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Next Stop: Pelvic Floor

Let’s be honest: When you think of your pelvic floor, you probably imagine it has one job and better do it well. But what if we told you that the muscles (yes, we said muscles!) at the bottom of your pelvis play an important role in supporting every single move you make, getting sexual satisfaction and, of course, preventing something embarrassing from happening when you laugh too hard. “The pelvic floor is the forgotten part of the core,” says Melinda Abernethy, MD, an assistant professor of female pelvic medicine and reconstructive surgery at Johns Hopkins University School of Medicine. So, yeah, there’s a lot more to the floor than most people think. Let us show you.

Where Exactly Is My Pelvic Floor?

First things first: a mini anatomy lesson.

Pelvic Diaphragm Aka your pelvic floor. The star of the show, it’s made up of muscles (the levator ani and coccygeus) that line the inside of your pelvis from pubic bone to tailbone. This bowl-shaped hammock supports your pelvic, reproductive and urinary organs. Within this layer are openings for your vagina, urethra and anus.

Pudendal Nerve Behind the scenes and located on both sides of your pelvis, it carries sensations to and from your genital area, urethra and anal area. It also helps them function.

Hip Muscles Think of them as your pelvic floor’s key teammates. The obturator internus and piriformis, to be exact, make up part of the muscular wall of the pelvis. The levator ani muscles connect to the obturator internus.

24 Hours in the Life of Your Pelvic Floor

While you’re probably not aware of it, these muscles are working day and night—and they have a pretty lengthy job description. Here are a few of the things your pelvic floor does.

Contract When you need to use the restroom badly, your pelvic floor muscles kick into gear to prevent you from having an accident.

Relax It’s a two-way street. Your muscles also need to release so you can use that bathroom when you find it, enjoy sex when you’re having it and more.

Balance The pelvic floor works with your abdominal and hip muscles to stabilize your pelvis and core whether you’re running after a kid, sitting at work or doing Pilates.

Counterbalance Together, the diaphragm, abdominals and pelvic floor regulate pressure in your abdomen. When your diaphragm lowers on an inhale, your pelvic floor and abdomen lengthen. When your diaphragm rises on an exhale, they recoil. Coughing, laughing and sneezing can place a strain on the area. If your system is out of balance you may have a leak, explains Julie Wiebe, a Los Angeles–based physical therapist specializing in sports medicine and pelvic health.

5 Signs You May Need a Specialist

1. Bladder Pain A frequent urge to pee and burning sensations could mean your pelvic floor muscles are clenched or pinching a nerve. “I’ve had patients who thought they had a UTI but antibiotics weren’t helping,” says Kimberlee Sullivan, PT, a pelvic floor physical therapist in Austin, TX. “Then we locate a huge knot in the muscle, we massage it and the symptoms go away.”

2. Pain During Sex Overworked muscles can make intercourse hurt, says Padma Kandadai, MD, assistant professor at Boston University School of Medicine. If they’re chronically tight, they can trigger spasms (like a charley horse), making penetration and orgasm painful.

3. Hip Pain A pelvic floor that is not well-balanced with its neighbors can impact the way you stabilize your hips, says Wiebe.

4. Lower Back Pain Too-weak, too-tight or even too-strong pelvic muscles can shift you out of alignment, overloading and straining your back.

5. Constipation It could be more than a lack of fiber in your diet. The problem may be due to muscles that won’t relax. Constantly straining to move your bowels can weaken the pelvic floor too, says Kandadai.

Four Sources of Pelvic Floor Dysfunction

1. High-Impact Sports While great for your overall health, activities like running, jumping rope and lifting weights all increase intra-abdominal pressure and fatigue your muscles. In fact, research shows that 43% of young, physically fit women have experienced leakage during high-impact exercise.

2. Pregnancy and Delivery Not only does the weight of the fetus add pressure to the pelvic floor, but your below-the-belt muscles and nerves also stretch with pregnancy and delivery, according to Abernethy. “After birth your muscles are slower to contract,” she says, which may cause incontinence or pelvic organ prolapse.

3. Inactivity Surprisingly, when you’re not busy moving there’s less work for your pelvic floor and it can weaken, explains Katy Bowman, MS, author of Move Your DNA: Restore Your Health Through Natural Movement. Sitting all day on a tucked pelvis results in your sacrum bearing the brunt of the work and your weight.

4. Menopause As you get older and hormone levels shift, you naturally lose muscle mass and tone. “It happens with the pelvic floor just like in your arms and legs,” says Barbara Levy, MD and VP for health policy at The American Congress of Obstetricians and Gynecologists. Research shows that collagen accumulates with age, which may lead to scarring of the pelvic floor muscles.

Q. What exactly does a pelvic floor PT do?

A. Pelvic floor physical therapists have received advanced training and are experts in treating pelvic floor pain and dysfunction in women and men. They employ both functional exercises (think bridges) and treatments (like massage). Don’t be surprised if you’re asked to have a pelvic exam during your appointment. Kimberlee Sullivan, a pelvic floor physical therapist in Austin, TX, observes the pelvic floor externally, noting skin color, texture and any discomfort. She also does an internal analysis to check the response of the deeper muscles while you perform a Kegel, bear down and cough. Depending on symptoms, she may test the pelvic floor rectally too.

Work It Out

These exercises from Katy Bowman, MS, author of  Move Your DNA: Restore Your Health Through Natural Movement, will get you in touch with your core’s floor.

Sit and Shift Improving your hip mobility makes your pelvic floor more flexible, explains Bowman.

• Sit with your legs tucked underneath you. Place hands on a stack of blankets on either side of your hips.

• Shift hips to the left toward the blankets. Hold for 10 seconds, then engage the muscles in your waist and lower body to switch sides and repeat. Use your arms for support as needed.

• Over time, decrease the blankets’ height and keep shifting until hips reach the floor.

Pelvic List This exercise develops your hip and glute muscles to support healthy tension in your pelvic floor.

• Stand barefoot with weight on your left foot.

• Without leaning or bending either knee, press your left hip down into the floor until your right foot lifts off the ground. Use a chair for balance as needed.

• Repeat 10 to 12 times. Switch sides.

• To increase difficulty, do the move on a yoga block, making sure your left heel is on the block. After raising your right foot, lower your right hip so your right foot descends below the block. Repeat and switch sides.

Legs on the Wall Relax your inner thighs with this passive stretch. If you’ve had a hip replacement, do NOT do this.

• Sit parallel to a wall about 8 to 10 inches away with knees bent. Then lie on your back and place your legs on a wall, forming a V.

• Let gravity pull your legs away from each other and roll your thighs open. Relax your abs and glutes and hold for 30 to 60 seconds.

• To come out of the pose, use your hands to gently bend your knees and bring them to your chest. Roll to one side and sit up.

The Truth About Kegels

You’ve probably heard Kegel exercises are key to a healthy pelvic floor, but these strengthening moves are only part of the puzzle. Your body needs flexible muscles that perform many actions—lengthen, contract and absorb shock—not just squeeze. Kegels teach you to flex your below-the-navel muscles (good for incontinence issues), but that can be problematic when you have a chronically tense pelvic floor or experience muscle spasms, says Abernethy. If your doctor or physical therapist recommends Kegels, request guidance since research shows that at least one in four women perform them incorrectly. You want to focus on the muscles that control the flow of urine and not bear down or flex your abs.