What are the pelvic floor muscles?

Table of Contents

• Anatomy

• Muscles

• Layers

• Pictures

• How to visualize the location of the pelvic floor 

• Function

• Squeeze & lift

• Release

• Bulge

• How to feel for the activation/relaxation of the pelvic floor

• Dysfunction

• Weakness

• Motor control

• Muscle tension

• When to see a pelvic floor physical therapist

• ReferencesG

GOAL: To have a general understanding of the pelvic floor muscles and why they are important. 

Anatomy

Muscles- The pelvic floor muscles are a group of 14 different muscles that create a bowl or hammock-like structure along the bottom of the pelvis. They attach to the inner circle of the pelvis (the pelvic inlet) including the sit bones (ischial tuberosities), the front of the pubic bone (pubic rami and symphysis) and all the way to the tailbone (coccyx) in the back. 

Layers- There are 3 different layers of pelvic floor muscles, meaning they have some depth to them. Generally, the superficial layer squeezes and relaxes to allow for proper urinary and bowel function, whereas the deep layers help to lift and support the organs sitting on top of them. 

How to visualize the location of the pelvic floor (Follow along!)

As you sit, try to feel for two generalized pressure points, one on each butt cheek. These are the sits bones. The pelvic floor is attached to these bones and runs between them. They also attach to the pelvic bone in the front and run to the tailbone along the back. These locations mean the main attachment points make a diamond-ish shape underneath us as we are sitting. When seated, we are basically sitting on our pelvic floor muscles.

Function

The squeeze & lift- These muscles need to activate when you want them to. This is done by muscle fibers shortening and producing force. This allows for: 

• Preventing urinary/bowel leakage. 

• Supporting the abdominal organs (viscera). 

• Providing core stability during every movement we make.

The release- Just as importantly, these muscles need to relax when you want them to. This is done by the muscle fibers lengthening and returning to baseline. This allows for: 

• Proper rest of the muscles.

• Optimized activation of the muscles when you go to use them again. 

• Decreased risk of pelvic floor dysfunction from muscles being too tense. (Very common!)

The bulge- These muscles are unique, for many reasons! One reason is they not only squeeze and release, they also have a gentle bulging or bearing down function. This allows for: 

• Bowel movements

• Having babies :) 

How to feel for the activation/relaxation of the pelvic floor (Follow along!)

Activate: To activate the pelvic floor, think about squeezing like you are gently holding back gas and holding back urine. These muscles also have a gentle “lift” or “pull” towards the head. Normally, even if you cannot feel it completely, if you think about both the squeeze and lift of these muscles you will elicit a more forceful contraction. 

Relax: To relax the pelvic floor, think about releasing  like your muscles are fully melting into the chair. It may take longer to completely  relax versus squeeze. Remember: This is JUST AS IMPORTANT as squeezing. 

Bulge: To bulge, think about gently bearing down like you are having a bowel movement or like you are pushing the muscles outward into the chair. We don’t want too much of this, such as repetitive straining,  because it may lead to dysfunction. 

~Secret Exercises~

• These muscles are VERY subtle and sometimes hard to feel for. A lot of times, less is more. The pelvic floor muscles aren’t as prominent as other muscles. You don’t “feel the burn” like working out a muscle in the arms or legs. Many times the body will try to compensate and recruit other muscle groups in order to feel more of a squeeze. 

• If you feel yourself lift from the chair that is your glutes compensating. Relax them and try again. 

• Also, everything else in the body should be nice and relaxed as well. If someone were to be looking at you activating and relaxing the pelvic floor they shouldn’t be able to tell you are doing anything at all (expect maybe lots of concentration on your face!). 

• Overall, these exercises should be slow and controlled and feel relaxing. 

Dysfunction

There are often misconceptions about what is causing pelvic floor dysfunction. And no, kegels are not the answer. (They very rarely are!).

Weakness- Sometimes, these muscles may be weak and may need to be strengthened with pelvic floor activation exercises. This is the least common issue. 

Tension- More commonly, the pelvic floor muscles can carry abnormal tension. This can be treated with pelvic floor lengthening exercises. 

Motor control- Also commonly, these muscles may not be squeezing/releasing when you want them to. This is called motor control dysfunction and can be helped with neuromuscular re-education exercises. 

When to see a pelvic floor physical therapist:

(Hint: Anytime can be helpful!)

• If you are experiencing pelvic floor dysfunction

• If you are pregnant/postpartum

• If you are experiencing menopause

• If you’d like to optimize core strength

• If you’d like to learn more about your body and its function

References:

• Gorniak, G., & Conrad, W. (2015). An anatomical and functional perspective of the pelvic floor and urogenital organ support system. Journal of Women's Health Physical Therapy, 39(2), 65-82.

• Prather, H., Spitznagle, T. M., & Dugan, S. A. (2007). Recognizing and treating pelvic pain and pelvic floor dysfunction. Physical medicine and rehabilitation clinics of North America, 18(3), 477–ix. https://doi.org/10.1016/j.pmr.2007.06.004

• Raizada, V., & Mittal, R. K. (2008). Pelvic floor anatomy and applied physiology. Gastroenterology clinics of North America, 37(3), 493–vii. https://doi.org/10.1016/j.gtc.2008.06.003