Your pelvic floor: what is it good for?

By Shannon Pacella, DPT, PHRC Lexington

 

The pelvic floor is a phrase used very frequently here on the blog as well as in our clinics, but to those unfamiliar with this area of the body, it may still be this illusive mystery. I want to break down the pelvic floor into each of the muscles it is comprised of, in order for you to get a better grasp of what’s going on down there.

 

If you are partial to 3D visuals and videos, you can Take a Tour of the Pelvic Floor.

 

The pelvic floor is comprised of multiple layers of muscles that close off the bony frame of the pelvic outlet and are key in supporting the pelvic organs. To quote from our previous blog post: A Cock in the Hen House: A look inside the Male Anatomy, “Although the external anatomy is different, all the other internal muscles that make up the pelvic floor are the same for men and women. The muscles sit in the pelvis like a muscular bowl, providing support to the organs of the pelvis and assisting in bowel, bladder, and sexual function. In women, the pelvic floor supports the uterus, the bladder, and the colon. In men, the pelvic floor supports the prostate as well as the bladder and the colon.”

 

 

First let’s discuss the bones that make up the pelvis/pelvic girdle. The pelvic girdle is a basin-shaped ring of bones connecting the vertebral column to your femurs. The pelvic girdle contains and protects the pelvic organs and allows for attachment of the pelvic floor muscles.

 

 

The pelvic girdle is comprised of:

 

• Ilium: the largest pelvic bones – when you put your hands on your hips you are touching the ilium.
• Ischium: the part of the pelvis that you sit on (aka sit bones).
• Pubis: the front part of the pelvis that joins both sides together via the pubic symphysis.
• Sacrum: the sacrum attaches to the ilium via the sacroiliac (SI) joint.
• Coccyx: also known as the tailbone, and attaches to the lower part of the sacrum.

 

 

Now that you have some reference material, let’s go through each muscle one by one:

 

• Bulbospongiosus: in men, this muscle runs along the underside of the base of the penis and forces blood into the penis during erection, and aids in ejaculation. In women, this muscle runs from the clitoris to the perineum along each side, constricts the vagina, and forces blood into the clitoris.

• Ischiocavernosus: attaches from the pubic symphysis to the ischial spine on each side, and forces blood into the penis and clitoris during erection.

• Superficial & Deep Transverse Perineal: this muscle has superficial (thinner band) and deep (broad) fibers that run underneath the perineum – the space between the anus and vagina (in women) or base of penis (in men). Supports the prostate and vagina.
• Ischiococcygeus (aka Coccygeus): attaches from the tendinous arc of the ischial spine to the lower sacrum and coccyx. Moves the coccyx forward and supports the pelvic viscera.
  

 

 

• Levator Ani is a group of muscles (highlighted above in red) comprised of:
  • Pubococcygeus: attaches from the pubis to the lower sacrum and coccyx.
  • Iliococcygeus: connects with pubococcygeus muscle and attaches to the coccyx.
  • Puborectalis: wraps around the rectum to form a muscular sling.

• External Anal Sphincter: attaches to the tip of the coccyx and surrounds the anal canal. This muscle closes the anal orifice.

• Obturator Internus: attaches from the pubis and ischium to the femur, helps to turn your hip outward (lateral/external rotation). *Fun fact: tightness and/or trigger points in this muscle can refer pain to the coccyx/tailbone.

• Piriformis: muscle deep in the buttocks (underneath gluteals), attaches from the sacrum to the femur, also works to rotate the hip outward (lateral/external rotation). Tightness in this muscle can be linked to sciatica (nerve pain down the back of the thigh), due to its proximity to the sciatic nerve.

 

Whew! That was a lot of information to get through! Now that you have a better understanding of what the pelvic floor looks like, let’s go over some ways this complex area of the body may lead to pelvic floor dysfunction in men and women.

 

Pelvic Pain

• Vaginal/penile/scrotal/perineal or anal pain

• Tailbone/sacroiliac joint/pubic symphysis pain
• Pain that interferes with sitting and exercise
• Pain that radiates to the abdomen/buttocks/thighs

 

Urinary Dysfunction

• Urinary urgency, frequency, and hesitancy
• Urinary retention
• Pelvic organ prolapse & incontinence  
• Decreased force of urinary stream
• Pain/straining with urination

 

Bowel Dysfunction

• Constipation
• Fecal Incontinence
• Pain/straining with bowel movements

 

Sexual Dysfunction

• Pain with intercourse/penetration
• Pain post ejaculaton

 

I hope this helped to give you a better understanding of the pelvic floor anatomy.

 

 

 

References:

1. Carriere B, Feldt CM. The pelvic floor. Germany: Georg Thieme Verlag; 2006.
2. Netter FH. Atlas of human anatomy. 6th ed. Philadelphia, PA: Elsevier Inc.; 2014.