The pelvic floor muscles (PFM) 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 fact sheet on Pilates for more information on this.
- Sexual function.
Most people do not give their PFM a second thought unless their function becomes affected. Signs that the PFM may not be working well 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 go to the toilet, with or without leakage of urine or having to go to the toilet 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
There is thought to be an increased risk of PFM dysfunction with both pregnancy and vaginal delivery, with the risk increasing with each subsequent pregnancy and vaginal delivery. Women may notice signs and symptoms of PFM dysfunction in the postnatal period as well as with the hormonal changes of menopause, or following any gynaecological surgery. While men may first experience problems following 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 PFM are strong enough to withstand the extra strain being put on this region. If they are not you may be at risk of developing PFM problems. Even Pilates exercises which are too strong, performed incorrectly or are unsuitable may lead to problems. For this reason, it is important that on commencing Pilates, an initial assessment with a Pilates Physiotherapist, involving the use of the real time ultrasound, is performed to ensure appropriate muscle activation. For more information on this, see our fact sheet on Pilates, Will It Help Me?
The action of a PFM 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. Men may find a contraction easier in standing focusing on 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 PFM 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 some of the above signs and symptoms may also be associated with other types of PFM dysfunction, which is why an individual assessment is very important.
If you are unsure whether you are activating your PFM correctly, or have difficulty relaxing the muscles after a contraction, or are experiencing any of the above signs or symptoms, then consulting a Physiotherapist with postgraduate qualifications in Women’s Health and Continence is recommended. This will ensure a thorough assessment of your problem and then an appropriate management program can be commenced. This may also include advice on suitable exercises which do not place excessive force on the PFM.