The Pelvic Floor
The pelvic floor acts like a hammock for the bladder, bowel and uterus that runs from the pubic bone to the tailbone. It is a complex structure of muscle, fascia and nerves that join to form the ‘floor’ of the pelvis.
The pelvic floor muscles play an integral role in:
Maintaining bladder closure to prevent urine leakage
Keeping closure around the rectum to prevent faecal/bowel leakage
Act as a support network for the pelvic organs (uterus, bladder and bowel) to prevent pelvic organ prolapse
Aids in sexual function and arousal
Work with our diaphragm and core to assist the trunk stability
Ability to fully relax at the correct time to allow for urinating, passing a bowel motion and to birth a baby
Pelvic floor dysfunction is an umbrella term for conditions caused by a pelvic floor that isn’t functioning properly. Similar to any other muscles in the body, the pelvic floor can become too tight, as well as too weak, and any change from the normal function of a muscle can lead to changes. Clinically, more women are presented with overactive or hypertonic pelvic floors, which have been linked to lifestyle choices through exercises, poor dietary choices leading to chronic straining and high stress/anxiety environments with a lack of relaxation.
What are symptoms of a dysfunctional pelvic floor?
Urine leakage with jumping, running, coughing, sneezing or sex
Inability to hold on to urine
Sudden urge to wee
Feeling unable to completely empty the bladder
Heaviness, dragging or pressure in the vagina
Feeling a lump coming out of your vagina
Sudden urge to pass a bowel motion
Inability to hold on to faeces or wind
Reduced sensation with sexual intercourse
Painful penetrative intercourse
LET’S START WITH THE ABSOLUTE BASICS…
The Pelvic Cavity
The pelvis consists of 3 bones that form a ring and within it sits 3 major pelvic organs: the bladder, uterus and rectum.
The pelvic cavity can be easier to understand if we break it into 3 separate compartments:
The front compartment or anterior compartment sits closest to the pubic bone. It houses the bladder, a storage vessel for urine; and the urethra providing a channel for urine to leave the bladder.
The posterior (or back) surface of the bladder and urethra rest against the anterior (or front) wall of the vaginaThe central compartment contains the uterus or ‘womb’ which is located at the top of the vagina and separated by the cervix. The vagina is the central canal under the uterus. The uterus can often sit anteverted over the bladder as it is higher in the pelvic cavity. Anteverted means the top of the uterus comes up and forward.
The back compartment or posterior compartment sits closest to the coccyx/tailbone at the back of the body. It contains the rectum (bowel) which is the lower part of the digest tract and stores faeces; and the anal canal is the exit channel for faeces. The anterior (or front) surface of the rectum and anal canal rest against the posterior (or back) wall of the vagina
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The Pelvic Floor
The pelvic floor is a complex structure of muscle, fascia and nerves that join to form the ‘floor’ of the pelvic ring. It is important to highlight: the pelvic floor is more than just muscle! It is important to know the muscular and fascial components of the pelvic floor to understand pelvic floor dysfunction.
Pelvic Floor - Muscular Components:
The pelvic floor can be separated into two muscular layers:
The superficial pelvic floor muscles involve the urogenital triangle and deep transverse pereneii, sitting anteriorly and the external anal sphincter, sitting posteriorly. The urogenital triangle includes the ischiocavernosus, bulbocavernosus and transverse pereneii superficialis.
The deep pelvic floor muscles includes puborectalis, pubococcygeus and iliococcygeus; collective grouped to be called: levator ani, and coccygeus. The muscle group levator ani are responsible for the ‘lift’ of the pelvic floor during muscle contraction.
We shouldn’t forget to discuss the perineal body when discussing the pelvic floor. It is the central fibromuscular mass in the midline of the perineum between the vagina and anus. It provides muscular attachment for the superficial pelvic floor muscles and some fibres of the levator ani.
Pelvic Floor - Fascial Components:
The endopelvic fascia holds the pelvic organs in place within the pelvis. It is fibromuscular tissue that provides support by suspending organs. If the endopelvic fascia is damaged or stretched, it can lead to loss of organ support or pelvic organ prolapse.
The endopelvic fascia is made up of:
Pubocervical Fascia
Located between the bladder and vagina
Supports the bladder and urethra
Damage can result in anterior vaginal wall prolapse where the bladder falls and adds pressure on the front wall of the vagina
Uterosacral Ligaments
Attaching the uterus to the sacrum (the base of the spine)
Damage can result in uterus descent or uterine prolapse
Rectovaginal Fascia
Located between the vagina and the rectum
Supports the rectum
Damage can result in posterior vaginal wall prolapse where the rectum falls and adds pressure on the back wall of the vagina