Consider this blueberry, so petite, delicate, and perfect. Now pretend you’re gently picking it up. With your vaginal cavity.
Do you feel a flex between your legs? That’s your pelvic floor, and it’s having a moment, thanks to new workouts and devices that go far beyond the age-old advice to perform Kegels at every red light. From specialized physiotherapy and gamified dildo-like devices to “pussy yoga” and “buff muff” boot camp, the concept of pelvic floor strengthening is receiving much-deserved attention these days. Continue reading to learn about your pelvic floor, how it works, and how to maintain optimal function for as long as possible.
What is the pelvic floor—and why is it so critical?
You know how some people with vaginal passages joke about peeing a little in their pants when they jump, sneeze, cough, or laugh—particularly after having children? As it turns out, that is not a joke. It’s a pelvic floor issue, and pelvic floor physical therapy and exercises may help.
The pelvic floor muscles, which are located between the front of your pelvic bone and the back of your tailbone, are a group of muscles that wrap around and control your pelvic organs (bladder, bowel, and uterus).
1 These muscles’ strength is required for a variety of tasks, from having an orgasm to not accidentally peeing a little while performing jumping jacks.
Pelvic floor disorders occur when the area’s supporting muscles are either excessively tight (referred to as hypertonicity) or excessively weak and stretched out (known as hypotonicity). While the latter is much more common in older women with vaginas, this does not make it an acceptable part of aging. Pelvic floor dysfunction can have a detrimental effect on your quality of life, including your ability to maintain an active lifestyle. According to some research, incontinence significantly increases the likelihood of women being admitted to nursing homes when compared to men, regardless of age, gender, or other medical conditions.
Prolapse is another common type of pelvic floor problem. It occurs when the pelvic muscles and other supporting tissues become weak, allowing the pelvic organs to fall out of place. In severe cases, these organs may protrude from the vagina or anus. It can be quite unpleasant to live with.
“Incontinence has been normalized, as has prolapse, and both are indicators that something is wrong,” says Amanda Olson, a Medford, Oregon-based doctor of physical therapy who specializes in pelvic floor disorders. “I believe we should not normalize it simply because it is prevalent. It is not typical.”
Pelvic floor problems can affect people of any gender. (In individuals with penises, the pelvic floor functions as a support for the bladder and bowel, which may impair sexual function.) However, the concern is particularly acute for those who have a vagina. Pregnancy and childbirth are two major risk factors for pelvic floor disorders. Due to hormones and the pressure of your growing baby, pregnancy can cause the muscles and connective tissue of the pelvic floor to relax. Childbirth, whether vaginally or via C-section, can also wreak havoc on that area, resulting in injury and nerve damage. Genetics and age are also risk factors. Finally, nearly a quarter of women in the United States are estimated to have one or more pelvic floor disorders, and the prevalence increases with age—from 10% of women between the ages of 20 and 39 to 50% of women aged 80 and up. 3rd
How do you determine if you have pelvic floor dysfunction?
The following symptoms may indicate that your pelvic floor muscles are underdeveloped or overdeveloped4:
- Pee that is leaking
- a leaking stomper
- Pain during sex Frequent bathroom visits
- A feeling of heaviness in the pelvis, vagina, or rectum.
Back pain in the lower back
If you’re experiencing any of the above symptoms, especially in a way that significantly or regularly impacts your daily life, it’s a good idea to consult a pelvic health expert. Because so many of these symptoms may be caused by other factors, consulting a professional is the best way to determine the functional state of your pelvic floor—and what you can do if your pelvic floor is causing your symptoms.
Here’s how to address an overly tight or underdeveloped pelvic floor.
We asked experts for advice on how to keep your pelvic floor muscles in shape and functioning optimally, including a gynecologist, two pelvic health physical therapists, and a “vagina coach”:
1. If you are experiencing pelvic floor problems, seek the advice of an experienced pelvic health provider.
Consult a physician who is knowledgeable about the pelvic floor—a gynecologist, urologist, or urogynecologist, for example—or a physical therapist who specializes in pelvic health. You can inquire about your current gynecologist’s experience with these issues, contact the office of a prospective new gynecologist, or conduct your own research online. You can find a pelvic health-focused physical therapist with the help of the American Physical Therapy Association5.
Many states and insurers have an open-door policy regarding care, allowing patients to see a physical therapist without a diagnosis or referral. However, if you require one, your family doctor, ob-gyn, urologist, gastroenterologist, or other prescribing provider may be able to assist you.
Physical therapy for pelvic health is available in a variety of clinical settings, including hospitals, private practices, veterans affairs, and university health education systems. It is also widely covered by insurance plans, including Medicare, some forms of Medicaid, private and military insurance, though as is the case with all things related to insurance, coverage varies by individual.
