What are pelvic floor muscles
The pelvic floor muscles (PFMs) are a complex network of muscles and connective tissues that connect the tailbone and pubic bone, forming the base for the core muscles. Together with the abdominal, diaphragm, and back muscles, they provide stability to the center of your body.
There are two main groups of muscles in the pelvic floor (PF) anatomy: the genitourinary and pelvic diaphragm muscles. Each group is divided into superficial and deep muscles.
The PFMs act like a sling, supporting the internal organs in the lower abdomen. They are vital for controlling urination, defecation, and enhancing sexual function in both men and women. For women, these muscles are essential for childbirth.
It is crucial to maintain proper muscle tone and positioning and to seek treatment for any muscle disorders promptly. In this article, you will learn how to do just that.
Primarily, they provide critical support to several organs in our body, including the bladder, urethra, and intestines in both men and women. In women, they also support the uterus and vagina, while in men, they support the prostate.
Additionally, these muscles are responsible for pushing during childbirth and play a key role in the process.
During sexual activity, the PFMs contract and relax, contributing to the pleasurable sensations felt during orgasm. It’s no wonder they’re sometimes referred to as the “love muscles”.
For men, these muscles are also responsible for the release of accumulated sperm during ejaculation. The rhythmic contractions cause the pulsations felt during ejaculation. Meanwhile, the bladder neck closes, ensuring that the sperm flows in the right direction and doesn’t end up in the bladder.
It’s clear that these muscles are essential for our sexual pleasure and reproductive function. So, it’s important to keep them healthy and strong by exercising them regularly and seeking medical attention if any issues arise. Trust us, you’ll thank yourself for taking care of these crucial muscles!
The muscles in your pelvic floor are responsible for stabilizing your torso and helping you walk. They’re actually the most active group of muscles you use during everyday physical activity! However, if the nerves that control these muscles become damaged, or as we age, problems can occur.
For example, the muscles may become weaker or too tense, which can lead to issues with urinary, gastrointestinal, or sexual function. In fact, studies indicate that PF dysfunction is detected in 77.2% of patients who complain of these types of problems.
Among other reasons:
- Persistent constipation;
- Chronic cough;
- Overweight and obesity;
- Injuries in the pelvic or perineal area;
- Surgeries in the pelvic area;
- Pregnancy and childbirth in women;
- Prolonged lack of estrogen in women.
Research indicates that weak connective tissue and high fetal weight during childbirth are significant contributors to PF disorders. According to studies, 42% of women experience discomfort during sexual intercourse three months after delivery, and 24% continue to experience discomfort twelve months after. Furthermore, 15% and 11% of women reported urinary incontinence three and twelve months after delivery, respectively. It is important to note that the occurrence of PF disorders was not related to the method of delivery, whether it was natural or via cesarean section or vacuum stimulation.
Other risk factors
The anatomical structure of women’s pelvis is wider and rounder than men’s, which in itself is a risk factor for weakened pelvic floor muscles and connective tissue. As a result, women should take proactive measures to maintain their pelvic health and prevent potential issues. Prevention is key, and we will delve into this topic later in the article.
Now, let’s explore the factors that heighten the likelihood of pelvic floor disorders:
- Incorrect posture;
- Sedentary lifestyle;
- Unhealthy diet: too much sugar and caffeine, alcohol abuse;
- Eating disorders that cause a lack of nutrients;
- Inappropriate physical exercise (in particular, exercising with heavy weights);
- Certain neurological diseases, including Parkinson’s disease;
- Sexual abuse;
- Anal sex;
- Irritable bowel syndrome.
More to their anatomical differences, women face additional risk factors for pelvic floor disorders. These include undergoing an episiotomy procedure during childbirth, as well as conditions such as endometriosis and interstitial cystitis. Simply being female is also a contributing factor.
For men, the primary risk factor for pelvic floor disorders is prostatitis.
It is essential to recognize that the human body operates as a whole, meaning that dysfunctions in one area can have a ripple effect throughout the body. Myofascial connections, irregularities in breathing patterns and the diaphragm, gait abnormalities, and other musculoskeletal impairments, as well as the development of trigger points in the muscles (hyperirritable spots), can contribute to functional disorders of the PF. Consequently, these issues can negatively impact the body as a whole.
Symptoms of pelvic floor muscles dysfunction
One of the most common indicators of pelvic floor disorders is discomfort in the genitals, anus, lower abdomen, lower back, or the pelvic region itself. Men may find it perplexing, as the symptoms are similar to those of prostatitis.
