Part 1: why are they important?
This is the first part of a three part blog on the pelvic floor muscles (PFM). In the first part I explain what they are, why they are so important and how you can get some idea of whether yours are tight or weak. In the second part I give some breath, touch and movement practices to connect with them. In the third part I share a visualisation.
For each part there is a blog on YouTube. The first part is here
I refer to the Extraordinary Vessels. If you want to know more about these I also have lots of blogs and videos on them in my Substack ” Rewriting your life”, as well as here on my website.
What are our PFM and why are they so important?
Introduction
You have all probably heard of the pelvic floor. But how well do you know them, and do you exercise them daily? If you have been pregnant, you are more likely to know about them than if you haven’t, but even if you are a man they are important. It is estimated that as many as 50% of Caucasian women suffer from some form of dysfunction.
They are important muscles for everyone to know how to love, young and old men and women, whether you have had children or not. I want to share with you what I have learnt over the years about the PFM both anatomically as well as their relationship to meridians in Chinese medicine and how you can love and care for them through the different phases of your life. They can be too weak or too tight, or indeed a bit of both!
They are not necessarily engaged correctly during sport, yoga, movement unless you are aware of them. However there are simple specific exercises which can be done to improve their muscle tone and strength and, importantly, also learn how to relax them. I’ve had clients doing them while brushing their teeth or stopped at red traffic lights because they have realised how important it is to care for them regularly.
Massage and shiatsu therapists, unless they have specific training, don’t directly touch the PFM, but we don’t need to touch them in order to assess and support them. However it is helpful for you to massage and touch them, and even get your partner to do this.
If you have problems with your pelvic floor, especially if you suspect a prolapse, then it can be helpful to go to a physiotherapist or osteopath who specialises in pelvic floor who can give you a specific assessment.
What are your pelvic floor muscles (PFM) exactly and what is the difference between them and your perineum?
They are a group of muscles attached to the different bones of our pelvis. Some are attached more between our front and back ( coccyx (tail bone) and pubic bone) and some more from side to side (our hip bones – ischium and ilium). Many of the muscles are named after the bones they attach to. They literally create a “floor” for your pelvis, supporting your pelvic organs. Sometimes they are known as your pelvic diaphragm.
The outer part is our perineum. It forms a figure of 8, between our pubic and tail bones, wrapping around our penis or clitoris, urethra, vagina and anus. It includes the bulbo and ischio carvernosus muscles. I love these names – the entry to our cavern or as the ancient Chinese said, our “Palaces” (reproductive organs). Running horizontally through the centre are our transverse perineal muscles. These attach to our sitting bones (ischium). At the centre of the 8 is the central tendon (or perineal body) where most of the muscles and some fasciae meet. This is crucial to providing support. If it is weak then our rectum, uterus, and even bladder may prolapse. Sometimes it gets ruptured when giving birth.
Below our perineum are deeper muscles – pubococcygeus, iIliococcygeus, and puborectalis together known as the levator ani. They are about 3-5 cm deep and supported by the ischiococcygeus muscles. In the diagram, you can only see the half of them which lie between the transverse perineal and the coccyx. The half between the transverse perineal and the pubic bone are hidden by the bulbo and ischio cavernosus. Their name is slightly misleading, because they surround our clitoris, vagina, penis and urethra as well as our anus. When they contract they lift up the whole pelvic floor.
The PFM work with other muscles which attach to our pelvis
It’s important when you want to connect with your pelvic floor that you are aware of other muscles which attach to the same bones in your pelvis. If your pelvic floor is weak, it may be because these other muscles are overcompensating for them. You think you are working your pelvic floor when in fact you are not.
Our buttocks (gluteus maximus) attach to our tail bone (coccyx) and pelvis and so it is easy to clench them and think we are working our pelvic floor. Fortunately it is easy to feel when you are tightening our buttocks or not.
Our inner thigh muscles (adductors) attach from our pubic bone to our thigh bone (femur.) If these are tight then you will be restricted in hip opening movements. If they are too lax then you may feel pain in your pubic bone or hips. Sometimes tightening and releasing our adductors can help us to isolate our PFM.
Our recti muscles, the outer layer of our abdominal muscles which run vertically, are attached to our pubic bone. Often we feel a tightening along the top of our pubic bone when we engage our PFM and this is quite normal. It is important to work them together. Often if the PFM are weak then so are the abdominals and vice versa.
When exercising your PFM explore different positions so you can be aware of these other muscles and feel which of these may be too tight or too lax. Then you can choose positions which lengthen the tight muscles and tone lax muscles and be aware of how this affects your PFM.
The PFM contract and relax with your breath
As we breathe in, our lungs fill with air and our diaphragm contracts to pull them down. This increases pressure on our pelvic floor, abdominal and back muscles which lengthen. As we breathe out, our lungs empty and our diaphragm relaxes. Pressure lessens in our pelvic floor, abdominal and back muscles which contract. It is important to be aware of your breath when exercising the PFM.
