It’s impossible to be on the journey of motherhood without hearing about the pelvic floor. Weak pelvic floor, overactive pelvic floor, pelvic floor exercises, pelvic floor physical therapy; these terms get tossed around with little explanation. Which can often lead to endless Google searches that leave you more confused than when you started. So let’s start from the very beginning and answer the most important question first, “What is the pelvic floor?”
What is the Pelvic Floor? Pelvic Floor Definition
Whether you call them pelvic floor muscles, PC muscles, Kegel muscles, or any other name the muscles of your pelvic floor are just that: muscles. These are skeletal muscles, just like your biceps or quadriceps that have involuntary postural function, and can be voluntarily contracted for more support. And, these muscles also happen to have close proximity to your organs responsible for elimination and sexual function, which is why it may be difficult to find people to talk to about them, or to treat them if there are issues.
To give you a more direct answer, the pelvic floor refers to a group of muscles and connective tissues located at the base of the pelvis. It forms a supportive hammock-like structure, providing key support to the pelvic organs, including the bladder, uterus (in females), and rectum. Think of the pelvic floor as a sling that spans from the pubic bone to the tailbone, with openings for the urethra, vagina (in females), and anus.
Pelvic Floor Muscles, Anatomy, and Functions
Here is a picture of how your pelvic floor muscles sit in your pelvis. This view is from the bottom up, and depicts a person with a vagina with their legs open.
Image ℅ OpenStax Anatomy and Physiology
As you can see there are a number of muscles. They all have different names and attachment points, including the pubococcygeus (PC) muscle, iliococcygeus muscle, and puborectalis muscle, but for the purposes of this, just think of them as a group of muscles. They all work together as a team.
Pelvic Floor Muscle Functions
These muscles have various jobs, and we can split them into the 5 S’s.
- Sphincter - The pelvic floor muscles play an important role in maintaining urinary and fecal continence by controlling the opening and closing of the urethra and anus. They close the openings to hold back urine, stool, or gas.
- Stability - The pelvic floor is an essential component of the core musculature, working synergistically with the abdominal and back muscles to maintain stability and balance.
- Support - They provide structural support to the pelvic organs, preventing prolapse (i.e., descent or bulging) of these organs.
- Sexual function - A strong and coordinated pelvic floor contributes to sexual satisfaction by enhancing blood flow and supporting healthy sensations during intimacy.
- Sump pump - The pelvic floor muscles help clear swelling (think of ankle pumps to help with foot and ankle swelling).
How to Find Your Pelvic Floor Muscles
Now that you know where your pelvic floor muscles are located anatomically and what they do functionally, how do you make them work consciously? It’s normal to overthink this or for it to be weird to think about because the pelvic floor muscles generally work automatically all throughout the day, so many people haven’t practiced using their muscles in a conscious way.
Locating and engaging the pelvic floor muscles can be challenging, but it is essential for effective exercises and overall pelvic health. The simplest way to make the muscles work is to think about an action they do.
For the pelvic floor, the easiest one is sphincter control. Lay on your back or sit in a chair and think about trying to stop the flow of urine or hold back gas. It should feel very subtle, and you shouldn’t feel movement from anywhere else (like your butt cheeks, legs, or be holding your breath) just the deep pelvic muscles. If you clenched your abdomen or butt muscles, try again, but with less effort. This should be a secret exercise. If you squeeze your pelvic floor, no one sitting next to you should see anything move.
During urination, you can also try to stop the flow of urine midstream. The muscles you engage to achieve this are your pelvic floor muscles. (Note: This technique should only be used as an initial step for identification, and not as an exercise. This just causes confusion for your body, and isn’t actually helpful in strengthening your muscles.)
Another cue is to imagine you are lifting up a blueberry with your vagina or anus. When you imagine “lifting” the muscles sometimes you can feel a bit of a stronger contraction.
What are the Most Common Pelvic Floor Conditions and Disorders?
When things aren’t working quite right with the pelvic floor, there is no one-size-fits-all condition or symptom to point to that matches everyone. The pelvic floor is involved in quite a few vital processes, so there are several common ailments that could be caused by a problem with the pelvic floor.
Here are some of the most common conditions and disorders associated with the pelvic floor.
Conditions Caused by Weak or Loose Pelvic Floor Muscles
Weak or loose pelvic floor muscles can cause several symptoms and conditions, including:
Urinary Incontinence
This refers to the involuntary leakage of urine. Stress incontinence, the most common type, occurs when pressure on the bladder increases, such as during coughing, sneezing, laughing, or physical activities.
Pelvic Organ Prolapse
Weakening of the pelvic floor muscles can lead to the descent or bulging of the vaginal wall. Different types of prolapse include cystocele (bladder prolapse), rectocele (prolapse of the vaginal wall), and uterine prolapse.
Fecal Incontinence
Weak pelvic floor muscles may contribute to the loss of bowel control, resulting in the accidental leakage of stool or difficulty controlling bowel movements.
Pelvic Pain
Weakness in the pelvic floor can cause discomfort or pain in the pelvic region, lower back, abdomen, or during intercourse.
Conditions Caused by Tense or Overactive Pelvic Floor Muscles
On the other end of the spectrum, chronically tense or overactive pelvic floor muscles can lead to various conditions, including:
Pelvic Pain Disorders
Conditions such as pelvic floor muscle spasms or overactive (sometimes called hypertonic) pelvic floor dysfunction can cause chronic pelvic pain, discomfort, or a feeling of tightness in the pelvic region. These conditions may be associated with conditions like vulvodynia, interstitial cystitis, or endometriosis.
Urinary Urgency and Frequency
Chronically tense pelvic floor muscles can contribute to an increased urge to urinate frequently, even with minimal urine volume in the bladder.
