There is a lot of misinformation circulating among women about what keeps your pelvic floor strong and healthy. So we turned to the experts to find out what you should and shouldn’t be doing to keep yourself in tip-top shape, regardless of whether you can do five kegels or 500.
It’s no surprise that the topic of strengthening your pelvic floor doesn’t come up all that often in casual conversation. Most women tend to be embarrassed about discussing their lady business in public, and assume other people aren’t having the same issues, like urinary incontinence or pain during sex. However, pelvic floor problems are far more common among women than we’re led to believe.
What Does the Pelvic Floor Do?
“The pelvic floor serves three main functions,” says pelvic floor physical therapist Nancy Silva-Mullins, supervisor of Northwell Health’s STARS Pelvic Rehabilitation Program in East Meadow, New York. “It supports the pelvic organs, so if there is weakness, it can lead to prolapse.” (Prolapse is a condition where the ligaments that hold a woman’s pelvic floor organs in place are stretched or weakened, slipping down into the vagina or rectum instead.)
The pelvic floor also assists urinary and anal sphincters in closure, which is why a weak pelvic floor can result in incontinence, says Silva-Mullins. She adds, “Lastly, it enhances sexual function and arousal. An unhealthy pelvic floor can cause dysfunction in the bowel or bladder or even lead to pain.”
If you think you might have a weak pelvic floor, you aren’t alone. Luckily, there are plenty of options available to strengthen this part of your body.
According to a 2022 study published in the journal Scientific Reports, researchers who studied 25,000 adult women determined that at least 32 percent of them had at least one pelvic floor disorder. The participants in the study ranged in age from their mid-twenties all the way to their nineties, and had previously chalked their problems up to aging rather than a pelvic floor disorder, simply because they had never been asked about their discomfort prior to the study.
Unfortunately, this is a common theme. Women often go years — or even decades — without seeking help for pelvic floor concerns because healthcare providers don’t talk about the pelvic floor or ask about common symptoms caused by weakness in that area.
“Many people think pelvic floor disorders are a normal part of aging,” says Larissa Rodriguez, MD, chair of the urology department at Weill Cornell Medicine and urologist-in-chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. “Because of the intimate nature of symptoms, many women do not talk to their daughters or sisters about problems like incontinence, for example, and assume it only affects them. In addition, primary care physicians do not usually ask women if they are suffering from symptoms, so the opportunity to educate them at the time of a well-woman checkup is often lost.”
Because of this frequent oversight, experts recommend looking for a board-certified female pelvic medicine physician if you think you might have a weak pelvic floor. They may also refer you to a pelvic floor physical therapist to help you develop a strong pelvic floor.
Interested in learning more? Check out Strengthening Your Pelvic Floor
9 Ways to Improve Your Pelvic Health
There are also things you can do on your own. We recently spoke to Silva-Mullins about her top tips to get your pelvic floor into shape. Here’s what she had to say.
1. Isolate Your Muscles During Kegels
“A kegel is simply a contraction of the pelvic floor muscles,” says Silva-Mullins. However, “kegels are pointless if you’re not isolating the pelvic floor but instead overcompensating with other muscles like the abdominals or glutes. You don’t want a tight belly or clenched butt cheeks. We give women the cue, ‘Think of your vagina like an elevator’ or ‘Suck up through a straw in your vagina.’ You want to make sure you are not using extra muscles. It should really just be isolating the pelvic floor.”
The expert suggests doing kegels hourly if you can, and typically prescribes three reps of three-second holds.
2. Just Breathe
Breathwork is an essential component to kegels, says the expert. “So many women come into the clinic saying, ‘I’ve been doing my kegels,’ but they aren’t doing them the right way.” Not only are they not isolating their pelvic floor, as noted above, but Silva-Mullins says a lot of times people will hold their breath while practicing kegels. “That’s actually putting pressure on the pelvic floor and having an adverse effect. You want to make sure you’re breathing during the contraction itself. We tell our patients, ‘Take a breath in and, as you exhale, that’s when you should be contracting your pelvic floor muscles.’”
