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The Secret Guide to Your Pelvic Floor

Most people have heard of the pelvic floor. It is usually associated with pregnancy or bathroom functions. If you have ever been pregnant you have probably been told to do your pelvic floor exercises (also known as Kegels) to prevent urinary incontinence. That is great advice by the way! However, there is more to the pelvic floor than just preventing “sneeze pee.”

What is the Pelvic Floor?

The pelvic floor is a group of hammock-like muscles (and connective tissue) that sit inside the pelvis. Think of it as a diamond shape. The top and bottom of the diamond connect to the pubic bone and the tailbone, respectively. Each side of the diamond connects to your left or right sitz bone (these are the bony aspects you feel when you are sitting, also known as your ischial tuberosities).

Pelvic Floor Function

So what exactly does the pelvic floor do?

(1) Constricts the urethra, vagina, and anal canal

Adequate control of your bladder and bowel depends on the proper functioning of your pelvic floor. The pelvic floor constricts and relaxes to help stop and start the flow of urine and fecal matter.

(2) Provides support for internal organs

The pelvic floor helps to keep the internal organs inside the body. Poor functioning can result in prolapse (slipping of one or more organs outside of the body). Proper functioning of the pelvic floor depends on its anatomical position, activity at rest, and the integrity of the fascia.

(3) Deep core stabilizer

The pelvic floor is part of an intricate system used to stabilize the core known as the deep stabilizing system. The muscles of the stabilizing system include the diaphragm, multifidus, transverse abdominis, and pelvic floor. The transverse abdominis and pelvic floor have been shown to be active in nearly all activities.

(4) Responds to breathing

The pelvic floor works hand in hand with the diaphragm during breathing. Think of the diaphragm and the pelvic floor as the top and bottom of a piston. When you breath in, the diaphragm expands and lowers resulting in relaxation and downward movement of the pelvic floor muscles. When you exhale, the diaphragm moves upward and the pelvic floor muscles contract as they move upward too.

Pelvic Floor Dysfunction

Improper functioning of the pelvic floor can result in:

  • Increased frequency of urinate (more than 6-8 times per day)

  • Leaking urine when coughing, sneezing, laughing, exercising or other exertion

  • Inability to make it to the toilet in time

  • Heaviness in the perineum

  • Feelings like things are “coming out” of the vagina or rectum

  • Difficulty inserting a tampon

  • Pain in the pelvic region, rectum, or lower back

  • Constipation or bowel strains

  • Difficulty emptying the bladder

  • Discomfort or pain during intercourse for women

Causes of pelvic floor dysfunction include:

  • Childbirth

  • Traumatic injury to the pelvic region

  • Obesity

  • Pelvic surgery

  • Nerve damage

  • Radiation

To Kegel or NOT to Kegel

Kegels are great isolated exercises used to improve functioning of your pelvic floor. They are easy to do and can be done by almost anyone (even men). Kegels can help reduce or eliminate prolapse, control your bladder, and improve your sex life (better control and blood circulation). However, if you want to keep your pelvic floor in tip-top shape, you should be doing a whole lot more than Kegels! Read more about how else you can protect your pelvic floor here.

Unfortunately, Kegels are not always the answer. Tension in the pelvic floor can also be a problem. A tense pelvic floor can cause difficulty emptying the bowel and bladder, weak urination, constipation, and painful intercourse. If you have any of these symptoms it is best to seek the help of a pelvic floor physical therapist (not every physical therapist is trained in the pelvic floor).

How to Perform a Quality Kegel

Not all Kegels are not created equal! Make sure you are doing them correctly. Close your eyes and pretend like you are trying not to urinate and pass gas at the same time. Gently pull the pelvic floor up into a contraction. Hold then relax completely. If that visual doesn’t hit the spot for you, imagine picking up a jellybean with your vagina and anus. Be sure to fully relax your muscles before trying to contract again. Start out doing 10 contractions 3 times a day. Work your way up to holding each contraction for up to 5-10 seconds each.

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