The Mysterious Pelvic Floor

Dr. Ashlee Richardson, PT, DPT

If you’ve taken a Pilates class, you’ve probably heard your instructor talk about engaging your pelvic floor. And you’ve probably wondered... “what exactly is a pelvic floor,” “why should I engage it,” and “what should I feel.” Well, I am here to hopefully clear some of that up so you can in turn get the most out of “engaging your pelvic floor!”

What do these muscles do?
Your pelvic floor muscles are a group of muscles which are located at the bottom of your pelvis. Their functions include:

  • Provide support and stability to your pelvis and low back;

  • Support the pelvis organs, including your bladder, uterus, and rectum

  • Help you breathe efficiently; and,

  • Help control bowel and bladder function.

Why strengthen the pelvic floor muscles?
We do not see these muscles, nor think about them on a regular basis so they often get neglected. Other factors like pregnancy, menopause, and obesity may also contribute to pelvic floor weakness.   

Studies have shown that an exercise program that involves strengthening the pelvic floor are effective ways to decrease low back pain and prevent/help with incontinence. These muscles support the organs in the pelvis to reduce the risk of organ prolapse (An organ prolapse is when the pelvic organs bulge into the vaginal canal). Pelvic floor strengthening can also help improve sexual function and recovery from giving birth.

How to strengthen your pelvic floor?
So, what exactly does it mean to engage your pelvic floor? The pelvic floor muscles are different from a lot of muscles we exercise and use regularly. They are more internal and because we cannot see them like we can muscles in our arms and legs they can be more challenging to contract. 

Imagine your pelvic floor muscles like a hammock that is hung up between your tailbone, sitting bones, and pubic bone. When the muscles contract, it is as though that hammock is being pulled taught, and lifting. This contraction will feel like you are stopping the flow of urine mid-stream or holding in gas if the time isn’t right. If these bodily function cues are not resonating, some other visuals that may help include imagining an elevator rising from the base of the pelvis toward your naval or a layer of material lying flat at the bottom of the pelvis that is being pulled up from the center as you contract the pelvic floor muscles. (Please note that stopping the flow of urination mid-stream is a tool that can be used to ensure you are correctly engaging the right muscles. It is however not recommended as an exercise to strengthen these muscles and should not be performed regularly as it may lead to infection).

If you are having difficulty finding your pelvic floor muscles, attempt contractions in different positions. For example, try lying on your back with a folded blanket or towel under the back of your hips to allow gravity to help you. As you get stronger you can progress to removing the towels, to sitting, and finally to standing! 

When to seek professional help?
It is important for these muscles to relax and contract at the appropriate times. Just like any of our muscles, problems can occur when the pelvic floor muscles become weak, stretched, or too tight.  

It may surprise you that physical therapy is an option for individuals who are experiencing problems related to the pelvic floor. Physical therapists who specialize in women’s/men’s health and pelvic floor dysfunction can assess your pelvic floor function and tailor an exercise program to meet your specific needs. It is recommended you talk to your physician or seek a physical therapist who specializes in the pelvic floor if you are experiencing any of the following symptoms:

  • Leak urine when you exercise, laugh, cough, or sneeze;

  • Inability to make it to the restroom in time or constantly having an urge to use the restroom;

  • Inability to contract pelvic floor muscles or decreased sensation in the pelvic area; and,

  • Pain in your pelvic area or pain with intercourse.

Ashlee Richardson, PT, DPT is the owner of CoreWorks Physical Therapy and co-owner of Pilates Center of Omaha. She specializes in women’s health and pelvic floor dysfunction. If you would like more information or set up a physical therapy appointment click here.