3. Don’t Practice Kegels When You Pee
You might have heard the suggestion that you should stop your urine midstream as a way to practice kegels, but that, the expert says, can lead to pelvic floor dysfunction and poor toileting habits. “Your body has a reflex to help empty the bladder. Practicing kegels while you pee sends confusing messages to the brain and will stop this reflex from working the way it was designed to.”
In other words, keep your kegel practice separate from your bathroom break.
4. Buy a Bathroom Stool
Remember when everyone was talking about the Squatty Potty? Silva-Mullins says you should believe the hype. She suggests using a stool when defecating so that your knees are elevated higher than your hips. You should also “lean forward, relax your jaw, and focus on your breathing. This will result in less straining and more successful bowel movements. When you strain, you are contracting your pelvic floor muscles, making it harder for them to relax and for the stool to easily come out.” And if you’re experiencing constipation, talk to your doctor for solutions.
5. Practice Better Posture
“Since COVID, everyone’s working from home and sitting on poor couches and our posture is affected. We get into this slumped position and what’s going to happen? Our hip flexors are going to tighten, which causes tension within the pelvic floor muscles. This can shorten the pelvic floor and lead to dysfunction,” says Silva-Mullins.
Not only will paying attention to your posture help keep your pelvic floor healthy, but you’ll hopefully notice less back and neck discomfort, too.
6. Don’t Forget to Stretch
Speaking of tight hip flexors: “Make sure to stretch daily, [or at least] two to three times a week, particularly your inner thigh muscles or hip abductors. Tightness in this muscle group, which attaches to the pelvis, can cause pelvic pain, urinary incontinence or urinary urgency.”
Silva-Mullins says a figure-four stretch, Butterfly pose, and Happy Baby pose are “all great for relaxing the pelvic floor muscles,” and recommends holding your stretch for 30 to 60 seconds to make it effective.
7. Ease Back Into Exercise After Giving Birth
“I would avoid activities like jumping rope and running for exercise shortly after having a baby. The pelvic floor will be weak and these are both high-impact activities that will most likely result in leakage,” says Silva-Mullins.
The expert adds that people with stress urinary incontinence (defined by the U.S. Food and Drug Administration as “a leakage of urine during moments of [certain] physical activity that increases abdominal pressure,” like during some forms of exercise, or when laughing or sneezing) may wish to steer clear of high-impact activities like jumping and running for that reason, too.
8. Practice Quick Flicks
A quick flick is a quick kegel — in other words, Silva-Mullins says, “a quick contraction of the pelvic floor muscles: You tighten, then release.”
She explains, “The pelvic floor consists of two types of muscles: fast twitch and slow twitch fibers. The slow twitch fibers provide support for the body over long periods of time and are slow to fatigue, while the fast twitch fibers can be recruited reflexively or on demand — for example, when coughing or sneezing. Because there are two types of muscle fibers in the pelvic floor, it makes sense that some exercises should be slow and some should be done fast.”
Doing pelvic floor muscle contractions for longer amounts of time will work the slow twitch muscle fibers, while these quick flicks work the fast twitch muscle fibers.
9. Make an Appointment With a Pelvic Floor Physical Therapist
If you think you might have a weak pelvic floor, you aren’t alone. Luckily, there are plenty of options available to strengthen this part of your body. “Look for experts in pelvic floor disorders such as pelvic floor physical therapists or board-certified physicians in female pelvic medicine,” says Dr. Rodriguez. “Working with a pelvic floor physical therapist is very helpful, and pelvic floor exercises and kegels can be very effective when done correctly and consistently.”
A consultation is worthwhile, Rodriguez says, because “you may think you only have one issue, but a physical therapist will be able to assess if there are other contributing factors and formulate a specific program for your needs.”
Both experts stress there is plenty you can do to improve your pelvic health, and issues such as incontinence, pain, or prolapse can be resolved with attention and the proper treatment.
