What is the Pelvic Floor?
The pelvic floor is a group of muscles located at the base of your pelvis. These muscles stretch like a hammock from the pubic bone at the front to the tailbone at the back, and from side to side between your sit bones. Despite its critical role in daily functioning, the pelvic floor often goes unnoticed until there’s a problem, such as bladder leakage, queefing, bowel issues, pelvic pain, or sexual dysfunction.
For pregnant and postpartum mommas, the pelvic floor muscles take on even greater importance. During pregnancy, these muscles support the weight of the growing baby and they are directly impacted by the process of childbirth. Postpartum, the pelvic floor requires recovery, scar mobility (whether perineal scar or cesarean scar) and functional strengthening and awareness to restore its function and prevent long-term issues like prolapse, back pain, pelvic pain, or urinary leakage.
The pelvic floor muscles consist of 3 different layers of muscles:
- Superficial Muscles: These muscles are our sphincter control and sexual function muscles. They are right underneath the skin of our vulva and anus and help us with bowel and bladder emptying and holding. Just under these muscles lives our clitoris as well which is critical in sexual pleasure and satisfaction.
- Intermediate Layer: This is mostly the deep fascial layer that connects our pelvic floor into our deep core of our abdomen, our transverse abdominis muscles, so that they can work together better. This layer also plays a key role in preventing bladder leaks as well as it has muscles that support our bladder and urethra.
- Deep Layer: This is the bowl of our pelvis that forms that pretty trampoline like structure that really lifts up and supports our internal organs. This is also the layer that connects into some of our deep hip muscles so it’s crucial in pelvic stability and low back and hip support.
What Do Pelvic Floor Muscles Do, and What Is Their Role in Our Body?
The pelvic floor muscles have several essential roles in our bodies, including:
1. Supporting Pelvic Organs: These muscles provide a base of support for organs such as the bladder, uterus, and rectum. A healthy pelvic floor helps keep these organs in place, preventing them from descending into the vagina or anus, which can cause pelvic organ prolapse.
2. Sphincter Control: The pelvic floor muscles help control the release of urine, feces, and gas. When you contract your pelvic floor, the muscles tighten around the openings of the urethra, vagina, and anus, ensuring you aren’t peeing, pooping, or having gas release when you aren’t ready to. Relaxing these muscles allows for the release of urine, feces, and even work on allowing baby to exit our body when having a vaginal birth.
3. Sexual Function: In women, the pelvic floor muscles play a key role in sexual sensation and function. A strong pelvic floor can enhance sexual pleasure and orgasm. Dysfunction in these muscles, such as tightness or weakness, can lead to pain with sex or reduced sensation or pleasure during intercourse.
4. Providing Stability: The pelvic floor muscles are part of the body’s core muscle group. Along with the transverse abdominis (the deepest abdominal muscle), the diaphragm, and the multifidus (back muscles), the pelvic floor contributes to stabilizing the spine and pelvis during movement. Without proper pelvic floor function, activities like walking, running, lifting, or even standing upright can be affected.
The pelvic floor muscles don’t just squeeze to stop urine and gas, but they have 3 main motions the move through. We can think of them like a multi-level house when imagining their role depending on our daily activities.
- Resting: This is the ground level of our pelvic floor muscles. They are relaxed, resting, not squeezing, not bearing down. This is typically where are muscles should be as we are sitting, relaxing, sleeping, and not doing any physical labor.
- Contracting: This is the pent house or attic of the pelvic floor muscles. This is where we are squeezing and lifting our pelvic floor muscles. Common cues can be: grab a blueberry with your labia and pull it into your body, stop the flow of urine and gas, or squeeze as if you have a fart you don’t want to release and zip up to your clitoris. This is important during lifting up objects, running, walking, coughing, sneezing, and even laughing.
- Elongating: This is the basement of our pelvic floor muscles. This is the full elongated and bulging of the pelvic floor muscles. This is important in passing bowel movements,urinating, and birthing babies. It’s important to have length in our muscles to having comfortable penetrative intercourse as well as being able to absorb impact with jumping.
