If you are interested …
There is an extremely brief overview of the anatomy of the area in the full presentation but for those who want to take a closer look I have this section for your interest. Please note there is gender specific language in this section.
So why is the pelvic floor important – basically it keeps your pelvic organs in place and is important for bladder and bowel control and sexual function – and when it isn’t working correctly it quickly lets you know.
The pelvic floor muscles also work together with the deep abdominals to provide support for the spine and pelvis. This provides stability and balance for movement patterns we do in our daily lives.
The pelvic floor is composed of a thin sheet of muscle fibre and associated connective tissue which spans the area underneath the pelvis. It reaches from the pubic bone at the front to the sacrum (tail bone) at back. It contains 65% slow twitch muscle fibres for endurance and 35% fast twitch muscle fibres for speed and reaction. We will look at them in more detail later in the course.
The pelvis is quite a complex structure – every individual is unique and so is their body. This next section covers ALL pelvic floors, regardless of gender.
The basics to bear in mind are that those with an anatomically female pelvis and those with an anatomically male pelvis differ only in that the shape of the bony structure is slightly larger on the male pelvis and the female pelvis is slightly wider to allow for childbirth to take place. Fundamentally the pelvic floor is the same with an additional aperture (the vaginal opening) on the anatomically female pelvis.
Ligaments connect bone to bone
Tendons connect muscle to bone
Fascia is the connective tissue which gives the body structure and surrounds every organ, muscle, bone and nerve. It is the information network for the body and all nerves, blood vessels and lymphatic vessels pass through it.
Nothing in the body works in isolation. On a musculature level the pelvis can be influenced by abdominal, buttock and leg muscles (all of which attach onto the bones of the pelvis). If we look at the body from a connective tissue or fascial viewpoint the influences on the pelvic floor reach much further. A model proposed by author and teacher Thomas W Myers indicates that the pelvis is embedded in several “lines” in the body. The Deep Front Line, Lateral Line, Spiral Line Superficial Back Line and Superficial Front Line. The upshot of this is that influences from and on the pelvic floor can range from foot placement to an issue with the jaw.
This is one interpretation of how fascia affects us but there are other teachers and anatomists out there at the moment doing amazing research into the intersections and connections of seemingly disparate areas of the body. John Sharkey, Robert Schleip and Gil Hedley are 3 notable contributors to this field. If this is something which interests you then I strongly recommend seeking out a Myofascial Release therapist to explore this further.
However, those concepts are far beyond the remit of this course and I will pull back from them and focus on the pelvis.
The pelvis is made up of three components – the ischium, ilium and pubis (or pubic) bones. The pelvic floor muscles use these bones as attachment sites on the inside of this bowl.
External to the this are muscles which also use the bones of the pelvis as attachment sites and these are classed as co-contractors of the pelvic floor. These are the ones which, in a traditional Kegel exercise, we are encouraged to avoid contracting. But, hopefully as you will see as we work through this course, they can be powerful allies in helping you engage with the pelvic floor. Especially in the early days of trying to re-learn how to control those pelvic floor muscles which have perhaps become a bit “switched off”. These co-contractor muscles are called :
The Gluteal muscles
Transverse Abdominis
Lower extremity adductors
Let’s start here and work our way in. I am keeping this brief (honest) and hopefully accessible to you especially if this is not an area you are too familiar with. I’m going to focus on the ones which are of most interest, so this is far from comprehensive.
The ilium is the origin site of the Gluteal muscles (Gluteus maximus, Gluteus medius and Gluteus minimus). They then attach (or insert) on to the upper leg.
The iliac crest which is the ridge at the top of the ilium is the attachment site for Tensor Fasciae Latae, Transverse Abdominis, Quadratus Lumborum and the Internal and External Obliques.
Now, apart from Tensor Fasciae Latae all the other muscles connect in some way to the rib cage and therefore you can see the connection with breathing which we will come on to in later sessions. For your interest, Tensor Fasciae Latae connects to your lower leg via the Iliotibial Band of which you may have heard.
The pubis and ischium have attachment sites for the lower extremity adductor muscles (Adductor magnus, Adductor longus and Adductor brevis). There are another two in this group and they are called Pectineus and Gracilis.
We have to mention two other important muscles in this area – psoas and piriformis. Psoas attaches from the lumbar vertebrae and travels through the body to attach on to the front of the upper leg. Piriformis has an attachment site on the sacrum at the base of the spine and inserts on the outside of the upper leg.
When we are learning to walk the connection between the gluteals, the adductors and transverse abdominis gives us rigidity and power to be able to stand up in gravity.
Now let’s go into the bowl of the pelvis and look at some of the important muscles in here. Again, this is not an exhaustive look at the structure of the pelvic floor.
Looking from the ground up into the body.
We have the levator ani group of muscles. Pubococcygeus and iliococcygeus – they work to support and maintain the viscera and resist increased intra-abdominal pressure (coughing, laughing, lifting something heavy, etc). And we have Coccygeus which attaches at the lower sacrum and the upper coccyx. It works in conjunction with the other two but, in addition, also pulls the coccyx forward following defecation or childbirth.
Below the level of the pelvic floor is the perinium. This is the corridor of tissue from the vaginal opening to the anus. There is a real sense of power in this area with an intersection of the main three components (superficial transverse perinaei, bulbospongiosus and the external anal sphincter) meeting at the perineal body. It is here that the perinium attaches to the pelvic floor muscles. However, this site is also vulnerable to injury especially during vaginal childbirth.
There are openings in the pelvic floor for the vagina, the anus and the urethra (where urine passes from the body).
Ostensibly the same muscles are present in the anatomically male pelvis. As in the female pelvic floor there is an opening for the anus whereas, in the anatomically male version, the penis contains the urethra for the passage of urine. The purpose of the muscles of the male perinium are the same as in the female pelvis. However, they are also required to power the erection of the penis and ejaculation of semen. Incontinence can occur when the urethra, as it passes past the prostate gland, becomes constricted due to an enlarged prostate.
Let’s now look at the nervous system…
Our main interest is in the pudendal nerve. It is part of the somatic nervous system (meaning we can control it) and it will be our friend as we start to re-train the pelvic floor. Branches of the pudendal nerve affect the small muscles of the perineum, the skin of the vulva and have motor and sensory functions.
We also have autonomic nerves and these are not under voluntary control which means they work automatically and are self-regulating. They control our heart, lungs, intestines and, of especial interest to us, the bladder and bowel.
We have the ability to use the controllable somatic nervous system to engage muscles in the pelvic floor and, by a handy feedback loop, this can influence the self-regulating autonomic nervous system and, potentially, calm down an over-active bladder. It works like this …
Brain sends motor signal via somatic nerve to ask muscle to contract then …
Muscle sends sensory signal via somatic nerve to brain to tell it that is has contracted.
The somatic nerves for our pelvic floor and the autonomic nerves for the bladder and bowel happen to access the spinal cord at the same place. Because of this we can calm down the bladder by doing a pelvic floor contraction. The somatic nerve cancels out the autonomic.
It is worth noting that nerves are damaged if they are stretched more than 15% of the normal resting length. During vaginal childbirth the pudendal nerve is stretched 13 – 35% of its resting length. That is a lot of potential damage and can cause muscle performance to be inhibited.
If we do not exercise our pelvic floor there is less sensory signal which then affects the autonomic nervous system and alters bladder control.
I hope that this made sense for you and that I’ve not wasted 10 minutes of your life. Ultimately you don’t NEED to know this, but I think it’s good for people to have a visualisation of their body.