Pelvic Floor Anatomy: The Body Connected

The pelvic floor consists of all the structures that form the floor or bottom of our pelvis from our pubic bone to our coccyx. Depending on the source, this may even include from the waist to the inner thigh or hip region. Muscles, nerves, blood vessels, fascia, organs and lymphatics reside in the pelvis. If we include the hip, lumbar spine and sacroiliac joint we now must consider how joint mobility and stability affect the pelvic floor and how the pelvic floor may affect these  In this post, not all anatomy will be discussed as this post would become a book. Enjoy some snippets of how our pelvic floor relates to the body.

Female Pelvic Floor Anatomy

To appreciate the pelvic floor for the female anatomy, see the images below:

This is an image looking from the bottom of the female pelvis depicting the urethra, vaginal and anal orifices (openings) and pelvic floor muscles. Some of the bony structures to view are the pubic symphysis (at the top), the ischial tuberosity (at the outer bottom) and the acetabulum. The acetabulum or concavity in the pelvic bone is the socket where the head of the femur (hip) attaches. An appreciation of the hip in pelvic floor issues can be realized by looking at the anatomy. The proximity of the hip joint to the pelvic floor and the hip muscles crossing the pelvis create a relationship to the pelvic floor.

This image is looking from the top down and into the inside of the female pelvis. You can appreciate the connections from the front (pubis) to the back (sacrum) and the attachments of the pelvic floor muscles and the direct relationship to hip musculature such as the iliacus, psoas and piriformis. The psoas, a long tubular muscle adjacent to the iliacus (see the image below), connects the lumbar spine to the femur by going through the pelvis. Contributions by the psoas may have a large effect on the spine and pelvic floor.

Male Pelvic Floor Anatomy

The image below shows a model of the male pelvic floor looking from the bottom up. The yellow lines depict the pudendal nerve which arises from the sacrum and has input for sensation, muscle activity of the urethra and anus. This helps with control over the bladder and bowel. It also relays information of touch, pleasure and pain to the brain. The large grey ligaments on either side of the pelvic floor are the sacrotuberous ligaments which aide in stability to the pelvis and connect into the hamstrings and the posterior superior iliac spine (ilium/pelvis).

The image below demonstrates the male pelvic floor model looking from the top down inside the pelvis. The hammock nature of the pelvic floor muscles shows the support nature for the anus and urethra to help control the bowel and bladder. At the top of the image, the abdominals are connected to the pubis of the pelvis. The abdominal wall can affect the pelvic floor. For example, if there are trigger points or knots in the abdominal wall pain can be referred to the pelvic floor.

Knowledge of anatomy, particularly the pelvic floor, is important in understanding the connections to the rest of the body and the impact the pelvic floor may have on our body and how it may affect it. If you think you may have a pelvic floor problem, please discuss with your provider to see if pelvic floor physical therapy may be appropriate for you.

References and Further Reading

• Donnelly, J., Fernandez-de-las-Penas, C., & Finnegan, M. (2019). Myofascial Pain and Dysfunction: The Trigger Point Manual (3rd ed., pp. 487-495, 530-533). Wolters Kluwer.
• Ghanavatian, S., Leslie, S., & Derian, A. (2023). Pudendal Nerve Block. StatPearls. https://www.statpearls.com/articlelibrary/viewarticle/27998/
• Koch, L. (2012). The Psoas Book (1st ed.). Guinea Pig Publications.
• Pudendal Nerve. (2021, September 14).  Cleveland Clinic. Retrieved April 3, 2024, from https://my.clevelandclinic.org/health/body/22000-pudendal-nerve
• Sacrotuberous Ligament. (2023, August 24). Physiopedia, . Retrieved 19:26, April 3, 2024 from https://www.physio-pedia.com/index.php?title=Sacrotuberous_Ligament&oldid=340406.