I was also really drawn to treating the pelvis because these clients kept showing up in my practice.

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Hello, everyone, and welcome! Welcome! Welcome! This is an introduction to the pelvic floor. My name is Krystal Lynn Couture and I am the pelvic acu. I want to first take an opportunity to thank the American Acupuncture Council for hosting this webinar. this video, as well as the many other educational video series that they have on their vlog.

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Let’s get started. First off, I want to let you know just a little bit about me. I became a PT in 2006 and later became an acupuncturist. I actually started dry needling in 2009 and very quickly I found that the power of a needle was more than just muscle release. I was immediately drawn to Eastern medicine.

And as doing so, I was also really drawn to treating the pelvis because these clients kept showing up in my practice. They didn’t know that much about it. I didn’t learn about it in school, in PT, in school for acupuncture, just, And it just kept happening that these clients needed help, they trusted me, they were seeing me for something else, and then it was like, hey, by the way, I’ve got this thing going on that I really don’t know who to talk to about it.

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And so at first I just listened, and I educated myself and educated myself. And eventually, I developed a system to bring pelvic care to clients. Through the lens of acupuncture to create successful treatment plans for these clients that address the root of the dysfunction through the physical body, through the emotional body, and of course, through the spirit, which is what we do really well with our medicine as acupuncturists.

Today, we are going to have a very brief introduction to the anatomy of the pelvis and the pelvic floor. First, we’re going to talk about the bony structure of the pelvis, then we’ll start talking about the superficial and deep musculature layers. We’ll talk about the differences between the female and the male pelvis.

We’ll get into the functions of the pelvic floor in relation to organ support, in relation to sexual function and reproductive function, as well as bladder and bowel function. And then finally, we’ll have a quick chat about qi and blood. If we can understand the science and the physiology of the pelvis.

and the organs that are contained within it, as well as the muscles and also the energetics that are contained within the qi and the blood, we can start to produce a really amazing way to treat the pelvis comprehensively. And this is what I love about bringing pelvic care into your acupuncture practice.

So let’s start with anatomy.

All right, I have my amazing pelvis here, and I’m going to use this as a model to serve us. So what can see first in the bony anatomy? We’ve got our iliac crests. Our iliac crests come into the pubic bone and the pubic symphysis. This forms our ischial, there we go, ischial tuberosities, or our sit bones.

And then on the back of the pelvis, We’re going to have our sacrum right here in the center with the sacral foramen, right? And then we’re going to come down to the coccyx. So that’s the basis of our pelvic bony anatomy. Now if we orient ourselves to the pelvis in the position from inferior to superior, we’ve got on each side those ischial tuberosities.

We’ve got our pubic bone, pubic symphysis, and then we’ve got our tailbone, right? So that forms a diamond. That diamond is what supports the hammock like structure of the pelvic floor musculature. Speaking of, let’s talk about the pelvic floor musculature. All right, so this is a very brief lesson today.

We’ve got a female pelvis here, so let’s go ahead and just orient ourselves. So we’re going to have the tip of the coccyx or tailbone. Then we’re going to have the external anal sphincter and the opening of the anus here. We’ve got the perineal body, right? And then we’ve got the vaginal opening. So if we want to talk about the superficial musculature, first off coming off of that perineal body, we’re going to have the transverse perineal muscle.

Okay. Next we’re going to have. Next to the vaginal opening, we’re going to have the bulbospongiosus muscle. And then coming right along the ridge, the underside of the ridge of the pubis, we’re going to have the ischiocavernosus muscle. Now let’s go to the deep layers. So we’ve got the levator anni, which is the magic of the pelvic floor muscles that most people refer to.

So levator anni is going to be these layers here. We start off with the puborectalis muscle. Then next we have the pubococcygeus muscle. And next we have the ischiococcygeus muscle. I hope the anatomy lesson provided you with the start of a foundation for understanding the pelvis and the pelvic floor.

Now let’s talk about the differences between those assigned female at birth and those assigned male at birth when we’re talking about the pelvis. So first up we’re talking about the inlet. Okay. This is the inlet. This oval shape here of the female pelvis is going to be wider and oval shaped. In the male pelvis, we’re going to see a little bit of a narrower opening, as well as a more heart-shaped inlet.

