Pelvic Floor Health: Where to Start

Pelvic Health Starts Here

Just as the title suggests, often the pelvic floor muscles and their health can leave us scratching our heads. Maybe you’re wondering what is pelvic floor health? Where are those muscles? How to activate them and even relax them. This mystery of where to begin can often leave folks just passing on this important part of their bodies.

The internet can be not much help either if you are looking to get connected with or focus on the health of your pelvic floor.

And here’s where I share a small pet peeve of mine. If you do an internet search of the pelvic floor, what comes up is only referring to the pelvic floors of women. I could go off on a tangent of this being a product of the patriarchy, but I’ll save that for another day.

To get back to pelvic floor muscles and your health.

While pelvic floor health for women is important, all humans have pelvic floor muscles. Sure, people with vaginas are more often than people without vaginas to experience symptoms of pelvic floor dysfunction-possible because many of those folks will become pregnant and grow a human for approximately 9 months in their bodies. However, pelvic floor health is something that everyone, every human, needs to know about and that it’s part of your overall health.

Why should folks be aware of their pelvic floor muscles?

Let’s dive deeper.

The Pelvic Floor

The pelvic floor muscles are a group of muscles that attach from your pubic bone to your tail bone and between your sitz bones.

They are often described as a hammock providing support to your internal organs located within the pelvis: bladder, intestines and rectum-and for those who have them, the uterus.

I like how the Wikipedia entry on the pelvic floor muscles also states that it’s sometimes called the pelvic diaphragm. Because, like the diaphragm that sits below your lungs, the pelvic diaphragm wants to move up and down as you breathe.

More one that below.

photo from

The pelvic floor is also one of your deep core muscles, along with your diaphragm, transverse abdominals, the multifidus muscles. They are the inner cylinder who’s main job is to stabilize and support the spine.

If the pelvic floor muscles are not functioning properly it makes it harder to contract your core and stabilize your spine.

When do you know if they’re not functioning optimally?

The Pelvic Floor MUscles Sending an SOS

If the pelvic floor muscles aren’t functioning properly you may experience things as a warning sign that something is up.

Your pelvic floor muscles are sending you an SOS if…..

  • Urinary incontinence-leaking while sneezing, laughing, lifting, jumping, running, trampolining or other exercises. Incontinence can also be a feeling of needing to pee often, sometimes referred to as a small or sensitive bladder.
  • Anal or fecal incontinence-losing gas or feces. Or sharting during lifting, running, jumping for example.
  • Constipation or straining to defecate.
  • Pain with sex or erectile dysfunction.
  • Hemorrhoids or pelvic organ prolapse: bladder, rectum or uterus.

If you are experiencing any of these symptoms, please know you are not broken. These are common experiences, as one study suggests that about a fourth of adult women (of course it’s in the binary and of course it’s about women.) are affected with some pelvic floor disorder. (studies words, not mine)

Also know that even though these symptoms are common, they are not normal. What I mean by that is contrary to popular advertising that wants folks to buy incontinence pads (for example), if you are experiencing any of these symptoms, there are avenues to seek help.

Find Your Team

Here are a few places I recommend:

  • Julianna Allen, Pelvic Health Physical Therapist, Arlington, MA, USA. Offers Transgender care. Offers in-person and telehealth appointments. Julianna’s approach shares a lot of the same values as ours.
  • Karlene or Diana at Women’s Journey, Physical Therapists, Cambridge, MA, USA. Offers in-person and telehealth. I have met Karlene and she is very kind and knowledgeable. I have had clients say that Diana is wonderful too.
  • Marathon Physical Therapy, various locations around Boston, MA, USA. Based on our conversations with Amanda, not all locations have pelvic health PT’s. This links to the general page, which is focused on women, but they have PT’s that work with all sorts of pelvic health issues.
  • Alexandra DiGrado, Pelvic Health Physical Therapist, Boston, MA, USA. Offers Transgender care. We don’t know Alex personally, but she works with Julianna so we feel really good about this recommendation.
  • Here’s also a directory to find a pelvic health specialist in your area.

Of course the above sos alerts could also be attributed to other health issues. So, if you are experiencing any of these seeing a medical professional is important and highly recommended.

Don’t Hop On the Kegel Train Yet!

Sure, [pretty much] everyone knows the Kegel, but not everyone needs the Kegel.

As Alexandra DiGrado said in the article linked below: In fact, not everyone even needs to strengthen their pelvic floor: Some folks need to learn how to slacken it. “Some people’s pelvic floor muscles are already so short and tight that they experience pain—maybe during sex, or in their sacrum or tailbone.”

Another great article I found had this to say: “One big myth is that pelvic floor physical therapy is just about Kegels. In the last decade, research is pointing us to a combination of a flexible pelvic floor that can relax and a strong pelvic floor that can support—and you really need a good balance between the two.” I also liked that this article was not only speaking in the binary.

I think many folks know about the Kegel exercise, but I don’t think many folks know it’s not for everyone. I hope this helps clarify why pelvic health is person specific.

Where To Go From Here

As I reference above, the pelvic floor is part of your deep core and wants to be moving up and down as you breathe.

However, due to our daily living poured over our laptops, our breathing and posture changes. These postural changes can make it more difficult for the diaphragm and the pelvic floor to function optimally, due to changes in our breathing mechanics.

This video talks about how we want the diaphragm and the pelvic floor working together with optimal breathing. It also goes over how less than optimal breathing can change how these muscle sets are working.

A good Alternative

First let me say if you are experiencing any symptoms listed please see a Pelvic Health Specialist. You deserve to be healthy and not experiencing those symptoms.

You also now know that the Kegel isn’t for everyone and how it could be an inappropriate choice for some folks.

So what can you do? Or what can you do while you wait to consult with a PT?

A place I like to start folks is with a breathing exercise. As you saw in the above video, the diaphragm and the pelvic floor have this relationship with one another. You want to get them working as a team again.

The exercise I like having people do is the Connection Breath.

I love this breathing exercise. When I first began it it was tough. It was hard to not breathe in my chest and to feel the expansion in my torso. I felt my diaphragm stretching as I worked to depress it lower on my inhales. Something I don’t think it had done in a long time.

As I practiced more and more, it got easier. More natural. Less uncomfortable. Eventually I could feel the synchronization of the diaphragm and the pelvic floor muscles moving together. It was and it awesome!

Get Started

Whether the Connection Breath is new to you, you know it or you have a list of exercises from your PT already, getting started or staying on track can be difficult.

I suggest some sort of way to keep you accountable. Schedule it on your calendar with a reminder alarm. Grab a buddy and breath over Zoom. Everyone benefits doing this breathing exercises even if they don’t have a pelvic floor issue.

You could also pair the Connection Breath, or pair you prescribed exercises, with another activity.

You could pair the Connection Breath with meditating or in a yoga class.

Once you feel confident in doing the Connection Breath lying down, pair it with sitting at our desk or one the couch. Once seated feels like a breeze, pair it with waiting in a line, or folding your laundry. Lastly, you could pair the Connection Breath work with your fitness exercises. Ultimately, that is what I hope for you as a fitness professional.

Wishing you luck with your practice. As always please feel free to reach out if you have questions or leave them as a comment.

Be Well, Theresa

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