The pelvic floor has been described a lot in the media and society as something that is definitely important, maybe too tight or too loose, has something to do with kegels, etc. While it's important to address all of these topics at some point, sometimes we need to go back to the basics.
The basics: What even is the pelvic floor??
The pelvic floor is made of muscle and soft tissue that goes from your pubic bone (the front) to your tail bone in back, and everything in between within your pelvis. It is the "floor" of your trunk, supporting the organs in your abdominal cavity. If you picture your trunk as a soda can, your pelvic floor is the bottom of that soda can. The top is the diaphragm, and the middle is the core wall.
We women have three holes in the pelvic floor: the urethral opening (where we urinate out of), the vaginal cavity, and the anus (where we poop from). These holes are surrounding by the muscles of the pelvic floor that help to keep us continent (i.e. not leak urine, feces, gas).
What is the role of the pelvic floor?
The main roles of the pelvic floor are to:
Help support the contents of the abdominal cavity. Think both organs as well as a baby when pregnant.
Help maintain continence (which is the ability to control urine, feces, gas when you do and don't want to release them).
Help provide sexual function and pleasure. Two specific muscles (the bulbocavernosus and ischiocavernosus) help stimulate excitation (clitoral erections are a thing) and maintain it in both men and women. We don't talk about how important sexual pleasure is, especially for women! Sexual health and pleasure plays a large role in quality of life if one chooses to be sexually active.
Let's expand on those roles:
Support:
In order to support all the things we carry in our abdomen, the pelvic floor has to maintain a balance between being tense enough but also with the ability to relax as needed to allow urine, a baby, or poop to come out. The ability to maintain resting tension, contract to prevent unwanted leakage, and relax as needed occurs without our conscious input.
When there is any sort of trauma to the pelvic floor, or overtime the muscles have become either under-active or overactive, it becomes necessary to learn how to consciously control the pelvic floor. Think of it like breathing; you don't need to constantly think about breathing, but if you're hyperventilating it's a good idea to know how to slow your breath down.
An example of this would be a loss of support from childbirth. The pelvic floor is placed under extreme stress and stretch during pregnancy and then vaginal delivery, and now does not have the resting tension needed to provide support of the organs sitting directly on it. This may lead to pelvic organ prolapse, which is very common after pregnancy and labor and also very treatable with pelvic floor physical therapy. Learn more about pelvic floor physical therapy!
Continence:
The definition of continence is the ability to control bowel and bladder movements. You want to be able to control when you do and don't urinate, pass gas, or poop. That's what potty training was for as a kid!
A common misconception is that incontinence is only a total loss of control, meaning you completely pee all over yourself, pants, and floor. Think adult diapers. And yes, that is included in the definition. But it also is when you leak just a little bit at inappropriate times, think a small leak with sneezing or at the bottom of a squat.
This can happen from either an under-active pelvic floor, or one that is overactive and then fatigues after awhile allowing for incontinence to happen.
Sexual Function
In women, the clitoris is the primary erogenous organ. The two muscles that attach to the clitoris are the bulbocavernosus and ischiocavernosus. The bulbocavernosus is responsible for initiating clitoral erection, and ischiocavernosus is responsible for maintaining it. The pelvic floor also contracts during orgasm, similar to a kegel without voluntary input.
Aside from the excitation of the clitoris, you can imagine why the pelvic floor plays an important role in sexual function, as penetrative sex occurs within the pelvic floor. Any previous pain or trauma to the pelvic floor, as well as changes in the hormonal balance, can lead to uncomfortable or even painful sexual encounters.
While it is not the purpose of this blog post to dive deep into painful sex, also known as dyspareunia, it is important to note that help is available. If you're experiencing pain during sex, or even pain at rest, reach out to a pelvic floor physical therapist or OBGYN to help assess what you may be experiencing and guide you through treatment options available.
TLDR:
The pelvic floor is the muscles / soft tissue within the boundary of the pelvis.
The pelvic floor muscles / soft tissue help support the contents of the abdomen. They work in tandem with your core to keep you upright and balanced.
Continence (control over bowel and bladder movements) is largely derived from the pelvic floor. The muscles are under conscious control, although we shouldn't have to think about not peeing ourself regularly.
Sexual health, function, and pleasure is a lesser talked about role of the pelvic floor. If you're experiencing pain with intimacy, reach out to an OBGYN or Pelvic Floor Physical Therapist to assess why.
About the Author:
Caroline Gamwell, DPT is a Doctor of Physical Therapy, specializing in Pelvic Floor and Women's Health. She is the founder of Worth It PT based in Denver, Colorado, a clinic whose focus is to help others achieve their health and wellness goals through a higher quality of healthcare.