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  • Writer's pictureNicole Cozean

5 Ways the Pelvic Floor is Different

What makes the pelvic floor so challenging and complex compared to other areas of the body?

We can all recognize there is a difference in complexity between a pelvic floor issue and an ankle sprain or post-surgical knee rehab. But why?

Understanding how the pelvic floor is different informs our care and allows us to manage expectations, prioritize our treatments, and better communicate with our patients.


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Here are the five biggest ways the pelvic floor is different. For more on the topic, make sure to check out the full 'sode of the Pelvic PT Rising podcast!

1. The pelvic floor is innervated by both the autonomic and somatic nervous system

The pudendal nerve is one of the only nerves in the body responsible for both autonomic and somatic functions.

This is why simply telling patients to relax their pelvic floor is difficult (or impossible). It's one of the challenges we have with 'reverse Kegels' (and something we cover in more detail in the Downtraining Masterclass). While it can be helpful in certain situations, it's just not how the pelvic floor functions in daily life.

We have to recognize some of our interventions have to be on the autonomic level if we're going to get the pelvic floor to behave like it does in real life.

2. The pelvic floor doesn't have a typical origin and insertion

The way the pelvic floor connects with the pelvic girdle is far more complex than a typical muscle. It slings across the entire pelvic area. It has to coordinate from side to side. Sometimes the 'insertion' point is an organ!

This is the reason I don't like comparing the pelvic floor to the biceps muscle. I know it's an easy comparison and simple to demonstrate. But the pelvic floor doesn't connect to the pelvic girdle the way the biceps does to the arm. And our language around 'shortening' and 'lengthening' becomes oversimplified to the point where it can be misleading.

I much prefer the analogy of the pelvic floor is like a trampoline (we do a deep dive into this comparison in the Essential Pelvic Strengthening: Not Your Mama's Kegels course).

But we can't treat the pelvic floor like a typical skeletal muscle that does have true origin and insertion points.

3. The pelvic floor has a deep connection with organs

Adding to the complexity is the pelvic floor has a relationship with our organs! They connect autonomically. Some of the muscle fibers interdigitate with organs. And the function of the pelvic floor affects the associated organs, they have to coordinate to fulfill their jobs together.

This hard-wires us to pay more attention to the area and means pelvic floor dysfunction can be massively more disruptive to the body than issues in other muscle tissues.

4. We are biologically and societally wired to care more about pelvic functions

The functions the pelvic floor governs or allows are integral to our very survival. Peeing, pooping and sex are biological imperatives. If we can't eliminate waste, we're going to have a big survival problem. If we don't procreate, we'll have a survival problem.

This is reinforced by our society. We're taught peeing, pooping and sex are private from a young age. They aren't things we're comfortable discussing with others. Many have a history of sexual trauma. And now something is going wrong with this sensitive area we've been trained not to talk about.

This means pelvic floor issues generate more emotional involvement than other areas of the body. We have to be cognizant of that while treating. We can't pretend it's just another ACL repair!

5. You can't 'just take a break' from using the pelvic floor!

If another area of the body is injured, we'll often tell a patient to avoid using it for a while. Shoulder giving you trouble with tennis? Just stop playing for a few weeks. If it's really bad we'll put it in a sling to immobilize it.

The pelvic floor doesn't work that way. We're constantly having to use the pelvic floor for major functions. We can't get a break from that. We can't just stop peeing and pooping to let the area calm down. Sometimes we don't take this into account with our patients or our expectations of how long a healing process might take.

In the podcast we likened it to trying to repair a ship at sea. It's far more complex because the ship has to keep doing it's primary job - staying afloat! - while you make repairs. That's what we're doing in pelvic health, and that makes it so much more complex than other areas of the body. Or, as Jesse said in the full 'sode of the podcast on this topic...

"You can't RICE the pelvic floor". -Jesse Cozean, Pelvic PT Rising Podcast

Essential Pelvic Strengthening: Not Your Mama's Kegels Course

If you want to learn more about the anatomy, functions and how to trade an isolationist (Kegel-based) approach for a more functional treatment approach, make sure to check out the Not Your Mama's Kegels course!

It's helped more than 300 clinicians integrate standing and functional evaluations, get patients off the table and re-think how they strengthen!

"Absolutely changed the way I practice, how I evaluate, and how I THINK about the pelvic floor. Pelvic strengthen in the system and for function!" - Sarah P. (Essential Pelvic Strengthening)


Nicole Cozean, PT, DPT, WCS

Founder of Pelvic PT Rising and PelvicSanity Physical Therapy in Southern California.

Dedicated to forever changing pelvic health with online clinical courses to help you be more confident in your practice and business resources to help start and grow pelvic health businesses.

Jesse Cozean, MBA

Co-founder of the Pelvic PT Rising and the Rising Podcast.

Jesse uses his business experience to help pelvic health business owners start and grow their practices so they can build a practice that truly works for them. From website design, SEO, conversions, marketing, finance and money mindset, he wants to make the process of owning your own practice easier and fun.

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