The cost of this type of therapy varies according to whether insurance covers it and how high the deductible or coinsurance is. Certain private practices, for example, do not accept insurance, according to Dr. Olson, who adds that these visits typically cost between $100 and $300 per visit, depending on the provider.
2. Begin pelvic floor muscle training as soon as possible.
Numerous studies indicate that pelvic floor muscle training may be extremely effective in treating pelvic floor-related issues such as urinary incontinence and fecal incontinence, as well as pelvic organ prolapse.
Certain individuals report that consistent and proper pelvic floor muscle training helps them experience stronger orgasms. 9th
To begin a training routine, your pelvic health physical therapist will typically begin with a brief anatomy lesson and initial evaluation, which will typically last between 45 and 60 minutes. They’ll assess the muscles of your pelvic floor manually, both externally and internally—the latter using a gloved, lubricated finger or a biofeedback device. (As a result, anticipate being undressed to the waist and wearing a dressing gown for at least part of the appointment.) Additionally, they may ask you to cough or simulate holding your pee in order to assess your Kegel contractions. They may also have you perform exercises like squeezing their finger to determine your strength or “tone,” your ability to control and direct your movements, and your endurance (yes, they will challenge you to squeeze longer and stronger).Additionally, you will receive a follow-up plan as well as Kegel and breathing exercises to take home.
They’ll also examine your posture and the muscle groups in your abs, back, and hips (all of which are connected), as well as your specific symptoms and goals, such as jumping on the trampoline with your child without leaking or running a 5K. “There is no such thing as a one-size-fits-all solution,” explains Dr. Olson, author of Restoring the Pelvic Floor for Women. ten”It is always customized to the individual in front of us.”
Chronic pelvic floor pain and tightness are a separate issue, which your physical therapist will assess as well. Even if your primary complaint is weakness, they may perform manual tissue therapy and stretching exercises in conjunction with you to address any issues.
Stephanie Prendergast, a physical therapist and cofounder of Pelvic Health and Rehabilitation Center11 in Los Angeles, has been treating pelvic floor issues for 20 years and believes that routine visits should be required for anyone within a year of having a baby (if not sooner) and at the start of perimenopause, which typically occurs in your 40s. “That’s when we recognize that there will be age-related changes to the pelvic floor,” she says. “Optimize it, and then I believe the transition will be easier.” Numerous issues could be avoided.”
3. Perform Kegels correctly on your own.
There is good evidence12 that doing Kegels, also known as pelvic floor muscle training, can help with incontinence symptoms. However, many people continue to perform them incorrectly. Squeezing the wrong muscles, such as your abs or butt cheeks, is a common mistake.
Kegels, named after American ob-gyn Arnold Henry Kegel, who developed the exercise in the 1940s, aren’t as simple as they appear. Pretending to squeeze a tampon with your vagina or attempting to stop the flow of urine are some helpful cues (like that squishy blueberry). (Note: According to the Mayo Clinic, doing Kegels while peeing can potentially increase your risk of urinary tract infection.)
A typical Kegels routine, which can be done twice a day for 5 to 10 minutes at a time, is as follows: Contract for three to five seconds; rest for three to five seconds; repeat 10 times in a comfortable position such as lying down (which puts less pressure on your pelvic floor than sitting or standing). Alternatively, try “quick flicks,” which are short two-to-three-second contractions—as well as longer ones, which gradually increase the length of both contraction and relaxation for 10 seconds each.
Also, keep in mind that Kegels aren’t for everyone. Working out your pelvic floor muscles if they aren’t healthy to begin with or are too tight, says Amy Benjamin, M.D., a gynecologist and the director of the Center for Chronic Pelvic Pain and Vulvar Disorders at the University of Rochester. “Some people have so much tension in their pelvic floor muscles that doing Kegels just adds to their tension and pain,” she adds. If you experience more tightness or pain as you begin your Kegels routine, stop and consult your doctor or physical therapist. Exercises and treatments for tight pelvic floor muscles focus on relaxing rather than strengthening the area.
4. Think about incorporating full-body movement.
Once you’ve mastered the fundamentals of Kegels, your physical therapist may ask you to “squeeze” them into more advanced exercises. Did you get it? While there is little research on combining Kegels with other exercises, some pelvic floor experts and Kegels-based fitness programs use a movement-based approach that includes combining pelvic floor muscle training with simple exercises such as squats, lunges, and weight lifting, where those muscles are required to turn on for support.
Kim Vopni, also known as The Vagina Coach14, is a certified personal trainer, certified pre-/postnatal fitness consultant, and the author of Your Pelvic Floor: A Practical Guide to Solving Your Most Intimate Problems in Vancouver.
