you pick up your little one, and relaxes when you put them down. The same response should happen with your pelvic floor. The more load placed on the pelvic floor, the more the muscles should activate in response. A sneeze causes increased intra-abdominal pressure, which means an increase in load to your pelvic floor. In response to that increased load the pelvic floor should engage, keeping your bodily fluids where you want them.

Sometimes, the pelvic floor muscles don’t function in this way – ever heard of the sneeze-pees? This dysfunction could be caused by a coordination issue, muscles that are too engaged, or muscles that are too lax. If pelvic floor muscles are chronically overactive they are unable to engage more in response to an increase in pressure - like a sneeze - leading to incontinence. Similarly, if the pelvic floor is too relaxed it doesn’t have the strength or coordination to respond appropriately, which leads to the same problem. 

If you have a crying baby that wants to be held but your bicep isn't strong enough, guess what? You’ll still pick your baby up. Your wonderful brain will recruit neighboring muscles to figure out a way to get your baby into your arms. Similarly, if the pelvic floor is not able to respond to the load placed upon it, your smart brain/body will activate muscles nearby to help out. That could mean that your low back pain or hip pain is actually a pelvic floor problem because they are being asked to do work that is not in their job description.

What are the possible causes of pelvic floor dysfunction?

A sedentary lifestyle, keeping the belly sucked in, pregnancy, childbirth, poor posture, or surgery to name a few.

So What Are The Takeaways Here?

1) The Pelvic Floor is a dynamic group of muscles that change coordination, activation, and length in order to support your organs, stabilize the bones of your pelvis, assist in sexual pleasure, and allow for continence.

2) Stronger isn’t always better: I hear people say “I know I need a stronger pelvic floor. I should do more Kegels” ALL. THE. TIME. It may not be strength that those people need! They may need to learn how to relax their pelvic floor, coordinate their abdominal muscles differently, or regulate their intra-abdominal pressure better.

3) Incontinence is NOT normal. Neither is pain with sex. I once had a postpartum client who was experiencing A LOT of pain with intercourse and her doctor said “Well, if you don’t use it, you’re going to lose it.” EFF THAT!!! See if you can find a pelvic floor PT to help you. Telehealth is huge right now, so if you don’t have a pelvic floor PT in your neck of the woods, or you don’t want to/can’t leave your house, look for someone who can help you virtually.

Although I’m not a Pelvic Health Professional I’m happy to speak with you about your situation and try to send you in the right direction. If you found this information helpful please share it with your community. Thanks for reading!

-Kat