Painful Intercourse
Overly tense pelvic floor muscles may cause pain, discomfort, or difficulty during sexual intercourse, a condition known as dyspareunia.
Constipation
Tension in the pelvic floor muscles can result in difficulty passing stool, straining during bowel movements, and chronic constipation.
Combination Issues
It is important to note that some individuals may experience a combination of both weak and tight pelvic floor muscles, leading to a complex interplay of symptoms and challenges.
Seeking professional guidance from a qualified physical therapist or healthcare provider specializing in pelvic floor rehabilitation is key for accurate diagnosis, individualized treatment plans, and appropriate exercises to address these conditions. They can help you restore balance, strength, and flexibility to your pelvic floor muscles.
Remember, postpartum recovery requires time, patience, and a comprehensive approach that includes exercises, lifestyle modifications, and self-care practices to optimize pelvic floor health and overall well-being.
Common Treatments for Pelvic Floor Conditions and Disorders
When confronted with any of the conditions above, there are a number of options for alleviating the discomfort and healing. Luckily, there is a lot that can be done to balance, strengthen, or relax your pelvic floor muscles, often without resorting to invasive procedures or expensive treatments.
Here are some of the most common treatments for pelvic floor conditions, like the ones listed above:
Pelvic Floor Muscle Training (PFMT)
PFMT is a cornerstone treatment for both weak and tight pelvic floor muscles. For weak muscles, PFMT aims to strengthen and improve the endurance of the pelvic floor muscles. For tight muscles, PFMT focuses on relaxing and releasing tension. A physical therapist (or a program created by pelvic floor physical therapists, like the Every Mother program) can guide you through proper technique, progression, and individualized exercise programs to target your specific condition.
Biofeedback
Biofeedback involves visual or auditory feedback on the activity of your pelvic floor muscles. This can be done by using specialized equipment, or can be taught with proper education on how your body should feel (which can be provided with Every Mother’s program). This helps you become more aware of your muscle contractions and learn how to effectively engage and relax them. Biofeedback can enhance the effectiveness of pelvic floor exercises and promote better muscle control.
Electrical Stimulation
Electrical stimulation involves the use of low-level electrical currents to stimulate the pelvic floor muscles. This treatment can help strengthen weak muscles and improve muscle coordination. It is often used in conjunction with pelvic floor exercises to optimize outcomes. While this is an option, there is only little evidence that this is an effective method, so in most cases this isn’t necessary.
Manual Therapy
Manual therapy techniques, such as soft tissue mobilization and myofascial release, can be beneficial for both tight and weak pelvic floor muscles. A skilled physical therapist can use hands-on techniques to release tension, improve blood flow, and address trigger points in the pelvic floor muscles.
Behavioral and Lifestyle Modifications
Certain lifestyle modifications can complement pelvic floor treatment. These may include:
- Dietary adjustments to promote regular bowel movements and prevent constipation.
- Fluid management strategies to optimize bladder health and reduce urinary urgency.
- Bladder training techniques to gradually increase the time between voids and improve bladder control.
- Education on proper lifting techniques and body mechanics to minimize strain on the pelvic floor.
Relaxation Techniques
Relaxation techniques, such as diaphragmatic breathing, mindfulness, and progressive muscle relaxation, can help reduce muscle tension and promote overall relaxation of the pelvic floor.
Surgical Intervention
In some cases, when conservative treatments have been unsuccessful or in severe cases of pelvic organ prolapse, surgical intervention may be necessary. Surgical options range from minimally invasive procedures to reconstructive surgeries, depending on the specific condition and individual circumstances.
It is important to remember that treatment plans should be individualized based on the underlying condition, severity of symptoms, and personal goals. Working closely with a knowledgeable healthcare provider or physical therapist specializing in pelvic floor rehabilitation is essential to determine the most appropriate treatment approach for your specific needs.
Consistency, patience, and active participation in your treatment plan are key to achieving optimal pelvic floor health and recovery.
How to Keep Your Pelvic Floor Healthy
The pelvic floor is skeletal muscle so in order for it to be healthy it needs to be able to contract, relax, and stretch, just like any other skeletal muscle.
Regular exercise can help keep a pelvic floor healthy, this could be general strengthening to the core and hips, which will affect the pelvic floor as well. Also a general stretching routine can help keep the pelvic floor relaxed and flexible. Usually stretching of the glutes and inner thighs can help with this.
But, don’t forget, A well-rested muscle is a happy muscle. Most people think a lot about how they can make their pelvic floor stronger, or more effective. But many times we forget these muscles need to rest.
Imagine how you would feel if you held a squat for 10 minutes, and then you were asked to run up a flight of stairs. You may feel like you were moving through mud, and you would feel weak. BUT, the muscles weren’t weak, they were tired! Now, imagine how your pelvic floor muscles feel if you clench them all the time. Then, all of a sudden you sneeze and your muscles don’t have the energy to respond quickly. They aren’t weak, they need a rest!
How to relax your pelvic floor muscles
Lie on your back with your knees bent and supported by a pillow, bolster, or even a chair. Place your hands on your belly, and take a deep breath in allowing your belly to expand. Now, think about your pelvic floor, and the area around your vagina or anus. As you inhale, imagine you are allowing that space to fill with air. As your belly rises, you may feel an “expansion” or “lengthening” in the pelvic floor. If you can fully relax, breathing can be a great gentle stretch to the pelvic muscles! You may also even notice that the muscles feel stronger once they have gotten a break.
Try a Proven At-Home Program
Try a customized, clinically-proven program to help heal and strengthen your pelvic floor. Every Mother is a total-body, evidence-based solution that is sure to bring you results, anytime and anywhere.
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By Leah Keller, Creator of the EMbody Program™. Learn more about Leah here.
This article was reviewed by Whitney Rogers, PT in 2023.
