ANATOMY AND PHYSIOLOGY OF THE PELVIC FLOOR
The pelvic floor muscles form a kind of hammock at the base of the pelvis. Anteriorly they are anchored to the pubic bone, posteriorly to the coccyx. The name 'pelvic floor' comes from the fact that these muscles literally form a floor for the pelvic bones.
The pelvic floor is a combination of structures that provide a stable and dynamic base to the entire pelvis and contribute to 'Core Stability'.
'Core Stability' refers to the ability to control the position and movement of the trunk on the pelvis and legs.
Specifically when we talk about the pelvic floor, we are referring to the muscular component of this complex, although there are other structures that are equally important. For example, a good neurological and vascular supply are essential for a good function of this area. Disorders such as unstable diabetes and multiple sclerosis cause peripheral neuropathies, a cerebrovascular disorder, or trauma occurring during vaginal delivery can compromise one or both systems.
However, enormous importance deserves to be attributed to the endopelvic belt. The advent of magnetic resonance has allowed anatomists to study functional anatomy at levels that could not be reached with cadavers alone. It now seems evident that this fascia, in the form of ligaments, not only supports the pelvic organs but also provides anchorage for the superficial and deep layers of the pelvic muscles.
In pregnant women, the tendon arch of the levator ani plays a fundamental role. Recently, three-dimensional ultrasonography has shown that this very important fascia can be damaged during the vaginal deliveries and even detachment can occur.
For Professionals in Voice and Singing, the pelvic floor muscles play a very important role in protecting the endopelvic fascia from overload during the management of support and support. All the connective tissues of the body can be stretched by applying a pulling force. If the pelvic floor muscles were weak or damaged and failed to protect the fascia, the fascia would be stretched thus causing a fall, a prolapse of the contained organs. This would destabilize Core Stability. The anchoring of the pelvic floor muscles to the perineal body, a fibromuscular body located in the perineum between the vagina and anus, is equally important for this function. A study done on a sample of women who gave birth showed that as many as 20% of them reported damage to this structure following a vaginal birth. Precisely for this reason, there is now a tendency to include programs dedicated to Core Stability in the management tables, especially for women.
THE PELVIC FLOOR COMPLEX
The pelvic floor includes the following structures:
- Endopelvic fascia
- Perineal body and perineum
- Levator anus: pubococcygeus (pubovaginal, puborectal, puboanal) and ileococcygeus
- External anal sphincter
- Superficial muscles of the pelvic floor
- Blood vessels
The pelvic floor muscles are striated muscles divided into 70% slow type I fibers and 30% fast type II fibers. For proper functioning, the pelvic floor needs to have a good balance of these fibers.
ROLE OF THE MUSCLES OF THE PELVIC FLOOR
- Support: The main role of the pelvic floor muscles is to support the contents of the pelvis ie bladder, uterus and intestines in women and bladder and intestines in men. If their function is impaired in a woman, these organs will push down into the pelvis and prolapse against the walls of the vagina. Normally this prolapse is not considered a problem because a mild degree of prolapse occurs in about 40% of women who have a vaginal birth. However, if these muscles are not strengthened after childbirth, beyond the period of the mild prolapse, this can worsen and start creating symptoms. Women may thus have difficulty inserting a tampon, discomfort during intercourse or a strong feeling of heaviness after physical activity. A further worsening would then lead to more important bladder and bowel problems that would not be able to empty completely. Unfortunately, surgery is often recommended at this stage.
- Sexual Function: The superficial layer of the pelvic floor muscles has been shown to play an important role in sexual function. In women it surrounds the vagina and the muscles also insert at the base of the clitoris, contributing to the effective stimulation during penetration. In men, the pelvic floor muscles have proven their importance in improving or maintaining an erection.
- In bladder and bowel control: the pelvic floor muscles help to control bladder and bowel and prevent accidental loss of urine and feces. The most common loss in women is urine, when intra-abdominal pressure increases for example during a fit of coughing, sneezing, laughter. This is commonly called stress urinary incontinence. The pelvic floor muscles also help control how often the bladder empties. When the bladder fills, it signals when it needs to be emptied, and a healthy pelvic floor allows urine to be retained until a bathroom can be reached. A damaged pelvic floor, on the other hand, will not be able to hold properly with the result of having to empty the bladder more often. This is called bladder urgency. Some women may experience both of these situations and in this case it is referred to as mixed incontinence. The posterior pelvic floor muscles contribute to bowel control, preventing accidental loss of stool. Normally these muscles work on a subconscious level and we only notice them when we have a full intestine.
- Pelvic floor muscles and Core Stability: the pelvic floor muscles are also part of a multi-structural unit called the lumbopelvic cylinder, which is essential in managing breath in support and support. This cylinder is composed of the thoracic diaphragm above, the transverse abdominals anteriorly and laterally, and the vertebral column supported by the multifidus anchors posteriorly. The muscles within this unit work constantly at low speed to maintain postural stability but must also be able to respond as the central nervous system increases load. On this basis in the 1990s there was the 'fashion' of teaching women to contract the transverse abdominals along with the contraction of the pelvic floor muscles. However, not all women were able to contract these two systems together and specific pelvic floor training was introduced.
OSTEOPATHIC TREATMENT AND PELVIC FLOOR
The Osteopathic Treatment associated with exercises aimed at recovering the muscle tone of the pelvic floor, makes an important contribution to the restoration and maintenance of the functionality of the lumbopelvic cylinder. Visceral techniques aimed at the pelvic organs, myofascial on the pelvic and thoracic diaphragms and on the muscular components of the cylinder, as well as structural techniques on the spine to restore its harmonic functionality, are always recommended for a 360-degree approach to the Artist.