Pelvic Floor 101

Pelvic Floor Muscle Functions 

Pelvic floor muscle functions include:

The pelvic floor muscles form a supportive hammock-like structure beneath the pelvis, extending from the pubic bone to the tailbone and connecting to both sit bones. During inhalation the pelvic floor muscles relax and descend, while during exhalation, they slightly engage and ascend. These muscles should function like a trampoline to provide shock absorption - proper alignment of the rib cage over the pelvis is key for this function.

The transverse abdominis and pelvic floor muscles should fire together. It’s best to exhale on exertion to prepare the body for increased abdominal pressure and prevent excess downward pressure on the pelvic organs or outward pressure on the abdomen. The pelvic floor muscles should have a normal resting tone, feeling soft and springy.

A healthy pelvic floor is one that allows you to go about your daily life without consciously sensing its presence. If you experience any symptoms or concerns related to your pelvic floor, reach out to a pelvic floor PT!

Relax Your Anus / Unclench Your Glutes 

When you constantly clench, you’re creating tension. Tight muscles are usually problematic. Let your booty go and your pelvic floor muscles will thank you 🫶

Diaphragmatic breathing🧘‍♀️helps to increase oxygenation of tissues, decrease muscle tension (the pelvic floor muscles should relax with every inhale), down regulate/calm down the central nervous system, and passively stretch the pelvic floor muscles.

Breathe in and allow 360-degree ribcage expansion, with the belly rising slightly, the ribs moving laterally, and the chest remaining steady. You might feel your anu$ dropping towards your feet.


The Pelvic Floor Muscles Should Function Subconsciously 

We shouldn't have to consciously think about engaging our pelvic floor muscles; ideally, they should function subconsciously. However, there are instances (such as pregnancy, childbirth, and trauma) when this automaticity is lost. 

Consult a pelvic floor physical therapist! We can evaluate your condition and prescribe initial pelvic floor muscle training to help develop conscious awareness. The ultimate goal is to achieve subconscious contractions before and during increases in intra-abdominal pressure (IAP) such as coughing, laughing, sneezing, lifting, pushing, pulling, and jumping. This proactive approach can effectively prevent pelvic floor symptoms such as leaking and pelvic pressure. 

*The pelvic floor muscles may have exessive tension, potentially limiting their ability to achieve a strong contraction. In such cases, the initial focus should be on muscle relaxation techniques.*


Don't Use Soap on Your Vulva 

▪️The v@gina is self-cleansing

▪️Soap removes good bacteria (lactobacilli)

▪️Increased vulnerability to infections

▪️Good bacteria help prevent infection by keeping the v@gina acidic and keeping away bad bacteria

▪️Decreased “food” for s3x hormones - can contribute to tissue damage (dryness and irritation), pain with s3x, and lower urinary tract symptoms


✔️Instead rinse with water – you can spread your labias and wash with your fingers and/or showerhead. Avoid scrubbing as this tissue is delicate.


It is especially important to maintain proper vulvovaginal hygiene during pregnancy and postpartum:

▪️Pregnancy is naturally depressed immune state

▪️Estrogen levels drop postpartum which can increase infection risk due to a drop in good bacteria (estrogen helps feed the good bacteria). Low estrogen levels can also contribute to v@ginal dryness. 


Breathe Diaphragmatically

Diaphragmatic breathing is 360-degree ribcage🩻 breathing. Breathe in and allow 360-degree ribcage expansion, with the belly rising slightly, the ribs moving laterally, and the chest remaining steady.

✨During inhalation the diaphragm contracts/lowers to allow the lungs🫁 to fill with air, the external intercostals contact to elevate the ribs, and the pelvic floor muscles relax/descend. This stretches the pelvic floor muscles.

✨During exhalation the diaphragm relaxes/moves up, the internal intercostals contract to pull the ribs down, and the pelvic floor muscles ascend.

Posture matters! Breathing is not as effective if ribs are flared or compressed, or if the pelvis is overly anteriorly or posteriorly tilted. When ribs aren’t stacked over the pelvis the diaphragm can flatten and cause the pelvic floor &/or abdomen to bulge. 

