Hi friends! We often talk about the importance of relaxing the pelvic floor muscles when they are tight and painful or to allow pee and poop to leave the body. So when we talk about relaxing the muscles as an exercise, you may think to yourself “I don’t want to relax the muscles too much because that might let pee or poop out accidentally!” The good news is that this should not happen with a healthy pelvic floor, but let’s talk about why.
First, let’s talk about the pelvic floor muscles. The pelvic floor muscles wrap around our body’s canals (the urethra and the anus) to help keep pee and poop in. These muscles should stay engaged and closed most of the time to keep pee, poop, and gas in. When we are ready to go to the bathroom, these muscles need to know how to relax and lengthen to open the canals. When these muscles aren’t doing the right thing at the right time (i.e. squeezing when they should relax, or relaxing when they should squeeze) we can have issues like leaking pee or poop, or constipation and pelvic pain.
In our bodies we have two types of muscle: smooth muscle and skeletal muscle. When we think of muscle, we are often referring to skeletal muscle. Skeletal muscles are the ones that move our bodies. We can control these muscles with our own will by thinking about doing something—when you want to move your arm to grab a cup of coffee, you are able to tell your brain to move those muscles.
Smooth muscle works differently but it is found throughout our bodies, too. It is in our blood vessels, uterus, digestive tract, and it makes up the muscular layer of our bladder (the Detrusor). Unlike skeletal muscle, we don’t have voluntary control of when smooth muscle moves and works. Think about your digestive tract, your food moves along the stomach and intestines due to smooth muscle, but you don’t control it the same way we do our arms and legs.
Both our anus (where poop exits the body) and urethra (where pee exits the body) are made up of both internal (smooth muscle) and external (skeletal muscles) sphincters. Because the internal sphincters are made up of smooth muscles we cannot consciously control them. Our external sphincters are made up of skeletal muscle so we can change what they are doing directly. When we relax the pelvic floor muscles, the external sphincters (the skeletal muscle) relax, but unless other factors are present, the internal sphincters (the smooth muscle) stay closed to prevent leakage.
The process of getting pee or poop out of the body is more complex than just thinking about muscles squeezing and relaxing. This is because the smooth muscles respond to a complex process that happens in our brains. When we relax the pelvic floor muscles, our brains make the decision whether to relax the smooth muscle. Some things the brain takes into account are whether or not we are somewhere where it is appropriate to pee or poop and how full our bladder or rectum are. Once our brains decide it is appropriate and time to empty, it will relax the smooth muscle. When this happens the bladder or rectum muscles then squeeze to help move things out.
Our brains sense and control what needs to be emptied (pee or poop) and relaxes the appropriate muscles. The right muscle relaxing, along with the bladder or rectum muscles squeezing, are why we don’t typically pee and poop at the same time.
Now you may be thinking to yourself, if my brain is required to relax the smooth muscles, why am I having leakage if I’m not on the toilet? Shouldn’t my smooth muscles be able to keep things in since my brain has not sent the signal for them to relax? This is a complicated question to address, but to answer it simply there are two issues that could be happening.
If we have issues like overactive bladder, our brains start to learn habits and can start trying to pee even when we aren’t on the toilet. For example, we may get the strong urge to pee when we open the front door, when we see a toilet, or when we hear running water. Over time, this urgency can progress to leakage because our brain thinks we want it to empty. Techniques like urge suppression and bladder retraining can help address this problem.
Leakage can also happen because of weakness in these muscles. A good example is stress urinary incontinence. If we sneeze, a large amount of pressure is created within the abdomen. If the combination of our internal and external sphincter muscle is weaker than the force of pressure from the sneeze, we will have leakage even if the muscles are squeezing. The same is true if we leak a little gas when we bend over or squat down. These issues can be addressed by strengthening the pelvic floor muscles and improving their coordination.
If you are experiencing any of these issues, be sure to talk to your medical providers. A pelvic floor physical therapist or occupational therapist can be a great resource to help you retrain this process to help you regain control and pee and poop when and where you choose.
Ready to learn more about pelvic health? Here are some helpful resources:
Subscribe to Pelvic Flicks for pelvic floor weekly workouts
Watch our YouTube channel
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics
Sign up for our email newsletter!
Visit our Instagram page for more on pelvic health.
For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual resources. At myPFM Academy you’ll find courses like:
Pelvic PT Evaluation of the Pelvic Floor Muscles with Dr. Samantha Richter, PT, DPT, WCS
New Structure for PFM Assessment Using ICS Terminology with Beth Shelly, PT, DPT, WCS, BCB-PMD
Pelvic Floor PT and OT How-Where-What: How to Become One, Where They Work, and What They Do with Jeanice Mitchell, PT, MPT, WCS, BCB-PMD
Written by Emily Reul, PT, DPT
Commenti