What Are Kegel Exercises? Pelvic Floor 101

October 27, 2020

People usually have a decent base of knowledge about the parts of their body that have the biggest impact on their quality of life -- think about your vital organs, or your limbs, etc. And the parts of the body that people have no idea about are often a little less critical (what does the appendix even do, anyway?). But the pelvic floor is a glaring exception to this rule. 

Pelvic floor function plays a key role in many aspects of both women's and men's health, from urinary incontinence / bladder control, to healthy pregnancy and postpartum recovery, to prostate health, to better sex. These days, a decent chunk of the population has at least heard of the pelvic floor, or Kegels (the exercise most commonly associated with it). But there is still a lot of ignorance (as well as misconceptions and myths) about the specifics of what it is, why it’s important, etc. So here is a quick primer on some of the basics. Welcome to Pelvic Floor 101!

What Exactly Is The Pelvic Floor?

The pelvic floor is literally the floor, or base, of your pelvis. However, it’s shaped more like a hammock than a flat floor, and it is also known as the pelvic diaphragm (which is apt, since it acts more like your breathing diaphragm does with your lungs than it does like a floor). Anyway, both terms are a shorthand for the collection of muscles, ligaments, nerves and connective tissue that create that natural hammock slung across the base of the pelvis. It’s placed right beneath the (breathing) diaphragm, and there are actually 20 muscles of the pelvic floor (including some fun ones that sound like Harry Potter spells, like the levator ani, coccygeus, and obturator internus).

To get a sense of its location, squat down and place one finger on your pubic bone and another one on your tailbone. The perineal space in between is where your pelvic floor is.
 
Another way to discover it is through a urine stop test, which we all have done when feeling the urge to go to the bathroom. Basically, just prevent yourself from peeing without moving your body -- you are using your pelvic floor muscles (note that this shouldn’t be done too frequently, as it can negatively affect bladder control).
 
The pelvic organs include the bladder, bowel, and uterus in women and the bladder, prostate and bowel in men. Although the pelvic floor muscles are hidden from view, they can be consciously controlled and therefore trained (and exercised), much like our arm, leg, or abdominal muscles.

What Does The Pelvic Floor Do?

1. Bladder control: these are the muscles that control both the opening of the urethra, where urine comes out, and the anus and rectum, where feces and/or gas come out, particularly when there is a sudden increase in abdominal pressure, like from a sneeze, laugh or jump. Muscle contraction of the pelvic floor muscles prevent leakage of urine, feces, and gas and a weak pelvic floor can contribute to continence problems (both urinary and fecal incontinence).
2. Sexual function: in women, voluntary contractions (squeezing) of the pelvic floor contribute to sexual sensation, arousal, and orgasm occurrence and quality. In men, the pelvic floor is important for erectile function, ejaculation, stamina and sensation quality. An excessively tightened pelvic floor (you may have seen this called overactive, high tone, or hypertonic) can also cause pelvic pain for men and women (especially in the context of intercourse).
3. Organ support: the pelvic floor muscles support the bladder, uterus, rectum and important abdominal organs against gravity and any added downward pressure, guarding against pelvic organ prolapse.
4. Musculoskeletal stability: the pelvic floor is one of the four structures that make up the body’s “core”, which stabilizes the pelvis and low back and supports the spine.
5. Circulation: the pelvic floor muscles help pump blood back up towards the heart.

 
The pelvic floor muscles in women also provide support for the baby during pregnancy and assist in the birthing process, and rehabilitation of the pelvic floor is a particularly important part of overall recovery for postpartum women.

For men, in addition to their gender-specific roles in sexual function, the pelvic floor muscles are particularly important in the context of prostate health. A strong pelvic floor can help mitigate consequences of various prostate-related health problems like BPH, and pelvic floor exercise is a key part of effectively preparing for and recovering from prostatectomy. 
 
These important roles are only fulfilled when the pelvic floor is working properly. When they're not, your pelvic health can suffer in numerous ways.

What Are Common Pelvic Floor Problems?

Do you ever leak a little pee when you cough, sneeze, jump, or even when you’re making your way to the bathroom? Do you ever have pain with intercourse or other sexual dysfunction? Do you feel heaviness in your pelvis or lower back area? Or maybe you feel lower back or hip pain in daily movements like getting out of bed, or walking? If your answer is yes, those issues may be caused by pelvic floor dysfunction. 

Common pelvic floor issues may be related to or include:

• Urinary leakage / problems with continence
• Chronic bladder or vaginal infections
• Pelvic organ prolapse (bladder, uterus and rectum)
• Pelvic pain (which is sometimes associated with trauma to the pelvic floor)
• Painful sexual activity, intercourse, or sexual dysfunction for women
• Sexual dysfunction for men, including problems getting / maintaining an erection or with climax timing
• Pelvic muscle weakness or tension

 
While these issues may be common, many women (and men) are unaware that they can seek help for them (or reluctant to), often thinking that their problems may be expected or inevitable as a result of childbirth or age. Spoiler alert: they’re not inevitable at all.

And, despite common misconceptions, they’re not something that you don’t have to worry about until you’re old. In the US, studies have found that more than 6% of twentysomething women and 14% of thirtysomething women have at least one pelvic floor disorder (and, as you would expect, the prevalence goes up significantly with age). Similarly, men have high prevalence rates across a wide age range for issues like Premature Ejaculation, ED, and urinary incontinence.

 
Lastly, additional risk factors can be present, such as if you are an athlete participating in impact sports like running, a chronic smoker, or someone who struggles with obesity. 

Keeping Your Pelvic Floor Healthy

The question of how to keep your pelvic floor health is a big topic (much bigger than we can tackle in this post)! Different modalities of pelvic floor exercise, often with biofeedback (either strengthening of weak muscles or down-training of overactive / high tone muscles) are one of the main weapons in the arsenal, but there are other options too, many of which we will touch on in future posts.

For now, we’ll just note that if you suspect you have a pelvic floor disorder, seeing a pelvic floor physical therapist or other specialized provider is a great first step to take. They can assess your body specifically and help you figure how best to address the issues you’re seeing, whether via a pelvic floor physical therapy plan or other wellness or lifestyle steps.