03 Oct What Is The Pelvic Floor
The Pelvic Floor is a term that is gaining more and more attention in the healthcare world. You might have heard this term specifically geared toward women or childbirth, or you might think that older folks are the only people with pelvic floor problems. You might be thinking what exactly is the pelvic floor, do I have one, and what can I do to help improve my pelvic floor health. Let’s begin with the basics by breaking down what is the pelvic floor exactly, and we will then demonstrate a few pelvic floor exercises that can allow you to maintain a healthy pelvic floor!
Understanding Pelvic Floor: Anatomy And Functions
The pelvic floor is a group of muscles that lie at the bottom of your pelvis and surround your genitalia. Here is a video discussing the anatomy of the pelvic floor.
These muscles have several functions:
- Support your abdominal contents (specifically the rectum, bladder, and uterus)
- Control urination and defecation by relaxing when you need to empty and by contracting when you don’t want to leak
- Regulate sexual responses including pleasure and reproduction
- Pump lymph fluid (waste management) out of the pelvic region
- Stabilize your pelvis as part of your core system
Does everyone have a pelvic floor?
Yes! The pelvic floor is a group of muscles like any other. There are some minor differences between sexes, but all humans have pelvic floor muscles and all humans can have issues with their pelvic floors that might need pelvic floor rehabilitation.
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Why is this important to me?
We commonly consider the core muscles to be our abdominal and back muscles, but the diaphragm and pelvic floor ALSO help to stabilize the pelvis. These four muscle groups create a structure like a soda-can and rely on each other to create stability for the spine and pelvis. If the entire unit is not in coordination with one another, or if one side is weaker than the other, then that may lead to negative effects on the body such as pain or incontinence (i.e. involuntary leakage of urine or stool).
“Permission for use granted to the author of this article as a member of the Global Pelvic Health Alliance (GPHAM). Visit here for more information on access to illustrations, courses, and the largest global pelvic health directory.
Interestingly, core dysfunction does not always cause pain in the genitals nor does it always cause leakage. Other symptoms include pain in the pelvis, hip, low back or tailbone region and it might lead to functional limitations like the inability to sit for prolonged periods, difficulty urinating/defecating, pain with sexual intercourse, difficulty squatting, and the inability to run/jump.
Just like all other skeletal muscles, the pelvic floor muscles require strength, endurance, flexibility, and motor control.
The motor control component is perhaps the most important as this means that the muscles need to be coordinated and sequenced in an appropriate pattern for proper function. Your pelvic floor could be very strong, but if it relaxes instead of contracts when you are jumping/coughing/sneezing, you could find yourself with wet pants. On the contrary, if it doesn’t relax when you need it to, this is when you could find yourself with difficulty emptying your bladder, pain with sexual intercourse, or pain with sitting.
This is also why “Kegels” are not always the answer for pelvic floor dysfunction. Kegels are like biceps curls for the pelvic floor. They involve contracting all of the pelvic floor muscles together as if trying to stop the flow of urine and hold back gas. (Yes, the gas part is important. Too often people just try to contract the “front” muscles.) Sometimes the pelvic floor is simply weak and needs pure strengthening, which is when kegels would be prescribed, BUT most often the issues have to do with a lack of coordination or flexibility deficits. If your biceps were tight, you would need to stretch them, not do more bicep curls. The same goes for your pelvic floor. In addition, all of your other core muscles need to be addressed! If you have some sort of shoulder dysfunction or if your arms were weak, you wouldn’t only do bicep curls in the gym to improve your arm strength, right?!
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How would I know if my pelvic floor isn’t working properly?
Usually, if the pelvic floor has some sort of dysfunction like poor flexibility, poor coordination, or weakness, you would experience urinary, bowel, or sexual dysfunction as well. As mentioned before, this could be in the form of leakage, difficulty emptying, or pain with sex.
Another way to tell is if you experience vague hip, low back, or pelvic pain that has not responded to traditional physical therapy. In addition, if you have also tried pelvic floor exercises and the pain remains. This is a situation where one would benefit from an evaluation by a pelvic health specialist. You can find a Board’s Certified Women’s Health Specialist near you at the APTA website by clicking HERE
What can I do for pelvic floor health?
There are a variety of interventions you may perform from relaxation exercises to strengthening exercises to promote quality pelvic floor health. We will describe some of these interventions next!
If you are experiencing any sort of pelvic pain, diaphragmatic breathing is perhaps the best exercise to try before seeing a pelvic floor specialist. Again, this will not replace evaluation and treatment by a pelvic floor physical therapist, but it may help alleviate symptoms.
