Much like how a well designed foundation of a house supports it’s entire load while keeping it standing strong for many years, a strong and healthy core is the foundation of our overall well-being. Among the key elements contributing to core strength is the often overlooked but equally as important pelvic floor. The pelvic floor muscles play a vital role in maintaining good posture, supporting our pelvic organs and allowing them to function properly, regulating intra-abdominal pressure, sexual health, and giving birth. In this article we will explore the importance of a well-functioning pelvic floor and provide you with a few effective exercises to try at home.
Understanding the Pelvic Floor
The pelvic floor is a complex grid of muscles that covers the entire base of your pelvis. These muscles extend from your pubic bone all the way back to your tailbone and out to either sides of your sits bones. The pelvic floor is designed to lengthen and contract, just like any other muscle in the body. It moves in sync with the diaphragm as we breathe, helping regulate intra-abdominal pressure.
Your pelvic floor is responsible for maintaining the proper positioning and function of the pelvic organs such as the bladder, uterus, and rectum and are integral in bowel and bladder control. These muscles also play a role in sexual function by contributing to arousal, sensation, and orgasm. It would only make sense then that the pelvic floor also plays a pivotal role during pregnancy and birth. During pregnancy the pelvic floor muscles support the growing uterus and the additional weight. Then during birth, these muscles help guide the baby through the birth canal. A strong and flexible pelvic floor is important for a smooth and efficient labor and delivery process. Cool, right?! Lastly but just as importantly, our pelvic floor muscles work in tandem with the deep abdominal muscles (transverse abdominis, multifidus, internal & external obliques and even the inner thigh muscles) to provide support to the spine and pelvis, helping to maintain proper posture and stability during movement.
Common Pelvic Floor Considerations
Pelvic floor dysfunctions can manifest in different ways and for different reasons. It is a common misconception that pelvic floor problems are caused by a weak or under-active pelvic floor however it is rarely this simple. It may be that the pelvic floor is hypotonic (weak / under-active) but it could be the opposite - hypertonic (tight / over-active) or a combination of both where some muscles within the pelvic floor are tight and overactive while others are not firing as they should. The best way to get a clear understanding of what is going on within your own pelvic floor is to seek the help of a qualified pelvic floor physical therapist who can do a thorough exam to determine exactly what’s going on and create a path to restoring optimal function. (If you need help finding a PT near you, check out our practitioner directory.) Let’s take a deeper look at some common pelvic floor dysfunctions & potential symptoms.
Urinary incontinence refers to the unintentional leakage of urine, which can occur due to weak or dysfunctional pelvic floor muscles. This can happen during activities such as coughing, sneezing, laughing, and in certain movements or exercises such as running, or jumping. Going back to hypertonic vs hypotonicity in the pelvic floor, stress incontinence can be caused by both. Under-active pelvic floor muscles and tissues lack the support the bladder and urethra need to function properly and there can often be a delay or inability to contractile pelvic floor enough to stop the sudden flow of urine. On the flip side, an over-active pelvic floor is in a constant state of contraction and therefore lacks the ability to relax. When it comes time to stop the flow of urine, the muscles aren’t able to contract further to stop it. Think of it like this. If you walked around with your bicep contracted all day then went to pick up a heavy bag with your bicep contracted it would be tough to get enough power to lift the heavy object. If you were able to extend your arm then contract your bicep you’d have the power needed to do so. Tight pelvic floor muscles can disrupt the normal function of the urinary system in much the same way.
If you do experience incontinence, know you’re not alone. According to studies like this one and this one, between 30-40% of women surveyed have experienced it at some point in their life, with that % increasing in people within their first year postpartum and again in post-menopause. Luckily a lot can be done to restore function and stop leaks! Seeing a pelvic floor PT is a great place to start, and our Core Restore program can help!
If you are currently expecting there are preventative measures you ca take as well. Learning to manage intra-abdominal pressure, practicing pelvic floor and core strengthening (and lengthening) exercises during pregnancy such as those in our Core Before program, maintaining a health weight gain during pregnancy, and avoiding straining during bowel movements can all help.
Pelvic organ prolapse refers to the descent or bulging of pelvic organs, such as the bladder, uterus, or rectum, into the vaginal canal. There are different types of prolapse, including cystocele (bladder prolapse), rectocele (rectum prolapse), uterine prolapse, and vaginal vault prolapse. Prolapse can occur due to various factors, including weakened pelvic floor muscles and connective tissues, excessive pressure mismanagement during pregnancy and childbirth, hormonal changes during menopause, obesity, chronic constipation, and repetitive heavy lifting or straining. Not all people with POP experience symptoms, but for those that do among the most common are a feeling of heaviness or pressure, the sensation of something being “stuck” in your vagina or as if something is falling out of it, bulging in the vagina, incontinence (urine, gas, and/or stool.) It sounds scary, but it doesn’t have to be! Thankfully there are things you can do to help prevent prolapse such as the aforementioned for incontinence, and a lot you can do to manage POP if you do have it. Learning to reconnect to your pelvic floor and core and implementing different strategies that aid in healing, build strength, and improve function is key. If you think you may have POP, we always recommend seeking out a pelvic floor PT for an assessment.
