The Lowdown:

If you’ve never thought about your pelvic floor muscles before, you’re not alone. If you’ve heard your grandma or aunts make a joke about peeing themselves when they laugh or jump on a trampoline, you have almost talked about it!

Your pelvic floor is the base of your core strength, and the muscles there (including your PC or pubococcygeus) see considerable stress during pregnancy and childbirth. These muscles hold your pelvic organs up inside your body and control elimination. They also play a key role in sexual pleasure and control.

Leaking urine, a heavy feeling in the vagina, and pain during intercourse or exams are signs your pelvic floor could use some attention.

A closer look

Pelvic-floor-diagram

You can think of the muscles of the pelvic floor` like a basket for your pelvic organs, which include your uterus and cervix, bladder, vagina, and rectum. The ideal [healthy] pelvic floor is stretchy and strong, like a trampoline.

A strong but stretchy pelvic floor holds everything where it belongs, allows you to hold your urine and eliminate when you want to, supports the rest of your core musculature, and allows for more control and pleasure during sex.

If the trampoline is too stiff and tense, you can have trouble releasing for birth, be more likely to tear, and have more painful intercourse.

When the trampoline is too soft, the organs aren’t held in place properly. And because the muscles that keep your urethra and anus closed are part of the basket, it can lead to incontinence.

With pelvic muscle laxity, you may leak urine or have trouble holding it. In some cases, people find it difficult to complete a bowel movement. Your cervix or other organs may press into the vaginal walls or “fall” down into the vagina. This is called prolapse.

Prolapse is actually very common, especially in older women who’ve had children.

Despite this, it is not unusual for Americans to have a child without anyone mentioning the pelvic floor at all! Most doctors, nurses, and midwives are not trained in pelvic floor health. For generations, postpartum women were told “that’s just how it is now” when they went to the doctor with pelvic complaints.

Most problems are due to pelvic floor weakness, but some people do have pelvic muscles that are too tight at rest. In either case, there is something you can do.

How to do pelvic floor work naturally

Sedentary lifestyles tend to build weak pelvic floors. The truth is, compared to our ancestors, most of us lead very sedentary lifestyles. Walking, squatting, and special exercises can help strengthen the muscles and prevent problems during pregnancy, birth, and postpartum.

Dancers, horseback riders, and others who regularly participate in activity that requires a strong pelvic floor are more likely to have muscles that are too tight. Survivors of sexual abuse may also have special tension. There are exercises and practices that can help in these cases as well.

You are probably already thinking about Kegels (an invisible exercise where you tighten your PC muscle). Maybe you’re even doing them right now! Because some of us are too rigid and some of us are too lax (and some nicely in the middle!), a universal prescription for Kegel exercise is not ideal [safe].

You can diagnose yourself a bit with what issues you have or don’t have, but everyone deserves a session with a pelvic floor therapist.

Signs you may need to see a professional.

Everyone deserves to see a pelvic health professional. In France, the government pays for postpartum women to see a pelvic health therapist and get individual therapy. We are not surprised the French value their sex lives more than we do.

Here in the states, you may have insurance that covers the therapy, typically done by a physical therapist with special training in the pelvic floor. If not, an exam is about $200 and that will let you know where to focus your exercise time and how to do the stretches and contractions.

Especially if you have any pelvic concerns, with sex, elimination, or uncomfortable feelings, it’s worth getting checked out. And just because you don’t leak urine doesn’t mean you don’t have laxity that could lead to problems.

Going to the physical therapist is not something you need to worry about doing right away. Don’t stress about getting in to be seen postpartum, certainly not before you’re all healed up. But sometime in the first 3-9 months, when you feel like you have the energy, make the call.

The Bottom Line

Ideally, we would all see a pelvic health therapist before we got pregnant so that we understood where we were starting from and could get a personalized exercise plan. Then we’d see them again postpartum to get a new plan.

Most of the exercises you do to help your pelvic floor need to be done daily. Kegels can be great, but you want to be doing them properly.

We can avoid problems that come from pelvic floor weakness by seeing a therapist and doing the exercises that she recommends. When in doubt, walking and squatting are a good bet.