Pubic symphysis, coccyx, iliococcygeus,  .... Say what??? Anatomy Lesson 101

OK ladies, it's time for an anatomy lesson! Please don't run away at the thought of this, it's actually really important.

In my last blog I emphasized the need to be able to talk openly about our pelvic health issues, but now we need to take the time to physically explore these areas that are contributing to those symptoms. How can you fully verbalize what's going on, or begin to understand these issues, if we don't know the components?

Unfortunately, our high school Sex Ed course probably didn't go into much detail about the pelvic floor muscles. And those posters in your doctor’s office don't really give you the best perspective either.

So let’s begin......

The pelvic floor muscles are at the very bottom of your pelvis and are often described as a sling of muscles attaching font to back. They support your organs, work with the rest of your core to help provide stability, have a sexual function and are needed for bladder and bowel control. Essentially, some pretty major functions to our basic needs!

The bones..... 


So let's do a little exercise to first orientate to the area we are talking about. If you can find a firm surface to sit on, sit tall and lift your bum cheeks out of the way. This will allowed you to feel your sitz bones (ischial tuberosities) firmly into the chair. Begin by rocking your pelvis forward and back.  You'll get a sense of your pubic bone in the front and your tail bone, coccyx, towards the back. Find the space between these two extremes or centre. Can you feel even weight between both your sitz bones? If you are having trouble gaining a sense of this area, try actually feeling these bones with your fingers. These bones are some of the main attachment points of the pelvic floor muscles. 

If you can visualize these bones, the pubic bone, coccyx, and both sit bones, you'll be able to see a diamond shape. In the centre of this diamond is your perineum, the space between your vagina and anus. This is the centre anchor point of your pelvic floor muscles. (The perineum is also the place where an episiotomy cuts through.) Remember these bones and the diamond formation when it comes time to contract your pelvic floor. 

On to the muscles......

There are three layers to your pelvic floor muscles, but it is the deepest layer that provides the contraction we aiming for. When the pelvic floor muscles contract they need to tighten or squeeze, but also lift upwards. The general tension and the ability to contract the muscles is what helps support the pelvic organs and maintain continence of both the bowels and bladder. Contraction will help provide closure of the Urethra (where urine comes out) and the anus (where feces comes out). Conversely, relaxation of these muscles is needed for proper elimination. The deepest layer, also called the pelvic diaphragm, is comprised of the following muscles: the Levator Ani (Pubococcygeus, Puborectalis, and Iliococcygeous) and Coccygeus. The Piriformis and Obturator Internus, which are hip rotator muscles, can also be palpated internally. 

Now picture these muscles attaching to the inside of that boney diamond we talked about. As they contract, pulling up and in, visualize the diamond getting smaller, and as you relax the diamond relaxes back to its original shape. 

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So give it a try, can you contract your pelvic floor?

Feeling this contraction can be difficult! Research has estimated that approximately 30% of women cannot contract their pelvic floor muscles properly. And physiologically they do not have the same receptors to say where they are in space. So don't get frustrated if you can't feel this contraction.....and go see a pelvic floor physiotherapist! I promise you will gain an entirely new awareness and understanding of this complex and amazing part of your body.