What is the Pelvic Floor & How Does It Influence Continence & Prolapse?

What is the pelvic floor?

The pelvic floor is a group of muscles and ligaments that support the bladder, uterus and bowel. The pelvic floor is an important component of the core – working in conjunction with the back, diaphragm and abdominal muscles to stabilise the trunk. The pelvic floor muscles have two layers – the superficial and deep. Both layers attach from the pubic bone to the tailbone. The pelvic organs run through the pelvic floor to their respective entrances – urethra (bladder), vagina (uterus) and anus (bowel). Therefore the pelvic floor acts like a sling, and plays a vital role in providing support to the pelvic organs and ensuring they don’t descend within the pelvic cavity.

Although the pelvic floor cannot be seen, unlike other body muscles it is still a muscle that can be consciously controlled. This means that it can be made stronger with specific training.

Many women have weak pelvic floor muscles. The reasons for this include:

  • Respiratory conditions that cause excessive coughing.
  • Being overweight.
  • Pregnancy and childbirth – especially if this involved having an instrument delivery, a prolonged pushing period, or birthing a large baby.
  • Changes in hormone levels with menopause.
  • Chronic constipation.
  • Persistent heavy lifting.

The Pelvic Floor, Continence and Prolapse

A weak pelvic floor can predispose you to incontinence of urine or faeces, as well as prolapse.

There are two types of urinary incontinence:

  • Stress urinary incontinence
    • Urine leakage – commonly caused by a cough, sneeze or laugh.
  • Urge urinary incontinence
    • An inability to defer going to the toilet, or leaking on the way to the toilet.

Common types of prolapse that can be helped by pelvic floor muscle retraining (depending on the severity of the prolapse) include:

  • Anterior vaginal wall prolapse: Movement of the bladder and/or urethra into the front of the vaginal canal.
  • Uterine prolapse: Descent of the uterus in the vaginal canal.
  • Posterior vaginal wall prolapse: Movement of the bowel into the back wall of the vaginal canal.

A strong pelvic floor prevents:

  • Incontinence of urine/faeces, as well as being able to defer going to the toilet until a convenient time.
  • Prolapse of the bladder, uterus and/or bowel through the vagina.
  • Surgical intervention for incontinence and/or prolapse.

As well as providing support to the pelvic organs, and control over continence, the pelvic floor is very important for sexual function. In women, voluntary contractions of the pelvic floor contribute to sexual sensation, arousal and orgasm.

How do I know if I have a weak pelvic floor?

  • Do you leak urine when you cough, sneeze or laugh?
  • Do you struggle to hold your bladder for greater than 30 minutes, or go to the toilet frequently?
  • Do you worry that you won’t make it to the toilet in time, or leak urine on the way to the toilet?
  • Do you strain excessively to pass a bowel motion?
  • Do you feel a bulge vaginally, pain with sex, and have abdominal or low back discomfort?
  • Decreased sensation during penetrative sex.

What can I do to prevent getting a weak pelvic floor?

  • Manage constipation and use appropriate defecation position strategies.
  • Avoid repetitive heavy lifting.
  • Manage your body weight.
  • See your GP or Specialist about medical management of your respiratory condition.
  • Participate in pelvic floor muscle retraining.

How can I do pelvic floor muscle exercises?

An accurate pelvic floor contraction can be complex to do. This is because it is a hidden muscle and you can’t see it contracting and relaxing. Up to 50% of women perform a pelvic floor muscle contraction incorrectly when told verbally how to do it (Hallam, 2015). Often women bulge and brace their abdominals, and tighten the buttock and thighs without actually isolating the pelvic floor muscles. This is counter-productive and will not improve your muscle strength.

The best way to activate your pelvic floor is to lie on your back with knees bent, keeping your legs and buttock relaxed. Think about tightening around your back passage to stop wind, and around your front passage to stop wee.

Seeing a Physiotherapist with Women’s Health training is the best way to get an accurate identification of pelvic floor strength, endurance and prescription of an individualised pelvic floor-training program. Further advice can be given for management of incontinence and prolapse.

Chloe has additional training in Women’s Health Physiotherapy and consults out of the Devonport GP superclinic on Tuesday afternoons, and PhysioTas Central Coast Monday, Wednesday and Friday.

About the Author:

Chloe is a Physiotherapist at Physiotas

Chloe completed a Bachelor of Health Science and a Masters of Physiotherapy Practice at La Trobe University’s Melbourne Campus in 2016 and started working at Physiotas in early 2017. Chloe enjoys the diversity of ages and conditions that private practice physiotherapy offers. She has a specific interest in women’s health, especially pregnancy and post-natal physiotherapy.

A self-confessed ‘foodie’, Chloe likes to visit local cafes and bake desserts in her spare time. She also likes to keep active by regularly participating in Clinical Pilates.