Because your diaphragm and pelvic floor are the muscles that lie at the top and bottom of the “soda can,” they should move in sync with one another. Practicing this coordination can help relax any tight muscles as it helps to decrease sympathetic nervous system activity. This means that if you are feeling particularly stressed or tensed, especially if you’re in pain, your body might respond by manifesting that tension physically. Diaphragmatic breathing will encourage nervous system relaxation and thus, muscle relaxation.
Proper diaphragmatic breathing means that your stomach rises and falls with each breath as opposed to your chest. Here’s how it works:
Lie on your back with your knees bent and feet flat on the ground. Place one hand on your chest and one hand on your belly. Inhale through your nose and exhale through your mouth. As you inhale, your belly should rise and as you exhale, your belly should lower. The hand on your chest should not move at all. Take 5-10 deep breaths here.
As you inhale, the diaphragm will lower leading to an expansion of the abdomen. As you exhale, the diaphragm rises up, which will move your stomach back inward. In this video here, Arash uses a kettlebell as a resistance cue to activate the diaphragm. You can easily use the opposite hand to ensure diaphragmatic breathing > chest breathing.
You might be able to notice your pelvic floor releasing tension or descending with each inhaled breath and gently recoiling upward on each exhale. The breathing exercise can be progressed by cognitively activating your pelvic floor with each breath so that you are actively relaxing on each inhale and actively contracting on each exhale. This way you can practice proper core mechanics. However, just like other muscles in your body, your pelvic floor doesn’t need to be contracting at maximum strength with each repetition. It is important to be able to increase or decrease the intensity of your pelvic floor muscle contraction based on the exercise you are doing. In the case of diaphragmatic breathing, your contraction should be 50% of your maximum contractile effort or less as this is a relaxation and coordination exercise – not a strength exercise.
If you aren’t experiencing pain, but you are having difficulty engaging your pelvic floor to prevent the leakage of urine, or if you feel like you are unable to engage your pelvic floor as part of your core, adductor strengthening can be a great way to help activate your pelvic floor muscles. Though it must be said, studies have shown that strengthening your adductor muscles will not impact the strength of your pelvic floor – these exercises will help you activate your pelvic floor muscles for more voluntary isolated control.
Below are two exercises that are great for the pelvic floor. Try to engage your pelvic floor by contracting those muscles as if you were trying to stop the flow of urine or hold back gas (men can try to act as if they are trying to lift their penis upward). At the same time, squeeze the ball or lift your leg and exhale. Relax your pelvic floor contraction between each repetition.
Pelvic Floor Exercises: Supine Adduction Isometrics
- HOW: Get set-up laying on your back with your knees bent. Place a foam roller, yoga block, your fists, or any object you feel comfortable with to squeeze in between your distal thighs and knees. You want your thighs to be at least parallel to one another. Perform the exercise by squeezing as hard as you can for a few seconds, keep the pelvic floor muscles engaged, relax and repeat.
- FEEL: You will feel the muscles on the inside of your hips and thighs and your groin working with this exercise.
- COMPENSATION: Your body shouldn’t move with this exercise, keep your low back flat.
Pelvic Floor Exercises: Sidelying Hip Adductor Isometrics
- HOW: Lie on your side. Squeeze your pelvic floor and quadriceps first. While maintaining the squeeze, slowly lift up your leg and control it back down.
- FEEL: You should feel the muscles on the inside part of your thigh working.
- COMPENSATION: Do not let your hips/core move. Keep them tight the entire time!
About The Author
Samantha Fazio PT, DPT
Samantha graduated with her Doctorate in Physical Therapy from Temple University in 2017. She has since been studying with Herman & Wallace Institute to advance her pelvic health knowledge and recently received her pelvic health certification from Evidence in Motion. She practices with Excel Physical Therapy in Philadelphia, PA where she treats a full caseload under the pelvic health specialty.
- Herschorn S. Female Pelvic Floor Anatomy: The Pelvic Floor, Supporting Structures, and Pelvic Organs. Rev Urol. 2004; 6(5): S2-S10.
- Key J. ‘The core’: Understanding it, and retraining its dysfunction. J Bodywork & Movement. 2013; 17: 541-559.
- Beales DJ et al. Motor Control Patterns During an Active Straight Leg Raise in Chronic Pelvic Girdle Pain Subjects. SPINE. 2009; 34(9): 861-870.
- Hung HC, et al. An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Man Ther. 2010; 15: 273-279.
- Amorim, AC, et al. Effect of combined actions of hip adduction/abduction on the force generation and maintenance of pelvic floor muscles in healthy women. PloS ONE. 2017; 12(5): e0177575.
- Stafford, RE, et al. Pattern of Activation of Pelvic Floor Muscles in Men Differs With Verbal Instructions. Neurourol Urodynam. 2016; 35(4):457-63.