Overview of Female Pelvic Floor Muscle Anatomy and Physiology

Original Editor - Jess Bell based on the course by Ibukun Afolabi
Top Contributors - Jess Bell, Jorge Rodríguez Palomino, Kim Jackson and Rucha Gadgil

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (5/12/2021)

Introduction

The pelvic floor does not exist in isolation. It is part of a complex system that works synergistically with structures and systems both nearby and further away in the body, including the ankle / foot complex, the thorax and respiratory complex, the central nervous system and the brain. Because the body is a dynamic, interrelated, fascially connected, biotensegral system, it is important that pelvic health physiotherapists consider the contribution of all these systems and structures when assessing and treating pelvic health complaints.

The Pelvic Floor

Health professionals might have differing views about what makes up the pelvic floor:

• Is it just comprised of the pelvic floor muscles?
• Should the pelvic organs be included?
• Is the hip joint part of the pelvic floor?
• Are the contents of the lower abdominal cavity also included?

For the pelvic health physiotherapist, the pelvic floor refers to the area at the bottom of the pelvis and all of its contents, and associated structures, including:

• The pelvis itself
  • Called the pelvic ring or pelvic bowl
  • Includes the pelvic joints
• Pelvic organs
  • The bladder, uterus and rectum in women
• Pelvic ligaments
• The endopelvic fascia and connective tissue
• The nerves which innervate the pelvic region, as well as blood vessels and the lymphatic system
• The external genitalia
• The pelvic floor musculature

Pelvic health physiotherapists are able to treat all these structures either directly or indirectly.

This page focuses on the anatomy of the female pelvic floor musculature. More information on the other structures within the pelvis is available here.

Pelvic Cavity

The abdominal and pelvic cavities are bordered at the front, top, back and bottom:

• The front border is the abdominal wall
• The top border is the respiratory diaphragm
• The back border is the spinal column
• The bottom border consists of the pelvic floor muscles

Pelvic Floor Muscles

The pelvic floor muscles act to close off the bony outlet, which they do so completely apart from specific openings:

• The urogenital hiatus
  • Contains the urethra and vagina in women
  • Positioned anteriorly
• The anal hiatus
  • Contains the anal canal
  • Positioned posteriorly

The muscles of the pelvic floor are divided into three layers.

Deep Layer - Pelvic Diaphragm

The deepest layer of the pelvic floor muscles is known as the pelvic diaphragm. It is a broad, funnel-shaped sling of fascia and muscle suspended from bony anchor points in the lesser pelvis (i.e. the area of the pelvic cavity below the linea terminalis.