Other symptoms may include:
Urinary issues. Leakage of urine during physical activity or exertion (e.g., coughing), pain, frequent or infrequent urge to urinate, difficulty starting to urinate, or sudden stops during the process.
Bowel movement problems. Difficulty with defecation, requiring a change in position or exertion to evacuate the bowels, chronic constipation, increased flatulence, small fecal discharge, particularly during physical activity.
Sexual difficulties. Pain during intercourse for women, difficulty achieving orgasm, or anorgasmia. Erectile dysfunction in men.
Self-diagnostic tips from gynecologist-endocrinologist Natalia Silina for women:
- To check your pelvic floor muscles, simulate a bowel movement by pushing a little. If you feel the anterior or posterior, or both walls of the vagina loosen or stick out, it indicates weakened pelvic floor muscles.
- Lie on your back with your knees bent and insert a clean finger into your vagina. Then, tighten your pelvic floor muscles. If you feel a uniform contraction of these muscles, everything is fine.
- During urination, try to stop the flow of urine. You don’t need to hold it, just make sure you can control the process. If you can’t, consult a doctor.
- Also, check your anal sphincter. If you can easily contract and then relax this muscle, everything is fine.
By the way, the last two tips are also relevant for men. It’s important to note that they are not a substitute for regular preventive visits to a gynecologist, urologist, or urogynecologist.
Complications of pelvic floor muscles dysfunction
When it comes to pelvic floor disorders, the main problem is that symptoms that we do not pay attention to can turn into complications, which are much more difficult to treat. This is where the risk factor – being female – turns into an advantage. Women have a greater chance of preventing complications at early stages, of course, if they seek help from specialists in a timely manner.
According to a study of over 25,000 American women, 32% had at least one pelvic floor disorder. The most common disorder is bowel dysfunction, affecting 25% of women, including difficulty with defecation (16%) and fecal incontinence (12%), sometimes both conditions at the same time. Urinary incontinence ranks third, with 11% of women experiencing this problem. All of these are the result of muscle dysfunction in the pelvic floor. And after 80 years of age, pelvic floor disorders that influence quality of life affect half of all women.
And although women experience these disorders more often, men are not immune – approximately 12-13% of them also face this problem. Almost one-third of complications are related to urinary incontinence or leakage.
Issues with urinary and fecal incontinence can cause embarrassment in both genders. However, it is men who delay their visit to the doctor most often. This affects the speed and effectiveness of treatment, so there is no need to be ashamed. You are not alone.
Among other complications, there are several conditions related to pelvic pain and intimate disorders that affect both men and women.
Chronic Pelvic Pain Syndrome (CPPS)
It is diagnosed when pain in the pelvic area lasts for more than six months. While this condition can equally affect both men and women, pelvic disorders are more prevalent in women, so they tend to suffer from CPPS more often.
Levator Ani Syndrome (LAS), also known as Pelvic Floor Myalgia
It is a condition that arises from constant tension in the muscles of the pelvic floor. The levator ani muscle is responsible for supporting the rectum, urinary bladder, and urethra in both men and women, while in women, it also supports the uterus and vagina. It arises from constant tension in the muscles of the pelvic floor, while weakened muscles can also spasm. LAS can cause a constant or frequent dull pain in the rectum, which is caused by spasms of the muscle of the left duct located near the rectum. This syndrome is also more common in women.
Women may experience pain during sex, which can lead to vaginismus – a spasm of the muscles of the vagina during sex. Difficulty achieving orgasm, anorgasmia may also occur. Men may experience erectile dysfunction, problems with erection, and painful ejaculation.
Pelvic Organ Prolapse
Pelvic organ prolapse refers to the descent or protrusion of any organ into the vagina or rectum. This condition can lead to various complications, including:
- Cystocele: prolapse of the bladder into the vagina (the most common condition);
- Urethrocele: prolapse of the urethra;
- Uterine prolapse;
- Vault prolapse: prolapse of the vagina;
- Enterocele: prolapse of the small intestine;
- Rectocele: prolapse of the rectum.
Preventing all these scary pelvic organ complications is much easier than treating it. It’s essential to remember that pelvic floor muscle disorders do not go away on their own, and can even worsen over time. In the next section, we will discuss preventive measures and treatment options.
Treating and preventing pelvic floor disorders
Being attentive to your body and having regular check-ups with a specialist are the first and most reliable ways to prevent pelvic floor dysfunction. As we age, our muscles weaken, affecting both men and women. However, early detection means faster and more effective treatment. Even better, by taking preventive measures, you may not need any treatment at all.
