Episode 01: Pelvic Floor 101

In today's very first episode of the Alexis Anderson Podcast, Alexis is talking with us all about the pelvic floor, its anatomy, and the importance of pelvic floor coordination. She explains the three layers of pelvic floor muscles, their functions, and how they contribute to urinary, bowel, and sexual health for people of all genders. The episode emphasized the significance of learning and practicing simple pelvic floor exercises for overall pelvic health AND to address common issues related to pelvic floor dysfunction. 

🎧 PS - This episode has helpful visuals if you check it out on YouTube!  
 

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SHOW NOTES  

0:57 – A welcome and introduction to what we are talking about today! 

1:21 – What IS the pelvic floor, what does it affect, and who has one? Alexis shares a visual model for our YouTube audience 

5:37 – Alexis describes the pelvic floor’s role in sexual functions 

8:30 – Alexis discusses the third and deepest layer, and reviews the pelvic floor anatomy with us 

10:10 – Alexis details pelvic floor coordination and why it’s important 

12:51 – Alexis leads us through a set of exercises to contract, relax, and elongate our pelvic floors 

22:42 – Alexis shares some issues that pelvic floor coordination can remedy 

26:17 – Alexis brings the episode to a close 

Transcript

SPEAKER_00 0:01

Hello, and welcome to the Alexis Anderson Podcast. I'm your host, Alexis Anderson, pelvic health physiotherapist and guide for anyone navigating the messy, confusing, and often isolating world of pelvic and sexual health. This season, we're breaking down the myths, sharing real stories, and giving you evidence-informed tools to understand your body. Whether you're a patient, a clinician, or someone quietly struggling, you're in the right place. Let's take the shame out of the conversation, bring clarity where there's confusion, and make pelvic health feel human, hopeful, and actually talked about. Before we get into it, let's talk the legal stuff. While I am a physical therapist, I am not your personal physical therapist. So please remember, this content is for educational purposes only and not a substitute for personalized medical advice, diagnosis, or treatment. Now let's get started. Hello, welcome. I am your host, Dr. Alexis Anderson, Doctor of Physical Therapy. Thanks for tuning in today. What I'd like to tackle is the pelvic floor. What is it? What does it do? Why is it important? And I want to talk about pelvic floor coordination because the coordination piece is what I see that gets missed often with patients. So let's jump into it. Your pelvic floor is basically a series of muscles that sit at the bottom of your pelvis. So if you're looking at your pelvis like a basket, so your abdominals are in the front of the pelvis, your back muscles, your low back muscles, your buttocks are in the back of the pelvis, and then the floor of that basket, that's your pelvic floor. That pelvic floor area is the area between your pubic bone and your tailbone. So if you were to sit on a bicycle or ride on a horse, you are sitting on your pelvic floor. All humans have a pelvic floor. Doesn't matter if you're a penis owner, a vulva owner, or an owner of a vagina, or anything in between for my non-binary trans folks, you have a pelvic floor. All right. Like I said, it's primarily made up of pelvic floor muscles, but there are arteries, nerves, lymphatics, veins, ligaments, there's other anatomical structures that are involved, but for the purposes of today's episode, we're just gonna keep it simple. So your pelvic floor goes from that pubic bone in the front to the tailbone front to back. For those of you who are listening in and not watching on YouTube, I have a model. This is a model of somebody who is a vagina owner. So just to show you, the pelvic floor muscles start in the front where the pubic bone is located, and they go to the back where the coccyx is located. So if I were to try this pelvis on, you can see this is the pubic bone. If I turn it around, the back here, that's my coccyx. To show you, as if you're looking up into my pelvic floor, you can see again, pelvic floor muscles go front to back from the pubic bone down to the coccyx, and they go in between the two sit bones. So those two big bones that you're sitting on, this whole area is your pelvic floor area. Okay, so you can sit on your hand and you'd be sitting on your pelvic floor. For those folks who have a vulva and a vagina, the pelvic floor muscles wrap around and surround the vaginal opening, they wrap around the anal opening, and they also wrap around the urethra, that little tube that you urinate from. For those folks who have a penis, it's not much different. Okay. Your pelvic floor muscles start at your pubic bone, they end at your tailbone, and they sit in between those two big sit bones. The major difference is that the pelvic floor muscles don't have an opening to surround the vaginal opening. Instead, they come together and they sit here to support the penis. In this particular model, the penis has been cut, but you can see this structure here that is the urethra, the tube