The Secret To A Healthy Pelvic Floor (Psst, It’s Not Kegels!)

Leaking pee when you work out? Do more Kegels. Pregnant and preparing for birth? Do more Kegels. In this article I will deep dive into the history of Kegels and why there are better ways to keep your pelvic floor healthy and happy! 

The Secret to a Healthy Pelvic Floor

What is a pelvic floor? Your pelvic floor is a set of muscles at the bottom of the pelvis. These muscles act like a hammock that connects from your pubic bone to the tailbone and to each sitz bone. Your pelvic floor is actually part of the “deep core,” or the innermost musculature in your trunk. It works very closely with your deepest abdominal muscle, small muscles along your spine, and your diaphragm. 

Now for the answer. The secret to a healthy pelvic floor is actually…breathing. Your pelvic floor moves like a trampoline with your diaphragm, up and down. If you’re not breathing correctly, then your pelvic floor is not moving optimally. Just like any other muscle in our body, the pelvic floor needs to fully contract and relax in a coordinated movement. Breathing is step one to a healthy pelvic floor. Step two is paying better attention to your body. Do you constantly squeeze your abs or “suck in”? Are your leggings so tight that they cause pressure down in your lower abdomen or pelvis? Do you find yourself pushing your pee and poop out? All of these factors can negatively affect your pelvic floor health. 

Pelvic floor relaxation is what occurs when you pee, poop, give birth, or have sex. The job of the pelvic floor muscles is to get out of the way during these activities, so your organs do the work. 

How To Perform Diaphragmatic Breathing 

Find a comfortable spot and either lay down on your back or sit. Place your hands on your lower rib cage. As you take a breath in, you should feel your ribcage, belly, and back expand around your entire midsection. As you breathe out, your ribcage and belly should gently come back in. That is true diaphragmatic breathing! 

Check in on these other factors: Are your chest and shoulders doing most of the work? Was only your belly moving and not your ribcage? Were you sucking in on the inhale and pooching out on the exhale? Breathing is the foundation for pelvic floor health. With every inhale your pelvic floor relaxes down and with every exhale gently contracts up. Once you get this down, your life will be changed forever. 

Why Kegels Won’t Fix Your Pelvic Floor Problems 

So, what exactly is a Kegel? A Kegel is a squeeze and lift of the pelvic floor muscles. This term was coined by a physician in 1948 to help women exercise these muscles. Huang et al. has shown that more than 30% of women do not know how to perform a Kegel correctly! 

There is also a second piece to the Kegel, the relaxation piece or “reverse Kegel.” Remember how the pelvic floor moves up and down like a trampoline? The Kegel is the up part, the reverse Kegel is the down part. If we don’t know how to let go and relax these muscles, they stay short and tight. This leaves very little wiggle room for that trampoline to move. You can see where doing more Kegels can potentially make those muscles shorter and tighter until they have little to no range of motion. This is where we get into trouble and can potentially lead to pelvic floor dysfunction.

What Is Pelvic Floor Dysfunction (PFD)?

The 14-16 muscles of the pelvic floor have a few different jobs:

1. Support the pelvic organs (bladder, uterus, and rectum)

2. Elimination of urine and stool

3. Sexual function

Dysfunction occurs when any of those jobs are disrupted and not working properly. It can take many forms. Leaking urine when you sneeze or workout, constipation, pain with sex, musculoskeletal issues from painful periods, and prolapse symptoms are all examples of PFD.

We’re told because we have children, our bodies change and we just have to live with it. Well, I simply don’t accept that. These conditions are treatable with some help from a pelvic floor therapist! People are referred to rehab after a car accident and surgery, so why aren’t we rehabbing moms after birth? Another point I want to make is that you can have PFD even if you haven’t had kids. Rodriguez-Lopez et al. found 45.1% of female elite athletes who have never had children have some type of PFD. Men are not exempt from these issues either. 

Toileting Tips

Let’s break down some secrets to get you peeing and pooping more effectively. When you’re going to the bathroom, do not hover over the toilet. Your pelvic floor muscles cannot relax properly if you're tensing and holding yourself up. Grab some toilet paper or a toilet seat cover and sit your butt down, your pelvic floor will thank you for this. Take some deep breaths and let your pelvic floor relax. You want to avoid pushing your pee and poop out and straining those muscles. Another way to avoid straining is to elevate your knees above your hips. You can do this with a step stool, small trash can, or Squatty Potty. This allows your pelvic floor muscles to “unkink” and fully relax to eliminate properly.

Sensational Sex

Sex should never be painful. I don’t care if you’re a virgin, just had a baby, or are going through menopause. That is a sign something in your body is not cooperating. It could be related to lubrication, tightness in the pelvic floor, lack of foreplay, scar tissue, previous trauma, or conditions like endometriosis and PCOS. If this is you, please reach out to a pelvic floor therapist. We are so passionate about helping women and are in this profession for all the right reasons. For now, focus on that breath during penetration. It will help those muscles learn to relax and feel safe again in such an intimate setting. 

Let’s say you're not having pain with sex. I still recommend using a clean lubricant as it makes the process a lot more comfortable. My favorites include Uberlube and Good Clean Love. Also, foreplay is a must! Wallen et al. concluded 90% of women report the ability to have an orgasm, however, most do not routinely (or ever) achieve this with intercourse. Whereas 100% of men do achieve orgasm regularly with intercourse. Increasing foreplay to at least 30 minutes can help women achieve climax with or without penetration. 

Pregnancy and Birth

Now, I mentioned earlier how Kegels are often recommended for women during pregnancy. It’s often implied that women need a “strong pelvic floor” to give birth, but that’s not technically the case. You need a coordinated pelvic floor – a pelvic floor that can stretch and relax fully to prepare for a vaginal birth, as well as contract. One of the jobs of the pelvic floor is to support the bladder, uterus, and rectum. The pelvic floor muscles work overtime during pregnancy to support the size of the growing uterus and baby. This can lead to some tension in the pelvic floor, so it’s beneficial to practice diaphragmatic breathing in various positions to give those overworked muscles a break. The same strategies apply if you are planning (or have an unplanned) Cesarean birth.

One of my favorite appointments is teaching women how to properly push for birth. If you’ve ever taken a birth class, it typically discusses breath-holding techniques to push a baby out. I teach women how to breathe the baby out and preserve their pelvic floor. This especially applies to first-time moms who typically have a longer pushing phase. We go over various positions to encourage the baby to drop down into the pelvis and ways to prevent severe vaginal tearing. I also prepare them for postpartum: what to expect, healthy movement, rest, and nutrition. 

Closing Thoughts

The pelvic floor muscles are so much a part of our daily activities but are not so well understood. The world of pelvic floor therapy is relatively new but has evolved tremendously since its origin. I hope that you’ve learned that performing random Kegels is not a guarantee to fix your concerns. Changing daily behaviors and learning to breathe properly will set you up for success! Are Kegels inherently bad? No, of course not. However, through clinical practice and research, we’ve learned how to train the pelvic floor in better ways with more effective outcomes.  

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