Pelvic Floor 201: What Does the Pelvic Floor Do?
The pelvic floor is important for the vital functions it performs. These muscles are active throughout the entire day and night, thanklessly allowing us to go about our daily lives. We don't ever think about what the pelvic floor is doing until one (or more) of these functions isn't working properly.
Sphincteric - The Gatekeeper for Bladder and Bowels
As the gatekeepers of the pelvis, the pelvic floor muscles are responsible for the control that we have over our bladder and bowels. These muscles are always active, keeping back urine and feces until we consciously relax and allow them to exit once we've found a bathroom.
Normal urination is 4-6 times per day. This may seem low, and many patients justify frequent urination with excuses like "I drink a lot of water" or "I must just have a small bladder", but urinating seven or more times daily is considered abnormal.
The bladder is an expandable bag of smooth muscle that sits right behind the pubic bone in the lower abdomen. As it fills to about one-quarter capacity, a signal is sent to the brain letting you know to start considering a bathroom break. If it isn't convenient to urinate you can easily hold it back with your pelvic floor, and as the bladder continues to fill it will send increasingly urgent signals to the brain until you give the pelvic floor permission to open the floodgates. Once you do, the bladder folds back down on itself and begins to slowly fill again.
There is a much wider range of 'normal' bowel movements; anywhere from 3 times per day to 3 times per week is considered normal, but you shouldn't have to strain or be seated for a long time to have a bowel movement.
Supportive - Keeping the Pelvic Organs Organized
Some of the most important organs in the body are clustered into the pelvic cavity. The muscles, ligaments of the pelvic floor are responsible for supporting these organs and allowing them to function properly. This is an involuntary function of the pelvic floor; it occurs throughout the day unconsciously. These organs include the bladder, rectum, uterus (in women), prostate (in men) and intestines.
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)
Stabilizing - All Roads Lead to the Pelvis
The pelvis is at the crossroads of the body. It deals with movement and force from both the torso and legs. The development of the pelvis was what allowed early humans to walk upright and differentiates us from the apes. A healthy pelvic floor can improve posture, enhance athletic performance, aid in balance, and leave you feeling more energetic.
The pelvic floor works to counteract strain put on the pelvis by other major muscle groups, including the quads, glutes, hamstrings, lower back, and abdominal muscles. It's a complex balancing act, and having a specific group of muscles that is either too tight or too weak can through the pelvis out of alignment.
When the lower back, abdominal, or other core muscles aren't performing well, the pelvic floor often springs to the rescue. Up to 80% of us have low back issues, so the pelvic floor is often overtaxed and strained.
Finally, the pelvic floor muscles have an integral role in sexual function for both men and women. They are responsible for arousal, function, and orgasm. A well-functioning and strong pelvic floor is linked to stronger orgasms for both men and women. Sexual function is one of the most complex roles of the pelvic floor, as it has to both relax and contract for proper function.
In women, the pelvic floor relaxes to allow for sexual penetration. Then contraction of these muscles is integral to all facets of intercourse and responsible for much of the pleasure experienced during sexual activity and orgasm. Muscles that are too tight can cause pain with penetration, while an inability to contract can result in less pleasure, lower libido, and the inability to orgasm.
For men, blood rushes into the penis to form an erection. Maintaining that erection requires pelvic floor muscles to continually squeeze to keep the blood trapped in the penis. They also contract to enable ejaculation.
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.