Diastasis Recti and the pelvic floor are closely interconnected. Diastasis Recti, also commonly referred to as “abdominal separation” naturally occurs during pregnancy to accommodate for the growing uterus. The two sides of the rectis abdominis (or 6 pack) muscles are connected by a thigh band of connective tissue called the line alba. This connective tissue is designed to stretch for this very reason. However, some people can end up with injury-based diastasis recti that has not resolved by around 8 weeks postpartum. This occurs as a result of excessive and unsupported intra-abdominal pressure (though other factors may also contribute.) This excessive pressure places too much strain on the lines alba causing it to stretch beyond it’s capacity and thus the separation remains.
The pelvic floor is also affected by this excessive and unsupported intra-abdominal pressure. Ideally the diaphragm, pelvic floor, transverse abdominis, rectus abdominis, and other4 muscles of the core all work together to stabilize the ribs, hips and spine. When injury-based DRA is present, it can cause increased pressure and tension on the pelvic floor, which may potentially contribute to pelvic floor dysfunctions. Luckily there is a lot we can do to help reduce the risk of developing injury-based diastasis recti as well as heal from it if it is present and restore function and strength to the core. The first step is to get assessed for DRA by a qualified physical therapist. You can also assess yourself at home using our diastasis recti assessment video with LUNA’s physical therapist, Alicia. If you find that you do have DRA, LUNA’s Core Restore program can help. We also recommend seeing a PT for individualized care as well.
Remember, if you suspect any pelvic floor or core dysfunctions or have any concerns, consult with a healthcare professional such as a pelvic floor physical therapist or your OBGYN who can help diagnose the specific condition and guide you towards appropriate treatment options. including pelvic floor exercises, lifestyle modifications, or, in some cases, surgical intervention.
3 Moves for Strengthening the Pelvic Floor
1. Pelvic floor contractions:
Start in a seated or supine position with your ribs stacked over your hips and your belly soft and relaxed. Relax your glutes, inner thighs, and shoulders. Inhale diaphragmatically feeling your ribcage expand out in 365 degrees. As you exhale, draw the 4 corners of your pelvic floor (pubic bone, tailbone, and two sits bones) inward as if you’re trying to pick up a marble with your pelvic floor, and then lift upward toward your heart. Think of it like grabbing the marble and lifting it up. Then as you next inhale, lower the marble back down and let it go. Repeat with your breath. Another way to think of this is as if you’re trying to stop the flow of urine and gas at the same time as you exhale. Then relax as you inhale.
2. Bridge pose:
This exercise is great because it targets the glutes, deep core, and pelvic floor muscles all at once! Start by lying on your back with your knees bent and feet flat on the floor, hip-width apart. Exhale and engage your pelvic floor, lifting your hips off the ground. Imagine you are trying to create a straight line from your knees to your shoulders and avoid arching your back. Inhale and relax as you lower back down. Yu can also squeeze a yoga block, firm pillow or Plates ball between your thighs as you raise your hips too.
3. Squats:
You may not typically think of squats when it comes to pelvic floor exercises but the truth is, our bodies are made with lots of moving parts designed to work together in order to function at their best. You pelvic floor needs to be able to respond to a wide variety of movements and actions. Which is why training your pelvic floor during bigger movements and not just doing isolated keels is key!
Stand with your feet shoulder-width apart. Inhale and hinge from your hips, lowering yourself down Ito a squat as if you’re trying to sit down onto a bench or chair. Keep your weight in the middle of your feet (don’t grip with your toes), chest up and spine neutral. At the bottom of your squat, exhale and draw your pelvic floor in and up as you rise back up to standing. Repeat for 10-15 reps.
3 Moves to Lengthen & Relax the Pelvic Floor
1. Diaphragmatic breathing:
Start by sitting or lying down and place one hand on your chest and the other at the base of your ribcage. Inhale in through your nose, breathing down into your low back, feeling you ribs expand out I 365 degrees. Exhale, feeling your ribs contract back in. Repeat for 5 minutes.
2. Child’s pose:
This yoga pose gently lengthens the pelvic floor while simultaneously releasing tension. Begin on all fours with your knees wide apart, big toes touching. Sit back onto your heels and lower your chest and forehead towards the floor, extending your arms out forward, palms facing up or down. Relax your body and focus on diaphragmatic breathing, sending the breath down into your pelvis as you inhale. Keep the pelvic floor relaxed as you exhale. Hold for 3-5 minutes.
3. Happy baby:
Lie on your back and pull you0r knees in to your chest. Grab the outside edges of your feet with your hands, flexing your feet and opening your knees out to the sides of your torso. Gently pull on your feet to bring your knees closer to the floor, feeling a stretch in your inner thighs, hip flexors, and pelvic floor. Breathe deeply and relax. Hold for 1-3 minutes.
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