In order to answer this question, we need to first understand where the pelvic floor muscles are. You are in for a surprise if you think pelvic floor muscles are muscles that have to do with your external genital area (around the penis or vagina) and anus. So let’s see what the pelvis even looks like.


Anatomy of the Pelvis


The pelvis is the ‘house’ that the pelvic floor is the ‘floor’ of. This is very important to remember because we seem to be too busy thinking of the ‘floor’ when the ‘house’ is not stable by any means. We will come back to this later on in this blog but keep this in mind for now.

The pelvis consists of 3 bones: 2 ilium and sacrum with the 2 ilium coming together in the front to form the pubic bone. The pelvis is attached to the spine via the sacrum at the top and connected to the leg bone at the bottom to form the hip joint. In fact, in the hip joint which is a ball and socket joint, the socket is offered by the pelvis.

Pelvis bones

Pelvis bones (courtesy of https://orthoinfo.aaos.org/)


Where are the Pelvic Floor Muscles Located?


The pelvic floor muscles line the bottom and the wall of the pelvis and are more than what is along the vagina or penis. The floor itself consists of 3 layers and the mistake in treating pelvic floor dysfunction is that the majority if not the full focus is on the floor but the floor does not sustain itself alone and is attached to the wall and influenced by what is attached to the pelvis. Focusing just on the floor is the reason why benefits from pelvic floor treatments don’t last long.

Pelvic floor model

1st Layer of Pelvic Floor Muscles (courtesy of yourpaceyoga.com)

First Layer (outer most layer)

  • Ischiocavernosus
  • Bulbocavernosus/Bulbospongiosus (interchangeable, for all genders)
  • Superficial Transverse Perineum
  • External Anal Sphincter


Second Layer (middle layer)

  • Urethral sphincter (sphincter urethrae)
  • Compressor urethrae
  • Sphincter urethral vaginalis
  • Deep transverse perineal
  • Perineal membrane
Diagram of cross section of layer 2 of pelvic floor

2nd Layer of Pelvic Floor Muscles (courtesy of ponsonline.com)

Third Layer (inner most layer)

  • Puborectalis
  • Pubovaginalis (female)/puboprostaticus (male)
  • Pubococcygeus
  • Iliococcygeus
  • Coccygeus
Third layer of pelvic floor diagram

3rd layer of pelvic floor muscles (courtesy of Quizlet)

Pelvic Wall

  • On the inside, the pelvic wall consists of 2 primary muscles the piriformis and obturator interns which are hip stabilizer muscles. When working internally on the pelvic floor, the piriformis is not accessible and the obturator internus may be reached. Frankly, with the internal manual work, the length of the examiner’s index finger determines how far and well these muscles are reached. Working on the muscles of the floor should NOT be first on the order of treatment as strengthening the pelvic floor muscles without the pelvis being strong, and without addressing the ‘influencers’ of its stability is a waste of time long term!


What Pelvic Floor Muscles Do Kegel Exercises Work On?


Now that you know about the anatomy of the pelvic floor muscles it is easier to see what layer of the floor Kegel exercises work on. Kegels when done correctly work on strengthening the second layer of pelvic floor muscles. When done by a therapist, it is the compression and pulling feeling on the finger inserted in the vagina or anus that allows the therapist to ‘grade’ the strength of these muscles.

It is then, through practice guided by the therapist, that the strengthening of those muscles begins. It is important to connect to these muscles so periodically throughout the day, they can be conditioned. The reality, however, is that once the problem (typically in the eyes of the patient, incontinence is the problem that signals having an issue) has lessened, people do not continue with Kegels and that is when the  Emsella chair plays a big role.

The Emsella chair is FDA-approved for incontinence by doing 400 Kegels a minute or 11,200 Kegels per session!! In my practice, I use this device and technology for all of my patients with weak pelvic floor  or pelvic floor dysfunction. While there are contraindications for doing Kegel’s and Emsella chair, this device has done wonders for many.

What Pelvic Floor Exercises Are Effective?


Pelvic floor exercises are only effective when not only the floor muscles, but the muscles of the pelvic wall, hip stabilizers, and lower back are addressed. Of course, and without any hesitation, all muscles involved in breathing are to be addressed or what has been worked on will diminish and fade away. I strongly advise you to visit my YouTube channel to learn about some of the exercises that you should be doing to strengthen your pelvis and pelvic floor muscles.

If you are thinking you know how to breathe, you know belly breathing and you have that down, you may want to watch the video below. You ought to think of breathing in while pushing the rib cage outward and the diaphragm down towards the pelvis, and breathing out from the pelvis up toward the chest.

Are Pelvic Floor Exercises Enough to Fix Pelvic Floor Dysfunction?


Now that you know about the importance of not just working on the muscles of the floor but the ‘house’ that the pelvic floor is the ‘floor’ of, when it comes to the fix, we need to address the issue with a wide angle lens. Being myopic when treating any health condition will lead to a temporary fix that we all wish to avoid. By browsing through my blogs, you will find many articles I have written about the pelvic floor, the myths and the facts, temporary fixes, and permanent solutions. In my blog: “ How is Pelvic Floor Dysfunction Diagnosed’, you see the comprehensive list outlined here.

Movement is like a concert and the body parts are like the musicians; the musicians not only need to know their part but to know when to chime in and phase out. That means the pelvis and pelvic floor need to know how to ‘play’ with the rest of the body if they are to sustain their strength and integrity. Postural neurology is only about the neurology behind posture so don’t mistake it with neurological examination to see if your nerves are working right!

Common sense says that the most authentic way to move is the way babies move. After all, all babies from all over the world go through the same developmental stages of movement which means that we are hard-wired to move that way. So if the issue is movement-related or supported, then we should see how we compare to the way we moved as babies. All discrepancies are then highlighted and can be corrected through Dynamic Neuromuscular Stabilization (DNS) exercises which are baby movements.

  • Gait Analysis:

The way you walk gives a lot of information as to what is going on neurologically speaking (with regards to movement and balancing) as well as bio-mechanically (how the joints and muscles come together to get you from point A to B).

Doing a foot scan is a part of the gait analysis in my practice to see how you distribute your weight on your feet which are your point of contact. We can’t build strength if the point of contact with the ground is unstable, bear in mind that we are not talking about orthotics here!

Double scale analysis shows if you put more weight on one side vs the other; this gives us a clue how deep the problem of imbalance is and is a gauge to measure going forward with the treatment.

  • Breathing

This was discussed above with an additional video that you will find by going to the blog itself.

There is no quick fix for health issues and blaming ‘this and that’ does not help you get rid of them. Instead of excuses that are thrown at us, blaming age, pregnancy, childbirth, excess weight, smoking, lifestyle and so much more, we should look into what we can do NOW to turn the tables around.

If you have pelvic floor dysfunction and are interested in taking action steps in the right direction, contact me today.