Pelvic Floor 101: What is the Pelvic Floor?
Many people have heard about Kegels, but not many people are aware of the muscles they are exercising: the pelvic floor.
The pelvic floor is a muscular bowl inside of the pelvis that helps support the pelvic organs, including the bladder, colon, and the uterus or the prostate.
Although these muscles are small and only as thin as a sheet of paper, they can really make a difference to not only important organs, but core stability as well. The rectus abdominis and other abdominal muscles often get all the credit when it comes to the core, but the pelvic floor is an actual true core muscle.
The pelvic floor works with other muscles to help keep you up-right and maintain your posture.
These muscles also facilitate lymphatic drainage because they contract and relax muscles that help pump fluid back up to the heart.
These little multitasking muscles are also helping you maintain continence. The reason you can hold back gas in a crowded room or keep from peeing your pants while driving home from work is all thanks to the pelvic floor.
When these muscles relax, you are able to urinate or have a bowel movement. So, we consider them very helpful.
Last but not least, these muscles help with sexual function. They allow erections to happen, both penile and clitoral, and they are involved in ejaculation and orgasm.
The muscles are essentially divided into two layers of muscles: superficial and deep.
The superficial layer is towards the surface and is often referred to as the urogenital diaphragm. It consists of the bulbospongiosus, ischiocavernosus, and transverse perineal muscles. The external anal sphincter muscles are also part of the superficial muscle layer.
The deeper muscles, also known as the levator ani, comprise the muscular bowl that most people associate with the pelvic floor. Again, these muscles support the pelvic organs and the urethra, vaginal canal, and rectum pass through these muscles.
In the event that these muscles become dysfunctional, they become tense, overactive, or not able to contract, which can lead to symptoms such as:
- Urinary Incontinence
- Fecal Incontinence
- Pain with Sexual Activity (penetration, erections, orgasm etc)
- Urinary Urgency/Frequency
- Bowel Urgency
- Low Back or Hip Pain
- Pelvic Pain (Pain in the Genitalia)
Many people assume that if a person has pelvic floor dysfunction and any of the symptoms listed above that the only treatment option is Kegels, but that is not correct.
If the pelvic floor muscles are restricted, hypertonic, or tense, trying to do a pelvic floor contraction is not the best treatment option and may make symptoms worse. Imagine if the muscles in your arm were in spasm and it was making it hard to pick up a cup, you wouldn’t do biceps curls. Instead, you would try to stretch and lengthen those muscles and then re-train them to move correctly.
The same premise is true with pelvic floor muscles.
Even for patients experiencing urinary incontinence, Kegels may not be the appropriate treatment option. Many times the pelvic floor muscles may be overactive, which causes them to not function correctly and leads to bladder leaks. This is why it is important to consult with a specialist before doing Kegels.
It is also important to consult a specialist because research shows that most people do Kegels incorrectly, and many people are unable to do them with verbal instruction alone. Furthermore, not all Kegels are the same. Some Kegels focus on strength. Some focus on endurance. Some work on overall coordination.
After a provider does an assessment, they will be able to determine if Kegels are an appropriate exercise AND what type of Kegels a person should be doing.
Many people worry about their pelvic health, even if they are not experiencing symptoms.
If you really want to do something to promote good pelvic health, I recommend getting your bowel movements in check!
Pushing and straining to poop can put a lot of pressure on the pelvic floor and can lead to pelvic floor dysfunction. Using a toilet stool to support your feet and create a squat-like position on the toilet is the optimal way to defecate and may help your pelvic floor stay happy and healthy.
If you aren’t sure if your pelvic floor needs some TLC or exercise, talk to your healthcare provider today.
Dr. Rachel Gelman is a pelvic floor physical therapist. She is the owner and founder of Pelvic Wellness & Physical Therapy in San Francisco which specializes in treating patients with pelvic floor dysfunction including pelvic pain, bowel, bladder and sexual dysfunction. She is an adjunct instructor at Samuel Merritt University where she teaches the pelvic health curriculum in the Doctor of Physical Therapy program.