Feature: Understanding the Pelvic Floor

By Barbara C. Bourassa

It's common knowledge that many women suffer from bladder weakness, leakage and/or drips. Why is this the case? The answer lies, in part, with the way the female pelvic region is designed. The pelvis is a large circular bone in your midsection which houses several internal organs. When you rest your hands on your hips, you're touching your pelvis. For a better understanding of the pelvic area, what organs are found there, and the role of the supporting muscles, ligaments and associated nerves, we contacted Raymond Rackley, M.D., a specialist in female urology at the Cleveland Clinic in Ohio.

At its most basic level, the pelvic region contains a complex system of organs that provide storage and evacuation functions, says Dr. Rackley. The uterus is designed to "store" a baby, while the bladder and rectum are designed to store bodily waste. Each organ is also designed to evacuate its contents when necessary-the uterus when giving birth, the bladder several times a day, and the rectum once a day or once every two days on average.

All these organs are surrounded by a series of muscles (and supporting ligaments and nerves) referred to as the pelvic floor muscles. While these muscles may have evolved from complex tail functions in primates, in humans, most women are not used to actively engaging them, says Dr. Rackley. "The pelvic floor muscles are located deep in the pelvis, you can't see them, and for the most part we don't consciously use them," he notes. In fact, many women are never aware of these muscles until there's a problem.

Because the uterus, bladder and rectum - as well as their respective openings, the vagina, urethra and sphincter - are so close together, any problems with one organ may sometimes affect the others. A difficult childbirth, for instance, may impact the nerves that help control the muscle movement of the bladder or urethra, or affect the surrounding muscles and ligaments that help control urine flow.

"The action of childbirth can be very dramatic," says Dr. Rackley. "In a sense, the uterus squishes everything out of the way during pregnancy." In some women, this can result in temporary or long-term bladder issues.

In addition, childbirth is not the only thing in a woman's life that can affect the pelvic floor muscles. Chronic constipation, chronic coughing, or complex pelvic surgery can also have an impact, he notes.

While many women feel that they are to blame for bladder weakness because of something they did or didn't do, Dr. Rackley says this is simply not true. "In many ways, it's because of the way the body is designed," he notes. Women have been experiencing bladder weakness or leakage throughout evolution, in part because the modern human body hasn't changed much.

Luckily for modern women, however, there are many solutions for overcoming or compensating for injury to the pelvic region, including medication, behavior modification, surgery or even exercises such as Kegels, which are designed to strengthen the muscles of the pelvic floor.

If you have concerns about your own pelvic health, be sure to consult your doctor or other medical professional for expert advice.