The pelvic floor is a group of muscles that support the bladder, uterus, and bowels. Weak pelvic floor muscles can lead to a variety of problems like urinary incontinence, pelvic organ prolapse, and pain. The good news is that you can heal and strengthen your pelvic floor through exercises, lifestyle changes, and sometimes surgery.
What is the pelvic floor?
The pelvic floor muscles form a sling or hammock across the opening of the pelvis. They stretch from the pubic bone in the front to the tailbone in the back. The main muscles of the pelvic floor are:
- Pubococcygeus muscles
- Iliococcygeus muscles
- Puborectalis muscles
Together, these muscles support the pelvic organs including:
- Bladder
- Uterus
- Bowel
- Rectum
The pelvic floor muscles have a few important jobs:
- Maintain continence – They help control urine flow and bowel movements.
- Support pelvic organs – They hold up the bladder, uterus, and bowel in their proper position.
- Aid in sexual function – They contribute to arousal and orgasm in both men and women.
What causes pelvic floor dysfunction?
There are several factors that can weaken or damage the pelvic floor over time:
- Pregnancy and childbirth – Pregnancy puts added weight and pressure on the pelvic floor. Vaginal delivery can overstretch or tear pelvic floor muscles and nerves.
- Menopause – Declining estrogen levels lead to loss of muscle tone.
- Aging – Pelvic muscles weaken with age.
- Obesity – Excess weight strains pelvic floor muscles.
- Heavy lifting – Regular heavy lifting causes wear and tear.
- Surgery – Hysterectomy, prostatectomy, or bowel surgery may damage supportive tissues.
- Chronic cough – Frequent forceful coughing increases abdominal pressure.
- Chronic constipation – Straining to pass stools weakens muscles over time.
Pelvic floor dysfunction can manifest in several ways including:
- Urinary incontinence
- Fecal incontinence
- Pelvic organ prolapse
- Pelvic pain
- Painful intercourse
How do I know if I have pelvic floor dysfunction?
Symptoms of pelvic floor dysfunction may include:
- Leaking urine when you cough, sneeze, exercise, or laugh
- Needing to urinate frequently or urgently
- Inability to fully empty your bladder
- Leaking stool or inability to control gas
- Feeling of heaviness or sagging in the pelvis
- Pelvic pain or discomfort
- Pain during sexual intercourse
If you are experiencing any of these symptoms, see your doctor. They can do an exam to check for pelvic floor weakness and prolapse. Your doctor may refer you to a gynecologist, urogynecologist, or physical therapist who specializes in pelvic floor disorders.
How can I strengthen my pelvic floor?
Pelvic floor exercises, also called Kegels, are the first line treatment for a weak pelvic floor. Kegels involve contracting and relaxing the pelvic floor muscles to make them stronger.
To perform Kegels:
- Contract your pelvic floor muscles for 5 seconds. Imagine you are trying to stop the flow of urine.
- Relax the muscles completely for 5 seconds.
- Repeat 10 times, 3 times per day.
When starting out, it may help to:
- Do Kegels lying down until you get the hang of it.
- Use a hand mirror to check that you are contracting the right muscles.
- Insert a finger into the vagina or anus to feel the muscles contract.
As your muscles get stronger, try to:
- Hold the contractions for up to 10 seconds.
- Do up to 20 repetitions per set.
- Add more sets per day.
- Practice contractions standing up or moving around.
- Squeeze before coughing, lifting, or exertion.
It takes diligence and consistency to see results from Kegel exercises. You may start noticing improvements in a few weeks but it can take 3-6 months of regular practice to gain optimal strength.
Tips for effective Kegels
- Focus on proper technique – Only squeeze pelvic floor muscles, avoid holding breath or tightening abs, thighs, or buttocks.
- Use apps or devices to guide practice – They provide biofeedback to ensure correct muscle engagement.
- Make it a habit – Link Kegels to daily tasks like brushing teeth to remember them.
- Watch your position – Sitting upright helps you isolate the right muscles.
- Relax fully between reps – Releasing tension is key to building strength.
- Be patient – Results take time, stick with your routine.
Are there other ways to strengthen my pelvic floor?
In addition to Kegel exercises, there are some lifestyle changes that can help reinforce pelvic floor muscles:
- Lose excess weight – Less pressure on the pelvic floor prevents weakening.
- Eat more fiber – Prevents constipation and straining during bowel movements.
- Limit caffeine – Caffeine is a bladder irritant, reduce intake to avoid urgency.
- Do lower impact exercises – High impact activities like jumping put pressure on pelvic floor.
- Practice posture and body mechanics – Stand tall, keep back straight, avoid heavy lifting.
- Quit smoking – Coughing from smoking strains the pelvic floor.
- Treat chronic cough – Get cough evaluated and controlled to reduce pressure.
Physical therapy that focuses on the pelvic floor muscles is another option. A pelvic floor PT can give you feedback on whether you are doing Kegels correctly. They may use techniques like:
- Myofascial release – Applying gentle pressure to relax tight muscles.
- Biofeedback – Using sensors to monitor muscle contractions.
- Electrical stimulation – Applying mild electric current to stimulate muscles.
- Dilator therapy – For pain with intercourse, stretching tightened muscles.
Sessions are hands-on but not invasive. Your PT will teach you how to properly use and strengthen your pelvic floor on your own.
When do I need surgery to repair my pelvic floor?
If conservative treatments like Kegels and physical therapy are not effective, there are some surgical options to repair the pelvic floor. Reasons you may need surgery include:
- Your pelvic organs are prolapsing out of the vagina or rectum.
- You have ongoing urinary or fecal incontinence that has not improved with other therapies.
- You have severe pelvic pain due to nerve damage.
Common surgeries to restore pelvic floor support include:
- Sling procedures – A mesh or tape sling is placed under the urethra or bladder neck to support it.
- Mesh implants – Strips of synthetic mesh reinforce weakened vaginal walls.
- Sphincter repairs – Damaged anal sphincter muscles are fixed.
- Pessary devices – A removable device props up descending pelvic organs.
Surgeries to treat pelvic pain include:
- Trigger point injections – Medication is injected into painful muscle knots.
- Nerve blocks – Pain fibers are temporarily numbed with an anesthetic.
- Neurectomy – Painful nerves are cut to interrupt pain signals.
Talk to your doctor about the risks and benefits of any recommended procedures. Pelvic floor surgery can help restore function but is not always curative. You may still need to do Kegels and follow up with your physical therapist after surgery.
Conclusion
It is possible to heal and strengthen your pelvic floor through a combination of at-home exercises, lifestyle changes, physical therapy, and sometimes surgery. Be patient and stick with the prescribed treatment plan. With time and consistency, you should start gaining better control over your pelvic floor.
Focus on contracting the right muscles during Kegels, reducing pressure on the pelvic floor through diet and activity modifications, and seeking professional help from a pelvic health physical therapist. Surgical repair of damaged muscles or nerves may be needed in severe cases.
A weak pelvic floor can impact quality of life but does not have to be an inevitable consequence of childbirth, aging, or gynecologic surgery. There are many tools available these days to rehabilitate pelvic floor dysfunction and help you regain strength, continence, and confidence.
