Dr. Kelly Sammis, PT, CLT
Pelvic Floor Anatomy + Function
Updated: Mar 19
How many times have you had a client standing in your clinic looking very puzzled while holding and spinning around your pelvis model say “wait…so all of that is muscle DOWN THERE?!” or the infamous “yeah, but I thought only women had ALL OF THAT” from your male clients? To approach healing holistically it is integral to educate our clients to help them understand the anatomy and function of the region that is impacting their daily lives.
Let’s take a walk down memory lane and review the anatomy of the pelvic floor and then we will dive into it’s function. The term ‘pelvic floor’ identifies the compound structure which closes the bony pelvic outlet, while the term ‘pelvic floor muscles’ refers to the muscular layer of the pelvic floor
(1). A heathy pelvic floor functions as a synergistic network of muscles, nerves, and connective tissues that are largely responsible for maintaining function of our bowel, bladder, and sexual systems (2). The urethra, vagina, and rectum pass through the pelvic floor and are surrounded by the pelvic floor muscles…starting to visualize how things are connected?
The pelvic floor musculature is often referred to as the pelvic bowl or the pelvic hammock by clinicians because of it's shape. Try to picture a large hammock that runs from the right side to the left side of your inner pelvis and from your tailbone to your pubic bone. This hammock has a few holes in it to allow those sensitive structures to pass through: the urethra, rectum, and vagina in women.
The group of muscles that comprise the pelvic floor musculature includes: the external anal sphincter, bulbospongiosus, ischiocavernosus, superficial and deep transverse perineal muscles, sphincter urethrae, compressor urethrae, levator ani (puborectalis, pubococcygeus, and iliococcygeus), coccygeus and the obturator internus. All of these muscles, with the exception of the obturator internus, are innervated by the pudendal nerve, originating from the sacral nerve roots S2-S4. The obturator internus is innervated by the nerve to the obturator internus, originating from the sacral plexus, L5-S2. (3) Did that take you on a trip down memory lane back to the one glorious hour of graduate school that reviewed the pelvic floor? Welcome back, my friends…welcome back.
These muscles, along with their nerves and network of connective tissues, function to stabilize and support our pelvic organs, control the function of our bowel, bladder and sexual systems, and are part of our 'core system'. In a heathy pelvic floor the network of muscles, nerves, and connective tissues work together to provide optimal function. If any of these components are not working properly, it can affect the function of one or all of these systems. Pelvic floor dysfunction can manifest as bladder, bowel and/or sexual problems with or without associated pain.
While the pelvic floor itself may be overwhelming to the clinicians who don’t specialize in this area, let’s not forget how much the pelvic floor can impact the kinetic chain. When you appreciate all that attaches to the bony pelvis…the abdominal wall, diaphragm, thoracolumbar spine, sacrum, and the anterior, lateral and posterior hip complex to name a few…it becomes easy to see how impactful this region is on the human body. If any of these regions are dysfunctional, it is going to impact how well the pelvic floor can function.
What are the functions?
Big picture, the pelvis is the crossroads of human function. It is the epicenter for load transfer, force generation and postural aptitude.
You will also see the functions of the pelvic floor musculature described as the 5 S’s in the literature.
1. Sphinteric control — these muscles contract to keep you continent, they also relax to allow you to urinate and defecate (3).
2. Support — these muscles are part of your body’s foundational anatomy, their job is to support your abdominal and pelvic organs (3). They work alongside your diaphragm and your other muscles of respiration to balance your body’s pressure system. If you leak urine when you cough, sneeze and/or laugh you might have a dysfunction within this pressure system.
3. Stability — the muscles work day in and day out to stabilize your back, pelvis, hips and lower body, taking it back to that mention of the kinetic chain earlier!
4. Sexual function — the muscles help with gaining and maintaining an erection, ejaculation and orgasm (4,5)…I’d say that’s pretty important, right?!
5. Sump-pump — the muscles act as a blood/lymph pump for the pelvis, without this function you may experience swelling or pelvic congestion.
Treatment is out there!
Many of our clients don't realize that there are therapeutic treatment approaches for these issues. If you think you might be experiencing dysfunction in your pelvic floor, schedule an evaluation with a trained pelvic health specialist!
To health + wellness for your pelvis,
1) Messelink et al. Standardization of Terminology of Pelvic Floor Muscle Function and Dysfunction: Report from the Pelvic Floor Clinical Assessment Group of the International Continence Society. Neurology and Urodynamics. 2005;24:374-380.
2) Herschorn, Sender. Female Pelvic Floor Anatomy: The Pelvic Floor, Supporting Structures and Pelvic Organs. Rev Urology. 2004;6:S2-S10
3) Raizada, V. and Mittal R.K. Pelvic Floor Anatomy and Applied Physiology. Gastroenterol Clin North Am. 2008 Sep; 37(3):493-vii.
4) Rosenbaum TY. Pelvic Floor Involvement in Male and Female Sexual Dysfunction and the Role of Pelvic Floor Reha-bilitation in Treatment: A Literature Review. J Sex Med 2007; 4:4.
5) Cohen, D., Gonzalez, J. and Goldstein, I. The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain. Sex Med Rev. 2016;4:53-62.