Anatomy of the Pelvic Floor | Physio Pelvic Floor

Structure

The pelvic floor is a layered group of muscles and connective tissues that span the base of the pelvis like a hammock, running from the pubic bone at the front to the tailbone (tailbone) at the back, and between the sitting bones on each side.

The Levator Ani group

This is the primary pelvic floor muscle group and includes three components:

Pubococcygeus runs from the pubic bone to the tailbone, supporting the bladder, urethra, and vagina or prostate.
Puborectalis, forms a sling around the rectum, critical for maintaining fecal continence and controlling the angle of your rectum.
Iliococcygeus (small muscle at your tailbone), extends from the ilium to the tailbone, providing broad pelvic organ support.

The coccygeus sits behind the main pelvic floor muscles and helps stabilize the tailbone and posterior pelvic floor.

The external urethral sphincter and stress urinary incontinence

The external urethral sphincter (EUS) wraps around the urethra and is a key contributor to the closing pressure that keeps urine in. Because it is striated (skeletal) muscle, it can contract both reflexively and voluntarily to compress the urethra, essentially closing the drain. Unlike smooth muscle structures that are harder to influence directly, the EUS responds to targeted training. With consistent, well-supervised exercise, it can regain meaningful strength within 12–16 weeks. This is why pelvic floor physiotherapy is highly effective for stress urinary incontinence, and why targeting the EUS specifically, not just the broader pelvic floor, matters in treatment.

Connective tissue and ligaments

The muscles are reinforced by pelvic fascia, a network of connective tissue enveloping the pelvic floor and supporting the organs. Key ligaments include the uterosacral and cardinal ligaments, which provide suspension support especially for the uterus. These passive structures are distinct from muscles and cannot be directly strengthened through exercise.

Organs supported

The pelvic floor supports the bladder and urethra, the uterus and vagina (in females), the prostate (in males), and the rectum and anal canal. Dysfunction in any of these areas can affect multiple organs simultaneously.

Five key functions

1 SupportMaintains position of pelvic organs against gravity and pressure.

2 ContinenceControls release of urine and feces through coordinated contraction and relaxation.

3 Sexual functionContributes to sensation, arousal, and response in both males and females.

4 StabilityWorks with the deep abdominals and diaphragm to stabilize the spine and pelvis during movement.

5 Pressure managementWorks with the diaphragm and abdominals to manage internal pressure in your abdomen during coughing, lifting, and impact.

Motor control

Pelvic function = motor control + agility

Pelvic function is not just about strong pelvic floor muscles. It is the ability of the pelvic floor, deep abdominals, diaphragm, and hip muscles to coordinate quickly and appropriately, tightening when support or closure is needed, and softening when emptying or free movement is required.

The six key motor skills

Timing, automatic pre-contraction a split-second before pressure spikes from coughing, laughing, lifting, or landing from a step.
Graded control, the ability to contract at low, medium, or high intensity rather than only all-or-nothing.
Endurance, sustained gentle support through standing, walking, or a long meeting without fatigue-driven leakage.
Relaxation / letting go, full lengthening and opening to allow complete bladder and bowel emptying without straining.
Coordination with breathing and trunk, matching the diaphragm and deep abdominals so internal pressure is managed efficiently during all movement.
Sensation and awareness, accurately sensing fullness, urgency, and pelvic tension so the right response is triggered.

Problems show up when the system is too slow (leaks with cough or run), too tense (difficulty starting the urine stream, constipation), too weak or fatigued (leaks later in a run or day), or poorly coordinated with breathing and hips.

Understanding your anatomy helps you get more from your treatment. When you're ready to be assessed, our clinic team is here. No referral required.

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