Biceps, triceps…and your pelvic floor? When thinking about working out, it’s easy to forget some important internal muscles. The pelvic floor is a group of muscles and ligaments that support the organs in the pelvis: the uterus, bladder and bowel. Strengthening your pelvic floor won't make you look like Michelle Obama, but is important for your long-term health.
When a pelvic floor is strong, organs are well supported and firmly in place. Think of the heavy furniture in your kitchen sitting firmly on a hardwood floor, as opposed to sitting on a floor made of pillows. The pelvic floor is usually strong when we are young, and weakens as we age (1). It can also be strained by vaginal childbirth, menopause, certain surgeries, weight gain, weight lifting, chronic coughing and pushing due to constipation (1,2,3).
A weak pelvic floor can cause your organs to fall out of place. This can lead to incontinence: trouble controlling your bladder, or more rarely, your bowel. It can also lead to a common condition called “pelvic prolapse” where one or more of the pelvic organs starts to drop within the pelvic cavity.
While mild prolapse doesn’t cause symptoms in everyone, others will experience things like vaginal bulging, pain and sexual discomfort that may require treatment (1,4,5). Certain preventative measures and exercises have been shown to be very helpful in avoiding (or improving) symptoms related to a weak pelvic floor, and in helping to avoid treatments like medications or surgery down the road (6).
What you can do:
1. Avoid stress factors
Keeping your pelvic floor strong is easier when you limit unnecessary strain. Here are some preventative habits to incorporate into your routine:
- Eat a healthy diet that’s high in fiber to reduce the chance of frequent constipation.
- Squat, don’t sit, when having a bowel movement. You can do this by keeping a small step stool beside your toilet, to help raise your knees up. Squatting allows the muscle in charge of bowel control (the puborectalis) to fully relax.
- When our knees are at 90 degrees, this muscle stays partially engaged. People who use the squatting position minimize strain, and take about a third of the time to have a bowel movement.
- Learn to lift heavy things properly.
- Maintain a healthy weight. (7-9)
2. Strengthening exercises
Pelvic floor exercise is the primary way to keep your pelvic floor strong and healthy. To find your pelvic floor muscles, try drawing in your vagina and rectum, while leaving your abdomen, thighs, and buttocks relaxed. This “sucking in” feeling is your pelvic muscles being engaged. Don’t forget to breathe. Once you get used to engaging your pelvic floor muscles, give these workouts a try:
- Kegels: You’ve most likely heard of kegels — they’ve been common vernacular since Sex in the City’s Samantha did them at a cocktail bar sixteen years ago. A kegel is the action of engaging the pelvic floor muscles, holding for 5–10 seconds and releasing. This is done about 5–10 times in a row, a few times a day. A kegel app is a great way to remind yourself to do your kegels throughout the day. We like the Kegel Trainer app.
- Core strengthening: Your pelvic floor is part of a larger group of muscles called your “core.” Keeping all your core muscle toned, along with your thighs and glutes, might be the best option for pelvic floor health; however, research on this is still unclear (5, 10). Exercises like yoga, pilates or squats which engage the whole core can help keep these muscles strong.
- Vaginal weights: Also known as vaginal ‘cones,’ these are small weights with bulbous ends that sit inside the vagina (one end in, one end out). When the weight is inserted, the vagina will naturally contract to hold it. This is called a “passive” contraction. Weights can be paired with active contractions or other exercise at the same time. Vaginal weights are worn for short periods of time up to several times a day. How often you use them will depend on how heavy they are and on your goals.
How often you do any of these exercises depends on a few different factors. You might want to do more muscle building if you’ve just had a baby, if you have urinary incontinence, if you are post-menopausal or if you are at a higher risk of a weak pelvic floor for any reason. For each of these exercises it is a good idea to start slow at first, as over-exercising can cause muscle fatigue.
3. Counteractive squeezes
It is helpful to establish a habit of counteracting any activity that strains the pelvic floor, when it can’t be avoided. You might try doing a little pelvic floor exercise…
- After every ‘difficult’ trip to the bathroom.
- After coughing or sneezing.
- After lifting something heavy.
Myths of vaginal “tightness” and pleasure.
There has been a lot of cultural messaging leading people to consider the “tightness” (vs. “looseness”) of their vaginas as being central to sexual pleasure — creams, exercise regimes and surgeries tout the benefit of an “ideal” vagina. But ideal for whom? Many of these claims are problematic, scientifically unfounded and predominantly based in myth (11,12).
The vagina is made of highly elastic tissue, supported by a series of mostly horizontal muscles in the pelvic floor. The length and width of the non-muscular vaginal canal varies slightly person-to-person (13). Its size and shape is also dynamic and changes throughout the cycle. This vaginal tissue can stretch and then return to the same size. It may change slightly as you age and after childbirth, but most felt changes are more likely due to changes in the pelvic floor muscles (14). Menstrual cups, tampons and frequent penetrative sex are very unlikely to change the size of the vagina, or have an impact on sexual pleasure (13-15).
The feeling of “tightness” during sex is primarily determined by the pelvic floor muscles around the vagina (16), but not always in the way you might think. These muscles contract and relax depending on how aroused you are. When you’re feeling aroused, the muscles are relaxed, making your vaginal space less constricted, or “looser” (17). When you feel anxious, the muscles become more engaged and “tighter.”
Instead of focusing on size, most people are better off considering factors that are more important for sexual pleasure, like arousal and lubrication (15,16). The pelvic floor may be more likely to influence sex if someone has just had a baby, or if they are in a later phase of life, when regaining strength may help them feel back to their personal norm — more research on this is still needed (14,18). A healthy pelvic floor can also influence sex by preventing prolapse and incontinence.