What is the pelvic floor and why do I need to know about it?
Like many things in life, the pelvic floor is something you often don’t give a second thought about until something goes wrong. What’s more, unless a health professional has spoken to you about the pelvic floor or a friend or family member has brought it up in conversation, there’s a good chance you have very little knowledge about what the pelvic floor is and why it is so important. If this is you – you are most certainly not alone. After all, we know it is much more difficult to bring up a problem with your pelvic floor in casual conversation than your sore knee or the pain in your neck. However, if we all knew a bit more about the pelvic floor, it would be much easier to understand how and when to seek help.
So what is the pelvic floor?
The pelvic floor is the ‘floor’ of the pelvis, made up of muscle and fascia (thick connective tissue). There are two layers of pelvic floor muscle; superficial and deep. The superficial layer we can see from the outside, but the deep layer is hidden inside and connects from the front of the pelvis (pubic bone) to the tailbone (coccyx).
Sitting on top of the pelvic floor is the bladder, uterus and bowel, the pelvic floor not only provides support to these organs but assists in the bladder and bowel control. When the pelvic floor relaxes, it allows you to pass urine and faeces; and when it contracts, it enables you to delay going to the toilet. The pelvic floor also plays a role in sexual function. Having control of your pelvic floor muscles can assist in achieving pain-free sexual intercourse.
Why is it important?
I like to describe the pelvic floor as similar to a hammock. When your hammock is new, you lie in it, and it feels so comfortable and supportive. As time goes on, however, your hammock might start to stretch. When you lie in it, you feel the support is weakening, and you’re getting closer to the floor. If you were to leave your hammock out in the weather, or maybe if you’ve torn a section of your hammock, you would find you lose support more quickly. If you jumped up and down on your hammock or added an extra 15kg of bricks to the hammock, you would probably find that the hammock would droop even further.
Just like the hammock can lose support, so too can the pelvic floor. It can happen ever so gradually over time that often women don’t notice a problem until years or even decades later. However, for some women, it can happen more quickly, especially if there are risk factors present. We know that certain things put extra strain on the pelvic floor. Damage (including tears) during childbirth, regular straining (e.g. constipation), repetitive (unopposed) downward forces and increased body mass can all lead to weakening of the pelvic floor.
What happens when the pelvic floor is damaged or weak?
If you were to put a marble anywhere on our droopy hammock, you would find it always ends up rolling towards the middle. Looking at the pelvic organs, the same rules of gravity apply, which can develop into a condition called pelvic organ prolapse.
Pelvic organ prolapse occurs in one of three ways:
- The bladder slips back and down into the vagina (cystocele or anterior vaginal wall prolapse).
- The uterus slips straight down into the vagina (uterine prolapse).
- The bowel slips forward and down into the vagina (rectocele or posterior vaginal wall prolapse)
The most common complaint of pelvic organ prolapse is low back pain that is worse towards the end of the day or after more activity, and is better at the start of the day or when you are lying down. Women may also complain of vaginal heaviness or dragging, pain with sex or issues with bladder and bowel control issues. The important thing to remember is that there are things you can do, including simple lifestyle changes and exercises to help maintain your pelvic floor. If in doubt, a physiotherapist trained in pelvic floor issues can be extremely helpful!
What should I do to look after my pelvic floor?
- Pelvic floor exercises (available on the Femma platform)
- The knack (available on the Femma platform)
- Maintain a healthy weight
- Avoid constipation and straining
- Avoid bearing down or holding your breath during exercise
- Use of a vaginal pessary (in cases of symptomatic POP)