The transversus abdominus muscle (TA) plays a very important role in pelvic floor (PF) rehabilitation and function, but most explanations for controlling continence don't mention any exercises other than kegels. 

Why is this? Have our media outlets failed us by over-simplifying the method of PF strengthening, leaving those who are following their direction destined for failure? I believe so. Today lets take a closer look at this postural muscle and the role it plays in core stability and pelvic floor strength.

First let's get a good visual of our anatomy. The muscle fibers of the TA, or lower abdominals, encircle our abdomen and pelvic area, reaching around to the thoracolumbar fascia of our lower back. This area that our TA muscle encircles narrows from our waistline down within our pelvic inlet (the area bordered in the back by our sacrum and on the sides by our 2 pelvic bones.) The transverse fibers of our lower abdominals run around our waist and within our pelvic inlet like a corset or brace that we can cinch up by drawing our belly button in. This corset of transversus muscle fibers narrows like a cone ending at the level of our pubic bone. As our TA contracts, this cone squeezes like a shrink wrap, displacing air and pressure upwards and providing more stability to the individual segments of our lower spine.

I also like to describe this TA squeeze as a vacuum, helping to pull our PF up and our lower abdominals in tight, only to displace the pressure upwards to our expanding lower rib cage and chest. It is easy to recognize someone standing or sitting with the TA muscle engaged because their chest will be lifted making them stand and sit taller. 
Now lets focus on role the TA plays in PF strength. It has been shown that the lower fibers of our TA muscle that lay within our pelvic inlet work closely with our PF muscles, which span the base of our pelvis. Some preliminary studies have even shown that there may be a direct connection of some of the fibers of the PF and TA. 

Whether or not this is proven to be true - one thing we do know is that these two muscles work together as the deepest contraction, the first stabilizers, as the root of our core.  (You can also include our multifidi muscles in this deep contraction but we will talk about those segmental stabilizers on another day).

You can feel this intimate connection between your pelvic floor and your TA as you perform pelvic floor elevations. When you do a true pelvic floor contraction and elevation, you will begin to feel how your TA is activated every time you work to draw your pelvic floor up into your pelvic outlet.

Conversely, you can also feel your PF contract every time you work to draw your TA in while holding neutral posture.  Studies have shown an increase in contractile force of our TA and PF muscles when activated together vs. contracting individually. This paints a clear picture that we need a strong TA firing along with our PF muscles to achieve optimal strength gains and efficient firing of our pelvic floor. Complete resolution of incontinence or better control of our prolapse symptoms can not be expected if we don't have both these muscles firing together.