The pelvic floor is a thin but strong sheet of muscle and connective tissue that closes off the pelvic cavity from below. It supports the pelvic organs in women, which include the urinary bladder, the uterus, cervix, and vagina, as well as the rectum, which is the last part of the large bowel. In men, the pelvic floor is comprised of the bladder and the rectum.
Muscles of the pelvic floor
The muscles that make up the pelvic floor are the levator ani and the coccygeus muscles that pair together to seal off the pelvic cavity, forming the pelvic diaphragm. The levator ani consists of two parts, which includes the inner pubococcygeus muscle and the outer iliococcygeus muscle. Both of these muscles are attached to the sacrum at the back but starting from the pubic bones and the ilial bones, respectively, in the front.
The levator ani muscles form a wide sling like a hammock, starting from all around the fan-shaped pelvic bone and connecting to the pelvic organs through firmly wrapped circular muscle fibers and thickenings of the fibrous tissue that envelops it.
The pubococcygeus muscles pass backwards, leaving a gap in the middle, which is where the passages for the pelvic organs are located, which is otherwise known as the urogenital hiatus. The rest of the levator ani is formed by the thinner iliococcygeus. The fibers of this remaining structure join behind the anus to form a plate of strong connective tissue called the levator plate, which supports the pelvic organs at rest.
The pelvic floor has two openings for each of the passages to the outside, which include the urogenital hiatus and the rectal hiatus. In women, the vagina and the urethra pass through the urogenitcal hiatus and the rectum passes through the rectal hiatus. In men, the urethra passes through the urogenital hiatus and the rectum through the rectal hiatus.
Female pelvic floor labeled - Image Copyright: Alila Medical Media / Shutterstock
Functions of the pelvic floor
The pelvic muscles form circular sphincters to control the passage of substances through each of these passages, namely, the urethral sphincter and the anal sphincter. Thus, continence is an important function of the pelvic floor.
Pelvic floor muscles are responsible for providing control over urination, defecation, and flatulence. These muscles are also involved in orgasms.
The pelvic floor muscles also hold up the pelvic organs against gravity, keeping them in position during moments of increased abdominal pressure, as when you sneeze or cough or laugh. When the bladder tightens to force urine out, there is a coordinated relaxation of the part of the muscle that circles around the urethra to allow the urine to flow outside. Similar relaxation occurs during defecation, childbirth, and vaginal intercourse.
When the pelvic floor contracts, the organs it supports are lifted higher and the passages are squeezed shut. When it relaxes, on the other hand, the muscular sheet descends and the orifices are opened.
Importance of the pelvic floor
The importance of this muscular sheet is immense. For example, the pelvic floor forms part of the core muscles, which are a group of voluntary muscles that are responsible for maintaining posture, abdominal organ position, and intra-abdominal pressure. These muscles work together with the deep abdominal muscles and the back muscles to keep the body straight without fatigue.
In the ideal situation, the changes in the pressure inside the abdomen that happen, for instance, during a cough, sneeze, or lifting something heavy, are automatically regulated between the abdominal, back, and pelvic floor muscles. As the pressure rises, these muscles contract to support the spine and the abdominal organs from being displaced, thereby allowing the body to perform actions smoothly.
However, the weakening of the core muscles leads to alterations of this rhythm. For instance, when the pelvic floor muscles are damaged, increases in intra-abdominal pressure push down the weak pelvic floor, causing the pelvic organs to descend lower. If this lasts a long time, the pelvic organs permanently change their position, which is called pelvic organ prolapse. Symptoms of this may range from stress incontinence to actual descent of the uterus through the vaginal opening.
The pelvic floor itself is not visible from the outside; however, it can be trained by conscious exercise. When the levator plate is weak, the pelvic organs sag and may slip through the enlarged urogenital hiatus.