We talk about the pelvic floor muscles and kegels a lot.  But I often wonder if most women really know what I am talking about.  I never heard anyone talk about these muscles until my residency in Obstetrics & Gynecology.  And I really don’t remember learning much about them in medical school.  So lets clear up any mystery and make sure we are all on the same page.  What are the pelvic floor muscles?

Where are the pelvic floor muscles?

The pelvic floor muscles are a collection of muscles at the bottom of the pelvis.  Technically, they are the “levator ani” muscles.  There are three pairs of muscles in this complex, one on the left and one on the right.  The muscles are the puborectalis, the pubococcygeaus and the ischiorectalis.  These muscles are shaped like a bowl.  They extend from one hip to the other hip and from your pubic bone to your tailbone.  They are intimately involved with the urethra, vagina, and anus.  If you are more visual and need pictures, check out the pelvic floor images at myPFM website.

What do these muscles do?

The pelvic floor muscles support all of the organs that are in the pelvis.  This includes the bladder, the uterus and the rectum.  These muscles are also connected to your urethral sphincter, your vagina, and your anal sphincter.  They help keep you clean and dry and often contract during sex.

How do the pelvic floor muscles work?

You can squeeze and contract these muscles when you want to.  This is easy for some women but lots of women have trouble contracting these muscles.  There are many reasons why women have trouble working these muscles.  It may be related to your nerves and how you are “wired”.  It may be because of a birth injury and the muscles may not work well.  It may be harder for you because you can’t see the muscle contract.

The pelvic floor muscles also work reflexively (without you’re even thinking about it).  They relax when you want to empty your bladder or rectum.  They contract when you aren’t trying to empty.  When you inhale these muscles relax.  When you exhale, they contract.  Exhaling while exercising contracts the muscles and can protect you from leaking.  Coordinated movement of the muscles is important and sometimes bad habits can lead to a lack of coordination.

How do these muscles get injured?

These muscles go through a workout during a vaginal delivery.  They stretch to allow the baby to exit the pelvis.  Some parts of the muscle stretch more than twice their baseline length.  This can result in injury to the muscles that can take more than 9 months to heal.  It can also cause permanent damage to part or all of the muscle.

When our pelvic floor works well, we usually ignore it. That is what we all really want- to have the pelvis function well without any deliberate action.  But if it isn’t working well, it can lead to functional problems like leaking urine and prolapse.  Physical therapy help you learn to use your pelvic floor in an optimal way.  And even if pelvic floor therapy isn’t the whole answer, it is frequently part of the answer to correcting your issues.  Having a strong pelvic floor helps improve sexual function, a leaking bladder, prolapse, and even a leaking rectum.  And having a strong pelvic floor is part of having a strong core- which is so important for so many different reasons!