Pelvic Floor Health: What You Need to Know

Pelvic floor health doesn’t always get the spotlight—but it should. Whether you’ve recently had a baby or simply laughed a little too hard and leaked some urine, your pelvic floor might need medical attention. In fact, nearly one in four U.S. women are affected by a pelvic floor disorder, according to the National Institutes of Health. But it’s not just women—men have pelvic floors too. In other words, pelvic floor issues can affect anyone, and some symptoms of this disorder may surprise you.

Jennifer Gibbons, a pelvic floor physical therapist at Memorial Hermann Sports Medicine and Rehabilitation in Katy, discusses what the pelvic floor is and why it’s so important to keep it strong. She’ll also cover how to recognize signs of a problem, what factors put you at higher risk and what you can do to improve your pelvic floor health.

What Is the Pelvic Floor?

The pelvic floor is a group of muscles at the base of your pelvis that form a supportive hammock for your pelvic organs. These muscles stretch from the pubic bone in the front to the tailbone in the back—the “floor” of your core.

The pelvic floor supports your bladder, uterus and bowel as the muscles work together to help you control the release of urine and feces. In essence, your pelvic floor is an integral part of your core musculature. It works in tandem with your abdominal muscles, back muscles and diaphragm (breathing muscle) to manage intra-abdominal pressure and support your spine. This means that a healthy pelvic floor doesn’t just prevent leaks—it also contributes to better posture, balance and core strength.

Why a Strong Pelvic Floor Matters

A strong pelvic floor is vital for everyday functions that we often take for granted. One major benefit is bladder and bowel control. The pelvic floor muscles give us conscious control over urination and defecation, and when these muscles are weak, problems like urinary incontinence (leaking urine) or fecal incontinence can occur. According to the NIH, about 16% of women experience urinary incontinence and 9% experience fecal incontinence. Keeping these muscles strong and conditioned can greatly improve or prevent such issues.

Another benefit of a healthy pelvic floor is support for the pelvic organs. The condition of the pelvic floor dictates how well your bladder, uterus and bowel stay in place. If the muscles are too weak, these organs can shift downward—a condition called pelvic organ prolapse. Prolapse can feel like a heavy bulge in the vaginal area and can cause discomfort or difficulty with urination and sexual intercourse. A fit pelvic floor provides critical support to keep everything in place.

Core stability and posture are also tied to pelvic floor strength. Because these muscles are at the bottom of your core, they work with your abs, back and diaphragm to stabilize your spine. A weak pelvic floor can contribute to lower back pain, hip pain or poor alignment, whereas strengthening these muscles can improve your balance and reduce strain on your back and hips. In fact, physical therapists consider pelvic floor exercises an important component of core workouts and rehabilitation for back pain.

Overall, pelvic floor fitness is a foundation of wellness. If these muscles are doing their job, you probably won’t notice them at all. It’s only when they’re not working optimally that problems arise.

Signs of Pelvic Floor Dysfunction

How do you know if your pelvic floor might be weak or malfunctioning? “The signs of a weak pelvic floor would be things like urinary leakage or incontinence, or even fecal leakage and incontinence, feeling heaviness in the vaginal area, or feeling pain in your pelvis or pain in the lower back,” Gibbons says.

The standing assumption of pelvic floor dysfunction is weakness, but it’s also possible that the muscles are too tense or overactive. In such cases, the symptoms can be different, with Gibbons noting that “symptoms of a tight pelvic floor include pelvic pain, pain in the tailbone area, constipation, difficulty urinating, urinary frequency and even pain with intercourse or with pelvic exams.”

If you notice one or more of these issues, it’s worth paying attention. “Many people—especially women after childbirth or experiencing menopause—assume that things like leakage are just part of getting older and/or that’s just what happens after having kids. And that's not true,” states Gibbons. While these symptoms are common—millions of women experience them—they signal a problem that can often be treated. “You don’t have to just accept them as your new normal,” she says. “In fact, there's so much that we can do to help if someone's having leakage or other symptoms.”

Common Causes and Risk Factors

What contributes to pelvic floor issues in the first place? There are several factors, and often it’s a combination of things. For women, pregnancy and childbirth are well-known causes of pelvic floor weakness. Carrying a baby puts increased pressure on these muscles, and the process of childbirth—especially vaginal delivery—can stretch or even tear pelvic floor muscles and connective tissues. It’s easy to see why new moms often experience leakage or pelvic heaviness in the weeks or months after giving birth. (This is why postpartum pelvic floor exercises and therapy are so helpful for recovery—but more on this later.)

