What is the Pelvic Floor?
The pelvic floor consists of striated muscles, ligaments, and connective tissues that support the pelvic organs against gravity and intraabdominal pressure. The musculoskeletal structure has been vastly overlooked in the past in terms of diagnosis and treatment and as a primary and secondary source of pelvic floor dysfunction. In the past, it was thought that the pelvic diaphragm is composed of the coccygeus muscle posteriorly and the levator ani anterolaterally. Emerging evidence and focus on anatomy has identified a much more complex interrelationship between several individual muscles; each with their own distinct function, action and susceptibility to injury. The components of the female levator ani consist of the iliococcygeus, the pubococcygeus, pubovaginalis and the puborectalis. Superficial muslces include bulbocavernosus, ischiocavernosus and transverse perioneal.
The pelvic floor must allow relaxation of this support at the urogenital hiatus during voiding and parturition while maintaining the anatomic position of pelvic structures.
The complex mechanics of its bimodal function and frequent insults to the integrity of the pelvic diaphragm from altered biomechanics, pregnancy, athletics, menopause, sexual trauma and obesity contribute to the pelvic musculature’s vulnerability to damage and injury.
Lying within the pelvic cavity are the piriformis, and obturator muscles, which are not elements of the pelvic diaphragm but may contribute to pelvic pain when injured. These muscles are easily accessible from an intravaginal perspective. Many underlying hip, low back and sacroiliac pain syndromes begin with PF dysfunction. This is why it is critical to consider more than just the levator ani and coccygeus muscle groups.