If we breathe shallowly our PFM experience less contraction and relaxation and become weaker. If we hold our breath through tension we restrict movement in the PFM which tend to become tight.
Feel your PFM now – how aware are you of them and your breath?
Whatever position you are in see if you can feel your PFM.
Place one hand over your pubic bone and the other over your sacrum with your middle finger on the tip of your tail bone (coccyx) . Visualise the complex network of your pelvic floor muscles which supports all your pelvic organs including your “Palaces” (reproductive organs). As you breathe out, can you feel the contraction of your pelvic floor without tightening your inner thighs or buttocks ? As you breathe in can you feel your pelvic floor relaxing. If you can feel your tail bone moving slightly you know you are doing this. You can do this movement seeing if you can increase either the contraction or the relaxation.
Next place a hand directly over your pelvic floor: your testes and penis or vagina and clitoris. As you breathe out slowly contract pelvic floor muscles and see if you can feel any movement. Hold your out breath as long as you feel comfortable and become aware of the inner parts of your Palaces – your seminal vessels and prostate or your cervix, womb and fallopian tubes. As you breathe in slowly allow your muscles to relax as much as you can.
Once you can feel your pelvic floor, do the same movements but become aware of your abdominal and back muscles drawing in on the outbreath and relaxing on your in breath.
Our breath also shows us how our pelvic floor support all organs, because of the relationship between them and our diaphragm and throat and upper body.
The PFM ultimately connect with the whole of our body!
Since our pelvis is the centre of our body, it affects and is dependent on the rest of our body. How we stand, hold our head and arms and how we move all affect our pelvis. Ultimately tightness or weakness in any muscle, including our jaw or our feet, affects our pelvis.
Our PFM are related to our head through the digestive connection of our jaw, mouth and throat with our anus and urethra. Our brain regulates our sexual desire through hormones such as oxytocin and the central nervous system. This link is also important during birth when opening our mouth and relaxing our jaw can help open our cervix.
We can even say that the PFM connect to our heart. Physically our heart and lungs play a role in our breath. They are also an expression of who we are and our most intimate connection to ourself and our sexuality. This is recognised in Chinese medicine through the pathways of the Extraordinary Vessels which connect our pelvis to our heart as well as our brain.
Ancient Chinese medicine is all about seeing the connections through the whole body and our PFM illustrate this.
The PFM and the Girdle Vessel
In Traditional Chinese Medicine (TCM) the importance of the pelvis was recognised, and it even has its own meridian, the Girdle Vessel, to support it. The base of this Vessel includes the PFM! The top of it is defined by our ribs and our diaphragm, indicating that the ancient Chinese also understood the connection between our breath and the PFM. Girdle Vessel regulates everything contained in its pathway – from bones to muscles, ligaments, organs, blood, lymph, fascia, skin and even our emotions. Often, like with any area of our body, one side may be tighter and the other weaker and so working with it can help correct left and right side imbalances. Like a girdle it affects what is above and below it which is our whole body. This includes our connection to our heart and brain as well as our feet. Within the pathway of the Girdle many other Vessels and meridians pass. The midline is particularly important, which is where the Conception, Governing and Penetrating Vessels flow.
This is partly why I am such a fan of it!. TCM is about the connections between things. Our physical body affects our emotional body and so the Girdle Vessel addresses our emotional connection as well. It is powerful for the expression of our sexuality and who we are.
Why are our PFM so important?
They stabilise our pelvis and its organs
They are vital for sexual connection and pleasure – clitoris, vagina and penis
They are important for elimination and digestion – bladder and anus
Essentially the “floor” of our pelvis, they help to keep it and its organs stable. Passing around our anus, along with our clitoris, urethra, vagina or penis, they also give support to them and the organs they connect with.
Stabilising the pelvis and its organs
The stability of our pelvis defines our core posture. Indeed people often talk about the need to “strengthen our core”. What does this mean? Sometimes people stress the importance of one particular muscle, like the PFM or psoas. However we already saw that it is important to be aware of how all other muscles, particularly our buttocks, abdominals, and inner thighs, which work together with the pelvic floor. If other muscles aren’t fully playing their role then we may experience problems such as back, hip, sacroiliac or symphysis pubis pain. We may experience issues with any of our pelvic organs, but, in more extreme cases, our bladder, bowel, womb or penis may prolapse (i.e not held in place). Prolapse is more common for women whose bladder, bowel or womb can collapse into their vagina or the bowel into the anus. Men tend to have rectal prolapse, where the bowel bulges into the anus. This will cause pain and issues with elimination (leaky bowel and incontinence).
One of my students, Lara Montgomery, did her course project on female prolapse. It is worth reading:
Women may experience prolapse after birth, like Lara, but women who have never had children may experience prolapse with age and the changes of the menopause. Age is a factor because if we haven’t looked after these muscles or overworked them then they may be weak.
