Ask any student I teach in our entry-level DPT program at UCA and they will tell you that I harp on my sincere belief that words matter! The words and phrases we use create a connotation, a visual in the hearer.
Well I want to bring up a phrase that drives me crazy. I cringe every time I hear “pelvic floor,” a term widely used when talking about the muscles inside the pelvis – the levator ani and coccygeus (or “kegel” muscles). I would like to suggest this is a poor phrases to accurately describe these muscles.
What image arises in your mind’s eye when you hear the word “floor”? . . . In my mind, “floor” brings up an image of a static, unmoving object. Floors are walked on, they get worn out, they get dirty. Floors have a hard surface, or at least a hard undersurface. They are flat. I don’t get a sense of something that is dynamic and responsive, nor a sense of something that deserves acknowledgement for having a variety of functions. A floor is beneath our feet, passive and unchanging.
The muscles that live in the pelvis are not flat. They are not static. They move and respond dynamically for a variety of situations. These muscles are shaped like a funnel or dome, similar to and mirroring the breathing diaphragm. They encircle the inside of the entire bony pelvis (minus the necessary openings for passage of pelvic organs and structures). These muscles have many functions when working properly. When I cough, they should quickly react to close off my urethral and rectal openings so I don’t leak urine, fecal matter, or gas. When I cough these muscles should also provide an upward supportive lift to prevent my pelvic and abdominal contents from moving downward with the increased pressure in this part of my body. When I need to empty my bladder or my bowels, these muscles must actively lengthen and allow opening for this passage. With sexual activity, these muscles also need to be coordinated for both relaxing at the right time (to allow intercourse), and to contract at the right time (to contribute to orgasm). When these muscles do not do what they are supposed to do, then I may leak urine, or have pelvic organs descending below where they should be (also called pelvic organ prolapse). If these muscles don’t relax when they need to, I may have difficulty emptying my bladder effectively, or have chronic constipation or pain with intercourse.
Some anatomists refer to this group of muscles as the “pelvic diaphragm.” This term makes sense to me, and parallels the breathing diaphragm. We need the breathing diaphragm to contract and move downward into the abdominal cavity to allow inhalation; and we need that same muscle to relax, returning to its upward position for exhalation. We can think of our “pelvic diaphragm” muscles similarly. Sometimes we need them to contract and move further up into the pelvic cavity to provide support and continence. Sometimes we need them to open up and release to allow bladder and bowel emptying.
I call myself a “pelvic health physical therapist,” and I refer to the “pelvic diaphragm” or “pelvic muscle” problems.
What do you think is a good name for the muscles inside the pelvis?
I would love to hear your comments! Let’s start a discussion and make a move for better terminology, and create a more accurate perception of these muscles for both patient/clients and all health care providers.
About the Author
Darla Cathcart, PT, DPT, CLT, WCS
Darla is the Director of Education for SoWH. A new resident of Conway, AR, she is fulfilling her lifelong passion for teaching as an instructor in the PT Program at University of Central Arkansas. She is pursuing a PhD in neurobiology to help research & find solutions for women with chronic pelvic pain. She loves her 7-year-old twin boys, Basset hound and Jack Russel, craft beer, good chocolate and good ice cream. She runs and lifts weights to balance out those last three.