Experts weigh in on the muscles you bear down on each and every day.

By Cassie Shortsleeve
Updated: March 21, 2019
Photo: Westend61 / Getty Images

If you're pregnant or have had a baby, you've likely heard all about your pelvic floor, the muscles that support your pelvic organs (think: your bladder and uterus)-not to mention all of the ways childbirth can wreak havoc on them (baby coming down the birth canal, anyone?). But mamas aren't the only ones who should care about these crucial muscles.

"As a urogynecologist, I see a lot of women who have pelvic floor issues who have not been pregnant," says Lauren Rascoff, M.D., an assistant professor and urogynecologist at the University of Colorado.

And being fit doesn't make you immune from these issues. While everything from hormonal dysfunction to certain diseases (endometriosis and PCOS, for example) or an infection can play a role in pelvic floor disorders, high-impact exercise (running, for example) and heavy weightlifting (CrossFit), both of which put significant force on your pelvic floor, can increase your risk of problems and pelvic floor dysfunction. That's when the pelvic floor muscles themselves are either overactive or underactive, explains Rachel Gelman, D.P.T., a pelvic floor clinical specialist in San Francisco. And if you're not using these muscles correctly-maybe you have posture issues or live a sedentary lifestyle-you could be at risk for dysfunction, and in turn, a disorder.

In fact, about one in four women in this country could suffer from what's known as a pelvic floor disorder, a group of conditions that negatively impact the pelvic floor muscles and can cause symptoms including urinary incontinence, a lack of bladder control, straining with bowel movements, pelvic pain, and even pelvic organ prolapse.

The problem? Many women don't know where to start when it comes to learning how to take control of the muscles. Fortunately, it's easier than you think. And once you're acquainted with your PF, you'll boost core strength, send nagging symptoms packing, and build a stronger body fit for your everyday activities.

Here, what experts want you to know about these precious muscles.

Bladder leaks and pain aren't "normal."

Embarrassing, sure. Not something you *quite* want to bring up with your doc? Maybe. But despite what your friends/older sister/mom told you, bladder leaking or unintentional urine dripping isn't "normal," says Lauren Peterson, D.P.T., owner and clinical director of FYZICAL Therapy & Balance Centers of Oklahoma City. "Bladder leaks are common," she says. "But they are preventable and a sign of unhealthy pelvic floor muscles." Same goes for pelvic pain. "Sex should not be painful. It should not be difficult to insert and use a tampon," says Peterson. Many times, simply learning how to activate your pelvic floor muscles (more on that later) is enough to help, too. (Related: 8 Reasons Why You Could Have Pain During Sex)

You might have to bring up your symptoms to your doc-and help steer your own treatment.

The problem with pelvic floor issues is that you might not get the answers you're looking for from a traditional doctor. "Some research shows that health care providers don't ask questions relating to pelvic floor dysfunction (pain with sex or urinary incontinence)," says Gelman. "Many patients don't feel comfortable bringing it up if a provider doesn't ask."

Here's why you should: Clinical practice guidelines by the American College of Physicians indicate that first line of treatment for urinary incontinence should be pelvic floor muscle and bladder training. But Cynthia Neville, D.P.T., national director of pelvic health and wellness at FYZICAL Therapy & Balance Centers, says that in her experience, many physicians treat pelvic floor disorders with medication (think: for bladder leakage and incontinence, constipation, or pain).

If your doc doesn't give you much insight or you want a second opinion? Do some research on a local pelvic floor specialist (you can find one here) who can help you to understand and train your pelvic floor, so you can learn how to strengthen or relax the muscles. (Related: Pelvic Floor Exercises Every Woman Should Do)

You may not know how to do a kegel (and that's OK).

If someone told you to do a kegel, could you? Some women can, but research finds that other times, women don't respond to verbal instruction alone. That's where a pelvic floor physical therapist comes in. Through both manual work and devices that stimulate your pelvic floor muscles providing biofeedback, a pelvic floor physical therapist can help you understand how to work these muscles. A full exam can also help ensure that you are strengthening the muscles that are weak and releasing the muscles that are over-tight, explains Peterson. Just remember: "Kegels are not appropriate for all women with over-tightening pelvic floor muscles until they know how to let go of them properly," she says. "Continuing to tighten overtightened muscles will likely worsen their symptoms."

BTW: A correct Kegel involves three things, says Isa Herrera, M.S.P.T., C.S.C.S., founder of PelvicPainRelief.com: The perineal body (the area between your anus and vagina) should move up and in, your anus should contract, and your clitoris should "nod." "They should all happen at the same time in a neutral pelvis position." (Related: The 6 Best Kegel Balls for Better Sex)

Also, when you kegel, you want to be working your deep ab muscles, the transverse abdominal muscles-and avoid contracting your glutes. Not using your abdominal muscles enough or gripping your butt muscles can cause many women pelvic floor muscle dysfunction, she says. It means you're not allowing your pelvic floor muscles to properly function.

Your pelvic floor needs relaxation, too.

Despite what you may have read, not *everyone* needs to strengthen their pelvic floor with kegels. "Many people need to focus on learning to relax their pelvic floor," says Gelman. "The pelvic floor is like any other muscle and it can be overworked. If you hold a 20-pound weight in a biceps curl for too long, the muscle will fatigue and may start the hurt." If your PF muscles are tight-aka hypertonic-you might feel pelvic pain, pain during sex, or urinary or bowel incontinence. (Related: 8 Reasons Why You Could Have Pain During Sex)

"For these people, my favorite stretch is Happy Baby," says Peterson. (Lie on your back with your feet in the air and your soles together.) If that's too extreme, start with your legs on the ground and your soles together, she suggests. Learning how to do proper diaphragmatic breathing, or belly breathing, is also one of the first steps a therapist might teach you if you have tight pelvic floor muscles. "There are often many other stretches I give to people with tight pelvic floor disorders that are specific to that patient's case," says Peterson.

And it's not just the areas you might immediately think of, she adds. "Often times the backs of the legs (hamstrings), the front of the hips (hip flexors), buttocks (gluteal), and deep rotator muscles all need stretching and strengthening. It is also important that the hip muscles and abdominal muscles surrounding the entire pelvis are truly 'healthy' muscles, meaning they are both strong and flexible."

Good bowel movements matter.

If you're all backed up or find yourself straining on the toilet, that's something to mention to your doc, too. Constipation and pushing with bowel movements can put a lot of pressure on the pelvic floor. Over time this can lead to dysfunction, says Gelman.

A healthy diet with plenty of fiber and good hydration are both important to keep bowels healthy. You might want to even reconsider how you go. Being in a squat-like position puts the pelvic floor in the best position for No. 2, she notes. Put a step stool under your feet or consider a product like the Squatty Potty.

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