The pelvic floor is something most people don’t talk about. Unless you’re pregnant or a new mom, the subject might never come up. But as an OB-GYN, I talk about it all the time with my patients—it’s so important. I believe the pelvic floor should be on every woman’s radar, whether they’re 25 or 85.
But First, What Is the Pelvic Floor?
The pelvic floor is a group of muscles that runs from your tailbone to your pubic bone. Picture a hammock suspended between your hip bones that holds your bladder, uterus, rectum and other pelvic organs in place. This muscular “hammock” serves many functions: It helps with bladder and bowel control, supports your spine and hips, helps with breathing and aids in blood circulation to the region, which increases sexual arousal. In fact, it is the pelvic muscles that contract and release during orgasm.
The pelvic muscles are instrumental during pregnancy too. As the fetus grows, it puts pressure on the pelvic floor, which, in turn, causes those muscles to work overtime to keep everything in order. Simultaneously, your body releases hormones, like relaxin and progesterone, which soften muscles and joints to prime the body for delivery. The relaxing of these muscles, combined with hormonal changes, can lead to bladder leakage. Consequently, by the time you’re ready to give birth (either vaginally or via cesarean), your pelvic floor muscles may be in a weakened state.
Common Pelvic Floor Disorders: What Can Go Wrong and Why
Recent statistics are hard to come by, but past research suggests nearly 1 in 4 women in the U.S. are affected by pelvic floor disorders, which occur when the muscles of the pelvic floor are either too tense or too relaxed. The latter is considered a “hypotonic” pelvic floor. This can result in a condition called pelvic organ prolapse, which occurs when the pelvic floor muscles weaken and organs like the bladder, rectum or anus begin to slip toward the vagina and protrude.
Often, this feels like pressure, fullness or the sense that something is hanging down. In addition to protrusion, bladder leakage may occur (called urinary incontinence) as well as pain and discomfort during sex. Prolapses are often associated with childbirth, but age, genetics and even frequent constipation can be contributing factors as well.
A “hypertonic” pelvic floor is one that is tense and nonrelaxing. This includes a condition called vaginismus (when your vagina tightens automatically upon penetration). It can also involve more general vaginal pain, discomfort during sex, constipation or pain during bowel movements. This condition stems from muscle spasms or general tension—your muscles contract, but they don’t relax.
How to Keep Your Pelvic Floor in Tip-Top Condition
Intentionally working the pelvic floor muscles regularly can reduce the risk of dysfunction later on and enhance your sexual pleasure right now. Here are four ways to condition this intimate muscle group for optimal function. (And yes, these pelvic floor exercises work for both hypotonic and hypertonic pelvic floor conditions.)
1. Kegel, Kegel, Kegel. The most commonly recommended pelvic floor exercises are Kegels, which involve contracting and relaxing the pelvic floor muscles to strengthen them. You’ve likely heard about Kegels so much and they may sound easy, but a lot of people do them wrong. They squeeze their rectum instead of targeting the correct muscles. Try this visualization to get the most out of your Kegels: Imagine sitting on top of a tiny marble. Now, try grasping and lifting the marble as you tighten your pelvic floor muscles. Still not sure you’re doing it right? Ask your gynecologist or a pelvic floor physical therapist for more tips on proper technique.
2. Breathe from your diaphragm. A small study published in the Journal of Physical Therapy Science examined the impact of diaphragmatic breathing on the pelvic floor and found that the muscles contracted and relaxed in conjunction with deep breathing. While more research is needed before this simple breathing technique can claim to be as instrumental to building pelvic floor strength as Kegels, it’s still great for your overall health. To do it, think of using the entire 360-degree circumference of your core when you inhale. I recommend checking out Robin Arzón’s 20-Minute Prenatal Basics class, where she goes over diaphragmatic breathing in depth. Aside from its potential benefits to the pelvic floor, this practice triggers the parasympathetic nervous system, which helps your body slow down and relax. Deep breathing can also help lower your heart rate and improve your capacity to carry oxygen.
3. Work on your core. If pregnancy or postpartum isn’t your main pelvic floor concern, lean into exercises that strengthen your psoas (pronounced SO-az) muscle. The glute bridge is one way to strengthen these muscles. Take a cue from Ally Love’s Beyonce Barre class where she includes this simple exercise in the warmup (around minute four). You can start on your back with your knees bent. When you’re ready, lift your pelvis off the floor (tailbone first). For more gentle exercises that engage both the core and pelvic floor muscles, check out Peloton’s Pilates and Barre classes.
4. Try the Teaser. This Pilates posture is a great way to strengthen both your abs and pelvic floor muscles. To do it, watch this tutorial from Peloton. The instructions: Lie on your back with your arms overhead. Inhale, lift your arms up toward the ceiling and peel your body up to a V-shape, raising your legs up at the same time. (Pro tip: Keep your knees bent if you need to modify.) Hold for one breath, then slowly lower your legs to the mat as you exhale.
And remember, if you already have pelvic floor issues, talk to your doctor or pelvic floor physical therapist before doing any strenuous physical activities. Gentle core exercises like the ones mentioned above are safe, but there’s some evidence that intense exercises, like weightlifting, can exacerbate pelvic floor problems. Always talk to your healthcare provider to find out what’s best for your body.
Heather Irobunda, MD is a board-certified obstetrician-gynecologist practicing at NYC Health and Hospitals and a paid consultant of the Peloton Health and Wellness Advisory Council. She is invested in sharing her learnings with her online community to improve access to reliable, relatable healthcare information for women. Follow her on Instagram and Tiktok.
This content is for informational and educational purposes only and does not constitute individualized advice. It is not intended to replace professional medical evaluation, diagnosis, or treatment. Seek the advice of your physician for questions you may have regarding your health or a medical condition. If you are having a medical emergency, call your physician or 911 immediately.