If you’ve browsed social media enough, you may remember a time where ‘kegel’ exercises were all the rage. From seemingly making people get abs to having a stronger pelvic floor, the exercise was touted to be beneficial for many reasons. But not enough people know about the pelvic floor, and blindly doing kegel exercises without knowing what it’s supposed to do isn’t helpful at all.

 

The pelvic floor muscles are an integral component of your body that aid in many functions, from the way you pee to soreness in your back. As the link between conditions like lower back pain and pelvic floor muscles becomes evident, it’s time to check whether yours is in optimal condition, pelvic floor disorders and weak pelvic floor can worsen your quality of life, even when it’s not noticeable to the naked eye.

 

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According to University of California, Los Angeles Health (USA), one in three women will experience pelvic floor disorders in their lifetime. With so many women affected by the problem, it becomes crucial to watch for any warning signs that can help you to take immediate action. Prenatal/postpartum fitness expert Nonie Tuxen is here to delve into the importance of the pelvic floor, how it works, and what you can do to strengthen it.

 

“Pelvic floor work is not only for women who are pregnant. A common misconception is that a weak pelvic floor is the only scenario in which you can experience symptoms. You can have something called a tight pelvic floor where symptoms of tight muscles are similar to a weak pelvic floor,“ she says. A tight pelvic floor can make you feel like you have to struggle to pee and pass bowel movement, which can be a real hassle when you just want to get it over with. The role the pelvic floor muscles play for men and women are significantly different, and here is what you need to know:

 

Pelvic Floor: For Men and Women

While men and women both have pelvic floors, the function they play and how they change over time is different. As stated by the Continence Foundation of Australia, the pelvic floor essentially enables a person to control the release of their urine, faeces, and flatus (wind) and when to release or empty their system. The contraction of the pelvic floor muscles lifts internal organs of the pelvis and tightens the opening of the vagina, anus, and urethra.

 

For males, the pelvic floor supports their bladder and bowel movement and affects their sexual functions (erectile function and ejaculation). On the other hand, pelvic floor muscles support the bladder, bowel, and uterus (womb) for females, according to the Continence Foundation of Australia.

 

Pelvic Floor Health After C-Section

As Tuxen says, even women who don’t give birth naturally will experience changing pelvic floor muscles. "A common myth is that having a C-section will mean that you don’t have any work to do on your pelvic floor after pregnancy.” But pelvic floor muscles need to be restrengthened and rebuilt after pregnancy, no matter how you have given birth.

 

Test Your Pelvic Floor

While the best way to test your pelvic floor strength is with the help of a medical professional, you can also test yourself at home. Although the test recommended by the National Association of Continence is not 100 per cent accurate, it can give you an idea about whether you’re suffering from pelvic floor issues or not.

 

To begin with, while naked, sit down with your back supported and prop your knees up so that knees and hips are bent. Take a mirror and look at your vaginal and anal area. Try contracting your muscles (similar to when you’re holding in pee). When you do this action, you should be able to see your muscles draw inwards and upwards, pulling away from the mirror. If you don’t see your muscles drawing, you may be suffering from a weak pelvic floor. On the other hand, if your muscles contract but don’t relax, it can be a case of suffering from hypertonic pelvic floor. This test is only applicable for women.

 

Having a Tight Pelvic Floor

“When we think about our pelvic floor, one of the key things you should understand is that you should be able to relax and contract the pelvic floor,” says Tuxen. Many people are aware of a weak pelvic floor, but what most don’t know is that the pelvic floor can also be too tight (hypertonic), in which the symptoms are similar to a weak pelvic floor. If you’ve had trouble going to the bathroom, or sitting for extended periods on a hard surface is painful, it might be because your pelvic floor is too tight, and you’re unable to relax it properly.

 

Cleveland Clinic, a non-profit academic medical center, states the following causes for a hypertonic (tight) pelvic floor:

 

• Becoming accustomed to holding in urine or stool
• Traumatic injuries to the pelvis
• Muscular dysfunction (abnormal posture, sitting for hours, irregular walking gait)
• Sexual or physical abuse
• Stress, anxiety, and depression
• Overuse of pelvic muscles (straining on the toilet) can cause poor muscle coordination.
• Other conditions like irritable bowel syndrome, endometriosis, anal fissures, and more.

 

When you’re suffering from a hypertonic pelvic floor, you may not realise it, or mistake it for a weak pelvic floor. But, if you’re facing symptoms mentioned below, you might be possibly suffering from a hypertonic pelvic floor and need to consult a medical practitioner:

• Bladder pain
• Pain while urinating or frequent urination
• Difficulty passing bowel movement
• Painful pooping along with gas
• Constipation
• Pain during or after sex
• Inability to orgasm
• Erectile dysfunction with painful erection or orgasm

 

If you are facing any of these symptoms, it might be time for you to visit an expert to find a long-term solution. “A physiotherapist will work one-on-one with the client to get to the underlying issues behind having a weak or tight pelvic floor. Your pelvic floor is connected to your lower back, inner thighs, core, and more. It can lead to other ailments, like having chronic back pain,” says Tuxen.

