The Core of the Issue – The Pelvic Floor and Incontinence


Do you experience incontinence or low back pain? To understand how to treat these two conditions, and get to the “core of the issue,” we must understand the importance of anatomy of the pelvis, lumbar spine, and internal organs.

The pelvic girdle is a complex ring of joints, ligaments, and muscles. The three main bones of this region, two ilium and the sacrum, meet together to form three joints. These areas are the pubic symphysis and two sacroiliac joints. These joints have very broad-based surfaces that allow them to have some movement and transfer large loads placed on the joints during activity.

In order for these bones to have some movement between one another when we walk, bend, and move the way we do, they must have an outside force to stabilize them. This stabilizing force is made up of the ligaments and muscles that control the amount of movement. Stabilization by the muscles is provided by four central muscle groups, which include the pelvic floor muscles, multifidi, transverse abdominis, and psoas major.

Imagine the pelvic area as a cylinder. You want to keep equal pressure on the contents of that cylinder if you are going to protect what is inside. After all, your entire spine, all the nerves, and the bladder live in that area. You keep equal pressure by coordinating the movement and contractions of the muscles, giving you a strong, stable core and support system. If you have weakness in any of these muscles or cannot coordinate them, you put more pressure on the contents inside or not enough on the bones, allowing them to shear at the joints.

group of runners

The pelvic floor muscles are a group of muscles that run from the tip of your pubic bone to the tailbone. They are comprised of several layers of musculature and serve several important functions for the health of your low back and sacroiliac (SI) joint and your bladder control. Research has shown that these muscles contract together with the transverse abdominis. The roles they play include:

  1. Supporting the bladder and internal organs
  2. Supporting the spine
  3. Sphincter closure (closing the vaginal and anal openings)
  4. Sexual function

Therefore, if we are not strong enough in our pelvic floor muscles or are unable to coordinate their contraction with the other muscles, we will not maintain stability of the pelvic ring or spine and will put more force on the bladder. Trauma to this region, including C-sections, pregnancy, lumbar injury, or previous lumbar and abdominal surgeries can impact how these muscles function and how well they support your spine and bladder. Furthermore, if we are going to do activities that involve bending, walking, or running, we need to have adequate stabilization of the spine so that we can use our hips, knees, and ankles without risking injury to the joints further down in our legs.

If you have any of these issues including: incontinence; pain in the pelvis, hips, or lumbar spine; previous history of surgical intervention in this region; or previous low back injury, you may benefit from a detailed physical therapy examination by an expert to assess how your pelvic floor and pelvic girdle are functioning together. If you have any sudden loss of bowel or bladder control, please consult your physician immediately.

Are you experiencing incontinence or pelvic discomfort?

Our pelvic health specialists are committed to the application of evidence-based treatment techniques to ensure you experience the best in rehabilitation and preventative care and see progress with every visit.

physical therapist talks to a patient

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