• Emily Reul, PT, DPT

Your Pelvic Floor Muscles

Hi friends! Today we are going to dive into anatomy and meet each of the pelvic floor muscles individually. While we often talk about the pelvic floor muscles as a group, you have 17 different muscles (depending on how you count them) in your pelvic floor! Some of these descriptions will be very technical, but the videos can be a great supplement if you are not a medical professional.



The pelvic floor muscles work to provide us with four main functions. The muscles work to provide stability as part of the core. They work to support our pelvic organs from below. They control the sphincters (or openings) to keep pee, poop, and gas in or out. And last but not least, the pelvic floor muscles play a large role in sexual function. To learn even more about what the pelvic floor muscles do watch this video below.



Before we start talking about each individual muscle, let’s talk about where the pelvic floor actually is. The pelvic floor muscles sit at the base of the pelvis and function like a hammock. They stretch from your pubic bone in the front to your tailbone in the back. Males and females have many of the same pelvic floor muscles with just a few differences between each.



There are two main muscle groups when talking about the pelvic floor muscles: Levator ani and superficial pelvic floor muscles. The levator ani includes the pubococcygeus, puborectalis, iliococcygeus, and coccygeus muscles.


Pubococcygeus

The pubococcygeus muscle (composed of the pubovaginalis, puboperinealis, and puboanalis) runs from the pubic symphysis to the anococcygeal body. This muscle works to provide support to the pelvic organs.


Puborectalis

The puborectalis muscle attaches to the pubic bone and forms a U-shaped sling around the rectum. This muscle is important in controlling anal continence (poop and gas). Posture while trying to poop is important because of the puborectalis. The best posture for pooping (knees above hips) helps to relax the puborectalis muscle to unkink the rectum and let fecal matter out. A Squatty Potty can be very helpful to sit in this position comfortably!


Iliococcygeus

The iliococcygeus muscle starts at the lateral walls of the pelvis and connects to the anococcygeal raphe (fibrous tissue) and the coccyx. This is another muscle that works to support the pelvic organs.


Coccygeus

The coccygeus muscle connects to both sides of your tailbone (coccyx) and attaches to your pelvic ligaments (bilateral ischial spines and sacrospinous ligaments). It supports the pelvic organs and flexes the coccyx (brings the tailbone towards the anus). If you’ve ever had a tailbone injury, your coccygeus was likely involved. The coccyx is often flexed by the coccygeus when the pelvic floor muscles are overactive and tight.

Now let’s talk about the superficial pelvic floor muscles: the bulbocavernosus, ischiocavernosus, and superficial transverse perineal.



Bulbocavernosus/Bulbospongiosus

This muscle runs from the perineal body to the clitoris (in females) or the penis (in males). This muscle helps to erect the clitoris in females and the penis in males, it closes the vaginal opening, and compresses the greater vestibular gland. This muscles automatically contracts during an orgasm. For males, this helps with ejaculation. For females, this muscle has to stretch an incredible amount during vaginal childbirth to allow the baby to come out!


Ischiocavernosus

The ischiocavernosus muscle runs from the ischiopubic ramus and ischial tuberosity to the crus penis or clitoris. It’s job is to help maintain erection of penis or clitoris during sexual activity.


Superficial transverse perineal

The superficial transverse perineal muscle also starts at the ischiopubic ramus and ischial tuberosity but runs to the perineal membrane/perineal body. It supports and fixes perineal body/pelvic floor to support abdominopelvic viscera and resist increases in intraabdominal pressure. You also have a deep transverse perineal muscle which lies under the superficial transverse perineal muscle and works in the same way.


In addition to the levator ani and superficial pelvic floor muscles, you have sphincters (compressor urethea and external anal sphincter) that help to control the openings to help keep pee and poop in as well as control the vagina and penile openings.


The compressor urethrae surrounds the urethra and helps to keep pee in while contracted and relaxes to allow urine to pass out.


The external anal sphincter (EAS) encircles the anus and runs posteriorly from the perineal body to the anococcygeal ligament. It helps to control poop and gas. It relaxes and opens when it’s time to go. If it’s not relaxing properly, you may get constipation, pain, and difficulty passing poop or gas. If it’s not contracting properly, you might leak poop or gas when you don’t want to. It may be injured during childbirth—grade 3 and grade 4 perineal tears involve the EAS. Midline episiotomies in theory do not involve the EAS but if a tear occurs on top of the episiotomy, the EAS may be involved. Thankfully, these are rare. The EAS is also one of the easiest ways to FIND and identify the PFM. When you squeeze, the anus closes and puckers up. When you relax, the anus opens, softens, and drops.




There are a few other muscles around the pelvis and hip that can affect the way the pelvic floor muscles work.

Obturator internus

The obturator internus starts at the ilium/ischium and runs to the greater trochanter of the femur. It’s main action is to externally rotate the hip and it assists in holding the head of femur in acetabulum.

Piriformis

The piriformis muscle starts along the sacrum and sacrotuberous ligament and it also attaches to the greater trochanter of the femur. It helps to externally rotate and abduct the hip and also assists in holding the head of femur in acetabulum.


Whew, that was a lot of information! The pelvic floor is complex but it is so important. Being able to find these muscles is one of the first ways in helping to fix any issues with them. Watch 7 Ways to Find Your Pelvic Floor Muscles to help find yours. If your muscles aren’t working, a pelvic floor physical therapist can help to address any issues that you may have including: incontinence, pain, pelvic organ prolapse, pain or difficulty with penetration, difficulty with achieving or maintaining an erection, and so much more!



Here are some great resources to learn more about your pelvic floor:

  • Ask your healthcare provider for a referral to a pelvic therapist.

  • Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.

  • Watch 10 Pelvic Floor Mistakes.

  • Watch 5 Minute Pelvic Floor Workout.

  • 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.

  • Visit our Amazon Store for pelvic health products.


For Healthcare providers, check out all of our continuing education courses here to help you better serve your clients. You can purchase courses individually, or join our Ambassador Program and most of our courses are included with your membership!


What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  


Written by Emily Reul, PT, DPT

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This information is for awareness purposes and not individual medical advice. You should seek your own professional counsel for any medical condition or before starting or altering any exercise or fitness program.

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