Why you need to work on strengthening your pelvic floor

What is the pelvic floor? What is its role in the body?

The pelvic floor, also called the pelvic diaphragm, is a diamond-shaped musculo-fibrous structure located at the base of the pelvis. It consists of soft tissues that close off the pelvic cavity. It is bordered by the pubic symphysis at the front, the sacrum and coccyx at the back, and the pelvic bones on either side. The pelvic floor includes a superficial layer (skin) and a deeper layer of muscles and ligaments forming the urogenital diaphragm.

Comprised of three muscular layers (superficial, middle, and deep), the pelvic floor has three openings in women: the urethra, vagina, and anus, and two in men: the urethra and anus.

Its primary functions include:

1. Supporting pelvic organs such as the bladder, uterus, and rectum.
2. Controlling sphincter contractions, regulating the openings of the urethra, vagina, and anus.
3. Enhancing sexual pleasure by increasing sensations during penetration with a strong pelvic floor.

In both sexes, the pelvic floor supports the urinary, digestive, and reproductive systems, ensuring urinary and faecal continence. Abdominal organs, such as the intestines and bladder, exert varying levels of pressure as they fill and empty. Since these organs are highly active, the pelvic floor is responsible for generating upward pressure to maintain consistent balance. This function is essential for sustaining overall health and well-being.

A strong pelvic floor is vital for long-term health and maintaining its effectiveness.

What causes pelvic floor weakening?

The pelvic floor can be weakened by various factors and habits, as the daily pressure from supporting organs can take a toll. Certain conditions exacerbate this risk:

• Pregnancy and childbirth (in women).
• Obesity or being overweight.
• Ageing.
• Chronic constipation (from repeated straining).
• Chronic coughing.
• Smoking (which damages tissues).
• Genetic predisposition (tissue quality).
• Menopause (reduced estrogen levels).
• Excessive water intake (increased bladder pressure).
• High-impact sports.
• Lifting heavy objects.
• Prostate surgery (in men).

Weak pelvic floor muscles may lead to:

• Pelvic organ prolapse (organ descent).
• Urinary or faecal incontinence (e.g., leaks during coughing, laughing, or exercise).
• Vaginal flatulence in women.
• Sexual dysfunction, such as erectile and ejaculation issues in men or pain.
• Loss of sensitivity in women during intercourse.
• Postural issues, as a weak pelvic floor can destabilize the pelvis and misalign the spine.

While men are less affected than women due to narrower pelvises, which reduce muscle strain from abdominal pressure, any signs like incontinence, pelvic pain, or sexual dysfunction warrant consultation with a specialist. A healthcare provider, such as a pelvic floor physiotherapist, can determine whether the pelvic floor is overly tense or too weak and create a personalized treatment plan.

What exercises strengthen the pelvic floor?

Pelvic floor exercises aim to restore natural muscle contractions. They strengthen the pelvic floor, which is crucial for continence, organ support, and sexual function. These exercises can be tailored for individuals and done independently or under the guidance of a professional.

General exercises

Kegel exercises

The most well-known method, Kegels involve voluntary contraction and release of pelvic floor muscles. These exercises should be done gradually, varying intensity, duration, and resistance. They can be performed discreetly anywhere, but it’s important to isolate pelvic floor muscles and avoid engaging the thighs or buttocks.

Muscle awareness

To locate pelvic floor muscles, sit comfortably and contract as if holding back urine or gas. Release after 5 seconds and repeat 10 times.

Breathing and coordination exercises

Controlled breathing: While lying down, inhale deeply. As you exhale, contract your pelvic floor muscles and draw in your stomach. Hold your breath briefly after exhaling for added effort.

Elevator technique: Contract the pelvic muscles in stages, reaching maximum contraction, then release gradually.

Using a ball

Place a ball between your knees while lying on your back with bent legs. Squeeze the ball as you exhale and contract your pelvic floor muscles. This exercise improves muscle strength and coordination.

Techniques for women

Manual guidance

A healthcare professional (midwife or physiotherapist) may use vaginal touch techniques to guide contractions, assess muscle tone, and focus on specific areas for tailored rehabilitation.

Biofeedback

This method uses a vaginal probe to monitor and display pelvic floor contractions on a screen. It offers real-time feedback, making the exercises engaging and helping track progress.

Electrical stimulation

Electrical impulses activate the pelvic floor muscles, often useful when voluntary contractions are insufficient. Once muscles are strengthened, Kegels can be incorporated.

Accessories

Vaginal weights or Kegel balls, such as geisha balls, progressively strengthen muscles. Initially, the goal is to hold the accessory in place; later, movement like walking or squatting can be added. Professional guidance is recommended before use.

Techniques for men

For men, the pelvic floor supports continence and sexual functions, including erection and ejaculation. Although naturally stronger, these muscles may need strengthening after events like prostate surgery.

Muscle identification

Contract the muscles around the anus as if holding back gas. This directly activates the pelvic floor.

Post-prostate surgery rehabilitation

After prostate removal, a few sessions of pelvic floor therapy can prevent urinary leaks and maintain sexual function.

Sport-based strengthening

Certain sports naturally enhance pelvic floor strength while improving posture and coordination:

Yoga and Pilates

These practices include pelvic floor-targeting poses like the bridge (Setu Bandhasana) and child’s pose (Balasana), which strengthen, stretch, and improve awareness of these muscles.

Hypopressive abdominal exercises

This technique tones deep abdominal muscles and reduces the risk of prolapse through controlled breathing.

Key takeaways

The pelvic floor supports vital functions like continence, organ support, and sexual health. However, it can weaken due to factors like childbirth, ageing, or obesity. Strengthening exercises, such as Kegels, are accessible and beneficial for everyone, provided there is no hypertonicity (a rare condition causing pain). Regular practice, with or without professional supervision, helps maintain pelvic floor health and overall well-being.

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