The pelvic floor muscles may be the most important muscles you never target with a workout. Like a trampoline that sits at the base of your pelvis, these muscles not only contribute to overall core strength, they also hold multiple organs in place — including the bladder, bowel and, for some, the vagina and uterus — ensuring they work properly.
And yet, many people don’t even know the pelvic muscles exist, said Dr. Amy Park, the head of female pelvic medicine at the Cleveland Clinic — at least, not until they stop working properly. “There’s a general lack of awareness about the pelvic area,” said Dr. Park. “I educate women multiple times a day about the fact that we have pelvic floor muscles.”
They may not be visible like triceps or quads, she said, but they are vital for everything from basic bathroom functions to sexual health to sitting and standing — and they benefit from a well-rounded fitness program.
The pelvic floor is “just as important in your daily life as your Achilles is for running, because we use it for everything,” said Liz Miracle, the head of clinical quality and education at the pelvic floor physical therapy provider Origin.
Historically, talking about this region of the body, even with one’s physician, has felt off limits to many. Even the name for the pudendal nerve, which runs through the pelvic floor, comes from a Latin word that means “to be ashamed.”
This prudishness has led to years of unnecessary suffering, said Evelyn Hecht, a pelvic floor physical therapist in New York City who began practicing in the 1990s: Many conditions could be treated or avoided entirely if women felt freer to discuss their symptoms, or if the public were better informed about the pelvic floor. Instead, millions live with pain or discomfort.
Nearly one in three American women suffers from a pelvic floor disorder, most commonly in the form of urinary incontinence, bowel incontinence, pelvic pain, pelvic organ prolapse or some combination of the above. And this doesn’t just affect women who have given birth: Studies suggest a significant percentage of women with pelvic floor disorders have never been pregnant.
When our pelvic floor is both strong and flexible, the muscles work together — or “co-contract” — with the core muscles to allow us to live our daily lives with ease and to stay active as we age, said Ms. Hecht, who now runs the digital pelvic health provider PelvicSense. The pelvic floor helps with balance and mobility during sports and exercise, too. “If I’m playing pickleball and I want to reach for a shot,” she said, “my pelvic floor is going to co-contract and stabilize my trunk.”
Pelvic floor problems can be caused or exacerbated by anything that puts pressure on the muscles over time, leading them to tear or weaken — that includes running, dancing, heavy lifting without proper form, chronic constipation or even regular coughing, pregnancy and childbirth. Injuries can also arise when the muscles become too tight, which can be caused by regularly “holding it in” when you feel the urge to go to the bathroom, by overtraining the core or even by long-term stress and anxiety. (When stressed, many people reflexively clench these muscles.)
Recently, pelvic floor specialists have reported an uptick in disorders resulting from tight pelvic muscles — a trend they’ve called “pandemic pelvis” since the most common cause appears to be stress combined with too much sitting.
But pelvic floor problems aren’t inevitable. Many pelvic issues can be prevented or mitigated by regularly stretching and strengthening these muscles — and understanding how they function. Most of us could benefit from “a personal trainer for our pelvic floor,” said Dr. Lauren Streicher, medical director of Northwestern University’s Center for Sexual Medicine and Menopause.
Ms. Miracle — herself a physical therapist and a kind of personal trainer for the pelvis — recommended that all women in good pelvic health (those who aren’t currently suffering from a pelvic floor disorder or injury) incorporate six foundational exercises into their fitness routine , aiming to do them at least three times a week. The workout can be done any time and place you feel comfortable, said Ms. Miracle; the only equipment you need is a chair or surface on which to sit upright with your feet on the ground. By tending to your pelvic floor before there’s an issue, she said, you can help to ward off problems down the road.
Learning how to move the diaphragm is key to connecting with, and then conditioning, your pelvic floor muscles.
Sit in a chair with your feet flat on the ground. Place one hand on your belly and one hand on your chest
Inhale and feel your belly expand, then exhale slowly through your mouth. (It might help to imagine a balloon in your belly: As you inhale, the balloon fills with air; as you exhale, the air slowly releases, as if your thumb were covering the opening and gradually letting it seep out.) Repeat 10 times .
