THE PELVIS AND ITS STRUCTURES
THE PELVIS AND ITS STRUCTURES
What is it?
The pelvis is a ring of bone that stabilizes the body at its center. It is the connection between the body and the legs. There are muscles on the inside of the pelvis called the pelvic floor muscles, forming both superficial and deep layers. These muscles help support and position the clitoris, the urethra, the vaginal opening, and the anus. The muscles form a sling within the pelvis, attaching in the front near the pubic bone and in the back at the coccyx (tailbone).
What does it look like?
*See PDF for photos
What does it do?
The bony pelvis acts to protect the bladder, urethra, uterus, vagina, ovaries, and rectum, all of which are found within the ring. The pelvic floor muscles not only serve as support, they help to control bowel, bladder and vaginal function. The pelvis also serves as an attachment for muscles from the back, the abdomen, and the legs (both in front and in back). These muscle structures are what give us the ability to stand upright, to walk, to sit, and to lie down.
What can go wrong?
The joints of the pelvis—one in the front (pubic symphysis) and two in the back (sacroiliac joints)—can be a source of pain. Joint inflammation, joint deterioration, and injury can cause pain in the low back and/or coccyx (tailbone). The nerves that serve the pelvic structures can also be injured (e.g. during a prolonged, quick, or assisted childbirth) or inflamed (e.g. following an injury), resulting in pain, muscle spasm and/or weakness. When uncontrolled muscle spasm occurs in the muscles of the pelvic floor, vulvar pain can be a problem as can pain within the pelvic floor muscles themselves (i.e. vaginismus), making intercourse difficult or impossible. Altered pelvic floor muscle function can also cause diarrhea, constipation, urinary stress incontinence, urinary urgency or frequency.
What can I do?
It is important to let your health care provider know that you have problems, either with pain or with your bowel or bladder. Your health care provider may send you on to another professional, such as a specialist physician, a psychologist or a physical therapist, who is more aware of what may be causing the trouble and can provide further diagnosis and treatment.
What can I expect?
It is important to try to find the cause of problems when they occur. Joint and muscle problems often require a combination of physical therapy and prescribed drugs. The treatment of vulvar pain, which combines conservative and drug management, should be a multidisciplinary approach, including your health care provider, a psychologist, and/or a physical therapist. Biofeedback is often used to help normalize the pelvic floor muscles while physical therapy works to rebalance all of the pelvic structures. In the worst case, some women may need surgery to address their symptoms. Talk to your health care provider about an appropriate referral.
International Society for the Study of Vulvovaginal Disease
Patient Information Committee, Revised 2014
Illustrations copyright 2003 Dawn Danby