Is the pelvic floor really a floor?
The Pelvic Floor: Not a Floor! Watch the YouTube Video Here
When people hear the phrase ‘pelvic floor’, the image that comes to mind is something flat, solid, and unyielding — like a hardwood surface or tiled floor. But in truth, the pelvic floor is nothing of the sort. The very metaphor is misleading, and has led to decades of miscommunication about how this vital part of the body functions.
Origins of the term
The term ‘pelvic floor’ appears in 19th-century medical literature, drawing on the language of German anatomy. The German ‘Beckenboden’ (literally “basin floor”) was used in texts like Henle’s Handbuch der systematischen Anatomie des Menschen (1855), later adopted into English translations and into Gray’s ‘Anatomy of the Human Body’. These early anatomists were working with cadaveric specimens laid on dissection tables and in fairness to them, the view from above suggested a ‘floor’ at the base of the pelvis. From a dissecting-room perspective, the metaphor made sense: the bony pelvis looked like a bowl, and the muscular sheet at the bottom looked like its floor.
Although this was visual convenience rather than functional description, the phrase stuck, and over time the ‘floor’ metaphor hardened into dogma, seeping into physiotherapy, gynaecology, urology, and even popular culture. Today, people talk about “strengthening” or ‘contracting’ the pelvic floor as though it were a rigid platform.(Vesalius, 1543)
A living, moving bowl
The pelvic floor is about as far removed from a an actual floor as it’s possible to be. Instead you can think (or re-think) of it as a three-dimensional, muscular basin formed by the muscles levator ani (pubococcygeus, puborectalis, iliococcygeus) and coccygeus, together with a myriad of fascial layers and connective tissues. In women, it is punctuated by three openings: the urethra, vagina, anus, and in men by two. Immediately the idea of a sealed, floor like surface is challenged by the presence of holes which would structurally challenge any solid floor.
The concept of a floor is however incredible ingrained, so we need to reset out imagery. Putting aside the location of what we’re discussing and imagine a hammock, a sling or even better, a golf ball resting in a bowl. Tilt the bowl even slightly and the ball rolls. In the same way, the pelvic basin is always influenced by vectors of force: spinal mechanics above, hip rotation and femoral pressures below, diaphragmatic descent with each breath, and intra-abdominal pressure from all sides.
The container itself is reasonably static in nature and cadaveric dissection shows us the architecture, but in living bodies this ‘floor’ is never flat, never still and never separate. It participates in breathing, walking, laughing, lifting, birthing, and defecating. It has to yield, adapt, and re-form with every change in load and is subject to change when tissues away from it are restricted or dysfunctional in any way.
The problem with ‘contraction’
Historically, advice to women and quite often the prevailing idea has been based around “contracting the pelvic floor.” This has sometimesdelivered with vague cues in antenatal classes or by trainers. While pelvic floor contraction (the famous ‘Kegel’ exercises, popularised by Dr Arnold Kegel in the 1940s) has its place, this oversimplification carries potential to be nit just ineffective but even harmful. (Grimes and Stratton, 2009;) (Loving et al., 2021;) (SMSNA, 2020;) (Cleveland Clinic, 2022).
Muscles are not designed to hold rigid, static contractions for long periods. They are designed to shorten, lengthen and coordinate with surrounding structures. When we reduce the pelvic floor to a simple clench, we ignore its role as a dynamic partner in a chain of function.
Too much emphasis on contraction can even lead to dysfunction: hypertonic pelvic floor muscles are associated with pain, incontinence, and impaired sexual function. A tight pelvic floor is no healthier than a chronically tight hamstring. The true goal is adaptability — the ability to support when needed and release when not.
Connections to breathing and the diaphragm
One of the most elegant demonstrations of this adaptability is the relationship between the pelvic floor and the thoracic diaphragm. Each breath creates a piston-like movement: as the diaphragm descends during inhalation, the pelvic floor yields slightly; as the diaphragm ascends on exhalation, the pelvic floor recoils.
This synchrony is mediated by intra-abdominal pressure and fascial continuities. The linea alba, thoracolumbar fascia and iliopsoas are also contributors to this integrated pressure system. When you cough, laugh, or lift a weight, the pelvic floor responds in real time to pressure shifts, like a trampoline absorbing impact.
