Pelvic Floor Basics 101: What Is It and How To Work It
Ever had problems peeing yourself when you sneeze or with jumping? What about constipation? Low back or hip pain? Feel like you can’t exercise the same way as before having children? Your pelvic floor muscles might be the culprit! Let’s get into the Pelvic Floor Basics.
What Is the “Pelvic Floor?”
Your pelvic floor is a group of muscles that form the support sling of your pelvis. Think of your pelvis as a bowl, and the pelvic floor muscles are the bottom of that bowl. These muscles are dynamic and adaptive–just like the rest of your body! The pelvic floor serves five functions:
1. Support: these muscles support our pelvic organs (bladder, rectum, and uterus) against gravity and increases in abdominal pressure
2. Sphincter Control: The pelvic floor muscles are constantly contracted to hold your urethra and rectal openings closed–in other words these muscles allow you to keep in your pee and poo, until it’s time to go, then they actually relax to allow you to go to the bathroom.
3. Sump Pump: Just like your calf muscles work to help pump blood/lymph fluid back to your heart, your pelvic floor muscles do the same! These muscles aid in the circulation of your pelvis.
4. Stability: These muscles attach to your hips and pelvis, and therefore play an important role in “core control.” They assist in controlling movement of the hips, sacroiliac joint, and lower back.
5. Sexual Function: During intercourse, the pelvic floor muscles help to achieve and sustain an erection for men. Sufficient strength of these muscles is necessary for orgasm, and excessive tension or sensitivity of the pelvic floor can also contribute to pain during or after sex.
How do I know if I have a problem?
Although commonly accepted as normal, especially after having children, having problems with urine leakage is common, but NOT normal. If you cough, sneeze, laugh, jump, run–whatever the movement is–and you pee yourself, then it’s time to get help. Pelvic floor problems can also present as a sensation of pelvic heaviness, pelvic floor pain, pain during or after sex, constipation, hip pain or low back pain.
When someone has shoulder pain, it’s generally an imbalance of strength, mobility, and coordination. If someone’s shoulder is “too tight” or immobile, then it can lead to issues, if there is weakness or poor muscle coordination, that can cause problems as well. The same thing can happen with the pelvic floor. The muscles around the pelvic can be “too tight,” they can be weak, and they can have problems with coordination (like contracting the way that it should to keep you from leaking when you sneeze).
How do I know if I should be strengthening or relaxing my pelvic floor, you ask? Great question! There’s no easy, one size fits all answer, but to really know, you should get evaluated by a pelvic floor physical therapist. However, let’s go through an exercise to help get an idea of what you may struggle most with, between strength, tightness, or coordination.
Pelvic Floor Basics Exercises
There are three important components to working your pelvic floor, being able to contract, relax, and bulge.
A pelvic floor contraction, or “Kegel,” lifts the pelvic floor up toward your lungs. For ladies, if you imagine you’re trying to sip through a cocktail straw with your vagina, it’s that pulling up and in motion. For gentlemen, if you’re about to wade into very cold water and you contract to pull your testicles up from getting touched by the water—that’s a pelvic floor contraction! Everyone should be able to do this without feeling like your glutes, inner thighs or abs are also contracting.
It’s helpful to picture your pelvic floor as an elevator of a building. Your relaxed state is your lobby level. When you perform a gentle pelvic floor contraction, or a “Kegel,” that brings your elevator up to the second floor. Stronger contractions should feel like they can lift your “elevator” even higher than the second floor, and when you relax, you should feel the muscles relax back down to the lobby level. To get down to the basement, you perform a bulge, or a slight pressing downward as if you’re trying to pass gas or initiate the flow of urine.
If you feel a strong contraction, however feel like it’s difficult to get back to a relaxed position, and it’s also challenging to initiate the bulge movement, then you may have more of a muscle tightness issue. However, it could also be coordination—your brain has a hard time telling those muscles what to do and when to do it. If you feel like it’s difficult to get a contraction or lifting up feeling in the pelvic floor, but you’re able to bulge down easily, you may have more of a weakness problem, but again it could be coordination. In general, if you have difficulty feeling any contraction, you also don’t necessarily feel “relaxed” in the pelvic floor, and have a hard time performing a bulge, it could be tightness or coordination.
