What is the pelvic floor and what does it do?

The pelvic floor is a group of muscles, like a sling or hammock, that forms the floor of the abdominopelvic cavity. The muscles are attached between the pubic bone at the front and the coccyx at the back and from one side of the pelvis to the other. 

The two main functions of the pelvic floor are:

1. To hold up the abdominal and pelvic organs.
2. To help to control the bladder and bowels.

The Pelvic Floor Muscles

The most important muscles for us to understand are the brightly coloured muscles that surround the openings in the pelvic floor and help us to maintain continence. These muscles are grouped together and called Levator Ani.

Watch a demonstration of the anatomy of the pelvic floor in my video: Pelvic Floor Anatomy for Beginners.

Pelvic Floor Muscles: What goes wrong and why

There are many disorders affecting the pelvic floor, but they can be broadly grouped into disorders of support (e.g. pelvic organ prolapse) and problems associated with constrictor function (e.g. urinary and faecal incontinence). Furthermore, these disorders can be further divided into dysfunctions of pelvic floor contraction (faecal and urinary incontinence) and relaxation (constipation and urinary retention).

There are many factors that can contribute to pelvic floor problems; a common contributory factor for females is pregnancy and childbirth.

Possible Effects of Pregnancy and Childbirth

If you delivered a baby vaginally you have an increased risk of pelvic floor dysfunction. A study in 2013 found that having a baby delivered vaginally is associated with a 67% increased risk of urinary incontinence (UI), and the risk of having UI that lasts for more than ten years was increased by 275% compared with a caesarean section.

Having three babies or more increases your risk or pelvic floor dysfunction as does obstetric trauma when pelvic floor muscles, nerves or fascia can be damaged. 

Causes of trauma include:

• Delivering a baby with a large head overstretching pelvic floor muscles
• An instrumental delivery (forceps or ventouse)
• Perineal tears (2nd, 3rd or 4th degree tears)
• Being cut (episiotomy)
• A long second stage of labour. 

Other contributing factors include:

• Age 
• Hormonal status
• Obesity
• Surgery
• Constipation
• Exercise levels
• Having a chronic respiratory condition.

What can I do to improve my pelvic floor?

The good news is that pelvic floor muscle exercises are an effective treatment for pelvic floor dysfunction. Strengthening the pelvic floor muscles can cure or improve symptoms of stress and all other types of urinary incontinence. So, let’s get cracking!

Pelvic Floor Exercises; Get it right!

Did you know there is a right way to do Pelvic Floor exercises? A study found that it is surprisingly common for women to get these exercises wrong! Bump et al found that 50% of women couldn’t contract the pelvic floor correctly after receiving brief verbal instruction, and that half of these were instead doing something that might aggravate their symptoms. 

The most important first step in performing pelvic floor muscle exercises properly is to identify the correct muscles. This is where understanding your anatomy can really help.

Once you know where the muscles are located, you are now ready to learn how to contract them correctly:

1. You might try stopping the flow of urine for a second or two next time you go to the toilet. Remember this is not recommended as regular exercise.
2. You can imagine stopping the flow of urine and/or holding in wind. 
3. Women who are familiar with using tampons can imagine squeezing in the vagina as if squeezing a tampon up higher in the vagina.
4. Visualise the pelvic floor as a diamond shape attaching to the pubic bone at the front, the tailbone at the back and the two sitting bones at either side. Now you can imagine bringing the bony points closer together, front to back, side to side or both at the same time!

5. Imagine the pelvic floor like the centre of a tissue and ‘pick up’ the centre of the tissue.
6. Use a mirror to observe an upward movement of the perineum.

Remember it is important that you NEVER ‘bear down’ when trying the above and try not to hold your breath.

You can watch a demonstration of how to contract the correct muscles in my video ‘Find and Feel the Pelvic floor’.

Now it’s over to you

I hope you are feeling more confident about the steps you can take to improve your pelvic health.  Remember, movement is medicine for the body and mind and in most cases if you do the work, it will make a difference. Act sooner rather than later to improve your outcome and prevent a worsening of your condition.

If you are in any doubt whether this advice is appropriate for you, please seek help from a medical professional.

Video 1 – A tour of the pelvic floor anatomy

Video 2 – Find and feel your pelvic floor

Think of the pelvic floor as a diamond shape attaching to the pubic bone at the front, tailbone at the back and the two sitting bones at either side. 

If you are not sure what it feels like to tighten the pelvic floor on purpose you can try stopping the flow of urine for a second or two next time you go to the toilet. But this is not recommended as a regular exercise.

Now we will look at a few different ways for you to achieve a pelvic floor muscle contraction

1. You can just imagine stopping the flow of urine and/or holding in wind. 
2. Women who are familiar with using tampons can imagine squeezing in the vagina as if squeezing a tampon up higher in the vagina.
3. Thinking of the bony attachments you can imagine bringing the pubic bone and tailbone closer together front to back. Or the sitting bones closer together side to side. You can even do both at the same time!
4. It might help you to imagine the pelvic floor like the centre of a tissue and ‘pick up’ the centre of the tissue.
5. Use a mirror to observe an upward movement of the perineum.
6. Last but not least you could insert a thumb into the vagina to feel the muscles at work

Always check with your doctor if you have any health problems or concerns before embarking on a new exercise programme.

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References

Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991 Aug;165(2):322-7; discussion 327-9. doi: 10.1016/0002-9378(91)90085-6. PMID: 1872333.

Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018 Oct 4;10(10):CD005654. doi: 10.1002/14651858.CD005654.pub4. PMID: 30288727; PMCID: PMC6516955.

Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primipara after vaginal or caesarean delivery. BJOG. 2013 Jan;120(2):144-151. doi: 10.1111/j.1471-0528.2012.03301.x. Epub 2012 Mar 14. PMID: 22413831.

Raizada V, Mittal RK. Pelvic floor anatomy and applied physiology. Gastroenterol Clin North Am. 2008 Sep;37(3):493-509, vii. doi: 10.1016/j.gtc.2008.06.003. PMID: 18793993; PMCID: PMC2617789.

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