© 2019 by Spinal Symmetry Pty Ltd

 

The Pelvic Floor

August 2, 2016

In this article we will be discussing the aspects of the pelvic floor and it’s relevance in how the Spinal Symmetry method is able to maximise pelvic floor function.

 

 

The pelvic floor is a group of muscles that function like a hammock suspended from the tailbone at the back, to the pubic bone at the front and to the surrounding sides of the inner or lower pelvic rim.  The pelvic floor consists of the broad levator ani muscles (at the front) as well as the coccygeal muscles (at the back).

 

 

The pelvic floor has a number of functions:

  • Locally, the pelvic floor muscles support the pelvic organs- the bowel and bladder, as well as the female or male genitalia. It does so by maintaining a constant state of contraction against the forces of intra-abdominal pressure, lifting the organs and tightening the sphincters or opening of the vagina, anus and urethra. In doing so, the pelvic floor assists in maintaining urinary and faecal control.

  • Globally, the pelvic floor has an important role in core stabilisation and breathing mechanics. It activates in a coordinated manner with the diaphragm and transverse abdominus (deep stomach muscles), as well as the deep intrinsic muscles surrounding the spine called the multifidi. Together, these four muscles form a barrel or corset-like structure, bracing the spine and pelvis as well as supporting the abdomino-pelvic organs.(1) (2) (3)

 

 

When the pelvic floor activity is compromised, it leads to pelvic floor dysfunction. It is important to know that these pelvic floor muscles can be consciously controlled. This means that if a person develops symptoms or signs of pelvic floor dysfunction, most of the time they can be trained much like any other muscle group in our body.

 

Pelvic floor dysfunction occurs in both males and females, however is more common in females.
Most signs and symptoms of pelvic floor dysfunction are caused by the internal pelvic organs not being supported.


Pelvic floor dysfunction also contributes to the integrity of the body’s core stabilisation also known as lumbo-pelvic stability, which may show up as low back pain.

 

Signs and symptoms of pelvic floor dysfunction may include :

  • Low back pain

  • Urinary stress incontinence- involuntary urinary leakage upon increased intra abdominal pressure such as heavy lifting or coughing

  • Urgency incontinence- failure to reach the toilet in time to urinate

  • Anal incontinence- uncontrollably breaking wind or passing stool when bending over or heavy lifting

  • Tampons that dislodge or fall out

  • A sensation of heaviness

  • Pelvic organ prolapse- a sensation of a vaginal or urethral descent, bulge or protrusion

(4),(5),(6)

 

Causes of pelvic dysfunction include

  • Pregnancy, due to the weight of baby in the uterus placing stress on the pelvic floor and increasing intra abdominal pressure. There is also weakness and laxity of muscles and ligaments due to release of the hormone relaxin.

  • Vaginal delivery, where muscles, nerves and ligaments may be traumatised.

  • Constant rise in intra abdominal pressure i.e from straining, coughing, sneezing and physical exertion.

  • Obesity

  • Sexual intercourse

  • Intra – pelvic surgery

(7), (8),(9)

 

Management of pelvic floor dysfunction traditionally involves muscle re-education or strengthening based exercises to re-engage or strengthen the pelvic floor muscles.


It is important to know that when dysfunction happens it is not only weakening of the pelvic floor muscles though physical trauma, there can also be a interruption to the messages to the brain (via the nervous system) from the pelvic floor muscles. 
This is termed a neuro-muscular control issue. This is a functional issue.

 

An effective way to deal with a functional issue such as this, is to work from the point of view that ‘structure governs function’. Structure in the human body is the skeletal system.
The skeletal system holds the body up in gravity. How the body functions is based on the feedback the brain receives from the body’s centre of gravity- which lies anatomically in the sacrum (which is part of your pelvis)

 

 

 

Based on the work we do within the Spinal Symmetry method, your centre of gravity is determined structurally by your hip angles.
If the angle of the hips are balanced, then the centre of gravity will lie within the sacrum (see diagram)


If the angles of the hips are not balanced, there will be a shift in your centre of gravity which creates a disturbance to the entire skeletal system!!

This happens because the communication between your brain and your centre of gravity determines how well you remain upright.


If in this case where there is a neuro-muscular issue in the pelvic floor (which is directly connected to your pelvis), then by correcting where your centre of gravity lies within your pelvis, we are able to allow the pelvic floor to send more effective messages to the brain.
This we find, is a crucial starting point in treating and managing pelvic floor dysfunction. Any exercises which involve muscular rehabilitation is then in a much better position (literally!) to respond well once the structure is corrected.

 

 

 

References 

  1. Clinically Orientated Anatomy 6th edition, 2010.

  2. Craig Liebenson : Rehabiliation of the spine 2007

  3. Corton M.M, 2009, Anatomy of Pelvic Floor Dysfunction. Obstetrics and gynaecology clinics of North America. 36(3):401-419

  4. Dr.  Sherburn M. 2014. Conservative Management of Adult Pelvic Floor Dysfunction: a Physiotherapy Approach.

  5. Wieslander C.K. 2009. Clinical approach and office evaluation of the patient with Pelvic Floor Dysfunction. Obstetrics & Gynaecology Clinics of North America. 36:445-462.

  6. Pelvic Floor. 2015 . Better Health Channel. (http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pelvic_floor)

  7. Maclennan A H, Taylor A W, Wilson D H. 2000. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. Journal of Obstetrics & Gynaecology. Vol 107, 12. 1460-1470.)

  8. Bo K, Berghmans B, Morkved S, Van Kampen M.2015. Evidence based Physical Therapy for the Pelvic Floor – Bridging science and clinical practice. 2nd edition.

  9. Eliasson, K., Elfving, B., Nordgren, B., et al. 2007. Urinary incontinence in women with low back pain.  Manual Therapy, 13(3), 206-212.)

  10. Korda A, Benness C, Dietz HP. A guide to understanding pelvic floor exercises. Sydney urodynamic centres .http://www.urodynamic.com.au

     

 

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