Pelvic Floor 101: What is it? What does it do? What happens if it is not working properly? Why are women more vulnerable than men? Can we do anything about it?

Heard of the pelvic floor but only have a hazy idea of what it is and what it does? This super simple outline of the key facts will increase your understanding of this amazing and super important part of your anatomy. Yay!

What is the pelvic floor?

The pelvic floor is a sling of soft tissue that forms the ‘floor’ of the bony pelvis. The bony pelvis is the beautiful bony bowl forming the stable base for our spine and to which our legs attach. The pelvic floor is made up of muscles and connective tissue structures such as fascia (think of the white tough parts you find in cuts of meat) and ligaments. This connective tissue, as the name implies, connects things like muscle and organs to the bony support of the pelvic bones and is what holds things in positions where they can function appropriately. This connective tissue is very strong, but it can be stretched over time or injured like any soft tissue, depending on the forces it is subject to. Genetics also has a role here as some people have very tight connective tissue and other people are more stretchy and bendy in their joints and connective tissue.

Check out this video for a quick tutorial of the anatomy and function of the pelvic floor!

What does the pelvic floor do?

The pelvic floor has many important jobs and the key ones include:

  • Supporting the pelvic organs (the bladder, uterus, vagina and rectum) in position within the protective space created by the bony pelvis
  • Maintaining automatic and conscious continence and preventing unwanted leakage from the bladder and bowel
  • Allowing things in (think penises during sexual intercourse!) and things out (babies!) of the vagina

What can cause problems for the pelvic floor?

Stretch, strain or injury to this connective tissue or the muscles can result in the pelvic organs and support structures no longer sitting in a position that allows them to function effectively and this can lead to pelvic floor dysfunction such as prolapse or incontinence. Stretch, strain and injury to the pelvic floor is usually the result of many factors including:

  • The aging process and the loss of collagen in our tissues which provides tensile strength and integrity to connective tissue. Just like our faces and boobs start to sag a bit as the years go by….. so too does the pelvic floor.
  • Gravity! (see above) Because we humans are bi-pedal creatures, that is, we walk on 2 legs instead of 4 our poor pelvic floor is subject to the full force of gravity all day long as we walk, run, jump, pick up our kids. Over a lifetime this is a lot of force!!!
  • Hormones – post-menopausal women’s hormone levels change dramatically and they lose the protective effect of hormones like oestrogen which is responsible for thick, juicy pelvic floor tissues!
  • Pregnancy – baby + placenta + fluid etc = lots of pressure directly down on the pelvic floor combined with pregnancy hormones, namely relaxin which has the pelvic floor literally…..relaxin!
  • Vaginal delivery – enough said perhaps! But the risk of pelvic floor dysfunction increases with bigger than average babies/head circumferences, long pushing phases, the need for instrumentation such as forceps and perineal tearing, particularly grade 3 or 4 tears which includes direct injury to the muscles
  • Coughing, sneezing and heavy lifting – any time we generate a lot of intra-abdominal pressure (so pressure inside our abdomen) for example when we cough, sneeze or pick up something that requires a bit of “oomph” we put a lot of pressure down onto our pelvic floor. So people with conditions that result in chronic coughing (asthma, allergies) or people who do a lot of heavy lifting without pelvic floor awareness are at higher risk of developing pelvic floor dysfunction
  • Constipation and straining – yes ladies, if you are regularly giving birth to a large, difficult ‘bowel baby’ you are putting your pelvic floor through some significant stress and strain! Constipation is a sign that something or things are not going right somewhere….from what food and fluid you put into your mouth, to your gut and digestive processes, to the very tail end of things so to speak. It’s not something to be ignored and tolerated, particularly if you are regularly having to strain to empty your bowels, or experience discomfort, pain, haemorrhoids or bleeding as a result of big hard poos! Seek support and professional advice! A women’s health physio can be a really good holistic resource with regards to good bowel health and habits.

Factors like these can change the ‘tightness’ with which the pelvic structures are held in position. Think of a brand new trampoline! Get a whole bunch of five year old kids to jump on it and still the trampoline will be so taut that they will hardly sink down as they jump! Now picture a really old trampoline….one from the 80s (not that PEOPLE from the 80s are old…) that’s barely hanging in there and is saggy, with frayed edges….. Now get that bunch of kids to jump on it and picture the trampoline sagging dangerously close to the ground with less support from those frayed edges. That’s one way of thinking about age related change occurring in the pelvic floor!

Why are women’s pelvic floors more vulnerable compared to men?
3 key reasons:

  • We have a ‘large’ (relatively speaking) gap in our pelvic floor that men don’t have, namely our vaginas! Creating a structure that is designed to support and hold everything in and up but that also has to stretch enough to allow babies to exit….frankly if you spoke to an engineer about it she’d probably describe it as a design flaw from hell! I’m kidding…..but still it’s a big ask and it is a big reason why pelvic floor dysfunction is much more common in women compared to men. From a urinary continence perspective imagine a vessel full of liquid (the bladder) with a short tube at the bottom going pretty much straight down (the urethra) as a basic analogy of female anatomy. The tube has a seal that can be opened or closed BUT if the seal becomes faulty in any way it gets pretty tricky to hold the fluid in – do you get me? Compare to a man whose tube is positioned more sideways and is far, far, FAR longer. The length of his ‘tube’ creates a pressure environment that is far more forgiving on the system than ours is. Does that make sense?
  • Pregnancy and childbirth (as above)
  • Hormonal changes (as above)

Can we have an positively impact on our pelvic floor and the reduce risk of dysfunction?

Absolutely. In fact (and I may be bias as this stuff is MY JAM but….) I believe that if all women had a good connection with their pelvic floor combined with a good understanding of how to reduce the risk of dysfunction there would in fact be less dysfunction. However, it’s a long and pro-active game in some regards. But I’m here to invite you to start treating pelvic floor awareness as something that is as important as brushing your teeth. Could it in fact be more important? If our teeth get cavities hey it may not be ideal? But it’s relatively simple to sort out. Not so much the pelvic floor yet. So there is value in being pro-active and getting to know your pelvic floor, even if only so that can have some awareness if things feel different.

What do I recommend?
Come and see me or one of my excellent Women’s Health Physio colleagues. Learn about your pelvic floor and how to optimise it! To be clear this is not all about strengthening! Some, in fact many women hold excessive tension in their pelvic floor muscles and one of the most common manifestations of this is dyspareunia which is a big fancy word for painful sex.  Working with these women is more about developing self-awareness around physical tension in the body and pelvic floor muscles and teaching relaxation and downtraining strategies. Ultimately knowledge is power and embodied knowledge, that is, the wisdom our body holds, is hands down the most valuable knowledge we can ever gain about ourselves and will change the way we operate in the world for the better. I’m not kidding. Embodied wisdom however you want to look at it, is the answer to …. Well everything my friends. So don’t be shy. Start getting to know your lady bits and all the key actors behind the scenes a bit better. You won’t regret it.