What is, and where is, your pelvic floor?

Pelvic Floor Anatomy Explained

The pelvic floor is a sling like muscle at the base of the pelvis that goes from the tailbone (back of pelvis) right to the pubic symphysis (front of pelvis). You can think of these muscles almost like a hammock holding everything up. You have two layers of the pelvic floor muscles working to achieve this function: there is the deep layer of your pelvic floor (collectively known as levator ani) which is literally at the floor or base of the pelvis and the superficial (outside) layer which surrounds the entrance of the vagina and anus. Your hip/glute muscles (obturator internus and piriformis) form part of the outside (lateral) walls that help to support the pelvic cavity. 

Your pelvic floor is what is responsible for holding up your internal/pelvic organs (think bladder, bowel, uterus); for ensuring you can control your bladder and bowel (so you don’t wee, fart or poo when you don’t want to); and for sexual pleasure and function. For all of these functions we need the pelvic floor to be able to contract and relax appropriately. We also need it to hold a level of resting tone, which allows us to be supported when at rest. This level of tone needs to not be too low and not too high.

In the case of pelvic pain, and difficulty with penetration, often the pelvic floor muscles have a high level of resting tone. This can make achieving pain free, enjoyable penetration difficult and sometimes impossible! 

Below: The superficial layer of the pelvic floor - looking from your toes towards your head. 

 

Below: A cross section of the pelvic floor, showing how the pelvic floor forms a "sling" to support the pelvic organs. 

 

Symptoms of pelvic floor dysfunction

If any of these muscles are not working as they should – be it low tone, high tone or poor activation/coordination the following can happen:

• Dyspareunia (Pain with sexual intercourse)
• Urinary incontinence (wetting yourself)
• Faecal incontinence (pooping yourself)
• Constipation (not being able to poop)
• Urinary frequency (going to the toilet a lot)
• Urinary urgency (having a strong urge to use your bladder)
• Pelvic organ prolapse (when your organs descend)
• Vaginismus (inability to use a tampon or insert anything in your vagina)

 This is not an exhaustive list, but I think you get the point; your pelvic floor is important!

  

So we have covered the anatomy, what else do we need to know about it?

Well it’s a good idea to start with knowing how to contract your pelvic floor. We know, based on research, that anywhere from 15-45% of women when asked to contract their pelvic floor will not do it correctly. So ensuring that you can correctly contract your pelvic floor is pivotal. When you contract your pelvic floor correctly you want to feel a squeezing inwards (superficial layer) and a lift upwards (deep layer). Have you ever heard someone talking about “kegels”? Well that’s a term used to describe exercises that strengthen the pelvic floor muscles; it is your pelvic floor contracting and lifting inwards and upwards. 

Here are some cues to help get you thinking about the way those muscles contract

• Squeeze and lift your pelvic floor like you are holding in a wee
• Squeeze and lift your pelvic floor like you are holding in wind
• Squeeze and lift your pelvic floor like you are lifting your vagina off your undies
• Squeeze and lift your pelvic floor like you are squeezing your partners penis during sex
• Squeeze and lift your pelvic floor like you are sucking up a tampon

When you are doing your pelvic floor exercises you should not be able to visually see anything (eg no bum squeezing or tummy contracting), so make sure your bum and tummy are relaxed.

It’s important to note that if you can’t feel anything, or if you feel like you fatigue really quickly, it may not be that your muscles are weak - it could be that your muscles are too tight! 

It is also important to note that pelvic floor exercises are not appropriate for everyone (even if you are having leakage), so if you have any pelvic floor concerns then I urge you to see a pelvic floor physiotherapist as soon as you can. There is so much help available to you and strengthening them isn’t always the answer.

Below: the symptoms that may occur if the pelvic floor is overactive and/or weak.