pelvic floor

introduction

The pelvic floor represents the connective tissue-muscular floor of the pelvic cavity in humans.
It has different functions and is divided into three layers:

• The front part of the pelvic floor (Urogenital diaphragm),
• the rear part of the pelvic floor (Pelvic diaphragm) and
• the erectile tissue and sphincter layer.

It is used to close the pelvic outlet and to secure the position of the organs in the pelvis.

Structure of the pelvic floor

1. Anterior part of the pelvic floor: urogenital diaphragm

He becomes through the Transversus perinei profundus muscle and superficialis formed and represents a horizontal muscle plate represent.
The deeper transversus perinei profundus muscle arises from the Ischium (Ramus ossi ischii) and on the lower part of the Pubic bone (Ramus inferior ossis pubis). When viewed from below, it has a trapezoidal structure and forms the support plate of the pelvic floor.
From the inside it rests on the superficial transversus perinei superficialis muscle. This arises from a bony protrusion of the Ischium (Sciatic tuberosity) and is formed from split-off fibers of the deep-lying M. transversus perinei profundus. Together with the deep muscle the two muscles close the levator gate and thereby mutually support their effects.
Both muscles are made by the one running in the pelvis Pudendal nerve innervated.

2. Rear part of the pelvic floor: pelvic diaphragm

This makes one funnel-shaped muscle loop in the pelvis and is called Levator ani muscle designated.

On closer inspection, however, it becomes clear that this Muscle made up of several muscles is constructed. The individual muscles usually get their name from their respective bone origin (M. puborectalis, M. pubococcygeus and M. iliococcygeus). The single ones Fibers then radiate into one common muscle plate and thereby form the M. levator ani (innervated by branches of the sacral plexus). The central fibers of the large muscle form the so-called Levator Gate. Through this gate the urethra and with the woman Scabbard outward.

Some fibers of the M. puborectalis embrace the rectum (Rectum) and connect behind the rectum with the fibers of the opposite side. This forms a muscle loop that is particularly useful for Continence conservation contributes. During defecation, this muscle relaxes.

Another muscle of the pelvic diaphragm is the Coccygeus muscle. This arises on a protruding bone of the Pelvic bone (Sciatic spine), starts on coccyx (Os coccygis) and strengthens the function of the levator ani muscle. In some cases, however, this muscle can also be absent. However, this does not lead to any symptoms or other abnormalities if the levator ani muscle is functioning properly.

3. Corpora cavernosa and sphincter muscle layer

It is through the M. ischiocavernosus, the M. bulbospongiosus and the External anal sphincter muscle educated.

• The Ischiocavernosus muscle is also innervated by the pudendal nerve and serves to strengthen the erection. In addition it inhibits the return of blood in men and women from the penis or the clitoris. This compression can be arbitrary and reflexive.
• The Bulbospongiosus muscle leads to rhythmic contractions during an orgasm and thus triggers a pulsating pressure wave in the man's erectile urethra and thus the discharge of semen during ejaculation. This muscle can also be contracted reflexively or voluntarily.
• The External ani sphincter muscle is the external anal and sphincter muscles and can be contracted and relaxed at will. He serves to maintain continence or defecation.

The Centrum perinei is located between the urogenital diaphragm and the rectum. It consists of tight connective tissue, tendons and fascia of the pelvic floor muscles and forms the mechanical center of the muscular pelvic floor.

Function of the pelvic floor

With its muscular and connective tissue parts, the pelvic floor forms the Closure of the pelvic outlet and takes care of the Securing the position of the organs lying in the pelvis. In addition, the pelvic floor has three main functions:

• Tension
• Relaxation
• Reflective counter-hold.

The Tension is important for Continence conservation with women and men.
The pelvic floor muscles significantly support the lower part of the urethra, the Sphincters the urinary bladder and des Rectum.

When urinating or defecating, the pelvic floor must be relax, to the Emptying to enable. In men, the pelvic floor also relaxes during an erection. During one Orgasm alternates between tension and relaxation.

Reflective counter-hold is necessary when coughing, sneezing, laughing, hopping or carrying heavily. This creates a reflective incontinence avoided.

Diseases

The pelvic floor can sag with age and then no longer perform its functions described above.
Overweight, chronic physical overload, poor posture or operations in the small pelvis can cause the pelvic floor to sag prematurely and lead to incontinence.
In women, childbirth can also weaken the pelvic floor. This can lead to mild to severe symptoms of incontinence, bladder subsidence, vaginal prolapse, and uterine subsidence. In most cases, these complications can be resolved with pelvic floor exercises (see below) heal again.

A permanent spasm of the pelvic floor muscles is called vaginismus. Affected women are then no longer able to relax the pelvic floor, which makes a gynecological examination or sexual intercourse very difficult or even impossible.