Historical Lessons from dissection
Classical anatomists such as Vesalius (De Humani Corporis Fabrica, 1543) described the pelvic muscles in careful detail, but did not use the term floor. Instead, they spoke of a “hollow” (‘cavitas’) or “basin” (‘pelvis’). The modern “floor” metaphor reflects a cultural need for tidy, mechanical analogies, with the body seen as architecture.
Yet when we look at preserved specimens or fresh prosections, the metaphor breaks down. The tissue is soft, perforated, and continuous with fascial planes. In reality, the so-called floor is more like a woven hammock strung between the bony landmarks of the pelvis, never flatand always under some degree of dynamic tension. (Henle, 1855).
Clinical Re-Framing
For manual therapists, movement teachers, and clinicians, reframing the pelvic floor is more than semantics. It shapes the way we cue, teach, and treat and how our clients think and talk about their bodies.
For yoga or Pilates instructors, it means moving away from rigid “squeeze” cues and towards language of release, buoyancy, and breath.
For manual therapists, it means recognising pelvic floor dysfunction not as a local failure but as part of a global system of load management.
For clinicians, it opens the door to holistic treatment of continence, pelvic pain, and postnatal recovery.
The metaphor matters because metaphors shape practice. If we see a floor, we tell people to build, strengthen, and hold. If we see a hammock or basin, we invite them to breathe, balance, and adapt.
Practical Takeaways
Breathing First: Encouraging diaphragmatic breathing to restore natural rhythm between diaphragm and pelvic floor.
Movement, Not Clench: Teaching gentle yielding and lifting rather than constant contraction.
3. Whole-Body Perspective: Recognising that foot posture, hip mobility, and spinal alignment all change pelvic floor dynamics. The focus becomes on how other elements of our movement impact through this area.
Towards better language
Language is not trivial — it is a lens through which patients, students, and clinicians perceive the body. Accepting a metaphor because it’s always been done that way, limits understanding and create misleading imagery.
I therefore propose that it is time to retire the term ‘pelvic floor’ entirely from our vocabulary. Words like ‘basin’, ‘hammock’, or ‘sling’ do more justice to the anatomy and its function. They impute movement and accept that forces that influence the tissues exist.
Misleading metaphors limit understanding and better or more accurate ones open new possibilities for health.
References and Further Reading
Cleveland Clinic (2022) Hypertonic Pelvic Floor: Causes, Symptoms & Treatment. Available at: https://my.clevelandclinic.org/health/diseases/22870-hypertonic-pelvic-floor (Accessed: 30 September 2025).
DeLancey, J.O.L. (1992) ‘Anatomic aspects of vaginal eversion after hysterectomy’, American Journal of Obstetrics and Gynecology, 166(6), pp. 1717–1724.
Grimes, C.L. and Stratton, P. (2009) ‘Female sexual function and pelvic floor disorders’, Obstetrics and Gynecology Clinics of North America, 36(3), pp. 527–546. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2746737/(Accessed: 30 September 2025).
Henle, J. (1855) Handbuch der systematischen Anatomie des Menschen. Braunschweig: Friedrich Vieweg und Sohn.
Kegel, A.H. (1948) ‘Progressive resistance exercise in the functional restoration of the perineal muscles’, American Journal of Obstetrics and Gynecology, 56(2), pp. 238–248.
Loving, S., Thomsen, T., Jaszczak, P. and Nordling, J. (2021) ‘Pelvic floor physical therapy for pelvic floor hypertonicity: A systematic review of treatment studies’, Lower Urinary Tract Symptoms, 13(4), pp. 271–285. doi:10.1111/luts.12351.
SMSNA (2020) How Can Overly Tight Pelvic Floor Muscles Impact One’s Sexual Health?. Society for Men’s Sexual Health. Available at: https://www.smsna.org/patients/did-you-know/how-can-overly-tight-pelvic-floor-muscles-impact-one-s-sexual-health (Accessed: 30 September 2025).
Van Kampen, M., Geraerts, I. and De Ridder, D. (2015) ‘The role of pelvic floor muscles in male sexual dysfunction and pelvic pain’, Sexual Medicine Reviews, 3(1), pp. 53–62. doi:10.1002/smrj.41.
Vesalius, A. (1543) De Humani Corporis Fabrica. Basel: Oporinus.
Gray, H. (1858) Anatomy of the Human Body. London: J.W. Parker and Son.
