Overview of Pelvic Floor Anatomy, Function and Dysfunction

By Carolyn Kisner PT, MS and Lynn Allen Colby PT, MS on February 24th 2009

Treatment of pelvic floor impairment has become more visible and accepted in the physical therapy community over the last 5 to 10 years. However, advanced and in-depth study of anatomy, physiology, evaluation, and treatment continues to be highly recommended for therapists who wish to specialize in this area.

Pelvic Floor Musculature

The pelvic floor musculature is composed of several layers with bony attachments to the pubic bone and the coccyx. The anterior-posterior fibers are oriented almost horizontally and form the inferior support for the trunk. Laterally, the tissues blend into a fascial layer overlying the obturator internus. Both right and left sides of the muscles contribute fibers to the perineal body located between the vagina and rectum. Fibers that run anterior-posterior create a superior force toward the heart, while the more superficial fibers surround the sphincters and produce a puckering motion.

Female Pelvic Floor

The female pelvic floor allows for passage of the urethra, vagina, and rectum. This creates less inherent stability when compared to the male anatomy.

Innervation
The pudendal nerve arises from ventral divisions of S2 to S4 in the sacral plexus, as well as direct branches from S3 and S4, and supplies the pelvic floor complex. This dual innervation provides a safeguard against direct damage to the pudendal nerve. The terminal branches are the perineal branch and the inferior rectal nerve, which ends in the external anal sphincter.

Function
The pelvic floor musculature has the following essential roles:

• Provide support for the pelvic organs and their contents

• Withstand increases in intra-abdominal pressure

• Maintain continence (through sympathetic nerve fibers) to the urethral and anal sphincters

• Sexual response and reproductive function

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Filed Under: Jeff, Physical Therapy
Tags: dysfunction, Function, Pelvic Floor

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