Amanda Olson, Certified Pelvic Rehabilitation Specialist and Doctor of Physical Therapy discusses the female anatomy, specifically pelvic floor structure, function, and the relationship between the pelvic floor muscles, kegel exercises, urinary incontinence, fecal incontinence, vaginal organ prolapse, and better sex.
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Hi, I’m Amanda Olson, from IntimateRose.com.
As a pelvic floor physical therapist, I see women in the clinic all the time who are experiencing urinary incontinence, pelvic organ prolapse, pelvic pain, and all sorts of different conditions related to the pelvic floor.
So what we’re going to do today is discuss what the pelvic floor actually is.
So what I’m going to do is just provide you with a tour of the pelvis in general, what the pelvic floor does, and why it’s so important to us.
This is going to be part one of a three-part series on an introduction to the pelvic floor, how to do Kegels properly, and when they are appropriate to do.
So what we’re going to start with is the outside structures of the pelvis.
This is the pelvis. This is the front, and what we’re looking at here, first, is the bony structure. So this is the pubic bone, here, and the iliac crests here on the side are the bony structures that are on top of the hip. The femur, this is the leg bone, comes in and attaches here.
Just to give you some orientation, the leg bone is right here, and the back, here. This is the sacrum, and here’s your spine.
One thing to note is that the lower back and the pelvis are married to each other, and they’re very reliant on each other to be doing their jobs properly. And the pelvic floor is sort of the glue holding this whole thing together.
The reason is that the pelvic floor attaches to the tailbone here; this white structure is the tailbone, and the pelvic floor wraps all the way to the front.
Now, certainly we have tendons, ligaments, and other muscles that are part of this whole anatomical structure. But the pelvic floor is a very important component of all of that.
Oftentimes, people can experience lower back pain, and they’ve tried everything under the sun, strengthening their abdominals, and nothing is really working.
I get those people referred to me in the clinic, and it’s because they have pelvic floor weakness. Part of the core, the deepest part of the core, is the pelvic floor.
We’ll touch more on that in a moment.
But I’m going to orient you to the key organs in the pelvis. So looking at it over the top, we have the bladder in the very front.
Again, here’s the pubic bone, and just right off into the pelvis is the bladder, the uterus, and the rectum in the back.
These organs are very close neighbors, and they share a tent wall, essentially, that separates them.
They are very, very reliant on each other to be functioning properly. And if one of them becomes irritated, say, the bowel, it can affect the other structures.
The pelvic floor envelops all three of these features.
So the pelvic floor starts up on the pubic bone, and it comes down and around the urethra, the vagina, and the rectum.
There are three distinct layers of the pelvic floor.
The first one includes the superficial muscles of the pelvic floor, which come out in a triangle and then encircle the rectum.
Then there’s a layer of fascia that connects it to the deep portion of the pelvic floor.
The deep layer is this layer right in here. It’s everything in red. This white here is just demonstrating some fascia underneath that muscle.
The deep layer comes off the tailbone, which is right here.
We have a sling, essentially, of muscles. Everything you see in red is muscle, encircling the rectum, the vagina, and the urethra, here.
With these muscles encircling the ends of these organs, they’re providing a stop closure around the urethra, around the vagina, and around the rectum.
If you’re experiencing leaking, one of the reasons may be that the pelvic floor is weak.
Here is something interesting to consider. The bladder sits right in the front. Another reason for leaking urine can be having scars over the top of that bladder that are putting pressure there. The most common one is a cesarean section scar.
That scar sits right on top of the pubic bone, and it can grow in very thick and very dense.
The interesting thing about scars is they are, by and large, genetic in regards to we lay them down, and some people just make scar tissue thicker than others.
The other thing about having a cesarean section scar is we’re not supposed to lift things. But it’s awfully hard to have a baby and not lift that baby.
Putting stress and strain on that scar can cause that scar to grow in a little bit thicker.
It can grow in and put pressure on the top of the bladder.
When you’re looking at what that creates, it creates a high-pressure situation above the bladder.
Couple that with a weakened pelvic floor from carrying a baby for nine months, or even the situation that you were in labor, and you were pushing, and ended up having a C-section later.
Then you’ve got stretching, and possibly some tearing, of the pelvic floor coupled with high pressure above, and that can result in some leakage.
In that instance, it can be very helpful to see a physical therapist specializing in the pelvic floor, because they can help you address some of that scarring above with some really gentle manual techniques.
The other scar that really commonly can present some problems with this delicate balance is the appendix scar, and that lies in the lower right part of the abdomen.
Depending on in what era you had your appendectomy, that scar can be rather sizable; 20, 30, 40 years ago, those scars were quite large, and quite long.
If you had an appendectomy recently, those scars from that surgery are quite small.
But either way, people lay down scar tissue differently. And that scar tissue in that lower right part can put pressure on the bladder and the uterus.
That can create pressure on the pelvic floor.
And if the pelvic floor is not strong, we can get instances of incontinence or even prolapse, coupled with other issues in the pelvis.
But that’s often something that’s simultaneously happening.
Again, that would be a good reason to go see a pelvic floor physical therapist.
One last thing. When we’re talking about the pelvic floor, its anatomy, and its structure, be aware of how posture relates to all of this.
If someone were sitting upright with relatively good posture, the spine is nice and tall.
But if someone were, say, slumped in their desk chair for several hours on end, their pelvis would be rocked back.
What that would do to the pelvic floor underneath is put those structures in an elongated position.
When you couple that with several hours, and multiply that by several days, if not years, that can create weakness in the pelvic floor.
It can also create imbalance between the back structures, where you would be slumped back and resting, and the front structures. When we’re talking about incontinence, that can happen.
Urinary incontinence would be leaking out of the front, obviously, versus fecal incontinence, happening out the back.
When we are looking at incontinence in general, if you’re not experiencing issues with fecal incontinence, we want to be able to focus on the front fibers, and I just want to orient you to what that means here.
In the pelvic floor, the front fibers are the ones that go around specifically the urethra.
When we talk more in the videos to come about doing Kegels, we’ll be talking about doing Kegels in different ways to address different problems.
Not all Kegels are created the same, and they don’t all address the same issue.
So you have that to look forward to.
Be sure to visit IntimateRose.com, and check out the vaginal weights; they are going to be brought up in our future videos as a method of strengthening the pelvic floor.