that you urinate from. On this particular model, this model doesn't have a scrotum or testicles, but it does illustrate the pelvic floor muscles here quite nicely. You have three layers of pelvic floor muscles. The first two layers sit in this triangular piece here. We call this the urogenital triangle, and they wrap around the external anal sphincter, aka your butthole. Okay, so those are the first two layers of pelvic floor muscles. The first two layers of your pelvic floor muscles are really important. We refer to them as the sphincterics because they act as sphincters. They close orfices to the outside world. So they close the anus when they contract, they close the opening to the vagina, they close the urethra. The urethra is that tube that you urinate from. So again, as a review, they close the anus, they close the vaginal opening, they close the urethra, which is that tube that you urinate from. So really important for bowel and urinary function. Now, also important for sexual function. Your first and second layer muscles, when they contract and relax, they help to cause an erection of the penis. They help to cause an erection of the clitoris. The clitoris is an organ that is often left out of many anatomical illustrations and books. I have one here in my hand. For those of you who are on YouTube, you can see if not, then you can check out YouTube later. But this is an actual size of a clitoris. This is a clitoris when it is not erect. Now, when I place it on the pelvic floor area, you can see that the nose or the tip is often the only thing that you can see when you're looking at this anatomy with the eyes. The neck, the arms, the legs, you often cannot see, and it is a whole organ that sits right around the vaginal opening, around that urethra opening. So the arms and the legs of the clitoris, okay, they sit where the outer and inner labia are located. So it is a world disservice if you're just trying to stimulate that tip. So the part that you can see. Some people will just try to rub that tip like it's a DJ booth. You're missing the whole organ, okay? That's just like kind of rubbing your nose, right? You have this entire space to stimulate and play with. So you can touch rub on the outer labia and the inner labia to really stimulate the entire clitoris. So oftentimes this whole organ gets missed. Alright, she's great, she's large, and she's so much fun. Okay. So I wanted to show that. So the first and second layer of your pelvic floor muscles, when they contract, they relax, they contract, they relax. They're responsible for clitoral and penile erection, and they contract, and that's what maintains your erection. Okay, so it's important that these muscles relax to allow blood in. They can contract to start to pull that blood into this area. Okay, so often when someone orgasms, they can feel that contract, relax, contract, relax. It kind of builds, right? It's like a sneeze. Sometimes it goes away, you don't orgasm, but you're like pretty close. And then oftentimes it builds with the builds, and then a choo, you sneeze, and then there's your orgasm. Okay, so that's kind of uh illustration of how those pelvic floor muscles work. To review, first and second layer of your pelvic floor muscles wrap around the urethra to control urine. They wrap around the vagina, they close and open the opening of the vagina, they contract and relax to close off the urethra if you're a penis owner. Okay, they contract and they relax to open and release the external anal sphincter. Now, first and second layer muscles are very superficial, okay, so they're the ones that are most to the surface. Then you have a third layer of pelvic floor muscles, and they're much bigger, they're much broader. Again, they go from the pubic bone down to the coccycks, okay? And this is referred to as the pelvic diaphragm. As pelvic floor therapists, we break these into different individual muscles, and when we do a pelvic floor assessment, then we assess all of these muscles. And I'll talk about later in a different episode what a pelvic floor exam includes, and we'll get into that. But for the purpose of this podcast, just know that you have a third layer of pelvic floor muscles. They're much bigger, they're much broader, okay, and these move. So when you contract and relax your pelvic floor muscles, they lift and they lower. Okay, so you've got three layers of pelvic floor muscles. They are at the bottom or the floor of your pelvis. If you sit on your hand, okay, then that is where your pelvic floor muscles are located. All humans have a pelvic floor, no matter your genitalia, okay, and it is responsible for urinary function, bowel function, and sexual function. So three really important functions your pelvic floor is responsible for, okay. It also helps to support the pelvis as a whole. So they work together with your abdominals to support the pelvis. Uh, you know, they don't they can contract, relax, and elongate in isolation, but they don't work in isolation. They work with other muscles of your body. So, pelvic floor muscles, anatomy reviewed. You can sit on your hand, you can feel this. You can take a look on YouTube if you want to see these