Most of us have heard of the pelvic floor, and know that it’s somewhere down there. But you might be surprised, even impressed by how much your pelvic floor does for you on a daily basis.
Your pelvic floor participates in a lot, from stabilizing your stance and walk to your ability to achieve an orgasm. It relates to all the organs in your abdomen, your spine, your pelvis and participates in regulating the pressure in your abdominal and thoracic cavities. It is of such importance to your health and wellbeing but unfortunately, too often brushed off or disregarded in the medical landscape of women’s health.
To us, using the word pelvic FLOOR is an oxymoron because it couldn’t be further from the image of the floor in your living room. A floor is viewed as something rigid, not pliable, that simply supports objects from the force of gravity. We prefer the image of a suspended hammock when it comes to representing the mechanics of our pelvic floor and prefer referring to it as our perineum or pelvic diaphragm. It has so many important functions that we describe in this article.
The perineum consists of a set of muscles, ligaments and fascia that suspend and anchor on the bones of the pelvis (ilium), the hip (femur) and the spine (sacrum & coccyx). It supports the main organs of the pelvis; the rectum, the cervix/uterus and the bladder.
In addressing and harmonizing any area of the body, we want to consider as much the container (the pelvis) as its content (the organs and structures inside the pelvis), because both contribute to optimizing function in the body. That means making sure the spine, hips and pelvis are addressed and balanced in relation with the perineum for more lasting and global results.
Movement. It allows the pelvis and hips to move without disturbing the genital and abdominal organs each step of the day. It acts as a flexible web that adjusts to the rhythm of changing pressures in the abdomen.
Support. Perineum muscles act like a hammock supporting your bladder, colon, rectum, vagina, cervix and uterus.
Stabilization. Working in unison with your hip muscles, lumbar spine and diaphragm, your perineum muscles stabilize your hips and trunk, helping you stand upright and walk. As the bottom most of your core, they also contribute to optimal force distribution and power while working out.
Breathing. All diaphragms in the body work in synchronicity. The perineum (or pelvic diaphragm) acts as a powerful element in the efficiency of your breathing mechanics through its connection with the respiratory diaphragm, your main breathing muscle. It is worth exploring if you're a cardio lover or runner to improve your cardiovascular efficiency while preventing perineal dysfunction.
Circulatory drainage. Arteries push fluids through your body and most of that fluid comes back through your veins. The lymphatic system participates in that drainage and is greatly helped by the contraction of the perineal muscles. In helping venous return, the perineum helps prevent varicose veins and circulatory issues in the legs and help blood circulation.
Maintaining continence. The perineum helps your bladder and anus open and close on demand when you need to pee and poop (and when you need not to).
Sexual sensation. The same muscles that prevent leaking are the muscles that rhythmically contract and release until reaching an orgasm. It’s a reflex but you can consciously work on your perineal muscles to increase muscle tissue and neurological quality, ultimately enhancing pleasure during sexual activities.
There are 16 individual muscles that coordinate to accomplish all these duties and their state will greatly influence how they’re able to perform 24 hours a day, 7 days a week. Because yes, your perineum never stops working!
What happens if your perineal muscles are too tight?
Like any other muscle, perineal muscles can hold tension and spasm. If they’re too tight and too tender, you might experience pelvic or tailbone pain, problems with your hips, bowel and bladder, or sexual dysfunction. Hypertonic perineal muscles can contribute to more painful menstruations. Any of these issues could be related to your pelvic diaphragm.
A session with your manual therapist (physio, osteo, etc.) to address this, paired with a good mobility and stretching program for your perineum is the way to go to help normalize tension and improve elasticity.
What happens if your perineal muscles are too weak or lack tonicity?
Symptoms related to a weak or hypotonic perineum are : Urinary or fecal incontinence while walking to the bathroom or laughing, coughing, jumping, etc. ; low back pain, because your abdominal muscles, thoracic diaphragm and back muscles work in synergy with your perineum; decrease or low sexual pleasure; rectal, vaginal or bladder prolapse.
We don’t want the muscles in your pelvic diaphragm to be too tight or too weak. We want a happy medium to be in harmony. The causes of dysfunction can come from pregnancy, abdominal or gynecological surgeries, sedentarity, menopause & other. 1 in 3 women will suffer from pelvic floor dysfunction in their life. It’s extremely common and needs to be addressed by a professional.
Different modalities to help with perineal function
“Pelvic floor” physiotherapy is one of the most efficient tools for an in depth perineum assessment and treatment plan addressing any of the functions listed in this article. Osteopathy can also address perineal dysfunctions with a more global approach, particularly with genital and abdominal organs. Specific and personalized exercises to complement treatment will provide optimal results.
Because of the taboo against talking about genitals and reproductive organs, many women live with unnecessary discomfort. Everybody would benefit from having their perineum examined and specific exercises to harmonize perineal health. There’s nothing to lose and only benefits that could come out of it.