Pelvic Floor 101: Muscles and Tendons and Nerves, Oh My!
In human health and medicine, few areas are as important (or as misunderstood) as the pelvic floor. Whether you're experiencing symptoms or you're simply interested in maintaining optimal pelvic health throughout your life, understanding your pelvic floor is essential.
At Cervu Health, we believe that knowledge is power. The more you understand about your body's intricate systems, the better equipped you are to recognize changes, seek appropriate care, and make informed decisions about your health.
Today, we're diving deep into pelvic floor anatomy and function to give you the foundation you need to improve and maintain your pelvic health.
What Is the Pelvic Floor?
When most people think about the pelvic floor (if they ever do!), they’re thinking about muscles…but it’s so much more than that! Your pelvic floor is a complex network of muscles, connective tissues, blood vessels, and nerves that form the foundation of your core.
The muscles attach to the base of your pelvis, stretching between your tailbone (coccyx) in the back, your pubic bone up front, and your sitting bones (ischial tuberosities) on the sides. Several types of connective tissue—think ligaments, tendons, and fascia—help to support these muscles. The blood vessels and nerves feed and control the muscles.
Think of your pelvic floor as a supportive hammock that cradles your pelvic organs from below. This "hammock" consists of three distinct muscular layers, each with specialized functions that work together to support your daily activities and overall health.
The Three Layers of The Pelvic Floor
Layer 1: The Outermost Layer The outermost, or superficial, layer contains four muscles that control the opening and closing of all the “holes”. For folks with female anatomy, these are the urethra (where you pee from), the vagina, and the anus. When functioning properly, these muscles:
Relax to allow urination and bowel movements, then contract to maintain continence between bathroom visits.
Allow for sexual function by contracting and relaxing the vaginal opening.
Layer 2: The Middle Layer This intermediate layer also consists of four muscles that assist the outermost muscles and provide additional support. These muscles help to:
Prevent urinary leakage by keeping your urethra closed when you aren’t on the toilet.
Provide structural support to your pelvic organs.
Control movement of the vaginal opening during penetrative sex.
Layer 3: The Innermost Layer The deepest layer contains two muscle groups that work like a supportive sling. These muscles:
Provide the primary support for your internal pelvic organs—including the bladder, intestines, and uterus, if it’s present.
Stabilize the pelvic joints at the base of your spine.
Some of these deep muscles also wrap around the rectum to assist in bowel control.
Helper Muscles
In addition to the three layers of “true” pelvic floor muscles, other muscles in the area assist in pelvic floor function. Think of these as “helper” muscles: pelvic function isn’t their main job, but they provide additional support when your body needs it.
Several muscles of the hips, for example, act as helper muscles. This is why most pelvic health physical therapists examine their patients’ hips: if your hip muscles aren’t functioning well, this can mess with your pelvic floor (and vice versa). It’s all connected!
The Deep Core Canister: How Your Pelvic Floor Connects to Everything
Speaking of everything being connected...your pelvic floor forms part of a larger system that pelvic PTs call the "deep core" or "core canister"—an integrated network of muscles that work together to provide stability and manage pressure within your abdomen and pelvis.
Imagine a cylindrical container, like a soda can. Your diaphragm—the primary breathing muscle—forms the top of this container. The cylindrical sides are made up of your deepest abdominal muscle (the transverse abdominis) and your deep spinal muscles. Your pelvic floor muscles form the bottom of this container.
These muscle groups work together to maintain a consistent pressure inside the container. Ideally, they function as a coordinated team, lengthening and contracting together in response to your breathing and daily activities.
However, if any one of them isn’t pulling its weight, the other groups must pick up the slack. If this goes on for a long time, the muscles doing extra work become fatigued and dysfunctional, while the tuned-out muscles get weaker and less efficient.
The Five Essential Functions of Your Pelvic Floor
Understanding what your pelvic floor does can help you understand why dysfunction in this area can have such wide-ranging effects on your health and quality of life. Your pelvic floor performs five primary functions:
1. Sphincter Control
Your pelvic floor muscles act as sphincters, controlling the opening and closing of your urethral and anal passages. Proper sphincter function allows you to maintain continence when it's not appropriate to empty your bladder or bowels, then relax appropriately when you're ready to go.
2. Support
Like a hammock holding a person between two trees, your pelvic floor provides structural support for the organs inside your pelvic cavity. This support system helps maintain proper organ position and prevents conditions like pelvic organ prolapse, in which organs descend from their normal positions.
3. Stability
Your pelvic floor contributes to core stability, helping to stabilize your pelvis and lower spine during movement. This stability is crucial for proper posture, efficient movement patterns, and injury prevention.
4. Sexual Function
The muscles of your pelvic floor play important roles in sexual sensation, arousal, and orgasm. If you have vaginal anatomy, they contract and relax the vaginal opening: this action contributes to satisfaction and comfort during sex. For those who deliver children vaginally, the pelvic floor muscles are critical to the childbirth process.
5. Sump Pump Function
Perhaps the least known (but critically important!) function is your pelvic floor's role in lymphatic drainage. The repeated contractions of pelvic muscles act like a sump pump, moving lymphatic fluid through channels out of your pelvis. This drainage system reduces swelling, prevents infections, and helps maintain proper fluid balance throughout your body.
Knowledge is Power: The First Step in Your Pelvic Health Journey
Understanding your pelvic floor is the first step toward optimal pelvic health. Whether you're currently experiencing symptoms or working to prevent future problems, this knowledge empowers you to make informed decisions about your care.
Remember that like any other muscle group in your body, your pelvic floor muscles can be strengthened, stretched, and retrained. With the proper guidance and tools, most pelvic floor dysfunction can improve significantly: you don’t have to “just live with it”!
If you're experiencing symptoms such as bladder leakage, pelvic pain, or sexual dysfunction, don't hesitate to seek help. Pelvic health physical therapists and other healthcare providers specializing in women's health can assess your unique situation and develop a treatment plan tailored to your needs.
At Cervu Health, we understand the crucial importance of healthy pelvic floors—and healthy humans. We also understand the unique challenges that female cancer survivors face in managing pelvic floor problems. We’re here to support you with tools to improve your pelvic health, no matter your history.
This article is intended for educational purposes only and should not replace professional medical advice. If you're experiencing pelvic floor symptoms, please consult with a qualified healthcare provider for proper evaluation and treatment.
About the Author
Caitlyn Tivy, PT, DPT, OCS
Dr. Caitlyn Tivy is a pelvic health physical therapist, clinical consultant, and medical writer. As Chief Clinical Officer of Cervu Health, she’s focused on helping Cervu users regain their health and wellbeing after cancer. Caitlyn believes that all survivors deserve compassionate, inclusive care and access to the most effective recovery tools. She specializes in smashing taboos, centering science, and making complex medical topics easy to understand.
