The pelvis is a complicated and fascinating structure in the body. From a musculoskeletal perspective, it is the central component of your body. A well-functioning pelvis is necessary to walk, bend forward, stand up, and roll over. In addition, the organs of the pelvis work in coordination with the muscles, ligaments, tendons and connective tissues to ensure healthy urinary, bowel, sexual and reproductive functions. Basically, the pelvis rules. It’s crucial. It’s a beautiful part of the body. And, it’s often forgotten, misunderstood, and unappreciated until something goes wrong.
Really, think about it. How often have you thought about your pelvis? Men, how many times to do you stand in front of the toilet and feel thankful that your muscles are relaxing right as your bladder contracts to empty? Ladies, how many times do you have sex and thank your muscles for stretching and contracting to help sex feel good for you? How many times do you walk up stairs and recognize that your muscles are perfectly supporting all of your joints around your pelvis to help you take those steps without pain? Unless you have a problem with your pelvis, you probably have answered “never.” Don’t feel bad. You’re not alone. Most people don’t recognize the fascinating complex structures within their pelvis until they have problems with it. And at that point, it can feel like a dark hole—complicated and unknown. That’s where we come in!
First and foremost, you must understand the role of the pelvis and the muscles at the base of our core.
These beautiful muscles (clearly, a pelvic PT bias 😉 ) serve many roles including sphincteric control, supporting the pelvic organs, stabilizing the pelvis as part of the core, and improving sexual function.
Most of the patients we treat are familiar with the role of the pelvic floor in maintaining continence (not leaking). These muscles wrap around the urethra, rectum, and vagina (in females), and in order to maintain continence of urine and feces, they must contract. Conversely, in order to completely empty our bowels and bladder they MUST fully relax. When the muscles do not function properly–whether they aren’t contracting well or aren’t relaxing well– we see problems in both urinary and/or bowel function. A pelvic floor therapist can help you to coordinate these actions to facilitate complete emptying and achieve continence if necessary.
Secondly, the muscles of the pelvic floor support the bladder, rectum, and in females, the uterus. When these muscles are weak, patients are at increased risk for pelvic organ prolapse (POP). POP occurs when the fascia, ligaments and muscles of the pelvic floor no longer support the pelvic organs resulting in the drop (prolapse) of the pelvic organs from their normal position (FDA). People can develop prolapse of the uterus, bladder, rectum or small intestines. According to Varma et al. “Women aged 50 and older are 6 times as likely as men to present with rectal prolapse. Although it is commonly thought that rectal prolapse is a consequence of multiparity, approximately one-third of female patients with rectal prolapse are nulliparous. The peak age of incidence is the seventh decade in women, whereas the relatively few men who have this problem may develop prolapse at the age of 40 or less”. Some risk factors for POP include childbirth, the aging process, genetic predisposition, connective tissue disorders, obesity and frequent constipation.
In regards to stabilization, the pelvic floor muscles are essential. This muscle group sits at the base of the pelvis and works in harmony with the diaphragm (breathing muscle), transverse abdominus (deep core stabilizer), and multifidus to provide stability prior to and during movement. This combination of muscles work sort of like a soda can to maintain a pressurized pelvis and core to allow for stability of the lumbopelvis. We wrote more about this role of the pelvis in our post, here.
Lastly, the muscles of the pelvic floor play a crucial role in sexual function. We will post more about this at a later time, but for now, know that the pelvic floor is important in women to stretch and allow for penetration and also to contract to provide pleasure and orgasm. In men, the pelvic floor contracts to assist in erection and relaxes to allow for ejaculation.
There you have it! We hope this blog post helps you to better understand how these muscles function.
Written by: Jenna Sires PT, DPT and Jessica Powley PT, DPT, WCS