Pelvic Floor 101

What is the pelvic floor?

The pelvic floor is a network of muscles, connective tissue and fascia that connect the pelvic bones to one another while supporting internal organs and structures. The pelvic floor is the bottom of our “core” and is shaped like a bowl.

We need the pelvic floor to be able to both contract (lift up) and relax (lengthen down). The pelvic floor contracts when we jump, cough, run, or do anything that requires stabilization. The pelvic floor relaxes and lengthens to allow us to pee, poop and birth a baby.

Fun fact: the pelvic floor (AKA the pelvic diaphragm) works synergistically with our respiratory diaphragm.

When we take a deep inhale, our pelvic floor lengthens and relaxes while the respiratory diaphragm contracts, causing the lungs to fill with air. Then when we exhale, the pelvic floor contracts and lifts while our diaphragm relaxes, allowing the lungs to release air.

What are pelvic floor symptoms?

Pelvic floor symptoms can show up from the pelvic floor having too little tension (weak) or too much tension (tight) and these symptoms often look the same so it can be difficult to discern without a proper assessment by a physical therapist or physician who specializes in the pelvic floor.

Pelvic floor symptoms can show up in any gender at any age – not just those going through pregnancy, postpartum or peri/postmenopause, although these can be a more common time to experience symptoms, even if you’ve never had symptoms otherwise.

Common pelvic floor symptoms may include:

• Incontinence, constipation or hemorrhoids 

• Diastasis Recti 

• Pelvic Organ Prolapse 

• Pain — inside the body, around the pelvis, pubic bone or low back 

Incontinence

Any issues with peeing, pooping or leaking – they all fall under this umbrella. There are a few ways folks can experience incontinence and they can happen during pregnancy, immediately postpartum or further down the road. 

• Stress Urinary Incontinence: an increase in intra-abdominal pressure, such as a sneeze or cough, can cause leaking as can physical exertion like jumping. 

• Urgency Urinary Incontinence: this can happen suddenly, where a person feels they don’t have time to make it to the bathroom. The bladder doesn’t need to be super full either, it can happen anytime. 

• Frequency Urinary Incontinence: this is when a person pees quite often - even when there isn’t much in the bladder, they still feel like they have to go. 

• Fecal Incontinence and Constipation: the same issues can happen but with the rectum, so poop or toots can sneak out. Another very common issue here is the opposite, when a person suffers from constipation and has difficulty having a BM. 

Read more about incontinence and happy bladder habits here.

Pelvic Organ Prolapse (POP)

POP is a dysfunction in the support system of the pelvic floor. This can be caused by weakness of the muscles and soft tissues or it can be caused by a tear or extreme stretch of the tissues (muscles, tendons, ligaments, fascia). What this feels like then is a bulging or downward pressure or like something is falling out of the vagina or rectum. 

There are 4 levels of severity and the management of symptoms will vary from person to person. POP can happen slowly over time or by a traumatic event (such as birth). It can even happen way down the road postpartum which is another reason why it’s so important to prioritize postpartum healing and not jump back into exercise before properly and progressively increasing strength and stability within the body. 

The 3 types of POP include: 

• Cystocele: anterior (front) vaginal wall and or bladder 

• Rectocele: posterior (back) vaginal wall and or bowels 

• Uterine: uterus and cervix 

Most folks find that exercise can really help reduce symptoms and give the person some relief! Physical therapy is so crucial here. One quick trick that can help folks with a POP flareup is to use gravity to your advantage. A simple exercise, like Legs Up the Wall or Down Dog stretching can really give relief. 

In some cases, surgery may be an option but there is also a high failure rate so working with the body’s own healing process and rebuilding support through the area is a first step that cannot be overlooked. 

Pessaries are an intravaginal support device that many find to be beneficial, particularly during certain physical activities or even during certain parts of their cycle, as hormone changes can contribute to symptoms. 

Prolapse can be scary because it feels like your body is broken and there’s no going back. But I promise you, your body isn’t broken, and there are absolutely ways to manage symptoms and do the physical activities you love to do.

Diastasis Recti (DR) 

DR is a thinning, weakening or widening of the connective tissue that bridges the two sides of the abdominal wall, which results in a separation of the ab (“6 pack”) muscles. This is a normal and natural adaptation that the body makes during pregnancy to allow for a growing uterus and fetus. 

This gap should close by 6 to 8 weeks postpartum and while the abdominals may not return exactly to their pre-pregnancy placement, most of the time, that's ok! Function is what's important. 

DR gets a lot of attention in the perinatal world as a problem that needs fixing. If you have any gap in your abdominals, you’ll always have low back pain! Painful sex! A “mommy tummy”. 🤔

Overtime, the abdominal muscles will come back together, but they may not come back together all the way, in the same way they were before pregnancy. This doesn’t mean function will automatically be impaired. If someone has a wide gap between their abdominal muscles but they can still generate tension throughout their core... great! No problem. But if they have a gap and they are having difficulty generating tension in order to exercise, care for their baby and meet the demands of their life, then that’s a time we would want to consult with a physical therapist who is well versed in postpartum and pelvic floor/core care.

But what about kegels? Aren’t those helpful for PF symptoms?

That depends! I see kegels as one piece of the pelvic floor healing puzzle. 

They can be a great tool but for some folks, they can be a bit redundant if they are already carrying around too much tension in their pelvic floor. Having an assessment done by a pelvic floor physical therapist is the best way to know if your body needs them or not. 

But let’s rewind. What is a kegel?! Learn more about them here.

And at the end of the day, kegels won't be the end all be all of pelvic floor recovery and symptom relief. They might be one of many tools in your toolkit that help you move through life easier.

Can I exercise with pelvic floor symptoms?

Absolutely yes.

There can be a lot of fear around movement with PF symptoms because we don’t want to make anything worse. It also stinks to feel like we can’t do something because of symptoms (or at least not in public).

But we can exercise in a way that relieves, if not improves, our symptoms over time. Exercise can be a valuable part of the healing process when dealing with PF symptoms.

Some exercises may feel better than others. Some we may need to take a break from or we may just need to tweak how we’re doing them. This is where working with a coach who is well versed in the pelvic floor can be so valuable. 

I don’t want to limit what you’re doing and I want you to feel better and more confident in your pelvic floor. We can absolutely accomplish both of these at the same time.

As someone who’s been mindful of their pelvic floor for 20 years, I know what it’s like to be consumed by it and I also know what it’s like to get better. It’s possible! I promise.

Interested in specific ways to reduce symptoms while exercising? Start here.