Given the range of functions the pelvic floor performs, it’s clear that keeping these muscles healthy is crucial for overall physical well-being. However, the demands of pregnancy, labor, and postpartum recovery can stretch and weaken these muscles, leading to dysfunction. Understanding how the pelvic floor works with the rest of the core system is key to maintaining pelvic health.
How Do Pelvic Floor Muscles Connect with the Deep Core?
The pelvic floor is one part of a larger system called the deep core canister. The deep core canister consists of four muscle groups that work together to provide stability to our upper and lower body with movement: the pelvic floor, the transverse abdominis (TA), the multifidus (small back muscles), and the diaphragm. These muscles form a "canister" of support for the body, working in harmony to regulate pressure within the abdomen and work to stabilize the spine.
1. Transverse Abdominis (TA): The TA is the deepest layer of abdominal muscles. It wraps around the torso like a corset, helping stabilize the lower spine and pelvis. The TA and pelvic floor contract together during core exercises and movements, ensuring support and balance. A weakened TA can place extra strain on the pelvic floor, especially during heavy lifting or pregnancy.
2. Multifidus (Back Muscles): These small muscles are located along the spine, helping to maintain posture and control spinal movements. They work on back extension stability and spinal strength. The multifidus and pelvic floor muscles work together to prevent back pain and keep the pelvis stable during everyday movements like bending, twisting, and lifting.
3. Diaphragm: The diaphragm is the primary muscle of breathing. During inhalation, it moves downward, creating pressure in the abdominal cavity. As this happens, the pelvic floor muscles relax slightly to accommodate the change in pressure and will elongate with it. On exhalation, the diaphragm moves back up, and the pelvic floor contracts and lifts up. This coordinated action of the diaphragm and pelvic floor is essential for core stability, proper breathing, and keeping blood pumping throughout our pelvis.
Together, these muscles form a pressure-regulating system that keeps the body stable and functional. However, pregnancy changes the way this system works. As the uterus expands, the diaphragm has less space to move, and the pressure on the pelvic floor increases. This can lead to challenges in maintaining the coordination between the diaphragm, TA, and pelvic floor, especially while the TA is being elongated and stretched with belly growing. Understanding how to restore this balance postpartum is key to recovering core and pelvic floor strength and learning how to work with the changes through pregnancy can help optimize our outcomes in postpartum while also preventing other issues throughout pregnancy.
How Bladder, Bowel, and Bracing Habits Influence Pelvic Floor Function
The habits you form around using the bathroom, how you brace your body during exercise, and even how you breathe can significantly impact the health of your pelvic floor. Let’s explore how each of these daily practices affects the pelvic floor and what you can do to promote better habits that can be protective for your long term pelvic health.
1. Bladder Habits
Your bladder and pelvic floor are closely linked. How often you urinate and how you position your body when using the bathroom can affect the strength and function of the pelvic floor muscles. For example, frequent “just in case” urination can train the bladder to become overactive, leading to urgency and leakage. Similarly, rushing to urinate or straining can place unnecessary pressure on the pelvic floor.
Tips for Healthy Bladder Habits:
- Urinate every 2-4 hours: A healthy bladder can hold about 1.5-2 cups of urine. Going to the bathroom too frequently can disrupt the natural function of the bladder and pelvic floor muscles, while holding too long can weaken the muscles around your bladder and place unnecessary strain on your pelvic floor too.
- Fully empty your bladder: When you go to the bathroom, take your time and make sure your bladder is fully empty. Rushing or straining can prevent the bladder from emptying completely, which can lead to infections or pelvic floor dysfunction.
-Sit as you urinate: hovering your bottom in a mini squat does not allow your pelvic floor muscles to relax and makes it more difficult to empty your bladder which may cause a UTI. This inability to fully relax your pelvic floor muscles can cause you to strain which can put you at risk of a prolapse and weaken your bladder too.
- Stay hydrated: Drinking enough water is essential for bladder health. Dehydration can lead to concentrated urine, which irritates the bladder and may cause urgency and even leakage.
