What is the pelvic floor?
The pelvis is the lower part of the torso sandwiched between the abdomen and legs. Pelvic floor muscles are layers of muscles that span the bottom of the pelvis like a hammock. Among vulva-owners, pelvic floor muscles provide support for the bladder, uterus and bowel. These layers of muscles have three holes for passages: the urethra, vagina and anus. Pelvic floor muscles contract and relax as needed to allow for urination, bowel movements, and penetrative sex.
There’s an assortment of exercises that one can do to isolate their pelvic floor muscles. One simple method is to place one or two fingers into the vaginal canal, then tighten to feel a squeeze.
Pelvic floor dysfunction often occurs after birth of a child due to pelvic floor muscles tearing. Some disfunction issues include incontinence, pelvic organ prolapse, and/or muscle weakness. Pelvic floor physiotherapy and exercises, especially postpartum, can help treat these.
How do I know if my pelvic floor is weak?
Some pelvic floor muscles can contract on demand, while others function outside our conscious control. Involuntary loss of urine, or urinary incontinence is a common sign of a weak pelvic floor. Couching, sneezing, laughing and physical activity can put pressure on pelvic floor muscles. An injured pelvic floor can result in pee leaking. An overactive bladder is a symptom of urinary incontinence. Those with an overactive bladder feel a sudden urge to urinate that’s difficult to control. Whether day or night urges, this condition leads people to run to the toilet many times. But, they do not necessarily have a full bladder or leak urine.
Without training, many can’t contract their pelvic floor muscles on demand. Specific pelvic floor exercises can help those with overactive bladders or incontinence. You can visit a pelvic floor physiotherapist to get an initial evaluation on pelvic floor strength. They may use a formal five point scoring system (0 = no contraction, 1 = flicker, 2 = weak, 3 = moderate, 4 = good, and 5 = strong) or an ultrasound and/or biofeedback device for more precise measurement. A biofeedback device is a sensor you can squeeze with your vaginal muscles. The device provides visual cues on a screen if pelvic floor muscles are being activated.
What is pelvic organ prolapse?
Pelvic organ prolapse often occurs when pelvic floor muscles are substantially weakened or torn. As a result, one or more organs shift out of their normal position and descend, eventually bulging out of the vagina. It is often described as a feeling of pelvic pressure and/or a sensation of something falling out of the vaginal opening.
Pelvic organ prolapse is sometimes referred to as pelvic floor prolapse. This is incorrect as the pelvic floor itself is not displaced from its normal position. Rather, it is the degraded state of pelvic floor muscles that allows them to "prolapse."
The pushing during childbirth can degrade the integrity of pelvic floor muscles, causing organs to slip and tilt. Even those who deliver via caesarean experience such pressure due to the weight of the baby.
The bulge outside the vagina can be felt during various activities. For example, wiping after going to the bathroom, physical exercise, or even sitting. In some cases, the bulge can interfere with solo or partnered sex or the flow of urine. Some vulva owners with this condition have difficulty with bowel movements. In these cases, they may need to insert their fingers vaginally and push down towards the rectum to provide support for a bowel movement.
The following are common types of pelvic organ prolapse: bladder (cystocele), rectum (rectocele), intestines (enterocele), uterus (uterine) and vaginal walls (vaginal vault).
How can I strengthen my pelvic floor muscles?
Many vulva owners experience pelvic floor issues. One study found that 1 in 3 people with vaginas are affected by a pelvic floor dysfunction. This is due to various factors (e.g., vaginal or perineal trauma from childbirth, menopause, chronic cough, high intense exercise, etc.). The good news is that there are plenty of options to strengthen pelvic floor muscles.
For most people with pelvic dysfunctions, simple lifestyle modifications can help. For example, a healthier diet and/or more regular physical activity. One can also integrate pelvic floor muscle exercises, also known as kegel exercises, into their daily routine. These are discreet workouts that can be done almost any time without anyone noticing. Here's how you do them: Squeeze your pelvic floor muscles in and up towards your belly button. Hold for 3-5 seconds, and then relax for the same count. Try practicing rapid contractions (1–2 seconds) and also sustained contractions (10 seconds).
Improvement will depend on your technique and dedication to doing kegels. If you have difficulty learning these exercises, physiotherapy can help. Pelvic floor specialists can offer more advanced pelvic exercises for women as part of rehabilitation.
Pelvic Floor Sources
Surgery for Pelvic Organ Prolapse. American College of Obstetricians and Gynecologists. 2021.
Kaiser Permanente Division of Research. "One In Three Women Has Pelvic Floor Disorder." ScienceDaily. ScienceDaily, 5 March 2008.
Kegel exercises: A how-to guide for women. Mayo Foundation for Medical Education and Research. 2021.
Laycock J. Clinical evaluation of the pelvic floor. In: Schussler B, Laycock J, Norton P, Stanton SL, editors. Pelvic Floor Re-education. London, United Kingdom: Springer-Verlag; 1994. pp. 42–48.