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  • Nicole Cozean, PT, DPT, WCS

Pelvic Floor 101: What is the Pelvic Floor?

The pelvic floor isn’t just a clever name; it’s literally the floor of your pelvis. The term is a shorthand for the muscles, ligaments, nerves, and tissue that create a natural hammock slung across the pelvis.

Pelvic Floor Anatomy

Top-Down View of the Pelvic Floor Muscles (Female)

In this view, as you're looking down at the pelvis and hip bones, the pelvic floor muscles form a sling across the bottom of the pelvis. They attach to the tailbone (top of the picture) and wrap around the pelvic openings. (Image courtesy of The IC Solution)

The pelvic floor is critical because of the major functions it performs. We can take these vital tasks for granted….at least until something goes wrong.


  • Sphincteric. The pelvic floor is a gatekeeper, responsible for holding back the flow of urine and feces throughout the course of the day. These are the muscles that you clench when you’re ‘holding it’ and relax when it’s finally time to go.

  • Supportive. The pelvic floor physically supports all the important pelvic organs, including the bladder, rectum, uterus (in women), prostate (in men), and intestines. It keeps them in the correct place and able to perform their functions.

  • Stabilizing. The pelvic floor also stabilizes the pelvis and lower back. It keeps the pelvis in balance aids the lower back, hip flexors, and abdominal muscles in stabilizing the core.

  • Sexual. For both men and women, the pelvic floor is responsible for sexual arousal, intercourse, and orgasm. In women, these muscles expand to allow for penetration during intercourse, while in men they maintain the erection and bring about ejaculation.

Female Pelvic Floor

Side View of the Pelvic Floor Muscles (Female)

The muscles of the pelvic floor are slung across the bottom of the pelvis, supporting the pelvic organs like the bladder, rectum, intestines, uterus (women) and prostate (men). (Image courtesy of The Interstitial Cystitis Solution)


1. Pelvic Floor Dysfunction

We usually only spare a second though for the pelvic floor when something goes wrong. The term 'pelvic floor dysfunction' refers to any muscular issue that causes the pelvic floor not to work properly. Common symptoms related to the pelvic floor are pelvic pain, incontinence, constipation, painful intercourse, pelvic organ prolapse, urinary urgency and frequency, or orthopedic pain in the low back, hips, groin, or tailbone. Resolving the underlying problem in the pelvic floor muscles can alleviate or resolve these symptoms.

2. Voluntary and Involuntary

The muscles of the pelvic floor are under both voluntary and involuntary control. They are active every minute of the day without any conscious thought, effortlessly supporting the pelvic organs, stabilizing the core, and holding back urine. However, you can also deliberately clench or relax the muscles of the pelvic floor. The act of intentionally squeezing the pelvic floor muscles, as when you hold back urine, is often known as a ‘Kegel’.

3. Attached to the Tailbone

All the muscles of the pelvic floor connect – either directly or indirectly – to the tailbone. A fall or injury to the tailbone, even many years ago, is a risk factor for pelvic floor dysfunction. Even if you don't have one memorable incident where you landed on your tailbone, a history of repeated falls can cause similar dysfunctions--snowboarding or skating, playing a contact sport, etc. The opposite can be true as well, where tight pelvic floor muscles tug on the tailbone and cause pain. The region is extremely interconnected, so dysfunction in one area can quickly spread throughout the entire pelvic floor.

4. All Roads Lead to the Pelvis

The pelvis and pelvic floor muscles don’t exist in isolation. In fact, we often say of the body that ‘all roads lead to the pelvis.’ Many of our major muscle groups, including the quads, hamstrings, hip flexors, glutes, low back, and abdominal muscles attach to the pelvis. Tightness or weakness in any of these muscles can put a torque on the pelvis, straining and irritating the pelvic floor muscles as they attempt to compensate. Any treatment of the pelvic floor must address these external factors to be successful.

Pelvic Floor 101


Additional Resources

Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.

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