15thVopni suffered from two types of childbirth-related prolapse, and when she found out about pelvic floor physical therapy, she preached it from the rooftops before retraining in pregnancy-related fitness herself. Her online pelvic floor fitness programs, such as the Buff Muff Challenge and Kegel Mojo for incontinence or prolapse, are full-body workouts designed specifically for people who have a weak pelvic floor.
“We have to respect,” Vopni says, “that there are fundamental differences within [someone assigned female at birthpelvic]’s floor that we need to consider.”
5. If you want to try Kegel trainers, do so—but keep your expectations in check.
Many products on the market promise to help tone your pelvic floor, such as vaginal weights or Kegel balls in various sizes and styles, such as the Ben Wa balls (part pelvic floor training device, part sex toy) made popular by Fifty Shades Darker.
However, according to a Cochrane16 review of studies on vaginal weights for training the pelvic floor against urinary incontinence, they are no better than doing basic Kegel exercises. The British medical research organization examined the data from 23 small trials involving over 1,800 women and found that, while using vaginal weights was superior to no treatment, there were no clear differences in effectiveness of the weights versus pelvic floor muscle training without weights. Having said that, the researchers acknowledged the need for large, high-quality studies to confirm how effective pelvic training with vaginal weights is for urinary incontinence. But if tools and devices inspire you, go for it, Jen Gunter, M.D., wrote in a 2019 New York Times article. 17thGunter, “Twitter’s resident gynecologist” and author of The Vagina Bible18, suggests looking for medical-grade products that can be cleaned properly. “This excludes so-called vaginal or yoni jade eggs, which were never intended for vaginal or pelvic floor use,” she cautioned.
Dr. Olson, who created a line of FDA-approved silicone vaginal weights under her brand Intimate Rose, says the extra pressure of the balls (which come in a set of different weights ranging from one to four ounces) can help you build strength and do Kegels correctly because they fall out if you’re not using the right muscles.
Kegels-focused “smart” devices that use biofeedback technology, such as the popular Elvie and kGoal, are also gaining popularity. They resemble mini vibrators in the shape of an egg or a pillow, and they connect to an app on your phone. Prompts on your screen indicate how well you’re performing your Kegels. The Elvie, for example, provides entertaining targets for you to hit with your “gem”—almost like Pac Man for your vagina. “I love the Elvie because it really helps people track their progress and know that they’re doing it correctly,” Prendergast says. “It’s surprising how quickly the ball will move on your phone, and what you’re supposed to be able to do, making people want to improve.”
6. Connect your breath to your pelvic floor.
To relax the pelvic floor muscles, your physical therapist will teach you how to breathe properly during Kegels (by taking deep breaths and breathing out as you squeeze) as well as diaphragmatic “belly” breathing exercises or relaxation poses such as Child’s Pose or Happy Baby. “A lot of people don’t give their pelvic floor muscles enough rest, and it’s critical that people understand that strengthening and lengthening are both necessary,” says Dr. Olson. Too-tight muscles can cause pain as well as weakness because they are exhausted from being overly engaged. “We require flexibility and mobility…as well as the ability to let go,” she explains.
Hypopressive exercises are another breathing technique that some people may find beneficial for pelvic floor issues, though there isn’t as much data to back it up as Kegels. Nonetheless, a recent randomized controlled trial published in the Journal of Clinical Medicine 19 discovered that both types of exercises reduced symptoms of pelvic floor problems significantly.
The exercises consist of a series of postures performed with coordinating breath and breath holds in order to work out the core in a low-impact manner. They’re difficult to master, but Vopni does them every day and claims they’ve helped her reverse a uterine prolapse. She needed surgery to correct a rectocele (when part of the rectum pushes through the vaginal wall).
7. Recognize that you have options, if necessary.
Depending on the severity of your pelvic floor issues, surgical correction may be one of the best treatment options, according to Dr. Benjamin, especially if you also have weak fascia, a.k.a. connective tissue, that exercise cannot correct. A pessary, which is a small device that you insert into your vagina to help with leaking, may be prescribed to you. Some people wear it only for exercise, while others wear it all the time. It is even possible to have sex while wearing one.
If you’re dealing with pelvic health issues, it can also help to find your tribe so you don’t feel so alone. Vopni created the Box Talk private Facebook group, where members, including a few physical therapists, can ask questions, share TMI, and offer support and advice on all things pelvic floor. “There is hesitancy even when they are exploring and recognizing that there are solutions,” says Vopni. “Pelvic health is being discussed much more than it used to be, but it is still a sensitive and intimate subject, and not everyone is open about it.”