In our Pelvic Health Part 1 blog, we discussed what is pelvic floor physical therapy and how often do issues with this muscle group occur. In part 2, we’re going to cover what the pelvic floor ‘does.’

What is the pelvic floor?

The pelvic floor is a group of muscles located in the base of the pelvis. It expands from the public bone in the front, back to the coccyx and sacrum (tailbone), and side to side between the ischial tuberosities (sit bones). Think of a hammock for your pelvic organs (bladder, rectum, uterus, prostate, vagina). This muscle group contains multiple sphincter muscles and are very important for bowel, bladder, and sexual functions. 

What does the pelvic floor ‘do?’

The pelvic floor has several major functions such as:

Sphincteric control: Maintaining continence (the ability to hold in urine, feces, or gas). The pelvic floor muscles and associated sphincters contract and relax for successful maintenance of continence and avoiding bladder or bowel leakage. When the pelvic floor is weak, too tight, poorly coordinated, or injured, this functionality changes and can result in incontinence or leakage among other issues. 

Supporting the pelvic organs (bladder, rectum, uterus and vagina in females, prostate and testes in men). The hammock like structure of the pelvic floor supports the pelvic organs against gravity and with increased stress on the abdomen (for example, sneezing, coughing, lifting a heavy weight, bending forward). Dysfunctions in the pelvic floor can result in organ prolapse or the organs “falling out” among other issues. A prolapse can happen through the rectum in all genders, or through the vaginal cavity in females. 

Sexual functions: The pelvic floor is highly associated with genital arousal and orgasm in both males and females. Dysfunctions in the pelvic floor can result in pain, difficulty achieving arousal or climax, or abnormal sensation (over or under sensitivity). 

Stability: the pelvic floor is a key component of your overall core strength providing stability and strength to the pelvis, hips, and tailbone. Pelvic floor dysfunctions can contribute to hip pain, coccyx pain, and even low back pain. 

Lymphatics: the pelvic floor muscles also help to pump fluid from the pelvic region through the lymphatic system to be eliminated from the body. Failure of the pelvic floor to complete this task can result in bloating or congestion in the pelvic cavity. 

Dysfunctions of the pelvic floor

Pelvic floor dysfunctions can come in a variety of forms. For example, they can be:

  • Too tight (hypertonic), or not tight enough (hypotonic) causing any number of irregularities in bladder, bowel, or sexual dysfunctions. 
  • Weakness: meaning they are not contracting as strongly as necessary to maintain support to the body or overcome abdominal pressure. 
  • Poor coordination: Because they are still muscles and have to be able to contract, relax, and stretch and not being able to perform all of their necessary functions can result in significant issues in pelvic function. 
  • Some people even have abnormal sensation, either too much, or too little which can be a result of pelvic floor dysfunctions. Lastly, pain in the pelvis can also stem from pelvic floor dysfunctions. 

Why is pelvic floor physical therapy important?

Many people have pelvic floor dysfunctions, but they often aren’t aware of it. Frequently, this is due to someone believing their symptoms are “normal/ that’s just how it is” or they’re embarrassed to talk about it with their medical provider. 

How common are pelvic floor dysfunctions?

  • For men: 9% – 40%  have reported pelvic floor dysfunction.
  • In women: 25% – 50%  have pelvic floor dysfunctions.
  • The incidence for all genders gradually increases with age.