a little bit closer. So, let's talk about pelvic floor coordination and why it's important. Your pelvic floor muscles are just like any other muscles in the body. They contract and shorten, they relax and soften, and they open, stretch, and elongate, aka, they lengthen. Again, your pelvic floor muscles contract, relax, open, elongate, lengthen. Why is this important? Well, we want these muscles to contract when we want to hold things in, when we want to hold in gas, when we want to hold back our urine. If we're exercising them, right, we want them to contract and relax so that we can strengthen them. Relaxation is super important. That's where your pelvic floor muscles should be when you're just functioning during the day in that nice, soft, and relaxed state. The lengthening, the opening and lengthening of your pelvic floor muscles are so important. When you open and you lengthen your pelvic floor muscles, that allows things to come out. So if you need to urinate, your pelvic floor muscles relax, they open, elongate, your bladder contracts, and the urine comes out. If you need to have a bowel movement or if you need to poop, your pelvic floor muscles relax, they open, elongate, get out of the way, your large intestine goes through peristalsis. Basically, your large intestine moves the stool out of your rectum and it comes out. If you are trying to release gas, right? Maybe you relax your pelvic floor, the gas doesn't come out. What do you do? You open an elongate, then the gas comes out of the anus. Okay, it comes out of the rectum. The elongation is also important if you're trying to let something inside of your pelvic floor outlets. So let's say you're trying to insert something into the vagina, you're trying to insert something into the rectum. You can relax, open elongate, and then allow uh entrance into the vagina and/or into the rectum. Elongation is also really important for those people out there who have tightness of their pelvic floor that may have pain. Okay. I have lots of patients that I see for pelvic floor pain, for pelvic floor tension, for gripping, for guarding, and they don't know that they can actually relax and or open and elongate their pelvic floor muscles. So elongation is super, super important and it often gets missed and it drives me crazy. So this is my public service announcement. Your pelvic floor can contract, relax, open, and elongate. All right, so let's try it. So you are going to sit on your hand. Okay. Uh you can look at your area, you know, you can look at your pelvic floor, you can sit on something. All of us learn in different ways. So if you're a visual learner, you may choose to look at your pelvic floor. If you're more of a tactile kinesthetic learner, you may sit on your hand so that you can feel these muscles move with your hand. But then also you're going to get the feedback from your pelvic floor on your hand so you can know where you are in space. Um, some people like to sit on a pillow, so you can grab a pillow, you can straddle it between the legs, take a seat on it, and that will give you feedback about what's uh happening. Some people like to sit on exercise balls like the big Swiss balls. Whatever feels good for you, you can try all three, whatever works. The important thing is that you're learning how to do the three different movements. Okay. So if you are sitting on your hand, okay, so you can feel what's happening. What you're going to feel, so your hand is here, your pelvic floor muscles are sitting on top of your hand. When you contract, you're going to feel your pelvic floor muscles contract, move up and away from your hand. When you relax, you're going to feel these muscles fall onto the hand. So you're going to contract, feel the muscles pull away from your hand, relax, have the muscles fall onto your hand. Let's try that a couple times. So you're going to contract and relax. Contract and relax. For those of you who are listening in your car, hopefully this is not distracting you from driving, but you know, you can sit on your car seat, right? And you can contract, relax, contract, relax, and you may feel that movement of your pelvic floor on the seat. Okay. If you're sitting on your on your hand, you're obviously going to feel it with your hand. If you choose to look at this area with a mirror, that can be really helpful. So you can sit back on your bed, on your couch, have your back supported. Your knees are going to come out to the sides. If you need to place pillows or towels or blankets underneath the knees to support the knee so you can fully relax, that's helpful as well. Then you can place the mirror down, resting on your feet. Okay, so you can see what's happening. You're gonna contract your pelvic floor muscles, you're going to relax. If you choose to look at this area, then what you're going to see is pelvic floor movement. How do you know if you're doing it right? Well, you will see your anus wink. When you contract your pelvic floor muscles, the anus is gonna wink at you. Okay. When you contract your pelvic floor muscles, that perineal body, that space between your anus and the vaginal opening, or that space between your anus and your