When we talk about the sacrum in the assigned female at birth pelvis, we’re going to see a wider and shorter. sacrum with a greater curve to it. In the male pelvis, we’re going to see a longer and narrower sacrum. But when we talk about the coccyx, what we’re going to see is actually the male coccyx has a little bit more curve to it than the female coccyx.

The female coccyx is going to be a little bit straighter, which allows that opening to be a little bit more open and spacious when we push A baby through the opening. The iliac crest. We know this from palpation and also observation. The iliac crests. on the male pelvis are going to sit a bit higher than they do on the female pelvis.

So there’s actually a little bit of a height differentiation. And then of course we have the pubic arch, which you can see here. This pubic arch is going to be much wider in the assigned female at birth pelvis versus the assigned male at birth pelvis. Finally, the bones of the female pelvis are going to be a bit lighter and thinner than the bones of the assigned male at birth pelvis.

So now we’ll go ahead and look at some graphics. Since my demo pelvis is just a female, we’ll go ahead and look at some graphics to explain these differences. So here we have the illustration of the pelvic inlet shape. On the left we see the male pelvis. We can really see that heart shaped On the right we have the female pelvis and we can really see that we’ve got a more oval and wider shaped inlet.

Next, with the sacrum and the coccyx shape. We can see on the left that male pelvis has that elongated sacrum that’s a bit straighter. Whereas the female pelvis is going to have that wider, shorter, more curved sacrum. On the contrary, we’ve got the Coccyx on the male, which curves forward a bit and the coccyx on the female, which is a little bit straighter.

Chatting about the pelvic height and pelvic angles. This is displayed a really nicely here. We can see that those iliac crests on the male pelvis on the left are a bit higher than those of the female. You can see there’s a little bit more width in the female. pelvis, right? And this makes sense when we just look at body shape, very often the male has that more triangular shape and the female has a little bit more curve shape to it.

So that makes good sense. In this picture, we can also see that pubic arch very well. illustrated. And so the pubic arch is going to be 60 to 70 degrees on the male pelvis and on the female pelvis that’s going to be more like 80 to 90 degrees. So now we want to talk about pelvic floor function.

Okay, so first off, the muscles of the pelvic floor provide that hammock like structure. As you can see, in our model, right? We’ve got that beautiful hammock like structure. What that does for organ support is it keeps the lower abdominal organs in alignment. And this is so important because the pelvic floor is actually activated in conjunction with the abdominal muscles and the muscles of the back, especially when we’re doing activities like lifting and bending and carrying and jumping, right?

What happens when we’re doing these activities is actually the pressure in the abdominal muscles. increases. Now the pelvis, the pelvic floor and the pelvic openings are obviously below when it comes to gravity, the abdomen, right? So what that means is the pelvic floor is particularly important in keeping those lower abdominal organs from being pushed outward.

or prolapsing. So you can start to see the importance of the pelvic floor, right? It keeps everything up and in and also helps to support the pressure between the abdomen, the back, the base of the pelvis, and also that respiratory diaphragm. When we talk about sexual function, and reproductive function.

It’s quite obvious that during pregnancy, the pelvic floor is going to support the pregnancy. It’s also going to relax and stretch during labor and delivery to allow that baby to come out, right? To be delivered. But sexually, what happens? The pelvic floor muscles actually play a key role both in those assigned female at birth and those assigned male at birth in labor.

providing movement of blood flow. So in females, the pelvic floor muscles help to increase blood flow to the genitals, which promotes arousal promotes lubrication, and it allows for ease of penetration and thus orgasm. In men, of course, the pelvic floor muscles help to manage the blood flow to the genitals by compressing the veins to the penis and thus trapping blood in the penis which creates an erection leading to eventual orgasm.

So those pelvic floor muscles have a big impact on our reproductive and our sexual function. Let’s talk quickly about the urinary and bowel function. Now, the pelvic floor is going to house the openings for the urethra from the bladder, the anus from the bowels, and the vagina from the uterus in females.

The pelvic floor is going to help close those openings to prevent leakage and then relax them for emptying. The pelvic floor essentially supports continence in both males and females. So here’s a quick image so that you can just orient yourself to the opening’s anatomy. So we can see on the left we have the male image, on the right we have the female image.

Left to we have the pubic bone to the tailbone. In between the pubic bone and the tailbone, guess what, we’ve got the pelvic floor. And then, in males, we have the bladder, the prostate, and the urethra. Then we have the bowel. So those are our two openings and our two spaces to consider. In females, we have the bladder opening to the urethra.

