7 Facts About Pelvic Floor Health That (Almost) Everyone Gets Wrong

Everyone has a pelvic floor.

While pelvic floors frequently come up in the context of people with a vagina and uterus, those born with a penis have one, too. It works much in the same way, except instead of supporting the vagina and uterus, their pelvic floor supports the prostate. In terms of supporting sexual function, rather than assisting with blood flow and vaginal contractions during sex, their pelvic floor helps with erection and ejaculation. Everyone’s pelvic floor holds their bladder, bowel (large intestine), rectum, and anus in place, and allows us to control when we go to the bathroom.

Pelvic floor dysfunction can happen to anyone.

So, what is pelvic floor dysfunction? In short, it refers to a range of symptoms and anatomical changes to the pelvic floor muscles that result in them not working properly. Examples include urinary or fecal incontinence, painful sex, and organ prolapse. And although there are some conditions and biological events known to cause pelvic floor dysfunction—like pregnancy, childbearing, menopause, and chronic constipation—it can also happen independently of any of these factors, without explanation.

In fact, Miracle says that as a physical therapist, she often sees it in high-achievers who are disconnected from their bodies—specifically, their pelvic floor. “They may not even realize that these muscles are tight or weak and in need of care,” she explains. “So there’s really no wrong time to check in with a pelvic floor PT.”

Your pelvic floor can be too tight.

There’s a lot of talk about strengthening your pelvic floor, but did you know that it can also be too tight or tense? “If a person is experiencing overactivity—or tightness—of the pelvic floor muscles, [it] may manifest as sexual dysfunction, constipation, urinary urgency, and/or frequency, [meaning that] they need a down-training, stretching, and releasing program,” says Riva Preil, DPT, physical therapist, founder of Revitalize Physical Therapy, and author of The Inside Story: A Woman’s Guide to Lifelong Pelvic Health.

Kegel exercises aren’t right for everyone.

If you’ve been given one piece of advice about your pelvic floor health, it’s probably that you should be doing your kegels. But according to Preil, kegels are only appropriate for people who have pelvic floor muscle weakness or underactivity, not those experiencing overactivity or tightness.

“The number of patients who have told me that kegels—pelvic floor muscle strengthening exercises—made their symptoms worse is astounding,” Preil says. “Kegels would only serve to further tighten a system that is already too tight, so they are contraindicated when there is pelvic floor muscle overactivity.”

Kegels work by tightening the muscles that help you hold back urine, gas, and stool, and lift the organs, Miracle explains, noting that this is one exercise where technique definitely matters. “When contracting the pelvic floor muscles, you want to feel as though you are stopping the flow of urine and holding back gas at the same time,” she says. “Oftentimes people are only squeezing one set of muscles, or think they are squeezing, when they are actually bearing down or pushing out.”

Sex should not be painful.

We tend to think about pelvic floor issues in terms of bladder leaks, but these supportive muscles are also intimately connected to our sexual health. “For comfortable intercourse and a strong, pleasurable orgasm, your pelvic floor needs to be able to both contract and relax,” says Miracle. “[These muscles also] provide us the ability to participate in pain-free sex.”

According to Preil, pelvic floor physical therapy can help make sex a much more enjoyable experience for everyone involved. “I work with many women who have been suffering in silence for far too long,” she says. “Many of them assumed the position that a patient of mine once articulated so well: ‘Sex being fun? That was something I just assumed was in the movies.’”

Pelvic floor trainers and smart devices don’t fix weakness.

Similarly, the range of kegel weights or balls that have been around in some form for ages, and the pelvic floor training smart devices that have hit the market over the past decade, aren’t helpful for everyone. 

“I understand the value and importance of devices in helping with pelvic floor strengthening, but we also want to make sure that people aren’t solely relying on a device if they’re dealing with pelvic floor dysfunction,” Miracle says. “These devices are meant to help guide people with healthy functioning pelvic floors.”

If pelvic floor muscle weakness is the cause of your symptoms, your physical therapist can teach you specific strengthening exercises to improve the power and endurance of those muscles, she explains. In addition to kegels, there are other core, hip, and back exercises that are all an important part of a pelvic floor strengthening program.

Your pelvic floor changes as you age.

As we get older, gravity takes its toll on our body—including putting increasing pressure on our pelvic floor muscles, which Miracle says could lead to a lack of support for our pelvic organs. For those entering menopause—which typically happens between the ages of 45 and 55— increased stiffness and changes in hormones can affect how the pelvic floor muscles function.

“Muscle bulk tends to reduce as well, affecting the force our muscles are able to generate,” Miracle explains. “This is why it’s so important to take preventative measures to strengthen your pelvic floor muscles as you age, remembering, of course, that a strong muscle is also a flexible muscle, and can fully relax, as well as generate force.”