Let's dive right in: The pelvic floor consists of a series of muscles that sit at the base of your abdomen and connect all the way towards the bone you feel when you sit down for too long — the "sits" bone for short. The pelvic floor helps to support, stabilize, and secure your pelvic organs and has a strong connection to your "core" as well as to maintaining sexual function.
Now, the core is a huge buzzword, especially in the fitness world. But do we even truly understand what the core is? Don't worry, I'm getting there, but let's first discuss what the pelvic floor is, and why it's so important.
What is the pelvic floor?
While many associate the pelvic floor only with urinary incontinence, this sheet of muscles is actually responsible for supporting and stabilizing all of our pelvic organs (think the bladder, rectum, part of the descending colon, and in females: the uterus, fallopian tubes, and ovaries). The pelvic floor also helps to aid bodily processes such as urination, bowel movements, sexual function, and libido.
Who has a pelvic floor?
EVERYONE. There’s a big misconception that only people who identify as females have a pelvic floor, but this isn’t the case at all. Both women and men have pelvic floors, so we can all benefit from learning how it works and how to maintain a healthy one.
Where is the pelvic floor located?
The pelvic floor begins in the middle portion of our pelvis. It then wraps all the way around the back of your body towards your "sits" bone. If you take a look at the pictures below, the red area indicates the pelvic floor muscles. Most will compare the pelvic floor to a "sling" or a “hammock” based on its shape, which is totally valid since it's helping to support your pelvic organs, but I like to think of it as a bowl filled with water.
Why is the pelvic floor important?
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Think about your day-to-day. As humans, we pee, we poop, we have sex, we squat... so why wouldn't we want to help the muscles that help us perform these actions?
Pelvic floor physical therapy can help us determine whether or not our pelvic floor muscles are functioning well. In order to assess the pelvic floor, a therapist may need to perform an internal and external vaginal or rectal examination to determine if the muscles are weak, tight, strong, coordinated, and can handle increased pressure (i.e. when we cough or sneeze). Of course, an exam is always performed with a patient's informed consent and is not always necessary depending on the symptoms a patient presents with. I personally think everyone can benefit from a full pelvic floor examination, but that doesn’t mean that an internal exam has to be performed right away!
A good practitioner will always make sure their patients are comfortable and that they understand every portion of the exam before it is performed. Ask lots of questions! We’re always happy to answer them; I sure am!
How can you tell if your pelvic floor is strong or weak?
Here are some important functions of the pelvic floor that I think most of us can relate to:
Holding in urine, gas, or poop when we don't have a toilet next to us
Holding in urine when we cough, laugh, sneeze, or jump (I totally let some go when I laugh too hard)
Supporting & stabilizing pelvic organs
Increasing sexual arousal or achieving an orgasm (Preach!)
Decreasing back, hip, or lower extremity pain
Maintaining proper "core" strength
If you're experiencing dysfunction in any of these areas, or if you're unsure of the state of your pelvic floor muscles, consulting a pelvic floor physical therapist is always a good idea.
What happens when you have pelvic floor dysfunction?
Your core consists of your abdominal muscles and your back muscles, and my personal definition includes the pelvic floor as well. Simply put, the abdominals make up the "front" of your core, your back muscles are the "back," and the pelvic floor is the "seat" of your core.
Remember that bowl analogy I mentioned: Picture it. Your pelvic floor is a bowl sitting in the middle of your body, and it's filled to the brim with water (which would consist of your pelvic organs and tissue lining). If one thing is off and the bowl gets tilted, pushed, or prodded, the water starts to fall out, right? This is what happens when one of your pelvic floor muscles, ligaments, or organs has a dysfunction. This can include being stretched, being too tight, lack of strength, improper positioning, overactivity, etc.
So, if those muscles aren't in proper alignment or if the bowl tips and the "water" gets into other areas of the body, your pelvic floor or the bowl you once carried at its full potential has now lost the function it needed to stay stable in the first place. And the chain reaction continues.
When is it important to start strengthening your pelvic floor?
Now that you know all of the necessary functions of the pelvic floor, you can probably see the benefits of working to strengthen it at any point in your life. For those of you who may be thinking, "Should I have been doing this sooner?" Don't worry — it’s never too late to start!
How do you know if you would benefit from a pelvic floor exam?
Since everyone has a pelvic floor, I personally believe that everyone can benefit from seeing a pelvic floor specialist for an evaluation. However, if you are experiencing any of the above symptoms related to sexual function, urination, or bowel movements, it may be time to schedule an appointment sooner rather than later. Your pelvic floor muscles play a larger role than you may think.
Alyssa Hariprashad, DPT is a physical therapist who believes in an individualized approach to healthcare. She enjoys treating different kinds of populations including pelvic floor dysfunction and gender reassignment surgical rehabilitation. She is also the creator of The Pelvic Floor Playbook, which is a blog/Instagram page that advocates for all people who want their stories and voices to be heard, along with her podcast All Things Pelvic.