Pelvic floor lengthening exercise
The next step in exercising the pelvic floor is learning how to relax and lengthen the muscles so they are capable of a full range of motion. The ability to relax the pelvis is especially important for basic functions like using the bathroom without strain (think: avoiding constipation) and having penetrative sex without pain.
Lie comfortably on your back with your knees bent and your feet flat on the ground.
Start with diaphragmatic breathing, inhaling deeply and allowing air to fill the bottom of your lungs. Feel your low belly, lower back and pelvic floor gently stretch — or lengthen — outward with your breath.
Exhale slowly through pursed lips, allowing your belly, back and pelvic floor to passively relax. Do not engage any muscles during the exhale,; keep your pelvic floor fully rested. Imagine the above balloon expanding 360 degrees in all directions on the inhale. One of those directions is downward between your legs and toward the perineum (the area between the vagina and anus). As the belly rises passively, the perineum will also balloon down and out passively. Repeat 10 times.
While the previous exercise helps us relax the pelvic floor muscles, Kegels train us to contract them. This exercise helps us hold in urine, stool or gas when we feel the urge to use the bathroom and also works to build endurance in the pelvic floor muscles, so they’re able to hold up our organs and balance out pressure put on the abdomen throughout the day.
Sit upright with your feet flat on the ground.
Inhale through your nose, relaxing your pelvic floor as your belly and rib cage expand.
As you exhale, squeeze and lift your pelvic floor muscles, holding the contraction for the duration of your exhale. Aim to hold for 10 seconds. It may help to imagine squeezing the muscles that stop the flow of urine in the front and hold back gas in the back — or to imagine these muscles picking up a marble and holding it inside. Be sure to engage the muscles inside your body, as opposed to simply squeezing your thighs or buttocks together.
Fully relax for four to 10 seconds — or longer, if you need it. The release is as important as the contraction, since only contracting the muscles without fully releasing can make them overly tight and restrict their range of motion. Complete 3 sets of 10 reps.
This exercise builds on Kegels by training the pelvic floor muscles to contract quickly — a skill that allows them to respond effectively to sudden, automatic bodily functions that create pressure inside the abdomen, such as coughing, sneezing or even laughing. (It can also help to prevent incontinence, or “leaking,” in the face of this pressure.)
Sit upright with your feet flat on the ground.
Repeatedly contract and release the muscles that stop the flow of urine, aiming for a cadence of at least 7 squeezes over 10 seconds. Complete at least 30 squeeze and releases.
“The Knack” with a “shhh” sound
While quick flicks train the pelvic floor muscles to respond quickly to the kinds of sudden bodily functions that put pressure on the abdomen (as discussed above), this exercise helps to build strength and endurance in the face of this pressure.
Sit upright with your feet flat on the ground.
Inhale through your nose, relaxing your pelvic floor as your rib cage and belly expand.
As you begin to exhale, squeeze and lift your pelvic floor muscles, then perform a quick, forceful and audible “shh” sound from your mouth while maintaining the hold.
From there, exhale fully slowly through pursed lips, allowing your belly, back and pelvic floor to passively recoil. Complete 3 sets of 10 reps.
This exercise targets your transverse abdominis muscles, which sit in the lower abdomen and support the core. These muscles work together with the pelvic floor muscles to help you with everything from sitting and standing to doing any workout that requires balance or stability. Learning to actively engage these muscles is a skill most of us have never been taught.
Exhale and pull your belly button in toward your spine. This should activate your transverse abdominal muscles. Be sure to keep your back flat and unmoving for the duration of the movement; your belly is the only thing that moves. (If you need a visual, imagine your belly is again full of air, like a balloon — now squeeze the air out of your balloon using your ab muscles, tightening them to your spine.) Repeat 10 times.
Danielle Friedman is a New York City journalist and author of “Let’s Get Physical: How Women Discovered Exercise and Reshaped the World.”
Produced by Deanna Donegan and Tiffanie Graham.
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