testicles, or that space between your anus and your penis, that area is gonna lift. Okay, you're gonna get a wink of the anus, you're gonna get a lift of that perineal body, then you're gonna get a little nod, okay? If you are an owner of a penis, what you're gonna see is that the base of the penis kind of nods or kind of lifts, okay? If you have testicles in the scrotum, when you contract your pelvic four muscles, you're gonna see the scrotum lift, you're gonna see the scrotum contract, the testicles are gonna lift up, you're gonna lift that penis, the penis is gonna lift up towards the ceiling, okay. My penis owners, they'll sometimes get an erection and then they try these exercises at home and they say, Yeah, they're like penis push-ups. So your penis is erect and then it lifts and lowers. If you have an erection and you put a towel over it, this is my penis owners tell me this that they put a towel over it because then they can see the towel lift and lower, so that you know you're doing that contraction and that uh relaxation correctly. For my vulva and vagina owners, what you're gonna see is that little nod of the clitoral uh uh of the clitoral head in the clitoral hood. So your clitoris is gonna kind of nod like yes, you are doing your contraction correctly. Okay? So to recap, when you contract your pelvic four muscles, you're gonna get a wink from the anus, a lift from the perineal body, and a nod. Ta-da! You've done your contraction correctly. Okay, so let's have you try this at home. You can sit on your hand, look at it with a mirror, sit on a ball, um, sit on a pillow, do whatever you'd like, but let's just practice that pelvic floor contraction, relaxation. Pelvic floor contraction, relaxation. Okay. And oftentimes with my patients, I don't give them reps or sets. It's more about just coordination. Can you learn how to do this? Can you feel this, right? So you're just gonna contract, relax, you're gonna get that down. Okay, great. Now let's talk about elongation. Elongation is when the pelvic floor muscles open, they elongate, they lengthen. Okay. Most people are like, I don't know what that is, it's very difficult to feel. It's okay. Lots of people struggle with this. That's why we're talking about it, and that's why I have a video on it. Okay. Most people can feel this by using their breath. So when you breathe and you're breathing into the belly, right, you're gonna feel the drop of your pelvic floor because your diaphragm connects to your pelvic floor. So when you inhale, you inhale, you breathe into the belly. When you inhale, the diaphragm drops, your pelvic floor muscles drop and they open. When you exhale, they come back up to resting. Of course, this is not every person on the planet, but for most people, this is what happens. Inhale, big belly breath, pelvic floor drops and it opens. Exhale, comes back up to resting. Inhale, drops, exhale, comes back up to resting. So whether you're looking at your pelvic floor with a mirror, you're sitting on your hand, okay, you're sitting on a ball, sitting on a surface where you get that feedback. Let's practice big belly breathing and pelvic floor opening. So you want to breathe in a way to where your belly opens and expands, falls and relaxes with your exhale. So, can you breathe in a way to where the chest stays relaxed and you're breathing into your low belly, you're breathing into your pelvic floor, long, slow, steady exhale. You're gonna feel your pelvic floor muscles open and bulge and elongate. It's not a very big movement, it's like butterfly wings. You can't you have to really tune in. Some people have to close their eyes to really feel this if they're more tactile. Some people have to really look with a mirror if they're more visual. Some cues that help some clients, telling them to breathe into their anus, that really helps. Some people say if you breathe into your penis, right? Breathe into the testicles, breathe into the clitoris, uh, breathe in to you know the vagina. Whatever terms you want to use, you want to breathe down into the pelvic floor, into your belly, feel that elongation, slow, steady, exhale, and relax. Okay, so that's how you're gonna get that elongation. All right. Once you're able to do this with your breath, then usually I teach patients how to do it on their own without the breath. So that's a little bit more of an advanced movement. Some people say, Oh, it's like wiggling your ears, you know, it's this fine motor, and it really is. It's more like a brain exercise than anything else. It may be challenging, it's okay. Not everybody teaches us how to move our pelvic floor, it's not something that most people talk about. Okay, but that's why we're doing it here. So you can sit down, you can do some belly breathing, you're really gonna relax, tune in, see if you can get this. Okay. Once you've practiced that, maybe it's clear, maybe it's not, maybe it's clear as mud, it's okay. Then you're Gonna try all three because then it might become more clear. So sitting on your hand, looking at the area, you're gonna try all three now. So now you're gonna contract your muscles, relax, big belly breath, open and elongate. You're gonna contract, feel