I see so many women who say to me, “I never knew what my pelvic floor was until xyz went wrong.’ And there is nothing wrong with that statement because many of the functions of our pelvic floor are reflexive or automatic, and there are so many other bids for our time that anatomy is probably not at the top of most people’s lists. But knowing how your body is made and how it should function empowers you, the owner, to be aware of any potential changes before they become problematic, or to be ready to address them when issues arise. Body awareness also helps to maximize the potential of each system, and your pelvic floor is sending you most definitely want optimized. But what is your pelvic floor, and what does it do? And why bother optimizing something that you probably don’t think about much?

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what and where

Let’s start with finding your pelvic floor. See the image above where the muscles have been isolated in the pelvis to get a good idea of its location. The pelvic floor is comprised of muscles, ligaments, and fascia that sit within the bowl of the pelvis (starting at those bony points on your lower abdomen and extending down to your sit bones and tail bone) and it is collectively shaped somewhat like a funnel within that bowl. If you want to feel externally, sit on your hand with your fingertips near your anus and gently squeeze like you’re stopping the flow of urine. If you feel slight motion under your fingertips, you’ve found your pelvic floor! The muscles themselves are all fairly small when you compare them to their very important functions. It’s a pretty good bang for your buck per square inch versus something like a hamstring or quad, in my opinion, although they all come in handy! I don’t think it would be all that helpful for me to share the names of all these muscles and ligaments, but it may be helpful to know that these muscles are divided into three distinct layers to understand both the complexity and sheer number of this muscle group.

Function

The functions of the pelvic floor are taught as the 5 S’s:

• Support: these structures are designed to support the pelvic organs above them. This includes tolerating some extra load during pregnancy, too! The pelvic floor also supports the pelvic organs when they move with jumping and coughing, and other activities-the list goes on, but they aide keeping things from falling out.

• Stability: there is a lot of weight resting on the pelvis-from your head to just below your navel. Fortunately it has stability from some pretty big hitters: your abs, glutes, and hip flexors to name a few. But there are also some major joints to stabilize. See the pubic bones, or small bones in the front of the pelvis? That little piece in the middle is a ligament. And there are two major joints in the back, the sacroiliac joints. These pelvic joints are all stabilized, in part, by the pelvic floor muscles, as well as some pretty intense ligaments.

• Sphincter: sphincters are typically at the end of tubes to control output. The sphincters in the pelvic floor control for leakage of both urine and stool, since this is where the urinary and digestive system end. Both systems have an internal and external sphincter (built in safety measures) with the external component under your control in your pelvic floor. The internal sphincters for both your bowels and bladder are automatically regulated by your body and some very interesting reflexes!

• Sump pump: the pelvic floor muscles help to drain lymphatic fluids as all muscles do. Any woman who has experienced swelling in the vaginal area during pregnancy has experienced this system when it’s not functioning at its best.

• Sexual: the muscle making up the vaginal canal contracts reflexively during orgasm, but if the entire system is weak even your automatic reflexes will be weak (and thus potentially less satisfying). A stronger pelvic floor is correlated to better sexual function.

So if you can imagine your day without one of these things going well, you can already tell it’s not going to be a good day. And even though these are the typical functions taught in pelvic floor courses, I believe they forgot to mention another really important function: stretch (I even managed to make it an ‘s’ if you didn’t catch that)!! While typical contract and relax function can fall under multiple of the above functions, the amount of stretch required for vaginal childbirth is greater than the degree that any other muscle in the body is required to both stretch and then return to normal resting length. A 2009 article suggests that some womens’ levator muscles (the deepest pelvic floor layer, pictured below from above the pelvis) will need to stretch anywhere from 24% to 245% depending on the size of mom and baby.

When anything changes in function…

Know that you are not alone. Many women (and men) seek treatment when any of the pelvic floor functions starts to go awry. But even more men and women don’t know that there is help. For every single function listed, there are conservative pelvic physical therapy interventions that are backed by research. You don’t have to live with changes (or chronic dysfunctions) just because you expect them with age, or pregnancy, or medical side effects, or just because your mom does. So get to know your pelvic floor, check in with yourself to see if you have any awareness of it, and advocate for yourself when you need to. I hope you feel empowered getting to know more of the ‘whole you.’