Updated: Aug 2, 2019
(The Bladder and Pelvic Floor Part 2)
(If you missed part 1, find it here.)
The pelvis is a strong and fairly rigid ring of bones. It acts as a cradle for all the abdominal organs, with the help of a lot of muscles. A lot of the muscles that work with the pelvis are what we often call the “core”.
Sometimes people think of the core as the abdominal muscles used for situps and twists, but really the core is a complete cylinder.
The length of the core cylinder is formed by layers of abdominal and spinal muscles. The top end of the core is the diaphragm. Because it moves up and down with our breath, the pressure inside the core is constantly changing!
The base of the cylinder is formed by the layers of muscles that fill in the opening at the lower end of the pelvis. This is the “pelvic floor”. It has muscles that run from side to side, muscles that run from front to back, and even muscles that form circles around our very important exit passages.
To make things even more complicated, there are multiple nerves involved in managing the muscles of the pelvic floor, as well as the bladder and bowel. The nerves carry very important messages so that our bladder and our muscles can act in harmony. That’s A LOT of structures working together!
Think of it like the staff in a restaurant. If everyone is working together, the meals come out on time and everyone is happy. But what if the wait staff don’t hear the call that the next dishes are ready to go out? What if the order for 3 more garlic bruschetta was never given to the chef? Communication leads to coordination, and that creates a better end result.
Fortunately there’s no need to learn the Latin medical names for all these muscles, nerves and organ parts. (Unless you’re a medical or physio student!) Here are some important basics:
There are layers of muscles. This means that sometimes one layer can learn to successfully compensate if another layer is damaged - perhaps torn during childbirth.
Coordination is important - problems can occur because the structures have ‘forgotten’ how to work together. This is usually due to past injury, but may not fix itself even though the injury has healed.
Muscles can be too tense. Just as tension in your neck can give you a headache, tension in your pelvic floor can cause pelvic pain. Some people benefit from strength training, some from relaxation training, and some from a combination of both.
Muscles are stretchy. We do hamstring stretches to make our hamstrings longer. If we continually stretch the pelvic floor muscles (eg straining because of constipation), they will get longer too. Like a slightly saggy trampoline mat, they can be pressed further down by the weight of organs, or by the internal pressure of things like coughing.
Why does it matter if the pelvic floor is hanging a little lower than it used to?
The urethra (the exit tube from your bladder) is open when urine is passing out, and closed when urine is being kept in. This is not just because muscles squeeze it shut. The tube is cleverly built, with a bend in it so that it keeps itself closed, as long as it and the structures around it are in the positions they are supposed to be in.
The pelvic floor is the lead player in keeping those structures where they should be. When you cough or sneeze, you create pressure that pushes the organs downward. Your pelvic floor needs to be capable of holding its position against that downward pressure, so the bend in the tube keeps the tube closed - and keeps the urine in.
What else does the pelvic floor do?
The pelvic floor has several jobs on the side, which we tend to forget because the focus is so strongly on pelvic floor exercises.
Extra Job One: The pelvic floor has a clever trick: activating the pelvic floor actually stimulates the nerve that tells the bladder muscle to relax – and a relaxed bladder can hold more urine comfortably. Squeeze up your pelvic floor, and you are telling your bladder to chill out until you find a toilet.
Extra Job Two: Another handy thing about a healthy pelvic floor is that the actual bulk of the muscle tissue also contributes to holding things in the right place. We know muscles that are exercised get larger, and muscles that are not used get puny and waste away like a leg that’s been in plaster. The same thing happens to pelvic floor muscles, we just don’t notice because we can’t see them. A healthy, bulky pelvic floor works for us even when it isn’t active.
Extra Job Three: Last but certainly not least, the pelvic floor isn’t just about stopping leaks. The muscles, especially the ones closest to the outside, have a sensory function during intercourse - that's polite for they help us feel the action. Pelvic floor muscle contractions can also help to stimulate our natural lubricant. And the muscles contract during orgasm.
Stronger muscles = stronger contractions = stronger orgasm.
It’s hard to think of a muscle we should be more keen to make strong and healthy!
Are you wondering if orgasms count as exercising the pelvic floor? I have the answer you’re looking for: YES. Partner optional ;)
Look for the next installment in the pelvic floor series with 3 ways to protect your pelvic floor HERE.
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