Written By: Hope Island Physiotherapist, Claudia Wharton.

Did you know that the Pelvic floor refers to much more than the pelvic floor muscles? The Pelvic floor is made up of all the structures located within the bony pelvis ie urogenital and anorectal viscera, pelvic floor muscles and their connective tissue as well as nerves and blood vessels (Bo et al 2017). That is why Pelvic Floor function does not just refer to pelvic floor muscles but also includes bladder and bowel, pelvic organ prolapse, sexual dysfunction and pelvic pain. 

The pelvic floor muscles and connective tissues work together to support your pelvic organs, help maintain control of your bladder and bowel, improve sexual function by enhancing sensation and arousal and support your lower back and pelvis.

Anatomy Deep Dive

The pelvic floor muscles stretch from your pubic bone at the front of your pelvis to your tailbone (coccyx) at the bottom of your spine. They also span sideways from one sitting bone to the other. They can be divided into two main layers. The deep Pelvic floor layer including levator ani and coccygeus which are the primary upward supports of the pelvic organs and maintain the anorectal angle (assists with faecal control). The superficial Pelvic Floor Layer includes the Urogenital Triangle Muscles and the External Anal Sphincter. These provide added closure to the entranceway of the vagina and anal canal which is important for sexual function and anal control. The perineal body (where lots of these muscles attach) and perineum (area between the posterior of the vagina and the anus) are also included. Lastly the Endopelvic Fascia both suspend the organs above as well as provide support laterally. It is primarily the fascia that holds the pelvic organs in their correct anatomical place and it is the pelvic floor musculature that provides support to the fascia. 

Let's talk about bladder leakage 

Wetting yourself, a little bit or a lot of leakage when you cough, laugh or exercise is referred to as stress urinary incontinence and happens to so many women however it is not normal! This type of urinary incontinence is very common and can unfortunately get worse over time. Another type is urge urinary incontinence and this refers to getting a strong and sudden need to urinate but often can’t make it to the toilet. It is important to know there are effective ways of managing and even curing this.

We know that the risk of urinary incontinence increases after menopause due to a drop in the hormone oestrogen, which can impact bladder control. Pregnancy, childbirth, having a chronic cough, constipation and drinking excessive amounts of caffeine also increase the risk of incontinence. Urinary incontinence also occurs in about 20-30% of young women (Kołodyńska et al., 2019). So, this is an important topic for all women across all age groups to be educated about!

You can improve leakage, it's never too late

Often if your pelvic floor muscles are not as strong as they could be symptoms such as leaking/ incontinence can occur. Pelvic floor strengthening exercises are part of improving this (plus bladder retraining for urge incontinence). Many women unfortunately perform their exercises incorrectly - either with timing, poor coordination the contraction or even difficulty being able to relax these muscles. 

It is important to note that pelvic floor strengthening exercises are not always suitable for everyone. If you experience vaginal or pelvic pain, you may need a special program to learn how to relax your pelvic floor muscles.

If you are experiencing any of these symptoms it can be helpful to see your GP or Pelvic floor/ women’s health physiotherapists who can provide advice on how to correctly exercise these muscles and create a program to improve your symptoms.

Remember that it is never too late or too early to seek help! 

Resources: 

Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, Bortolini M, Dumoulin C, Gomes M, McClurg D, Meijlink J, Shelly E, Trabuco E, Walker C, Wells A. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017 Feb;36(2):221-244. doi: 10.1002/nau.23107. Epub 2016 Dec 5. PMID: 27918122.

Kołodyńska, G., Zalewski, M., & Rożek-Piechura, K. (2019). Urinary incontinence in postmenopausal women - causes, symptoms, treatment. Przeglad menopauzalny = Menopause review, 18(1), 46–50. https://doi.org/10.5114/pm.2019.84157

Jean Hailes Women's Health Week 2022