Strong and supple pelvic floor muscles are essential to our good health, wellbeing and continued enjoyment of great sex, urinary and fecal continence, core stability and even good breathing technique. Since the YouTube release of “CrossFit -Do You Pee During Workouts?” the issue of stress urinary incontinence (SUI) has become a hot topic. While the ignorance of the professionals on the video is shockingly sad, opening up this conversation is a good thing. Peeing during workouts, laughing, coughing, running is not normal! There is help!
The pelvic floor is formed primarily by two sets of muscles – the levator ani and the coccygeus, and together they form the funnel-shaped pelvic diaphragm – the base of our core cylinder. The levator ani is comprised of three muscles – the puborectalis, pubococcygeus and the iliococcygeus – their names telling us where they are located within the pelvis. The puborectalis attaches at the pubis to each side of the pubic symphysis and slings around the rectum. The pubococcygeus reaches from the pubis, anterior to the obturator canal, and the anterior portion of the tendinous arch on the ischium, and then surrounds the rectum and attaches to the anococcygeal raphe and the lateral coccyx. The iliococcygeus originates from the posterior tendinous arch, obturator internus fascia and ischial spine, and attaches at the anococcygeal raphe and coccyx. And finally, the coccygeus is situated posteriorly to the levator ani and attaches on the ischial spine and the sacrospinous ligament and reaches back to attach to the lateral part of the lower sacrum and upper coccyx.
The pelvic diaphragm lies deep to the superficial perineum. The perineum is the diamond shaped area framed by the pubic symphysis, the ischial tuberosities and the coccyx. Here the small muscles associated with the orifices of the pelvic organs – sphincters of the urethra and anus, and muscles of the vaginal opening are fixed within the double-layered perineal membrane, as is the clitoris. A line drawn between the ischial tuberosities divides the area into the urogenital triangle anteriorly and the anal triangle posteriorly. This distinction becomes important when trying to isolate and exercise the different areas of the pelvic floor musculature.
The main functions of the pelvic diaphragm are:
1 – providing physical support for and securing the positions of the lower abdominal organs – bladder, uterus or prostate, and rectum.
2 – continence – having both voluntary and involuntary mechanisms for the contraction of muscles involved in starting or stopping urination, tightening the vagina or maintaining penile erection, and contracting the anal sphincter.
3 – supporting respiration – responding to and moving with the respiratory diaphragm, regulating the pressure of intra-abdominal fluid, and directly affecting the quality and fullness of the breath
4 –core stability–working together with the transverse abdominis, respiratory diaphragm and multifidi, the pelvic diaphragm provides constant support and stability to the pelvis not only as we move, but in preparation for any movement, including simple arm movements.
To successfully perform the above functions, the pelvic diaphragm must be able to alternate between strong and activated, and relaxed and supple. This balance between muscular tonicity and elasticity is a functional requirement sadly lacking in too many bodies.
So, that’s the pelvic diaphragm anatomy lesson. Tune in to Part 2 for some great YogaTune Up® techniques and exercises that will strengthen your pelvic floor muscles to embody this strong and supple balance.