Chapter 6 – The Bladder and the Pelvic Floor

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The Pelvic Floor

The pelvic floor is a complex muscle structure which refers to the levator ani or pelvic floor muscle (PFM), the urinary and anal sphincter muscles and the perineal or superficial pelvic floor muscles, along with the organs that sit on this muscular floor (bladder, uterus, rectum) and their outlets which pass through this floor (urethra, vagina and anus).

The levator ani muscle is comprised of two components, the puborectalis and iliococcygeus muscles. However this muscle complex normally acts as a whole. When the PFM actively contracts it pulls forward and upwards to support the organs and close the urethral and vaginal outlets. The anal sphincter muscles can both contract with the PFM to help seal the anus, or act independently. The superficial PFM are more involved in sexual function than support, as they contain erectile tissue and form the muscular part of the clitoris.

For full function of the PFM, these muscles must have strength and endurance, act rapidly in response to changes in abdominal pressure (e.g. cough, sneeze), and also be able to relax fully. PFM weakness may be associated with urinary leakage and vaginal prolapse, and increased tone in the PFM may be associated with pelvic pain and vaginismus.

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