To start preventing pelvic floor dysfunction, it’s essential to eliminate risk factors. A healthy lifestyle, proper nutrition, and moderate physical activity all play a crucial role. Kegel exercises are a popular method that can be done anywhere if you master the correct technique. Here is a guide for these exercises for men. While these exercises are effective during the prevention stage, it’s essential to consult a physiotherapist or gynecologist before starting them. They will guide you on how to perform the exercises correctly for the best results.
Simple tips to help prevent pelvic floor dysfunction:
- Avoid prolonged periods of sitting or standing;
- Take care of constipation ASAP, especially in young girls;
- Keep your weight in a healthy range and seek treatment for obesity if necessary;
- Quit smoking, limit alcohol intake, and reduce your consumption of caffeine and artificial sugars;
- When exercising, avoid heavy lifting and focus on low-impact activities that don’t strain your pelvic floor muscles.
Preparing well for labor is crucial for women. This involves enrolling in childbirth preparation classes, selecting a doctor, and discussing a birth plan with them. Furthermore, in the third trimester, women can begin preparing their bodies by practicing perineal massage and Kegel exercises, with the approval of their obstetrician. If the baby’s weight reaches 4 kg or more at 38 weeks, inducing labor may be a viable option to promote the onset of labor naturally.
C-sections may be recommended by a specialist (and specialist only) for weak labor contractions or a large baby size that is unsuitable for your body.
Methods to help strengthen the pelvic floor muscles
Kegel exercises are commonly suggested for both men and women with muscle weakness in the pelvic area. However, you should perform them accurately to engage the right muscles. You can seek assistance from a physical therapist or gynecologist to help you do the exercises correctly.
Physical therapy is often combined with other approaches to help restore normal muscle strength, endurance, and contraction. For women with weakened muscles, electrical stimulation and vaginal cones can be beneficial for stimulating proper tension and restoration. The benefits of the therapy can also be confirmed through the use of biofeedback technology, which allows for the control of the correctness and effectiveness of contractions. Additionally, biofeedback can enhance the effectiveness of specific exercises that strengthen the pelvic floor muscles.
Pelvic floor muscles can also be activated using a magnetic field or extracorporeal magnetic innervation (ExMI). This technique further stimulates the nerves in the pelvic area, not only affecting the muscles themselves, but also improving the functioning of the organs.
Alongside, depending on the degree of dysfunction, a doctor may recommend medication to ease symptoms. Vaginal cream with estrogen is often prescribed for women, and in cases of severe urinary incontinence, a supportive vaginal pessary can be used. This allows women to maintain muscle support and confidently leave their homes without stress, as well as avoid surgical intervention. Certain types of pessaries even allow for sexual activity.
Hyperactive PFMs treatment methods
Cramps caused by myofascial trigger point formation can be treated using relaxation techniques. These may include stretching, massage (deep and cross massage), and manual trigger point relaxation via the vagina or anus. Another technique that improves muscle condition is mobilization of the hip, pelvic, and spine joints, which can increase their mobility and muscle involvement. Additionally, muscle relaxants can be prescribed to alleviate symptoms.
When it comes to prolapse – the dropping or protrusion of organs – surgery is often recommended. It can either aim to repair the damaged tissue or organ, or to remove it entirely (such as in a hysterectomy to remove the uterus). However, this is a last resort and radical method that does not guarantee full recovery. That’s why it’s better to focus on prevention once the first symptoms appear, and even better – before they do.
Remember, prevention is key. Taking care of your body and making healthy choices now can help you avoid pelvic floor problems in the future. Act today to protect your pelvic floor muscles and prevent future complications. If you have any concerns, talk to your healthcare provider.
And the first way to prevent any disease is to understand your body and its processes. Founder of the School of Women’s Health, Natalia Silina, talks about this and more in her book “Women’s Business.”
For women’s health, body, physiology, and pleasure, there are also authorial courses like A girl becomes a woman, All about you. What it’s like to be a Woman, All about you 35+.
I’m eager to offer these courses in English. Please send a request to email@example.com.
We wish you health, strong muscles, and only preventive visits to the doctor.
And here, you can always rely on the specialists at Lior Medical Center.
Prepared by Dr. Silina School of Women’s Health, journalist Maria Zavialova.
All materials published on the Dr. Silina School of Women’s Health website have been reviewed by Natalia Silina, PhD, a gynecologist-endocrinologist and founder of the educational project.