Between your pelvic organs and gravity lies a thin layer of muscles and ligaments called the pelvic floor. During physical exercise, coughing or sneezing, or pregnancy these muscles contract to stabilize your core and keep your pelvic organs in place against downward pressure. And, they relax in coordination with the contraction of the bowel or bladder muscles, to allow you to urinate or defecate. But sometimes pelvic floor dysfunction occurs, and when it does there are exercises that can help.
A strong pelvic floor keeps organs from slipping out of place, or prolapsing. However, dysfunction of the pelvic floor is common and depending on the severity, a progression of symptoms may occur, including pain or pressure in the pelvis or low back, painful intercourse, urinary or bowel incontinence, pelvic infections, and organ damage. Various conditions cause or contribute to pelvic floor dysfunction, including normal processes, such as pregnancy and childbirth, and menopause.
Pelvic floor and pregnancy
During pregnancy, in addition to pressure on the pelvic floor, hormones are released that soften the muscles and ligaments in preparation for delivery. Although hormone levels return to normal after childbirth, often the pelvic ligaments, which lack the elasticity of muscles, aren’t able to completely return to their original length. As a result, many women experience pelvic floor dysfunction while pregnant and after giving birth.
Menopause and pelvic floor dysfunction
Later in life, pelvic floor dysfunction can occur during menopause due to loss of estrogen, which normally helps maintain healthy connective tissues throughout the body. As a result, the pelvic floor muscles and the sphincter muscles of the bladder and bowel become weakened. Additionally, trauma to the low back or pelvic area, obesity, pelvic surgery, or conditions that damage the pelvic nerves can be contributing factors. When the pelvic floor becomes chronically stretched out, lax, and weakened, it is described as hypotonic.
The pelvic floor can also become overly tight and contracted, or hypertonic. This condition, which is variably referred to as pelvic floor muscle spasm, pelvic floor overactivity, or nonrelaxing pelvic floor, is often due to learned behaviors or habits. These may include suppressing the urge to urinate or defecate due to stressful situations, an emotional response to traumatic childbirth, injuries to the back or pelvis, or an altered walking gait. Sometimes, a combination of both hypotonic and hypertonic pelvic muscles occurs at the same time.
The pelvic floor muscles work under both automatic and intentional control. This means you don’t have to remember to contract them when you run or lift something heavy. This also means you can exercise your pelvic floor muscles to prevent or manage pelvic floor dysfunction.
Following are a few helpful exercises for strengthening and stretching the pelvic floor muscles to help improve your pelvic health.
Kegels
This exercise is performed by contracting the muscles that stop or slow the flow of urine. It’s perhaps easiest to learn Kegels in a lying down position, but once you get the hang of it, they can be performed while sitting or standing. And, Kegels can also improve your sex life. According to a 2019 meta-review, Kegels were shown to improve sexual function in post-partum women.
Heel slides
This is a great exercise for activating and strengthening the pelvic floor and deep abdominal muscles. Start while lying on your back with legs extended; bend one knee and slowly slide that heel toward your buttock, then reverse and repeat with the other leg. Heel slides can also be done seated, which adds the challenge of working against gravity.
Toe taps
This exercise is a more intense, version of heel slides that strengthens core and pelvic floor muscles. While lying on your back with your knees bent, contract your pelvic floor muscles and press your low back flat to engage your core muscles, then slowly raise one leg to tabletop position, lower that leg and raise the other leg. Repeat, alternating sides.
Happy Baby
As fun as it sounds, this exercise soothes the low back, lengthens the inner thigh, hip, and groin muscles, and strengthens the pelvic floor muscles. While lying on your back, bend your knees in toward your chest with your feet flexed, then reach forward and hold onto the outsides of your feet. Holding the knees wide apart, slowly rock your legs from side to side.
Diaphragmatic Breathing
Stress often inhibits the normal diaphragmatic breathing pattern, which is designed to decrease tension in the pelvic organs by allowing the abdomen to expand during inhalation. To practice diaphragmatic breathing place one hand on your lower abdomen and the other on your chest while lying or seated. As you inhale, expand your abdomen fully, then slowly exhale.
Pelvic Physical Therapy
If all of the above seem a bit daunting it may be helpful to consult a pelvic physical therapists. Pelvic Physical Therapists are specially trained physical therapists; they work with clients to relieve their symptoms and help the pelvic muscles work efficiently. Be sure to look for pelvic physical therapists who have special certification such as Herman Wallace.
Pelvic dysfunction can affect women at all stages of life, but you don’t have to resign yourself to living with it. Consult your doctor for guidance on these exercises and other effective solutions.