In pilates we call it our deep core. In yoga we call it Mula Bandha, or root lock. This is our pelvic floor.

For many years the pelvic floor and all its wondrous functions has been a secret topic, only to be discussed in the dark depths of a doctor’s office with maximum security in order to maintain anonymity. But times are changing, and both women and men are becoming more empowered and encouraged to talk about the things that are happening beneath the belt.

What I have come to realise when I began educating people about their pelvic floor, (aside from being a bit of a taboo topic), is that there is not a whole lot understanding about where the pelvic floor is and what it does. I also found following my pregnancy and the birth of my daughter that it only takes 1 person to make 1 comment and suddenly the room is alight with women eager to share their experience; “When I had my baby…. What my sister told me…. When I laugh too hard….”, and so on and so forth.

Perhaps by talking about it we are normalizing it, empowering ourselves to understand it, sharing what is and is not normal, and indeed, encouraging ourselves and others to seek treatment if they have any concerns or difficulties in pelvic floor health and continence.

Of course, seeking treatment is the first step. And when that first step is taken, I often hear women telling me that they have shared what I told them with friends and now they are coming in for treatment! Promising stuff! So… let’s talk about it!

What is the pelvic floor?

The pelvic floor is a magical set of muscles that holds our liquid in and stops our insides from falling out. Ok, that is an overly simplified version! The pelvic floor is actually a collective term used to describe the vastly complex network of pelvic organs, ligaments, nerves and muscles (voluntary and automatic) that assist us in maintaining control over our bladder and bowels, support the pelvic organs and provide sexual functions in both men and women. The pelvic floor muscles are a group of muscles that extend, like a hammock, from the pubic bone at the front of the pelvis, to the tailbone at the back of the pelvis. You can see in the image below (courtesy of the Continence Foundation of Australia)  that the pelvic floor muscles cross over the urethra (where urine will pass through), the vagina and the bowels.

female pelvic floor anatomymale pelvic floor anatomy

Images: © Continence Foundation of Australia (2016). Accessed on 27th June, 2016, from http://www.continence.org.au/pages/how-do-pelvic-floor-muscles-help.html

What does the pelvic floor do?

The primary actions of the pelvic floor muscles are to “squeeze” and “lift”.

The first function, “to squeeze”, is your defence against incontinence, or as our lovely friends at Tena put it, “LBL: light bladder leakage” (by the way, if you haven’t already heard some of my rants, pads are not the only answer to bladder weakness). A contraction of the pelvic floor muscles does indeed give us a squeezing action, which closes off the opening to our urethra (urine passage) and the flow of urine, closes off our rectum and the passage of bowel contents, and also narrows the vagina.

The second function of the pelvic floor muscles, “to lift”, elevates the pelvic floor organs from underneath, and together with the pelvic organ ligaments, is your prime defence against pelvic organ prolapse, which is basically a descent or slipping forward of your pelvic organs (uterus, bladder or bowel), usually into the walls and space of the vagina.

The boat in dry dock theory.

In 1993 DeLancey and Norton gave us the ‘boat in dry dock theory’ to better explain the pelvic floor, muscles and prolapse.

Take a moment to imagine a ‘boat in dry dock’. It has ropes attaching the boat to the dock and at the same time has water beneath the boat to provide buoyancy and push the boat up from underneath. If the water level drops or is taken away, the weight of the boat is taken through the ropes. Eventually, without the support of the water, the ropes will not be able to withstand  the tension of the boat, and they will fail, leaving the boat to descend, or prolapse, in a downward direction.

boat in water as metaphor for pelvic floor and prolapse

Now take our ‘boat in dry dock’ image and replace it with our pelvic floor anatomy. The uterus is now the boat. The ligaments of the pelvis are its ropes and the pelvic floor muscle are the water beneath. As long as your pelvic floor muscles are strong enough to continue to support your organs from underneath, as the water supports the boat from underneath, the ligaments, or ropes will be under normal tension. If we lose the integrity of our pelvic floor muscles, or if we lose the water underneath our boat, the ligaments and ropes are placed under full tension. Eventually they will fail to some degree, and the boat, or uterus in our case, will lose support and may suffer from signs of prolapse.

In this short video, pelvic floor ambassador, Shira Kramer, discusses and demonstrates how to activate your pelvic floor muscles.

And this is just the beginning…

Coming up…

If you would like further instruction or feedback on activating your pelvic floor muscles, please visit a pelvic floor & continence physiotherapist, and stay tuned for more blog updates on the pelvic floor.

In my next blog I will be discussing the symptoms and signs of prolapse, and how to avoid the risk factors that can lead to prolapse. Until then…

 

Be kind to yourself,

Julia Berger
Physiotherapist