The Core Canister 

These deep core muscles provide trunk stability and control intraabdominal pressures. They should create stiffness/tension and engage first to stabilize in preparation for movement. When breathing with the rib cage aligned over the pelvis these muscles function together to manage changes in abdominal pressure.

In a dysfunctional core superficial muscles tend to dominate leading to trigger points, tension, and muscle shortening which can inhibit the deep core muscles from doing their jobs. Underlying causes to a dysfunctional core include dysfunctional postures and breathing patterns. When this occurs hypertonic muscles need to be “released” while the deep core muscles need to be retrained. Poor deep core muscle coordination and recruitment and suboptimal breathing patterns may cause pelvic floor dysfunction as well as load transfer or lumbopelvic pain problems.

Learning to coordinate breathing with deep core muscle activity is valuable to rehabilitating low back and pelvic girdle pain, urinary incontinence, and other core issues. The ability to engage deep core muscles without superficial muscle activation, coordinated with breathing, is the first step in retraining core muscle control. Diaphragmatic breathing helps to decrease pressure forces on areas of weakness. In scenarios of suboptimal breathing/pressure management the escape of pressure can look like a hernia, diastasis reci (“6 pack” ab separation), or prolapse.


What is pelvic floor physical therapy?

Pelvic floor physical therapy (PFPT) is a specialized form of physical therapy that focuses on the muscles, ligaments, and tissues that support the pelvic organs, such as the bladder, uterus, and rectum. pelvic floor physical therapy can be a highly effective non-invasive treatment option for patients with a range of pelvic floor disorders affecting their bladder, bowel, and sexual function. 

Benefits of pelvic floor physical therapy:


Signs/Symptoms of Tight Pelvic Floor Muscles 

Pelvic floor muscle signs/symptoms may be common, but they’re not normal. Pelvic floor physical therapy (NOT kegels) can help!

When the pelvic floor muscles are hypertonic/tight, they can contribute to signs/symptoms such as:
• Urinary urgency/frequency
• Difficulty starting urinary steam &/or emptying bladder/reduced urinary flow
• Spraying urine while peeing
• Dribbling urine after peeing
• Feel like you have to pee again right away
• Leaking urine (with urgency)
• UTI like symptoms

• Bowel urgency/frequency
• Pain with bowel movements
• Constipation/skinny poops
• Slow transit time
• Irritable bowel syndrome
• Hemorrhoids
• Anal fissures

• Lower abdominal pain
• Pain with s3x/penetration/tampons
• Vulvar burning/pain
• Repeated UTIs
• Diminished or painful org@sm
• Erectile Dysfunction

• Pelvic pain
• SI joint/tailbone/back/hip pain
• Teeth grinding
• Shallow breathing

During pregnancy, the muscles surrounding the pelvis may overcompensate due to ligament laxity, leading to pelvic floor muscle tension. It’s great to see a pelvic floor PT to address any hypertonicity and prepare for childbirth.


MYTH: Drinking water will make me have to pee more

Please keep drinking water💦 normally! If you try to reduce your water intake, you will make your urine more concentrated, and this will give you more urges to urinate.

The goal is to sip 64 oz (or ½ your body weight (in lbs) in ounces per day) of pure, flat water throughout the day. Don’t drink a lot of your water at once. Instead, sip water consistently throughout the day.


MYTH: It's normal to leak urine if you're pregnant or postpartum

Urinary incontinence (leakage)💦 might be common, but it’s not normal. Taking care of your pelvic health early is crucial! As we age👵, symptoms can worsen, decreasing quality of life and putting more strain on caregivers. During my time in PT school on my hospital🏥 rotation, I noticed that urinary incontinence💦 was the #1 reason people were sent to live in a skilled nursing facility instead of going back home🏡

Leakage💦 can be due to impaired:

▪️pelvic floor muscle function

▪️pressure management

▪️scar tissue mobility

▪️foot mobility

▪️hip mobility

▪️rib and spinal mobility

These are just some of the many factors that can contribute to leaking💦- reach out to a pelvic floor PT for individualized treatment!