Sexual connection and pleasure
Our PFM are vital for sexual connection and pleasure. If our PFM are too weak or too tight they may create erectile dysfunction, painful intercourse or reduced sensation and ability to orgasm.
In some cultures women placed objects like jade eggs inside their vagina to help strengthen their muscles, enhance sensitivity and improve energy flow. This practice is becoming popular today. You can not only buy jade or other types of crystal eggs of different weights and sizes, but you can also buy beads and weights.
Elimination and digestion
When we laugh, cough or sneeze, or lift heavy objects there is increased pressure on our PFM. This is part of their role. However if they are weak we may get problems. If our bladder is not supported properly then we may experience leaking urine (stress incontinence). Lack of support for the bladder can also increase the risk of urinary tract infections. If our rectum is not supported we can get issues with elimination and this may affect our whole bowel, even causing irritable bowel syndrome. We may also experience haemorrhoids.
What can make them weak?
Being pregnant or overweight
Sedentary lifestyle
Poor diet
Being pregnant or overweight
The more weight they have to support the more they have to work. Being pregnant or overweight can make them weaker. In pregnancy we also get hormonal changes which soften them and so it is even more important to care for them.
Sedentary Lifestyle
Squatting is key to pelvic floor strength. When we squat our pelvic floor has to work harder to support our pelvis and it also has to lengthen. Squatting is great for tight PFM and it also releases our glutes and inner thighs, which are often tight.
In the days before we had chairs and sitting toilets, squatting was part of daily life. Now we sit a lot which means our pelvic muscles become weak and often shortened. Most people don’t squat at all, even though it is a natural position, and have to relearn how to do it. This can be challenging and is important to build up to it gradually. If your PFM are weak or you have prolapse, then squatting is too strong.
Poor Diet
If people eat too much processed food, don’t drink enough water, and are on certain types of medication, they may become constipated. This often creates straining when we eliminate and so can weaken the PFM, especially around the anus, causing haemorrhoids.
What can make them tight?
Tension, breath holding
Excessive or incorrect exercise
Sexual trauma
Tension, breath holding
If you don’t breathe fully then the muscles may not be able to relax. Emotional as well as physical tension may express as holding in the PFM.
Excessive or incorrect exercise
It is important when doing sport to engage them. For example in martial arts practitioners use their out breath to support their pelvis as they engage with an opponent. However people who do a lot of sport, aren’t always aware of how to relax their pelvic floor and may have tight PFM. This can be the case in activities where the PFM have to work hard, like horse-riding or ballet dancing.
Sexual trauma
If someone has been abused then they are likely to protect this area, often unconsciously. This can make it quite difficult to do any of the exercises, and it is important to address the trauma.
How would I know if they are weak or tight?
It is not always so clear, because some areas may be tighter and others weaker. Often our pelvis is tighter more on one side than the other. For example if your glutes, inner thigh muscles or recti muscles are tighter on one side than the other, this is likely to be reflected in the PFM. In different positions you may experience your PFM as tight or weak. This is why it is so important to be able to tighten (contract) and relax your PFM.
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Signs of tightness
If they are tight you are more likely to have issues with breathing fully in, feel tightness or pain around your pelvis, experience pain during intercourse or when inserting a tampon. You may find it hard to start urinating, and you may not be able to fully empty your bladder, so you need to urinate often. This may cause UTI’s. If you find it hard to relax your muscles focus more on positions which support relaxation. In your life, favour activities which help you to relax.
Signs of weakness
If they are weak you are more likely to feel aches and fatigue in your PFM or in your pubic bone or sacrum. When you laugh or cough you may experience escape of urine and you may have haemorrhoids. You need to urinate frequently and often you leak before you get there. You may often experience gas and find it hard to orgasm. When you do the exercises you will find it hard to feel any lifting and so you need focus on positions which help you lift up. You will also need to gradually build up to the positions which work the PFM more, such as standing and squatting. It is probably not a good idea for you to insert a Yoni egg, and you may want to see a professional to get advice on whether it is advisable to use weights to build up strength.
Seek out assessment if necessary
If you are not sure you can get an assessment with an osteopath, or physiotherapist or another health professional who specialises in pelvic floor work. They can do a hands on assessment, including the internal muscles. I always advise that you find someone who not only also does a thorough assessment of your pelvis but of your whole body.
If you feel they are weak or tight more because of an emotional issue, then find a practitioner, like a shiatsu practitioner, or other somatic practitioner who can support you in this aspect.
A final word
Enjoy getting to know your pelvic floor and having an idea of whether yours are too weak, too strong or doing their job well. Practice the breathing awareness exercises and see if you can engage your pelvic floor when you lift or change position. Notice how different positions engage your PFM differently.
You might want to try my exercises on the Girdle Vessel as part of your exploration.
If you have any questions or anything you want to share, please get in touch and I can include the answers in my next blog, which will be about exploring breath, touch and movement to engage with your PFM.