We have the uterus opening to the vagina, and then we have the bowel opening to the anus. So here’s your example. You can also see this really well from my superior to inferior view. of my pelvis here. So we can see there we go. We can see the rectal opening, we can see the vaginal opening, and then we can see where we’ve got the urethra as well.

Up next, let’s get in to chi and blood. Okay. Chi and blood are that crucial energetic aspect that are going to help us put everything together as we bring a unique lens to treating the pelvic floor as acupuncturists. The Great Void consists of qi, and qi condenses to become the myriad of things. In terms of Chinese medicine, qi is the energetic foundation of the universe, as it is the physical and spiritual substrate of human life.

Life.

So what does Qi do? Qi is going to promote, it’s going to warm, it’s going to protect, it’s going to hold, and it’s going to transform. Qi promotes the essential functions of the organs and channels in the human body. So when we think of the body as the body kingdom and the organs as officials, And the channels as communication between the officials, we can see how Qi is the director of essential function, warming.

Qi is going to be young in nature, and it’s tasked with warming the body and providing heat. Qi defends us against pathogens or the six evils, which we know in the winter we have colds, In the spring, we have wind. In the summer, we can have summer heat, which is that damp heat, or heat, which is dry heat.

We can also have damp or dry in their own right. Qi is going to hold and contain substances in their respective places and control secretions. We know this when we think about spleen qi deficiency becoming, um, spleen chi sinking, right? Transformation. Chi also metabolizes fluids and substances within the body, which includes our blood and the chi itself.

So when we’re looking at chi as a vital substance and thinking about these functions, we can already start to see how we’ve got all these fluid balances that are occurring in the pelvis. itself within the organs, but we also have that musculature that’s going to require qi and blood as well.

Let’s talk blood. Put simply, blood is going to carry oxygen and nutrients to the cells while carrying away waste. Chinese medicine believes this too and Chinese medicine believes that blood carries the human conscious or consciousness within it. So blood has this very physiological robust nature to it, and by carrying the consciousness within it, it’s got a very robust spirit as well.

Just to review, the spleen is going to make the blood. The heart will govern the blood, and the liver will store blood. When it comes to the uterus will store and release the menstrual blood. Blood functions include nourishment, moistening. Holding the mind or the spirit and determining menstruation.

The blood circulates continuously through our system, providing us with nutrients to our organs on the interior and to the muscles, the tendons, the bones, and the skin on the exterior. The blood of each specific organ ensures that the skin. and the hair and the eyes and the sinew and the tongue are properly moistened.

So the blood has a direct role in moistening. This is really important as we start to think about female cycles. Chinese medicine teaches us that the heart and specifically The blood vessels hold the shen or the spirit. Finally, blood determines menstruation. The quality of blood determines one’s bleeding cycles monthly and also throughout the lifespan.

So how are qi and blood alike and different? First off, blood, of course, is the mother of qi. And qi is the ruler of blood. Talk about that for a mouthful, right? Blood has a yin nature to it, where qi has a yang nature to it. Blood nourishes and sustains the zongfu organs that help produce qi, while qi provides the force and the energy to the zongfu to produce blood.

So we can see that they have a pretty symbiotic relationship. Qi is I’m sorry, blood is essentially a denser form of qi. Blood and qi are inseparable. Qi will move blood. And Q will also hold blood. So once we understand the energies of QI and blood, we can start to understand the source of the function or dysfunction within the pelvis.

We can start to understand how to put the layers together, and then all of a sudden, instead of treating the diagnoses of erectile dysfunction, we’re able to go to the depths of kidney young deficiency, or whatever it might be, whatever pattern we come up with, and also identify emotional patterns, spirit patterns that could be contributing, and get really deep into the source.

And treat the pelvic floor, treat the pelvis, treat the root of the body, and treat the root of the dysfunction to really help our clients to feel better and to improve their quality of life. So once again, this presentation is brought to you by the AAC, American Acupuncture Council, and I hope you loved it.

We are also going to be doing a few more presentations. We’re going to be sharing presentation on the pelvic floor and menstruation, the pelvic floor and fertility, the pelvic floor and pregnancy, The pelvic floor and postpartum, and of course the pelvic floor and menopause. I would love to have you join me for this series.

Once again, my name is Dr. Krystal Couture, and I am the pelvic acu. It has been a pleasure to be with you today, and I can’t wait to see you soon.

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