What is the Pelvic Floor and What is its Function?

The pelvic region is the lowest part of the abdomen. This area within the pelvis contains the bladder, lower urinary tract, the rectum (the last part of the large intestine), the anus, external genital organs, as well as the ovaries, uterus, and vagina in women, and the prostate in men.

The pelvic floor is a comprehensive structure composed of muscles and ligaments within the pelvis that supports the uterus, bladder, and rectum. This group of muscles covering the lower, inner part of the pelvis forms the pelvic floor, providing support for the bladder, uterus, ovaries, and rectum.

The structures forming the pelvic floor are suspended like a hammock between the front part of the pelvis (pubis) and the sacrum, which is the final section of the spine. The function of this hammock is to carry and stabilize the organs resting on it. The smooth muscles in organs such as the bladder and large intestine, located above this hammock, operate involuntarily through the autonomic nervous system. In contrast, the pelvic floor muscles are voluntary and can be controlled, similar to our arm and leg muscles. This feature allows conscious control over the bladder and the exit part of the large intestine. The function of these muscles is crucial for urinary and bowel control as well as for sexual function.

Pelvic Floor Problems and Their Causes

Functional disorders can occur due to weakness or excessive contraction of the muscles in the pelvic floor.

• Chronic constipation
• Straining
• Obesity
• Chronic cough
• Advancing age
• Frequent urinary tract infections
• Pregnancy, multiple pregnancies
• Vaginal childbirth (prolonged and difficult labor)
• Menopause
• Pelvic surgeries (colon, rectum, uterus, prostate)
• Diabetes
• Sedentary lifestyle (prolonged sitting, etc.)
• Use of caffeine, smoking, alcohol
• Congenital anomalies
• Pelvic trauma, nerve injuries

What is Pelvic Floor Rehabilitation?

Pelvic floor rehabilitation comprises treatments aimed at optimizing the function of the muscles in this area. Primarily, if there is tension and increased tone in the pelvic floor muscles, the initial goal is to achieve relaxation in these muscles. It involves patient education, exercises to strengthen and coordinate the pelvic floor muscles, manual therapy techniques, and biofeedback applications.

Applications of Pelvic Floor Rehabilitation

• Frequent urination: Urinating more than 8 times a day may require treatment.
• Incontinence: This refers to the involuntary leakage of urine or feces. It is not normal to leak urine or feces during activities such as coughing, laughing, sneezing, or exercising.
• Difficulty in urination/defecation: Not feeling fully relieved during the elimination process, feeling full, and experiencing pain during elimination are not normal and indicate that the elimination process is incomplete.
• Bedwetting at night: It is not normal for children to wet the bed after the age of 5.
• Constipation: Having bowel movements less than 3 times a week is an indicator of constipation. Pain during defecation, inability to fully empty the bowels, and excessive straining are other signs of constipation.
• Chronic pelvic pain: This is pain felt in the lower abdomen, lower back, hips, and genital area. It can result from musculoskeletal disorders in the region. Endometriosis and painful menstruation are common conditions associated with this pain.
• Painful intercourse/Vaginismus: This condition involves inability to engage in intercourse or experiencing pain during intercourse. Tight pelvic floor muscles may cause this condition.
• Sexual dysfunction
• Premature ejaculation
• Pain and discomfort during intercourse

Treatment Methods for Pelvic Floor Rehabilitation

The rehabilitation of the pelvic floor is carried out with a special program tailored to the individual’s specific problem. Initially, relaxation of the pelvic floor muscles is achieved, followed by patient education and exercises.

Patient education

• Lifestyle changes
• Bladder training
• Bowel training

Exercises

• Postural awareness training
• Core stabilization exercises
• Pelvic floor exercises
• Pressure-reducing exercises (hypopressive exercises)
• Breathing exercises
• Designing a home exercise program

Benefits of Pelvic Floor Rehabilitation

• Regulates the function of pelvic floor muscles.
• Increases circulation in the pelvic floor region.
• Enhances the functions of the lower back, hips, and respiratory system.
• Regulates urinary and bowel functions.
• Helps in resolving sexual dysfunction.
• Improves quality of life.