If there was an award for “Best Supporting Muscle Group,” it would be the pelvic floor, hands down. While it’s finally starting to get the recognition it deserves, the pelvic floor remains an obscure set of muscles to most people. Until recently, my knowledge of the pelvic floor started and ended with Kegel exercises (thanks, Sex and the City!). Little did I know the importance of maintaining a healthy pelvic floor, nor the starring role it plays in everyday functions or even where/what it is.
If you’ve experienced the best orgasm of your life or managed to hold your pee in rush-hour traffic, you have your pelvic floor to thank. On the flip side, if your libido is leaving much to be desired or, worse, you feel pain during sex, consider them red flags that your pelvic floor muscles could use some TLC. I decided it was time to give Kegels a rest and look beyond Samantha Jones for sexual health tips. I tapped into the expertise of Dr. Jennifer Carr, an orthopedic and pelvic health physical therapist and clinical director of Origin in Brentwood, California in Los Angeles, and gave pelvic floor therapy a go. Below, find an intensive course on all things pelvic floor. Step aside, Kegels.
What is the pelvic floor?
Let’s start with Pelvic Floor Anatomy 101. At the bottom of your pelvis lies a group of muscles—the pelvic floor—that form a bowl-like shape between your sit bones. “The pelvic floor is composed of three layers of muscles that sling from the pubic bone in the front all the way to the tailbone in the back,” Dr. Carr explained. “It’s made of muscle, but it’s unique in that it not only gives us strength and power as it coordinates with our trunk muscles, but it also supports our internal organs and keeps urine and poop in our bodies until we are ready to empty,” Dr. Carr continued. “A healthy pelvic floor can stretch and open to empty the bowel and bladder or have sex and stay closed to keep us dry, clean, and feeling supported.” In other words, the vital muscles give us the ability to control our bladder and bowel movements and enjoy physical intimacy—things we don’t give a second thought to and take for granted, unless something doesn’t feel right.
What better way to understand (and appreciate) the female anatomy than by seeing it IRL? Using a pelvic floor model, Dr. Carr showed me the various pieces of the puzzle, so to speak, including the urethra, clitoris, and vagina. Then, using a mirror I imagine you’d find in Inspector Gadget’s bag, came the eye-opening exploration of my own pelvic floor. Until that day, I had never gotten an up-close-and-personal look down there and my relationship with my vagina and surrounding parts would best be described as acquaintances at best. Let’s just say I was mind-blown and we’ve all become much more familiar with one another.
How do you determine the health of your pelvic floor?
Think of your core, the act of going to the bathroom, and knocking boots as windows into your pelvic floor. If you have any issues in those areas, chances are, you have a pelvic floor dysfunction. Dr. Carr explained that symptoms like leaking urine, constipation, pain with penetration (including a tampon), or discomfort sitting are signs of pelvic floor dysfunction.
According to Dr. Carr, to understand what’s going on with your pelvic floor and get to the root cause of your symptoms, you might want to start with an internal pelvic floor examination when seeking pelvic floor therapy—that is, if you’re comfortable with it. “If you opt in for the pelvic floor internal assessment and your therapist determines it’s safe and appropriate to do so, the setup is very similar to when your OB-GYN performs a Pap smear, except we are looking at the muscles, not the organs,” she explained.
Other common symptoms of pelvic floor dysfunction can include but are not limited to:
- hip, back, abdominal, or leg pain
- feeling of heaviness or dragging in the pelvic floor or like something is falling out
- strain with a bowel movement or strain and push to empty your bladder
- unable to completely empty your bowel or bladder
- strong urgency to urinate or feeling like you must use the restroom all the time
What can you expect from pelvic floor therapy?
It should come as no surprise that the first session involves a lot of chatting. Your pelvic floor therapist will ask a series of questions to understand what’s going on with your body and pelvic floor (think: medical and family history, concerns, goals). Then, when proceeding to the more intimate part of the appointment, they’ll know what to look out for. So what does a pelvic floor therapist look for down there? “Part of the examination involves looking at the pelvic floor to see how it responds to cues,” Dr. Carr stated. “It involves examining the skin to see if it’s healthy, looking for any scarring, and then evaluating each layer of the pelvic floor for strength, coordination, length, and response to pressure using a gloved, lubricated finger.”
Once the therapist has performed the examination, they can determine a course of treatment. While there is no one-size-fits-all approach, Dr. Carr said the plan of action should almost always involve education on the function of your pelvic floor for various activities, like what it should do when you cough, sneeze, or lift something heavy. For example, if you have pain or discomfort in your pelvic floor, you may need help lengthening its muscles. Your pelvic floor therapist can walk you through exercises that encourage relaxation of the muscle group, which you can also do at home.
Why should pelvic floor therapy be a part of our wellness routine?
About 25% of women in the U.S. are affected by a pelvic floor dysfunction (and there’s probably a lot more women who don’t know they have it). Needless to say, it’s about time we get some one-on-one time with the hammock of muscles that we don’t give enough credit to. “Understanding how your pelvic floor functions can be life-changing,” Dr. Carr said. “It can make sex more comfortable and pleasurable if it isn’t, facilitate delivering a baby vaginally more effectively (and optimize your recovery), cultivate feeling more comfortable in your skin, and help you feel stronger and more capable with all types of activity.”
Just like we do push-ups to strengthen our triceps, pec muscles, and shoulders and squats to build our glutes and quads, everyone with a pelvic floor can afford to prioritize and be mindful of the important muscle group. It does a lot of the heavy lifting in our body, after all! When most people think of pelvic floor exercises, it’s all about Kegels. But that buzzworthy movement isn’t for everyone, and when performed incorrectly, it can do more harm than good. By working with a pelvic floor therapist, you’ll get an individualized plan to train your pelvic floor muscles for optimal health, whether you have dysfunction or not.
Find a therapist who makes you feel comfortable and takes the time to guide you through every step of your session. Dr. Carr advised that your therapist should always explain what they are going to do and why. “Advocate for yourself if you think you need physical therapy for your pelvic floor,” she said. “Whatever pelvic floor symptom you have, I guarantee, there are many others out there who are dealing with the same problem.”