The pelvic floor is a group of muscles and soft tissue that make up the bottom of the pelvis. They run from the pubic bone in the front to the tailbone (coccyx) in the back and from the sitz bone (ischial tuberosity) on the right to the sitz bone (ischial tuberosity) on the left. The following picture is taken from the bottom of the pelvis looking up.
This diamond of muscles can be thought of as being made up of two triangles: a triangle in the front including the urethral and vaginal opening and a triangle in the back including the anal opening. Pelvic floor muscle contractions (PFMCs), otherwise known as kegels, are the exercises used to strengthen these muscles. It is important to be able to contract both of these triangles equally well. Note: it is not possible to voluntarily contract one triangle without the other but focusing on one area at a time will help to ensure you are able to control each of these areas to the same degree. Therefore, a woman could train the front triangle by thinking about stopping the flow of urine or by imagining drawing a ping pong ball into the vagina. These visualizations will bias the brain into thinking primarily about the front triangle. Alternatively, thinking about stopping the passage of gas or drawing a marble into the rectum will activate the back triangle. When you are able to activate both areas equally well, you can then activate both of them at the same time for a whole pelvic floor muscle contraction. A proper PFMC activates only these muscles and keeps the glutes, inner thigh muscles and abdominal muscles relaxed. You can pair the contraction with your breath too, contracting your muscles on the exhale.
These muscles are made up of fast-twitch and slow twitch fibers, just like other muscles in our body and it is important to train both. We can strengthen the slow-twitch, or endurance fibers, by squeezing and holding these muscles up to 10 seconds and then relaxing for 10-20 seconds. Alternatively, we can strengthen the fast-twitch or “sprinter” muscles by contracting as quickly as possible for 1 second and then relaxing for 1-2 seconds.
The pelvic floor muscles have five functions:
- Sphincter
- The pelvic floor muscles include sphincters that wrap around the bladder/urethra and rectum, which helps to keep us continent of urine and stool.
- Sump
pump
- These muscles help to pump blood and lymphatic fluid out of the pelvis back towards the heart.
- Sex
- The pelvic floor muscles help to achieve and maintain an erection, as well as contribute to orgasm.
- Stability
- These muscles attach to the pelvis and hips and are an important part of the inner core, providing stability for the trunk and whole body.
- Support
- The pelvic floor muscles support the pelvic organs (the bladder, uterus, and rectum).
We are particularly concerned with the support function of these muscles when discussing pelvic organ prolapse (POP). If these muscles experience excessive strain (chronic coughing, chronic constipation, pregnancy/delivery, etc) or weakening due to increasing age or hormonal changes, they may fail to provide the support the pelvic organs require. This can contribute to the development of POP. Therefore, it is important to strengthen your pelvic floor muscles as much as possible if you experience signs or symptoms of POP. Please note, however, that sometimes these muscles are shortened or tight and doing kegels only makes things worse. Therefore, it is important to see a pelvic floor physiotherapist who can assess the state of your pelvic floor muscles and advise whether kegels are appropriate for you.
If you suspect you have pelvic floor dysfunction, particularly in that these muscles are no longer sufficiently supporting your pelvic organs, give us a call. We specialize in the assessment of the pelvic floor muscles and fitting of pessaries for women who need the extra support a pessary can offer.
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.