2. Bowel Habits
Constipation and straining during bowel movements are common issues that can damage the pelvic floor over time. Chronic constipation (pooping less than 3-4 days per week or having excessively hard bowel movements) places extra pressure on the pelvic floor, weakening the muscles and increasing the risk of pelvic organ prolaps, leakage, or even pain. Straining can also stretch and strain the pelvic floor muscles, leading to long term issues.
Tips for Healthy Bowel Habits:
- Eat a high-fiber diet: Fiber helps keep bowel movements regular and reduces the need for straining. Aim for 25-30 grams of fiber per day from fruits, vegetables, and whole grains. Work on mixing soluble and insoluble fiber sources so you can maximize bowel motility and consistency of your bowel movements
- Stay hydrated: Water helps soften stools, making them easier to pass and reducing the risk of straining.
- Practice proper toileting posture: Sitting with your knees slightly higher than your hips (using a footstool) can help relax the pelvic floor and make bowel movements easier without straining.
3. Bracing Habits During Exercise
How you brace your body during physical activity can also impact the pelvic floor. Holding your breath and bearing down through your pelvic floor muscles during exercise creates extra pressure in the abdomen, which can strain the pelvic floor muscles. This is especially problematic during pregnancy when the pelvic floor is already under increased pressure from the growing uterus.
Tips for Healthy Bracing Habits:
- Avoid breath-holding: Exhale during exertion (like lifting weights, groceries, or your kiddos) rather than holding your breath. This helps manage intra-abdominal pressure and reduces strain on the pelvic floor.
- Engage your pelvic floor: Before and during lifting or performing strenuous exercises, engage your pelvic floor by gently contracting the muscles as if you were stopping the flow of urine and gas. This provides extra support to the pelvic floor and core.
What Are Healthy Bladder and Bowel Habits?
Maintaining healthy bladder and bowel habits is key to keeping your pelvic floor strong and functional. Here are some habits to keep in mind:
Bladder Health
- Go every 2-4 hours
- Avoid “just in case” peeing
- Fully empty your bladder each time
- Stay hydrated
-Sit on the toilet
Bowel Health
- Eat 25-30 grams of fiber per day (soluble and insoluble)
- Drink plenty of water (half your body weight in ounces is typically recommended)
- Avoid straining during bowel movements
- Use a footstool (or squats potty) for optimal toileting posture
Why It’s Important to Think About Your Pelvic Floor During Pregnancy and Postpartum
Pregnancy and childbirth can have a significant impact on the pelvic floor. During pregnancy, the pelvic floor muscles support the weight of the growing baby and help manage the increased pressure within the abdomen. Childbirth, whether vaginal or via cesarean section, can stretch and weaken the pelvic floor muscles. Failing to address pelvic floor health during this time can lead to long-term issues such as urinary incontinence, pelvic organ prolapse, and chronic pelvic pain.
Here’s why focusing on pelvic floor muscular health is crucial:
1. Preventing Leakage (Bladder, bowel, or gas): Reconnecting, learning to coordinate, stretching, and strengthening the pelvic floor muscles before and after pregnancy can help prevent bladder leakage, a common issue for many women during pregnancy and postpartum. If you aren’t sure how to do this, make an appointment with a local pelvic floor physical or occupational therapist to check out how your muscles are working.
2. Supporting Faster Recovery: Working on pelvic floor coordination, awareness, and control through pregnancy is helpful in avoiding issue during pregnancy, but can also support a better postpartum recovery as you are better able to reconnect to these muscles than you would have been if you hadn’t worked on it during pregnancy. This can help with improving your return to exercise and life postpartum, return to intimacy with your partners without pain or difficulty with pleasure, and can help in preventing future back of pelvic pain that can come with poorly functioning or weak pelvic floor muscles.
3. Enhancing Core Strength: The pelvic floor is a key component of the core system. If our pelvic floor muscles can work well, then our other muscles of our core canister can work well too. If we can optimize what each of these muscles are doing and able to do then the other muscles and ligaments in our pelvis, abdomen, and back don’t have to do all the work.