the pelvic floor muscles lift, lift up and away from your hand, relax, feel them fall onto your hand, big belly breath, feel them open and release down into the hand. Again, contract, feel the tissue come up away from your hand, relax onto your hand, big belly breath, fall into the hand. So you're gonna practice all three. Contract, relax, open, elongate. Contract, relax, big belly breath inhale. Take your time, go really slow. These are little fine uh movements, they're not big movements, okay, but they are so important to learn. So that is pelvic floor coordination. Why is this important? Your pelvic floor coordination is so important because by learning those three basic movements, it can treat so many pelvic floor issues that I see with clients. For example, uh, if you have a weaker pelvic floor, you can practice the contraction and relaxation to do exercises, right? If you have pain and tension, you can learn how to relax. That relaxation or that relaxed state, rather, is where you want to be during the day. If you have tension tightness, for some people, that big belly breath, elongation, that lengthening can really help you get out of that contracted state. For people who have bowel issues, right? So they may have uh incontinence of gas, basically they're leaking gas. You want to contract, learn how to hold that gas in. If you're having constipation or outlet issues, right? Well, constipation is kind of a big word, but if you can't allow your pelvic floor to relax to get your stool out, then learning how to relax, learning how to open and elongate can really help you with your bowel movements, okay? For some of my patients who have post-void dribble, right? So they may dribble a little bit. Uh, usually this happens with my penis owners. They urinate and then they put their penis in their pants and they walk away and they have a little bit of dribbling. After you urinate, contract, relax, contract, relax, contract, relax. That's gonna get some of that urine out of that urethra so you don't have the dribbles. If you have pain with insertion, uh, insertion into the vagina, insertion into the rectum, you can learn how to relax, open, elongate, okay. For some of my patients who have that tension, um, that contraction, they may have to do this contract, relax, elongate so they can learn, okay, this is contraction, this is relaxation, this is elongation. So they may have to do that a couple times to learn, okay, this is relaxation, that's where I need to be during the day. If you're somebody who has that tension or that tightness, sometimes for some people, what actually works better is just doing the belly breathing, that elongation, right? That will help them kind of get down into that more relaxed state. For sexual function, right? So we talked about the pelvic floor needs to be able to contract and relax, contract and relax, contract and relax in order to get an erection of the clitoris or the penis. And so if your pelvic floor muscles are tight and they're in that tightened position, it's very difficult for that blood flow to get in. So you have to relax first and then have that pumping mechanism work for you. So, like I said, there's so many issues that are that that can be treated simply by knowing how to control your pelvic floor musculature. Another really popular one is vaginis, inserting in something into the vagina, the the pelvic floor muscles contract or spasm. Um, that can happen in the anus as well. So, at attempt of inserting something into the anus, they contract a spasm. It's really nice if you have this ability to control your own pelvic floor muscles because in over time you can learn how to relax. Over time, you can learn how to open and elongate so that when you are attempting insertion into the vagina, now you can coordinate your pelvic floor muscles to open, elongate, and then allow entrance into the vagina. Big belly breath, open, elongate, allow entrance into the rectum. So, again, your pelvic floor muscles are three layers of muscles. You know, you have a superficial, a middle, and a deep layer. They can contract, they can relax, they can open and lengthen. Um, and hopefully, by watching and listening to this podcast episode, you now can understand how to do these movements. Um, I think that this is something that's super important, and I hope this is helpful. So if you found this to be helpful, if you think that someone else could use this information, please like, share it, and subscribe. Thank you so much for being here, and I can't wait to see you at the next episode. Thank you so much for joining me in today's episode of the Alexis Anderson Podcast. I hope you learned something that brings you more clarity, validation, and compassion for your body and your journey. If this episode supported you or you think you could help someone else, please share it, leave a review, or send it to someone who might need to hear it. And if you're a clinician or patient looking for more resources, tools, or support, you'll find everything linked in the show notes. Remember, you're not alone, you're not broken, and treatment exists that treats you as a whole person. I'll see you in the next episode.