What Is Your Pelvic Floor and Why Should You Care?
You’ve probably heard of the pelvic floor, and you know it’s somewhere down there. But you might be surprised — even impressed — by how much your pelvic floor does for you on the daily.
You have it to thank for everything from your ability to stand to your ability to achieve an orgasm.
What is the pelvic floor and where is it located?
The pelvic floor is a group of muscles and connective tissues attached to the bones at the bottom of your pelvis. If you could look down vertically in-between your hip bones, you would see the pelvic floor muscles at the bottom (floor!) of your pelvis.
What does your pelvic floor do?
Your pelvic floor is working 24/7, and some of its job duties may surprise you.
Pelvic floor muscles act like a hammock supporting your bladder, colon, rectum, vagina, cervix and uterus.
Working in unison with your hip muscles, your lumbar spine and your diaphragm, pelvic floor muscles stabilize your hips and trunk, helping you to stand upright, walk and shimmy.
Arteries push fluids out through your body, and most of that fluid comes back through your veins. But the lymphatic system that drains the rest relies on the movement of muscles like those of the pelvic floor, without which you would reach unprecedented levels of bloat.
Pelvic floor muscles help your bladder and rectum open and close on demand when you need to pee and poop (and when you need not to).
Those same muscles that squeeze to keep your pee from leaking are the muscles that contract and release during the Big O. That’s an involuntary contraction but you can also consciously work those muscles to increase sensation during pants-off dance-offs.
There are 16 individual muscles that perform these job duties, and how well they perform has a lot to do with what kind of shape they’re in.
Tina Allen, P.T., a physical therapist at the UW Medicine Pelvic Health Center, uses a fairy tale analogy to explain pelvic floor function to her patients.
“Just like Goldilocks didn’t want her porridge too hot or too cold, you don’t want your pelvic floor too tight or too loose. There’s a happy medium with your pelvic floor muscles. You want them just right,” she says.
What happens when your pelvic floor is too tight?
Allen, along with Dr. Anna Kirby, an obstetrician-gynecologist who specializes in female pelvic health, often sees young women suffering from a pelvic floor that is too tight. Many women and people with vaginas have either overtrained their muscles or they hold stress and anxiety there. This can also be a result of sexual trauma or abuse, says Kirby.
Like any other muscle, pelvic floor muscles can spasm. If they are too tight and too tender, you might experience pelvic or tailbone pain; problems with your hips, bowel or bladder; or sexual dysfunction. Any of these issues could be related to your pelvic floor.
But people with an overly tight pelvic floor don’t necessarily know that’s the problem
“There is a lot of cross-talk in the pelvic region,” says Kirby. “This means that if one organ in your pelvis is irritated, it can influence and sensitize another organ through nerve pathways.”
But because of the taboo against talking about your genitals and reproductive organs, many people live with unnecessary discomfort.
“We want everyone to know that sex is not supposed to hurt,” says Allen. “If it does, you should come tell us about it. Make an appointment with a pelvic floor specialist and we can help you.”
What happens when your pelvic floor is too loose?
Do you sometimes leak pee when you cough, sneeze or laugh at your friends’ latest antics on Instagram? This happens when your pelvic floor muscles receive more pressure than they can handle and is known as stress incontinence.
A loose pelvic floor can land you on the floor — lying there in agony from low back pain. Because your pelvic floor muscles work in harmony with your back and abdominal muscles, when one group isn’t working well, another group picks up the slack and ends up becoming overworked and sore.
If you can’t quite reach climax during hanky panky time, this could be due to a weak pelvic floor as well. So could a climax that starts to feel a little less climax-y than it used to.
Pregnancy can contribute to pelvic floor weakness and so can lots of other things — being overweight, not exercising and (alas) getting older.
If your pelvic floor becomes too weak to sufficiently support your pelvic organs (bladder, colon, rectum, vagina, cervix, uterus), they may shift, bulge or push outward. And you’ll have less control over when you start and stop peeing and pooping.
But pelvic floor training can help you develop muscles that are both mobile and stable.
“I would refer just about anyone who comes to my clinic to pelvic floor physical therapy if they have the time and the interest,” says Kirby. “Pelvic floor training with a physical therapist can help a woman to achieve that balance between strength and support and length and flexibility.”
The more Kegels the better?
Thanks to obstetrician-gynecologist Arnold Kegel, you’re probably already familiar with the pelvic floor exercise that he developed in the 1940s for patients experiencing stress incontinence or sexual dysfunction after childbirth: the Kegel.
It’s that thing where you contract your pelvic floor muscles by squeezing as if you’re trying to stop the flow of pee and then release.
“Kegels are a great exercise in the right circumstances,” says Allen. But since they increase the strength of the pelvic floor, if yours is too tight Kegels would be “the worst possible thing you could do.”
Both Kirby and Allen point out that our culture discourages women from talking about the kinds of problems that originate with the pelvic floor. And they want to counter that influence.
“Pain during sex is not necessary, a little bit of urine leakage after having a baby is not something you just have to live with: We have treatment for these things.” says Allen. “You should come tell us about these problems because we can help.”
“There are places in the world — like France — where the majority of women see a pelvic floor specialist after birth. Just because,” says Kirby. “There is no downside to it.”
This article was originally published on April 6, 2018. It has been reviewed and updated with new info.