The Pelvic Floor: anatomy and dysfunction

The pelvic floor: anatomy and dysfunction

Did you know pelvic floor dysfunctions can refer to the lower back or pelvis and cause pain there?

Pelvic floor (PF) muscles function to support pelvic floor organs, assist in urinary and fecal continence, aid in sexual performance (orgasm), stabilize connecting joints, and act as a venous and lymphatic pump for the pelvis.

Anatomy

Bony Pelvis

The pelvic floor consists of three muscle layers:

1. Superficial perineal layer: innervated by the pudendal nerve – nerve roots S2-S4
* Ischiocavernosus
* Bulbocarvernosus
* Superficial transverse perineal
* External anal sphincter (EAS)

2. Deep urogenital diaphragm layer: innervated by pudendal nerve-nerve roots?

* Compressor urethera
* Uretrovaginal sphincter
* Deep transverse perineal

3. Pelvic diaphragm: innervated by sacral nerve roots S3-S5

* Levator ani: pubococcygeus (pubovaginalis, puborectalis), iliococcygeus
* Coccygeus/ischiococcygeus
* Piriformis
* Obturator internus

Trigger Points in the muscles of the PF may refer pain in the distribution of the pudendal nerve. The pudendal nerve’s distribution is sensation from the skin of the anus, perineum and both male and female external genitalia. It also supplies motor power to muscles of the pelvic floor including the external urethral and anal sphincters.

* Bulbocavernosus and Ischiocavernosus refer pain to the perineum and adjoining urogenital structures
* EAS (external anal sphincter) refers pain to posterior pelvic floor
* Levator ani and coccygeus refer pain to sacrococcygeal area
* Levator ani refers pain to vagina
* Obturator internus refers pain to vagina and anococcygeal area

Pelvic floor disorders

PF problems occur when it becomes weak or damaged and is not strong enough to hold the pelvic organs.

Symptoms of pelvic floor weakness:

Incontinence (urinal or faecal)

Prolapse of pelvic contents (uterus, bladder or bowel) into the vagina or vaginal canal or anus causing a protrusion.

Increased urgency to urinate

Painful urination

Urinary retention

Constipation

Discomfort or uncomfortable pressure in the vagina or rectum

Muscle spasms in the pelvis, genitals or buttock region

Who should you see if you have any symptoms?

You can go and see your doctor who should refer you to a radiologist (to help diagnose your condition through imaging and scans) urologist, urogynecologist or gastroenterologist.

From there you may be referred to by a physical therapist such as an osteopath, physiotherapist or chiropractor who should be trained to provide you with exercises to retrain the pelvic floor.

Please contact me for further information.