You should have a slightly better idea of which category you fall into, because “just doing Kegels to strengthen” isn’t the right answer for everyone with pelvic floor problems. If you have too much muscle tightness in your pelvic floor, doing pelvic floor contractions all day can make your symptoms worse.
Pelvic Floor Strength and Relaxation
To work on pelvic floor strength, it is important to practice both the endurance of the pelvic floor muscles, as well as speed. Technically, all day and night your pelvic floor is slightly contracted to support your sphincters—they relax to allow you to go to the bathroom. At the same time, these muscles need to be able to quickly contract to resist forces such as sneezing, running or jumping.
If you have pelvic floor weakness, practice 10 contractions for 10 seconds each, with a FULL relaxation in between each contraction. After the 10 endurance contractions, give yourself a minute or two rest, then perform 10 quick contractions. Try to tighten the muscles and fully relax them as quickly as you can. These should be done 3-8 times a day.
If you have pelvic floor tightness, focusing on deep diaphragmatic breathing and relaxation is important. When we take a full breath in, the diaphragm (your breathing muscle) descends into the abdominal cavity, and that pressure on the organs actually creates a downward pressure on the pelvic floor, so you should also feel that slightly relax an descend. It’s very subtle, but it should feel like you take a big breath and “hit a brick wall” in your pelvic floor. Aside from working on deep breathing into your pelvic floor each day for 3-5 rounds of 2-3 minutes each, you can still work on pelvic floor contractions. However, instead of trying to perform maximal strength contractions, just perform a gentle contraction to feel a slight lift up, and put more emphasis on making sure the muscle fully relaxes, then try a gentle bulge. 10 gentle reps 3-8 times a day.
Putting it all Together
When it comes to putting this into practice, we need to recognize the importance of posture and breathing. As mentioned above, because the breathing diaphragm and pelvic floor work together, if you walk around with your rib cage flared out and pelvis anteriorly tilted, it changes the pressures that are put on the pelvic floor. This alone can contribute to symptoms. Next time you’re performing a movement that tends to cause leakage—squatting, running, jumping, etc—then try adjusting your posture, and make sure you are breathing and not holding your breath.
The other important component is recognizing that the pelvic floor is a group of muscles, and strength takes time to build, and coordination/relaxation can take practice. Just like building up weight when you first start back squatting, it’s important to slowly build up to train these muscles. If you know you get leakage with impact, say after 15 double unders, or 5 minutes of running then:
1. First check your posture and breathing
2. Make sure you’re landing softly
3. Think about your pelvic floor contraction
4. Take a break when you feel the leakage happen
Your muscles might just be fatigued and need a rest—that’s ok! If you are trying to do a 30 minute run and leak after 5 minutes, then do a couple minutes of walking to allow your pelvic floor muscles to relax, then try another 5 minute jog. Keep repeating until you get to your 30 minutes—but respect where your pelvic floor is telling you to stop because the muscles are fatiguing. Same goes for box jumps or double unders, just break it down into smaller sets than may be prescribed for the workout. When you reach a point that the leakage is happening as soon as you start the next round of running or jumping, then drop down to an easier movement that doesn’t cause the leakage, ie walking, single unders, or box step ups. You’ll see that overtime, when you respect this boundary, then you’re able to do more and more before that leakage happens as those muscles get stronger or the coordination and relaxation improve.
If you’re still feeling lost, it’s ok! These aren’t easy things to perform or understand because it’s not as obvious as performing a bicep curl. It really does come down to how well you can work the muscles and the mobility of the tissue, just like with any other joint.
Click here to schedule a FREE 15 minute consultation to see if virtual or in-person pelvic floor physical therapy might be right for you!