INNOVATIVE PHYSIOTHERAPY APPROACHES IN PELVIC FLOOR DYSFUNCTION

The pelvis, which supports the weight of the upper body, is a central structure of the human body situated between the lumbar region of the abdomen above and the thighs below. The pelvic cavity refers to the space enclosed by the pelvic bones. Superiorly, it is continuous with the abdominal cavity, while inferiorly it is bounded by the pelvic floor. This cavity is divided into two regions: the greater pelvis and the lesser pelvis. The greater pelvis, considered a part of the abdominal cavity, is also known as the false pelvis. In contrast, the lesser pelvis belongs to the true pelvic region and is referred to as the true pelvis. Posteriorly, the pelvic cavity is bordered by the sacrum and the coccyx. Functionally, the pelvic cavity serves as a housing space for the urinary bladder, pelvic colon, internal reproductive organs, and the rectum. Additionally, it contains various internal structures and tissues, including muscles, arteries, veins, nerves, and pelvic connective tissue (1). The pelvic floor is a group of muscles that provide support for the organs within the pelvis. It consists of the pelvic diaphragm, which stretches from the pubic symphysis at the front to the coccyx at the back, forming a hammock-like structure that upholds the pelvic organs. The muscles of the pelvic floor include the levator ani group — composed of the puborectalis, pubococcygeus, and iliococcygeus muscles — along with the coccygeus muscle. The levator ani muscles play a crucial role in maintaining pelvic organ support and are innervated by the fourth sacral nerve (2). The pelvic floor structures receive their main nerve supply from the sacral nerves S3 and S4 via the pudendal nerve, and their primary blood supply comes from the parietal branches of the internal iliac artery. The muscles of the pelvic floor support the pelvic organs — including the bladder, urethra, prostate (in males), vagina and uterus (in females), anus, and rectum — as well as the intra-abdominal contents, help maintain urinary and fecal continence, and contribute to sexual functions such as arousal and orgasm (3).