The pelvic floor muscles are a group of muscles which sit at the base of the pelvis.
These muscles have a role in:
- Supporting the abdominal and pelvic organs
- Control of the bladder and bowel functions
- Control and support of the lumbo-pelvic region in association with the deeper abdominal and back muscles. These groups of muscles, in conjunction with the diaphragm, form what is commonly known as ‘the core’. See our page on Pilates for more information on this
- Sexual function
Most people do not give their pelvic floor muscles a second thought unless their function becomes affected.
Signs that the pelvic floor muscles may not be working optimally are:
- Leakage of urine with a cough, sneeze, laugh, changes in direction or position or with high impact exercises involving bouncing or jumping movements. This is termed stress urinary incontinence
- Feelings of urgency when needing to urinate, with or without leakage of urine or having to go to the toilet to urinate very frequently
- Difficulties completely emptying the bladder or bowel
- Difficulties holding onto a bowel movement
- Feelings of a bulge or lump in the perineum or vagina, or heaviness or dragging in this area which may indicate a pelvic organ prolapse
- Internal pelvic pain or painful sexual intercourse
People may notice changes in their pelvic floor muscle function during pregnancy, during the postnatal period, during the perimenopausal period and following menopause, as well as following gynaecological surgery, or prostate surgery
Other people who are at risk are those who:
- Are overweight or obese
- Have a chronic cough
- Regularly strain on the toilet to empty their bowels (particularly those who suffer from constipation)
- Regularly perform high impact exercise which involves repetitive jumping or bouncing movements, or very strong abdominal exercises, all of which may cause a significant downward pressure onto the pelvic floor
If you are performing any types of exercise such as these, it is important to know that your pelvic floor muscles have sufficient strength and co-ordination to withstand the extra strain being put on this region.
The action of a pelvic floor muscle contraction is a squeeze and lift action around the front and back passages. Often it can be helpful to focus on the action of stopping yourself passing urine or controlling wind, or the action of lifting the testes up.
The muscles should be able to perform a sustained contraction, plus fast contractions in response to sudden increases in intra-abdominal pressure. Also important is the ability of the muscles to relax following a contraction. Possible signs of difficulties in relaxing the pelvic floor muscles may be:
- Voiding difficulties such as problems with starting a void, slow stream, feelings of needing to strain with voiding or bowel movements, incomplete emptying
- Pain with vaginal examinations such as a pap smear, difficulties inserting tampons, or pain with sexual intercourse
Note that an individual assessment is important in determining the specific type of pelvic floor muscle problem.
If you are unsure whether you are activating your pelvic floor muscles correctly, have difficulty relaxing the muscles after a contraction, or are experiencing any of the above signs or symptoms, then consulting a continence and pelvic health physiotherapist is recommended.
This will ensure a thorough assessment of your problem and then an appropriate management program can be commenced.