 

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Having a Weak Pelvic Floor

Many people end up mistaking a tight pelvic floor for weakness, when that’s not actually the case. However, your pelvic floor can weaken over time when you’re gaining weight, or doing a lot of heavy weight lifting without proper guidance. If you’ve ever sneezed and had to clench your stomach internally for fear of leaking, a weak pelvic floor may be what you’re suffering from.

 

If you think you’re suffering from a weak pelvic floor, see if the following causes, as listed by the Continence Foundation of Australia have occurred to your:

• Pregnancy and childbirth
• Menopause
• Ongoing cough
• Heavy weight lifting
• High impact exercises
• Age and weight
• History of back pain

 

While symptoms for a weak pelvic floor can look similar to a tight pelvic floor, leakage is one important symptom of a weak pelvic floor. Cleveland Clinic states the following symptoms of a weak pelvic floor:

• Needing to urinate frequently, sometimes forcefully
• Constipation
• Straining to pass a bowel movement or constantly changing positions to eliminate stool
• Leaking stool or urine (also known as incontinence)
• Painful urination
• Ongoing pain in the pelvic region, genitals, or rectum

 

The longer you wait before getting your pelvic floor checked, the worse it might end up getting. Your healthcare provider will typically enquire about any symptoms you have been dealing with and your medical history to reach a correct diagnosis. A physical exam can also reveal the current state of your pelvic floor so treatment can begin immediately. But, if you don’t know if your pelvic floor needs work, try out a test to see what you need first.

 

Pelvic Floor Changes After Pregnancy

When we talk about the pelvic floor, many people are aware that pregnancy can drastically change the existing condition of their bodies. “Most women will have a weakened core during pregnancy, which can contribute to a weakening pelvic floor,” says Tuxen.

 

Childbirth, whether natural or through medical procedures, can contribute to the development of pelvic floor disorders, according to UCLA Health. While vaginal births double the rate of pelvic floor disorders, even a Cesarean delivery poses risks which include pelvic floor disorders. According to a 2018 study published in the National Library of Medicine, pregnancy can lead to urinary incontinence in about 26-70% of women. Pelvic floor muscles work harder during pregnancy to support a growing child, and they can also be softened by pregnancy hormones released during this period.

 

Since the weight distribution in a woman’s body changes during this time, the pelvic muscles, abdomen, and spine must work harder. Since the pelvic floor muscles are interconnected with the spine and core, conditions can arise which affect all of the involved muscles. Most women will experience a weakened pelvic floor after childbirth, and Tuxen states that women must do exercises after giving birth to regain control of the pelvic floor.

 

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The Impact of Pelvic Floor on Other Conditions

The pelvic floor is connected to other muscles and parts of the body, and even chronic back pain could be due to a deteriorating pelvic floor. Ailments that you can be suffering from due to your pelvic floor without knowing are:

 

• Chronic lower back pain: The pelvic floor supports the lower back, and when they are not strengthened, the lower back stops getting the support it needs from the pelvic floor muscles. Inadequate support and constant strain on the lower back can lead to chronic back pain which becomes hard to manage.
• Digestion problems: Since constipation is a common symptom of pelvic floor disorders, you may notice a change in your eating habits fuelled by the fact that your bowel movements are not normal.
• Painful sex: When the pelvic floor is too tight and unable to relax when needed, sex can be extremely painful for women. Vaginismus (when penetration is attempted, the vaginal muscles tighten up) is a common condition that is a by-product of pelvic floor disorders
• Erectile dysfunction: According to Cleveland Clinic, pelvic muscle tension or pain can lead to erectile dysfunction in men.

 

Pelvic Floor Exercises to Try

According to a 2015 study published in the National Library of Medicine (2015), around 25% of women suffered from one or more pelvic floor disorders. Age is another factor that can lead to a worsening pelvic floor; according to Tuxen, “as we grow older, our muscles generally do tend to deteriorate a bit, incontinence is something that older adults do experience, but this can be improved by a qualified physiotherapist.”

 

When you want to regain control of your pelvic floor, Tuxen has an exercise in mind that can help, even when you’ve just got five minutes to do it. Here is what you should do:

• Lie on your back and put your feet up on a chair (to relax). Develop the muscle-mind connection between your brain and pelvic floor. You must relax the abdominal muscles before starting.
• Take a deep inhale, and with it, you should be able to relax and feel your pelvic floor lengthen from top to bottom. Feel the release of your pelvic floor completely.
• Exhale after a few seconds; you want to be able to pick up the pelvic floor. Imagine picking up your pelvic muscles and holding them still for a few seconds, as if you are stopping the wind from passing or urinating.

 

“Using your breathing to relax and contract your pelvic floor is a good exercise many people can benefit from. The mind-muscle connection between the pelvic floor and your brain is often ruptured after childbirth, particularly in a vaginal birth. Work is required to find those muscles once again, and visualisation can help in this situation.” Tuxen recommends visualising your pelvic floor muscles, along with your anus, urethra, and vagina. Finding those muscles again can be challenging, but when you’ve got a clear image in your mind of what needs to be relaxed and contracted, it can become significantly easier.