Rethinking the name: pelvic ‘floor’

We use some strange terms in medicine. There are the long complex words such as spinal spondylosis or osteoarthritis, which can really invoke fear in people but are in fact only describing the normal ageing process our joints undergo.

Then there are the other unhelpful words such as a ‘spinal disc’ or a ‘pelvic floor’ neither of which accurately describe these structures and can in fact mislead people.

Two of the main aims of physiotherapy are to explain and empower patients so they can understand more about their bodies and how to help themselves. This leads nicely onto the content of this blog article. It is impossible to understand much about the pelvic floor area of our bodies if we think of it as a floor!

In actual fact it is an incredibly well-designed part of our anatomy and when working well can bring so much joy into our lives – but unfortunately it is often ignored, perhaps it is the Cinderella of muscles. So here’s why it is more than a floor and why it is well worthwhile giving it some love and attention.

Floors are usually flat and do not move.

The lower pelvic muscles (we’re going to use this term rather than the pelvic floor) make up the base of your pelvis and they are dome shaped and constantly moving. They should be ready and waiting to respond to your direct or indirect commands.

If you cough or sneeze they should react quickly to shut off your outlet pipes avoiding any bladder or bowel leaks and preventing unwanted sound effects. So shortening, tightening and lifting upwards and forwards is a movement these muscles should be able to perform quickly and easily.

Check up: can you tighten your lower pelvic muscles and feel that upward and forward movement?

Floors should not have holes.

The lower pelvic muscles have three absolutely essential openings for the bladder, vagina and bowel. So these muscles need to be able to lengthen and release in a controlled way in order to allow your bowel and bladder to empty. They also need to relax to have penetrative sex (and tighten to play a part in orgasm).

You can see how controlling these openings can be a challenge! Yet if your muscles are working well they co-ordinate and function as an efficiently trained team.

Check up: if you can tighten your lower pelvic muscles and feel that upward and forward movement can you also release and ‘let go’. Does your ‘undercarriage’ area feel totally relaxed?

Floors do not change their thickness

Have you ever exercised and over a period of time noticed your muscles becoming ‘thicker’? It often happens when we load our skeletal muscles and make them work harder than they are used to. Certain types of fibres in the muscle rise to the challenge and the end result is a muscle that is better defined and bulkier.

The lower pelvic muscles are no exception to this rule and with the correct kind of loading the increase in background resting tone will give the pelvic organs better support. This is one of the reasons we believe pelvic muscle exercises can help reduce symptoms of prolapse.

Check up: stand up straight and press your fingers into your buttock muscle. See if you can ‘tighten your bum cheeks’. You may be able to feel this big muscle contract under your fingers. Like the lower pelvic muscles this muscle can become better defined with the right kind of exercise.

 Floors do not glow in the dark! 

Sorry to disappoint you but neither do your lower pelvic muscles! What many people don’t realise however is that all our muscles work by using changes in electric charge.

The amazing thing about your lower pelvic muscles (let’s refer to them as LPM!) is that they are linked by a set of electrical reflexes to your bladder. If your bladder is sensitive and you have a sensation of urgency when it’s ready to empty you can calm your bladder down by tightening your LPM.

Bladder emptying is a very complex process however one very simple electrical reflex rule is that LPM activity reduces bladder activity.

Check up: next time you experience an unwelcome urgency associated with the need to pass urine try gently engaging your lower pelvic muscles and doing some diaphragmatic breathing. If you wait a few minutes the urgency often fades.

So this is why there is so much emphasis on the importance of these muscles. They’re pretty awesome and with a bit of effort the rewards for getting them stronger far out way the effort you’ll put in – that’s a pelvic health physio’s promise.