How does the pelvic floor work?


How does the pelvic floor work?

It is important to keep in mind that the pelvic floor is one functional unit (integral theory) working like the elastic membrane of a trampoline. It consists of a fibro-muscular membrane through which pass the rectum, the vagina, and the urethra. It also consists of ligaments working like shock absorbers. The muscular membrane and the shock absorbers are suspended from the pelvis at the front, the middle, and the back. Forward forces stretch the vagina to close off the urethra. Backward forces stretch the vagina to close off the bladder neck. The uterus and the bladder lie on the pelvic floor.



Fig.1 left: Simplified diagram of the normal pelvic floor with vaginal membrane (red), ligaments at the front, middle and back (red lines), pelvic bone griddle (black).

Right: Muscle membrane and ligaments are overstretched. The trampoline cannot work. The nerve endings at the bottom of the bladder (blue) are signalling permanently to the brain that the bladder is full. This makes you feel you have to pass urine, or you feel urge symptoms.

The vagina works like an elastic membrane. Its tissue can become lax with age and after childbirth. If the vaginal tissue is lax the muscles cannot close off the urethral tube. Thus, when you cough, you can loose urine (stress incontinence). The same laxity fails to support the filling bladder. The nerve endings at the bottom of the bladder are stimulated prematurely and overcome the brain's inhibition at a lower bladder volume (bladder instability). This may be expressed as a sensation of urgency, wanting to pass urine frequently, or getting up at night to pass urine (nocturia).

The following diagram can be used as a guide to understand what the connections between your symptoms and the site of the anatomical damages (front, middle, back) are. 


Frequency, getting up at night, and passing urine before arriving at the toilet may occur in all zones. Not all criteria may be present for a particular zone. Requirement for help is always a precise and individual method of diagnosis according to the symptoms.
If you are interested in the diagnosis and treatment of your special problems concerning the bladder and pelvic floor please make an appointment. During this appointment we will carry out a gynaecological and special examinations to localize your problem. We will explain you the results and the recommended treatment. 

- Deliveries

Childbirth is often the reason for future incontinence or prolapse problems. Deliveries can result in laxity and stretching of the vagina, the ligaments, nerves and the pelvic floor muscles. Consequently many women suffer from discomfort, pain or loss of urine during sex. After giving birth many women have the feeling that the vagina is too lax and too big. As a consequence they may not feel attractive anymore as a sexual partner.

- Operations

Occasionally previous operations in the lower abdomen, e.g. hysterectomy, are responsible for bladder and pelvic floor problems. Prolapse operations may result in partial or even total loss of smoothness of the vagina because of scar-tissue formation. This leads to severe incontinence and even to discomfort during intercourse and pain.