MYTH: Leakage is always a result of weak pelvic floor muscles

Leakage can also be due to impaired:

✨pelvic floor muscle tone

✨pressure management

✨scar tissue mobility

✨foot/ankle mobility

✨hip mobility

✨rib and spinal mobility

These are just some of the many factors that can contribute to leaking - reach out to a pelvic floor PT for individualized treatment! Urinary dysfunction, pelvic floor muscle tension, and low back or pelvic pain can be related. Typically, this is due to failure of the core to work as a unit. Sometimes we need to restore the motion and normal muscle tone of the pelvic floor muscles before adding strengthening exercises💪


Do you have a strong urge to pee as soon as you get home, see a toilet, or hear running water?

This is often referred to as key🔑 in the door syndrome! It can hit you as soon as you arrive home, open a door, hear running water🚿, or catch sight of a restroom/toilet🚽. The triggers for this phenomenon are varied and numerous 👀

Here are some tips:

▪️Take 10 deep/slow diaphragmatic breaths that make your belly expand/pelvic floor muscles relax on the inhale to stimulate the vagus nerve to help stay calm.

▪️Bladder self-talk (“I’m ok, I didn’t need to go to the bathroom 5 minutes ago”).

▪️Do 5-10 quick kegels for reflexive inhibition.

▪️Perform calf raises (the calves share the same nerve roots as the bladder).

▪️Try mental distraction activities – count backwards from 200 in 3’s, unload the dishwasher, etc.

▪️Find a Pelvic PT near you for personalized care


Women Need Testosterone Too

The clitor!s and vestibule (a part of the vulva) are testosterone dependent. An imbalance of estrogen and testosterone at the vestibule can lead to a host of symptoms such as burning🔥, stabbing, and UTI like symptoms.

Hormone changes may be related to the use of hormonal contraceptives and drugs that suppress androgens like spironolactone (an acne medication💊). Estrogen levels at the vulva can also decrease during the postpartum and perimenopause periods. This can contribute to vaginal dryness, thinning, irritation, pain with intercourse, urinary incontinence💦, and increased susceptibility to UTIs.

Pelvic floor physical therapy, in collaboration with a MD can be a game-changer! When appropriate, physicians may prescribe estrogen and/or testosterone creams to be applied at the vulva to help increase these hormones locally.

Also, the spice fenugreek may help improve testosterone and estrogen levels, as well as reduce period cramps. Phytoestrogens (found in foods such as ground flaxseeds) may help normalize estrogen levels as well

🙅‍♀️This is not medical advice and it’s important to note that individual responses to hormonal changes can vary

Reasons to use a Vulvar Moisturizer:

✨Relieves dryness and discomfort: Provides soothing hydration, particularly beneficial post-shaving or waxing to restore moisture and alleviate any dryness or discomfort experienced in the vulvar area.

✨Postpartum: Hormone levels decline after childbirth and remain low during #lactation. This can lead to dryness and irritation of the vulva due to hormonal changes.

✨Perimenopause: Hormone levels fluctuate during the 5-10 years leading up to menopause, potentially causing vulvar dryness and irritation.

✨Menopause: Decreased levels of estrogen and testosterone after menopause result in vulvar and vaginal dryness, leading to discomfort, itchiness, and painful intercourse. This condition is known as Genitourinary Syndrome of Menopause (GSM). While low-dose vaginal #estrogen is the gold-standard treatment for GSM, a vulvar moisturizer applied externally can provide relief on days when vaginal estrogen is not used.

✨Relief from cancer treatments: Hormone levels and skin integrity can be impacted.

✨Autoimmune vulvar conditions: Inflammation or changes to the skin can compromise the skin barrier. A vulvar moisturizer can help maintain the vulvar skin barrier and complement the treatment of conditions such as lichen sclerosis, lichen planus, vulvar eczema, and Sjogren’s syndrome.

✨Perineal massage: The goal of perineal preparation is to reduce the risk of perineal tearing during childbirth by training the body to relax, rather than tense, when stretch is applied to the pelvic floor muscles. Initiating perineal preparation around 34 weeks gestation can yield several benefits, including increased flexibility of the perineum, reduced risk of perineal tearing or the need for an episiotomy, and decreased pelvic floor pain. Additionally, it is beneficial for individuals experiencing painful intercourse due to overactive (tight) muscles and vaginismus. A vulvar moisturizer can be used instead of a lubricant, as it tends to last longer without drying out.

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