Ultrasound or an MRI of the pelvis are particularly suitable for making diseases of the pelvic floor visible.

Pelvic floor training

There are different reasons why it makes sense to train the pelvic floor muscles. Most of the time it will Women recommended the one pregnancy have behind you, as pregnancy expands the pelvis. However, training should not be started immediately after the birth, as otherwise healing of the damage caused by the birth could be hindered.

Also through Hormonal changes, for example during the Menopause, it can be useful for women to train the pelvic floor and strengthen the muscles in this area. When the uterus sags, a problem that affects many women throughout their lives can be a Pelvic floor training be helpful.

But also Men Exercise of the pelvic floor muscles can be recommended under certain circumstances. So can after Operations of the prostate or at Potency problems training the muscles in this area is recommended. Exercise to strengthen the pelvic floor muscles is recommended for both sexes, if Incontinenceproblems, Obesity or one Connective tissue weakness are known.

You can find more information on our website: Pelvic floor training.

Exercises

In order to be able to train the pelvic floor muscles effectively, there are a number of exercises that can help to selectively contract the muscles. Since the tension of the muscles in this area is particularly dependent on the breathing depends, it is advisable to have one calm and relaxed attitude to take and to breathe relaxedwhile the exercises are being performed. The most relaxed posture for the pelvic floor muscles is on your back with your legs bent and slightly apart.

A Tension of the pelvic floor should always coupled with an exhalation become. It is therefore advisable to do two normal breathing cycles and the pelvic floor muscles as well as the third breathing cycle Abdominal muscles to tighten firmly. With the next breath, the muscles should be completely relaxed again. This exercise should be done for a few minutes every day.

It is important not to tense the abdominal muscles too much without tensing the pelvic floor at the same time. This could lead to an unwanted lowering of the pelvic organs due to the increased pressure in the pelvis due to the tense abdominal wall. There are also a number of other exercises, the one described here having the advantage that the pelvic floor muscles are brought into absolute relaxation in a resting position. This means that you can switch between maximally tense and relaxed several times in a minute without any problems.

Tension

The targeted tensing pelvic floor is a task that is very difficult to do without guidance. The pelvic floor consists of voluntarily controllable musclesHowever, it is very seldom that one consciously tenses these muscles alone. Fortunately, there are exercises that can help you tighten your pelvic floor muscles. It usually helps to do the exercises in the To sit or Lie perform.

To tighten the pelvic floor, the sphincter be so tense that at the same time the feeling arises, which when Stopping urination arises. In order to internalize the feeling that arises when the pelvic floor is tense, the jet can be stopped several times when urinating on the toilet. When the pelvic floor muscles relax again, the urination process should be continued. The same feeling should then occur when tensing the pelvic floor without urinating.

This exercise works because the The pelvic floor muscles squeeze the urethra when contracted and the Process of urination interrupts. Another exercise is to try using muscle strength to bring the penis / vagina closer to the anus. With a little imagination, the pelvic floor muscles are then tensed.

Relaxation

The voluntary relaxation of the pelvic floor muscles is more difficult than the voluntary tension of the same. Most effective for a complete relaxation of the pelvic floor is one certain posturethat makes this possible. The most relaxed position for the muscles of the pelvic floor is when lying down Lie on your back with your legs bent high. In this posture at the same time relaxed breathing and resting position should also be the Pelvic floor muscles relaxed to the maximum be.

Preventing postures and processes in which the pelvic floor muscles are involuntarily tensed can also ensure a relaxed pelvic floor. This is how the Sneeze a very strong pressure on the pelvic floor. The strain on the pelvic muscles can be reduced somewhat by voluntarily tensing the pelvic floor. Through the Avoiding long periods of standing, which also increases the pressure on the pelvic floor, the local muscles relieved become. That too Lifting heavy objects increases tension on the pelvic floor and should be avoided if the pelvic floor is weak.

Summary

The pelvic floor is exposed different muscles together, which all together the Closure of the pool and the Securing the position of the organs in it serves. This will be Pelvic diaphragm and the Urogenital diaphragm distinguished whose muscles perform different functions.

However, all muscles mainly serve the Continence conservationwhich is why they are mostly arbitrarily tense or relaxed can be. Only in this way are they controlled urination and the Defecation (Defecation) possible.
For this reason, the urethra, rectum and, in women, the vagina penetrate the muscular layer of the pelvic floor and are thus encompassed by the muscles.

The muscles of the pelvic floor can, however, by constant heavy physical exertion, childbirth or strong Obesity are very stressed. This can be used for Relaxation of the muscles and thus to Incontinence to lead. However, since the muscles, as long as they are intact, like any other muscle can be trained, it is possible to correct this condition again.