What is the Pelvic Floor?

The pelvis, or the pelvic girdle, is a complex, funnel-shaped, structure of bones that is located in the inferior part of the abdominal cavity, and functions to support and connect the upper trunk with the lower trunk. It extends upwards into the abdominal cavity, and downwards into the perineum.
 

Since the pelvis has to support a considerable amount of body weight, it is strengthened by muscles, ligaments, and bony walls, so that it is protected from easily getting injured or disabled.
 

The female pelvis holds great importance in anatomy, mainly because this part of the body is greatly involved in the process of childbirth, so it is important to be aware of its structures and the vasculature that it contains, to assure a safe and easy delivery without any complications.
The pelvis consists of an anterior wall, a posterior wall, two lateral walls, and a pelvic floor.
The pelvic floor is the topic of particular interest here, as this is the only part of the pelvis that is clinically important because it is easily susceptible to injury and prolapse.
 

The pelvic floor is formed of muscles and fascias, which are shaped in the form of a bowl, and are collectively referred to as “Pelvic Diaphragm”. These muscles are the coccygeus, and the levator ani muscles and their fascias. 

 

Structure and Functions of the Pelvic Floor

The coccygeus muscle spans the lateral walls of the pelvic cavity, whereas the levator ani is seen attached to the pubic bone anteriorly, and the ischial spines posteriorly, along with thickening considerably in between these two bony points to strengthen the pelvic floor and reinforce it.
The levator ani has three parts (Puborectalis, Pubococcygeus, Iliococcygeus), which contribute to its strength.
The levator ani muscle remains actively contracted the majority of the time, which thus enables it to 

• Maintain urinary and fecal continence 

• Provide support and protection to the bladder, uterus, cervix, vagina, and the rectum (in females). 

• Impart support to the abdominal cavity structures during periods of extreme stress

• Fix the trunk posture when the upper limb is exerting (lifting heavy weights, during strenuous exercise, etc.)
  
  
  
  Image Source: PelvicGuru
   

 

Dysfunction of the Pelvic Floor 

The pelvic floor or the pelvic cavity, in general, is supported by several muscles which impart strength to it and enable it to support different organs and perform a variety of jobs in an individual. However, under certain conditions, like during the delivery of a fetus, these muscles might get subjected to a lot of stress, which may lead them to be injured or torn and to lose their active state of contraction, which further complicates things for an individual, and interferes with their normal functions. These conditions are fairly common in women, although they may affect men too.
 

In this condition, there is a loss of coordination between the pelvic floor muscles, due to which they do not relax completely, leading to their poor and imbalanced, nonsynchronous performance, and may even cause the organs to prolapse.

Many conditions may lead the pelvic floor to dysfunction, some of them include:
 

• Childbirth (Most Common Cause)

• Trauma

• Nerve Damage 

• Old Age

• Post-surgery complication, or tears

• Obese or Overweight Personality

Whatever the cause may be, a wide range of symptoms is experienced by the patient which leads to the condition getting finally diagnosed. Some common signs and symptoms experienced by the patient are: 

 

Source: liftlaughkegel.com

 

Treatment of Pelvic Dysfunction 

As soon as a patient gets diagnosed with pelvic floor dysfunction, the condition must get treated as soon as possible to avoid further consequences. The condition in itself may be quite embarrassing, inconvenient, and painful for the patient, so it should get treated in the initial stages.
 

There are many treatment options suggested for the patient, depending upon the damage and severity of the affected area. This condition has high curing rates, and it gets treated without any surgical procedure, which is even better.
Here are a few common treatment plans used for the treatment of pelvic floor dysfunctioning:

 

Pelvic Floor Physical Therapy 

This is the most helpful and the best of all treatment options. Even though it has been highly underestimated for years about doing no good, this is the only reliable option that although slow, brings fruitful results in the long run. These exercises help patients with pelvic dysfunction in reducing the symptoms of incontinence of urine and feces, painful intercourse, and help to strengthen the muscles all together. It can be subdivided into a range of different exercises which can be easily done at home too.
 

1. Kegel’s: This is the pelvic muscle training method, which focuses on strengthening the muscles by causing them to contract and relax simultaneously. It is extremely beneficial for patients with urinary incontinence issues.
    

2. Glutes: This exercise greatly helps in activating the pelvic floor muscles, along with the glutes and the hamstrings.
    

3. Squats: Squats help with improving muscle contraction by increasing the strength of the muscles. 

 

If these exercises are done regularly for at least 15 minutes, then a noticeable alleviation of symptoms is sure to be noticed in the patient within a month. They are extremely beneficial for pregnant women, who, if they start doing these exercises during their pregnancy, can strengthen their muscles enough to prevent tears during delivery, and incontinence after it.
It is up to a person’s choice, if they wish to do these exercises by themselves, or go to a professional therapist. The latter can educate and train the patient on their condition better, and would also ensure that the patient is complying with all the instructions.

 

Biofeedback

This is a modern-day technique, in which the doctor or therapist uses special sensors to monitor the pelvic muscles’ conditions, and using these sensors, helps them in regaining their old functions. This is a painless, and easy technique, and allows the patients to gain their normal muscle movements back.

 

Medications 

Occasional, and supportive medicines can be taken for relieving the symptoms of pain and constipation.

 

 

References

1. Allen RE, Hosker GL, Smith AR, Warrell DW. Pelvic floor damage and childbirth: a neurophysiological study. BJOG: An International Journal of Obstetrics & Gynaecology. 1990 Sep;97(9):770-9.

2. Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American journal of obstetrics and gynecology. 1996 Jul 1;175(1):10-7.

3. Dumoulin C, Cacciari LP, Hay‐Smith EJ. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane database of systematic reviews. 2018(10).

4. Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, Hay-Smith EJ. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. 2020(5).

5. Hagen S, Glazener C, McClurg D, Macarthur C, Elders A, Herbison P, Wilson D, Toozs-Hobson P, Hemming C, Hay-Smith J, Collins M. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. The lancet. 2017 Jan 28;389(10067):393-402.

6. Bonde EH, Wei XK, inventors; Medtronic Inc, assignee. Pelvic floor muscle training. United States patent US 10,201,702. 2019 Feb 12.

7. Narayanan SP, Bharucha AE. A practical guide to biofeedback therapy for pelvic floor disorders. Current gastroenterology reports. 2019 May 1;21(5):21.

8. Richmond CF, Martin DK, Yip SO, Dick MA, Erekson EA. Effect of supervised pelvic floor biofeedback and electrical stimulation in women with mixed and stress urinary incontinence. Female pelvic medicine & reconstructive surgery. 2016 Sep 1;22(5):324-7.
    

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