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The 9 Roles of the Pelvic Floor

Introduction

The pelvic floor (PF) plays a variety of important roles in our bodies. There are many factors that influence the ability of the pelvic floor to fulfill these roles. Yoga can serve as a valuable adjunct in pelvic wellness and rehabilitation by enhancing and supporting these roles using a biopsychosocial, whole-person perspective. This is a guest blog written by Shelly Prosko, a physiotherapist, yoga therapist, educator and pioneer of PhysioYoga with over 20 years of experience integrating yoga into rehabilitation. Below she will outline nine important roles of the PF as the first step to understanding how yoga can be used to enhance pelvic floor health and why we need to consider this group of muscles as physiotherapists, healthcare professionals, and movement therapists.

Roles of the Pelvic Floor 

The anatomy of the PF is described in my online course. The roles of the pelvic floor are outlined as follows: 

I. Connects Pelvis to the Sacrum:

The pelvic floor supports the connection between the pelvis and the sacrum. Muscles, fascia, and ligaments are all important in this connection.

II. Supports Pelvic Organs:

The PF  plays a role in the support system of the organs situated in our pelvic cavity. Organs including the vagina, cervix, and uterus in women, and the rectum, small bowel,  bladder, and urethra in both men and women, are all supported in part by the pelvic floor. 

There are many other structures in the pelvic cavity that help to support the pelvic organs and the extent of support also depends on the pressure system which is influenced by the way we breathe and move. Disruption in any one or more of these factors can sometimes contribute to a pelvic organ ‘falling’ down (ie, ‘prolapse’) which may or may not lead to problems. The good news is, there are practices we can do to help address this issue! I discuss this in length, with accompanying practices, in my online course, PhysioYoga and the Pelvic Floor.

III. Helps in Bowel and Bladder Function: 

Bowel and urinary continence mean the ability to control the bowel and bladder. It is certainly a part of overall bowel and bladder health. We must have the ability to voluntarily and involuntarily engage and relax the PF muscles in order to control the bowel and bladder, including stopping the flow when we need to and also relaxing enough to fully and efficiently empty both bowels and bladder. 

IV. Supports Sexual and Reproductive Function:

The pelvic floor plays a role in reproductive function such as in labor and delivery in women. The PF also plays a role in sexual health and function and sometimes when PF issues like too much tension or a non-relaxing PF arise, this can lead to pain and problems with sexual activities of daily living, including intercourse, masturbation or other activities involving the pelvic floor and genitals. In my online course, I also address this role of the PF and the biopsychosocial factors that may influence its ability to fulfill its role in these areas.  

V. Acts as a Team Player in the Core Strategy System:

The pelvic floor is part of the core strategy system along with the respiratory diaphragm and many other synergistic muscles, that help to control and regulate intra-abdominal pressure and contributes to efficient movement. The amount of engagement of the PF will depend on the demands of the task. 

VI. Works in Timing with Breathing:

The pelvic floor and the respiratory diaphragm move together in a rhythm when we breathe. An important point here is that the direction of the movement is sometimes misunderstood. The PF and respiratory diaphragm both go down on inhalation and rise back upon exhalation. The amount of movement that happens will depend on many factors, including the demands or intention of the activity.

Shelly Prosko of PhysioYoga demonstrates the extended child's pose to help us understand the movement of the pelvic floor with the breath cycle:

VII. Supports Hip Health and Function:

The association of the pelvic floor with hip function is no surprise as the sidewalls of the PF anatomically include some hip muscles. Learning about pelvic anatomy can help us understand the role that the PF plays in hip health and function and then we can use that information to inform our rehab practice or our own health.

Dive deeper into pelvic anatomy to learn and enhance the connection to and awareness of the pelvic floor. Register for PhysioYoga and Pelvic Floor with Shelly Prosko.

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VIII. Contributes to Our Balance:

The pelvic floor helps us with our balance reactions. Here, we can refer to balance as the ability to come back to the center when our center is displaced outside of our base of support. 

A study done by Smith et al. (2008), found that a group of women that had pelvic floor dysfunction as measured by incontinence also had decreased balance ability when compared to a group of continent women without PF dysfunction. The poor balance and PF dysfunction also were associated with an over-activated PF (not under-activated as one might think)!  This is relevant when we think of the PF as a part of our overall core strategy system, and how this coordinated system is important for movement and balance.  

IX. Facilitates Voice Production:

The respiratory diaphragm and the structures of the vocal diaphragm work together to produce sound. On an exhalation, the respiratory diaphragm ascends and the air is pushed out through the voice box. This allows the vocal folds to vibrate and produce sound.   

The quality of our voice, the volume, and the projection can depend on a variety of factors, including our breathing system. Recall that the PF moves in timing with the respiratory diaphragm, and both can influence the quality and mechanics of the exhalation, therefore contributing to our voice! 

Relationship of the Pelvic Floor to a Chakra System:

While there is no scientific evidence of the chakra systems, we can gain practical information and insights by learning about what yoga traditions teach about chakras, and perhaps consider some of these perspectives and use them to inform our pelvic rehab and wellness practice, staying within the scope of practice of our professions. I give some examples of how this might be done and why it might be valuable in some of the case studies in my online course.

Whether you are a pelvic floor physiotherapist looking to expand your current approach or a brand-new practitioner (healthcare or yoga professional) wanting to learn more about the pelvic floor, Shelly’s online course is meant to help support you on your path to learning more about how yoga can be integrated into pelvic rehab and wellness in an evidence-informed manner.

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Conclusion 

In this blog, we reviewed the wide-ranging roles that the pelvic floor plays in our body. Pelvic health is essential for all of us, men and women, and the roles of the pelvic floor are not just limited to bowel and bladder health or reproduction and sexual functions but it also plays a role in hip health, breathing, vocalization, and is also a key player in our core strategy movement and balance system. Furthermore, there are numerous biopsychosocial factors that may influence the ability of the pelvic floor to fulfill the above roles. This is where yoga comes in and can offer a pragmatic and accessible biopsychosocial, whole-person centered framework and specific practices to enhance pelvic floor rehab, health, and wellness.

Whether you are a pelvic floor physical therapist, yoga therapist or other movement practitioner looking to expand your current approach or wanting to learn more about pelvic floor and yoga therapy, continue your education with Shelly’s complete online course (over 14 hours of a combination of lecture and practices on video content) which you can take on your time and schedule, and own forever.

Shelly Prosko, PT, C-IAYT, CPI 

Shelly is a physiotherapist, yoga therapist, author, educator, and pioneer of PhysioYoga with over 20 years of experience integrating yoga into rehabilitation with a focus on helping people suffering from chronic or persistent pain, pelvic health conditions, and professional burnout. She guest lectures at yoga and physiotherapy programs, contributes to academic research, presents at yoga therapy and medical conferences globally, provides mentorship to health providers, offers onsite and online continuing education courses for yoga and health professionals and is a Pain Care U Yoga Trainer. She maintains a clinical practice in Sylvan Lake, Canada and believes that cultivating meaningful connections, compassion, and joy can be powerful contributors to recovery and well-being. Shelly is co-editor of the book Yoga and Science in Pain Care: Treating the Person in Pain.

Please visit www.physioyoga.ca to learn more

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