However, you don’t have to give birth to develop pelvic floor problems. Anything that puts chronic stress on these muscles can cause them to weaken over time. One major factor is aging and menopause—muscles naturally lose tone as you age, and in women, the drop in estrogen during menopause can further reduce muscle elasticity and strength. It’s estimated that pelvic floor disorders affect over 40% of women between the ages of 60 and 79 and about half of women age 80 or older, partly due to these age-related changes.

Other conditions that also can lead to pelvic floor issues include the following:

• Habitual constipation: Constantly straining to pass bowel movements can weaken floor support.
• Certain exercise habits: Long-distance cycling can put prolonged pressure on the pelvic floor, and high-impact sports with lots of running and jumping can exacerbate leakage. Weightlifting can also be problematic—without proper breathing techniques the pelvic floor is at risk of too much pressure when air flow is poorly managed.
• Stress and anxiety: Mental health issues can exacerbate pelvic floor tension, and over time, these tight muscles can lead to pain or dysfunction.
• Prostate issues: Males who’ve had prostate surgery and/or prostate cancer can experience pelvic floor weakness.
• Being overweight: Carrying excessive pounds puts pressure on the pelvic floor over time, and research has found that individuals who are overweight have more pelvic floor disorders than those who live at a healthy weight.

How to Strengthen (and Relax) Your Pelvic Floor

The good news is that, like any other muscle group, the pelvic floor can be strengthened and rehabilitated. Pelvic floor therapy often focuses on two things: strengthening muscles that are weak and relaxing muscles that are too tight. The approach you need will depend on your specific issue—this is where a pelvic floor physical therapist can provide an individual assessment—but there are general exercises and techniques that many people can try.

1. Kegel exercises (pelvic floor contractions): This is the classic pelvic floor exercise. “This is a great exercise if someone is experiencing weakness in the pelvic floor,” Gibbons mentions. “A Kegel is just another name for a pelvic floor contraction.” To perform a Kegel, you squeeze the pelvic floor muscles as if you’re trying to stop the flow of urine or hold in gas— “think of the muscles you engage when you’re trying to avoid passing gas in an elevator,” she explains. “This gets those pelvic floor muscles to contract and turn on.” Imagine drawing up and in with those muscles (closing the openings and lifting). Hold the contraction for a few seconds (if you can) and then fully relax. It’s important not to hold your breath when you perform Kegels—breathe normally as you squeeze and release. If you’re new to Kegels, try doing them lying down (gravity is eliminated, which makes it easier). Then, progress to sitting, and eventually to standing, which is the most challenging position because you’re working against gravity. Gibbons notes that many people just “squeeze and relax” quickly, but to really build strength and endurance, you should practice holding each Kegel for 5 to 10 seconds. 

2. Don’t overdo it—focus on full range of motion: More is not always better with Kegels. “Unlike having a weak pelvic floor, some people hold tension and tightness in their pelvic region. Those people need to relax,” Gibbons offers. If you try Kegels and they cause pain or if you suspect your pelvic muscles are too tight, you should focus on relaxation first instead of contraction. Even when doing Kegel exercises, the relaxation phase is just as important as the squeeze. You want the muscles to be able to go through a full range of motion—contracting and releasing. Making sure you let the muscles “drop” completely after each contraction will ensure you’re not carrying residual tension and that the muscle strengthens in a functional way.
3. Other stretching and relaxing techniques: Other techniques to relax and lengthen the pelvic floor include deep breathing, gentle stretching and yoga poses that open the hips. “Certain poses, like a happy baby pose or child's pose, are especially helpful to lengthen the pelvic floor,” Gibbons advises.
4. See a pelvic floor physical therapist: If you’re struggling with symptoms or unsure if you’re doing these exercises correctly, consider seeing a pelvic floor physical therapist. This is particularly beneficial for postpartum women. “Getting in with a pelvic floor therapist about six weeks after giving birth can be really beneficial,” Gibbons explains. “The therapist can check things out and provide ideas for how to progress in that early postpartum period to prevent future pelvic floor issues.”

But remember: You don’t have to be postpartum to see a pelvic therapist. They treat people across the lifespan—from young athletes and postpartum women to women in menopause and men with pelvic pain.

Embracing Pelvic Health

The important takeaway is that pelvic floor issues are common but treatable. As Gibbons shares, many patients attest that addressing their pelvic floor problems has been “life changing” and has allowed them to regain confidence and return to activities they love without fear of leaks or pain.

If you’re experiencing any of the signs mentioned—or even if you’re just curious about preventing problems—don’t hesitate to prioritize the health and function of your pelvic floor. Simple exercises like Kegels or yoga stretches can make a big difference over time. However, if you have persistent symptoms or questions, talk with your primary care provider or a specialist. Remember, there is no need to feel embarrassed—health care providers talk about these issues every day. Most of all, they want to help you back to full health and function.

Memorial Hermann The Woodlands Medical Center

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