Pelvic Floor FAQs
What is the pelvic floor and where is it located?
The pelvic floor is a group of muscles that stretch from the tailbone to the pubic bone (from the back to the front of the base of the pelvis) and support the pelvic organs, including the bladder, rectum, and prostate gland in men. These muscles are made up of three layers: the superficial layer, the middle layer and the deep layer. The superficial layer is composed of the bulbospongiosus, ischiocavernosus, and transverse perineal muscles which are involved in urinary and faecal continence as well as playing a role in ejaculation. The middle layer consists of the deep transverse perineal muscles and the perineal membrane. The deep layer includes the puborectalis, pubococcygeus, and iliococcygeus muscles and is involved in the maintenance of continence and supporting the internal organs.
What is the function of the pelvic floor muscles?
The pelvic floor muscles contribute to continence by acting as a sling or hammock, supporting the pelvic organs and maintaining their proper position. The muscles are responsible for controlling the urethral and anal sphincters, which allow for voluntary control of urination and defecation. When the pelvic floor muscles are weak or dysfunctional, it can lead to incontinence (an inability to control voluntary function of bladder or bowel movements leading to leakage of urine or stool). The pelvic floor muscles also physically support the bladder and bowels, helping maintain the correct pressure within the bladder. Additionally, the pelvic floor muscles are involved in sexual function, including maintaining an erection in men and orgasm in both men and women.
How do the pelvic floor muscles contribute to continence?
The pelvic floor muscles contribute to maintaining our continence as they surround the urethra (the tube that carries urine from our bladder out of our body) and the rectum (the passageway from our intestines out of our body). By surrounding these structures, when these muscles contract, they squeeze around these tubes, constricting them and disallowing the passing urine or faeces. We can control this, and conversely (hopefully when we’re at the appropriate place to urinate or defecate) when these muscles relax, they allow urine or stool to be released. The strength & coordination of these muscles are key factors in being able to maintain our control of this function, thus our continence.
What can go wrong with the pelvic floor?
The pelvic floor can become dysfunctional and the pelvic floor muscles can become weak, tight, or have poor coordination, leading to a range of symptoms, most typically incontinence by not being able to control the constriction of the urethra and rectum as outlined above. Other symptoms can include erectile dysfunction, painful urination or bowel movements, and pain or discomfort in the pelvic area.
What causes pelvic floor dysfunction?
There are a few factors that can contribute to dysfunction of the pelvic floor muscles. Undergoing prostate surgery is one of the primary reasons men experience pelvic floor dysfunction. It is thought this may be due to: a disruption in neural function supplying the pelvic floor muscles; inflammation in the area of the prostate due to the surgery; a change in the position of the pelvic organs with the removal of the prostate gland; a change in bladder function after surgery.
What are some other factors contributing to pelvic floor dysfunction?
What can I do to improve my pelvic floor?
Pelvic floor muscle training (PFMT) is a great tool to help overcome challenges you may have with dysfunction and improve your continence. Just like any other muscle, your pelvic floor can be trained! It can be tricky though as you can’t see your pelvic floor, thus it’s hard to get feedback on whether you’re performing the exercise correctly. This pelvic floor muscle training can help improve the strength and endurance of these muscles but most importantly your control of these muscles (the ability for your brain to signal to these muscles to contract).
What are some tips for pelvic floor muscle training?
It is important to learn to isolate and contract the pelvic floor for pelvic floor training. Using cues is most helpful to achieve this. Cues such as ‘nuts to guts’ or ‘stopping the flow of urine’ or ‘shortening the length of your penis’ are helpful for most men trying to contract these muscles. It is important to ensure the contraction is localised to just the pelvic floor (the rest of your body should be relaxed - don’t hold your breath or contract your abdominals!). A physiotherapist can help guide you through this and ensure you are performing the exercises correctly.
Often it is recommended to use various types of contractions to train your pelvic floor in different ways. Your muscles have two different types of fibres called slow twitch and fast twitch fibres. Slow twitch fibres are better for endurance (think contracting all day to support your organs and provide light pressure to the urethra to prevent leaking) and fast twitch fibres are better for contracting quickly and forcefully (think preventing leaking when you cough, run or jump). Therefore it’s best to practice holding a light contraction for a few seconds before releasing and fully relaxing (this is important) the pelvic floor and slowly increasing the time you can hold it. To train the fast twitch fibres you can do what is called ‘the knack’ ('ma ma ma myyy Sharona! ... no, not that Knack - but if that helps you remember it, great!). This is a fast, strong, well timed contraction held briefly, then fully relaxed.
What can we do to help here at Sycamore Health?
At Sycamore Health, we have expert physiotherapists who have undergone additional training in the area of Men’s Health. We can provide a thorough assessment of your pelvic floor function and work with you to regain control of your continence and your life. We will work with you to ensure you are able to perform the exercises properly and have the correct prescription. We have access to real time ultrasound which can be a very effective tool to get live feedback of your pelvic floor function and your ability to control it.