The pelvic floor is a group of muscles that lie across the base of the pelvis. Everyone, regardless of sex, has a pelvic floor and keeping it strong can help prevent problems like incontinence.
Dr. Emily Hu, an obstetrician-gynecologist in the San Francisco Bay Area in California, told Live Science that the pelvic floor consists of muscles and connective tissues that support important organs in your pelvis.
"[These include] your bladder, bowel and internal reproductive organs," she said. "The two actual muscle groups of the pelvic floor are the levator ani and coccygeus muscles. The levator ani composes the bulk of your pelvic floor muscles."
The pelvic floor runs from the pubic bone at the front of the pelvis to the tailbone in the back.
"These muscles extend from side to side, ultimately forming a hammock or bowl at the base of the pelvis," Valerie Adams, a physical therapist at Duke Health in North Carolina, told Live Science.
What does the pelvic floor do?
The main function of the pelvic floor muscles is to hold the abdominal and pelvic organs in place, Hu said.
"They also function to maintain the continence of urine and stool. The muscles assist with defecation, sexual activity and childbirth."
A strong pelvic floor can also help control the urge to urinate, according to the Urology Care Foundation. To reduce or eliminate the urge, squeeze and relax the pelvic floor muscles quickly several times (but don't fully relax between squeezes). This sends a message to the nervous system and back to the bladder to stop contracting. As the bladder stops contracting and starts relaxing, the urge feeling will subside.
"Pelvic floor muscles need to be able to contract in order to hold back urine, stool and gas," Adams said. "They also need to be able to fully relax so that we can empty our bowel and bladder when it's time to do so."
The pelvic floor muscles also play a role in arousal and orgasm, Adams said. In men, these muscles play a role in erectile function during intercourse, according to the National Health Service in the United Kingdom.
Pelvic floor muscles are an integral part of our core.
"We can think of our core as a canister," she said. "The pelvic floor muscles form the bottom of the canister and a muscle called the diaphragm forms the top. All of our core muscles work together to stabilize and support us as we move throughout our day."
What is pelvic floor dysfunction?
Pelvic floor dysfunction occurs when the muscles of the pelvic floor do not function properly, causing issues like incontinence or retention, according to the National Institute of Health's National Center for Biotechnology Information. Incontinence refers to difficulty holding in release of urine or feces, whilst retention occurs when a person has trouble fully emptying the bladder or bowels.
As the pelvic floor supports the urologic, gynecologic and colorectal systems, there are several things that can go wrong when your pelvic floor is weakened. According to Adams, examples of common pelvic floor muscle dysfunction include stress urinary incontinence (leaking urine when coughing, laughing or sneezing), urge incontinence (leakage due to urinary urge), pelvic organ prolapse (a heaviness or bulging sensation in the vagina due to organs that have dropped from their original positions), and bowel incontinence (leakage of stool or gas).
What causes a weakened pelvic floor?
Around one in three women experience pelvic floor dysfunction at some point in their lives, according to UCLA Health. Pelvic floor related problems are generally a result of pelvic floor damage, such as tears in the connective tissue or weakened pelvic floor muscles.
Risk factors include pregnancy and childbirth, Hu said.
"During pregnancy, hormonal changes and weight of the growing baby place increased demands on the pelvic floor muscles," Adams said. "With a vaginal birth, the pelvic floor muscles undergo substantial stretch. If assistance is needed during a vaginal delivery such as forceps or vacuum, or if a [mother] experiences significant perineal tearing with delivery, the pelvic floor muscles are further impacted."
Women who have cesarean sections can also develop pelvic floor dysfunction, Adams said. A 2020 paper in the journal Scientific Reports assessing instances of pelvic dysfunction six years after uncomplicated birth between vaginal birth and cesarean birth found that women who underwent vaginal birth more commonly experienced symptoms of urgency and stress incontinence. However, urinary incontinence still occurred in those who had given birth by cesarean section, with an increased risk of 2.3 (vaginal) and 1.5 (cesarean) compared with women who had never given birth.
Menopause and aging also change the pelvic floor. "As part of the natural aging process, there is a loss of skeletal muscle mass," Adams said. "Estrogen levels drop during menopause and there is a thinning of the vaginal, vulvar and urethral tissues [as a result]. This combination of factors can lead to pelvic floor dysfunction."
The Continence Foundation of Australia explains that this weakening of the pelvic muscles during menopause can also be due to weight gain and causes pelvic dysfunction as weaker muscles provide less robust support for the pelvic organs.
In men, pelvic floor dysfunction looks a little different. Pelvic floor weakness is usually due to prostate or other pelvic surgery, repeated heavy lifting or long term coughs, according to the Oxford University Hospitals’ guide. Similarly to women, being overweight or constipated can also cause pelvic problems. Usually men will be treated with physiotherapy and prescribed pelvic floor exercise to strengthen these muscles, particularly after surgery.
In extreme cases of pelvic floor dysfunction in women, surgery can help to alleviate problems such as fecal or urinary incontinence. Surgeries such as vaginal wall repair, rectum or bowel support, bladder repair, uterus removal or a sling procedure may be offered to repair a prolapse (where organs have dropped through the pelvic floor) or to better support pelvic organs.
Less invasive treatments include physical therapy from a trained pelvic floor specialist, pessaries (a removable donut-shaped device that is inserted into the vagina to help support prolapsed organs) and some medications to alleviate constipation, depending on the case.
