Signs Your Pelvic Floor Could Use A Workout, From A Urologist

You don't need an anatomy degree to have a basic understanding of your body's major muscle groups. Most folks know that their biceps sit on the front of their arms, between their elbow and shoulder, and their quads make up the front of their thighs, for instance. 

It's more difficult to imagine and comprehend the pelvic floor, a group of muscles that act like a "hammock" in your pelvis to hold the bladder, urethra, vagina, rectum, and other organs in place for optimal functioning.

However, tending to this often-neglected muscle group can pay off for your sexual health, digestion, and more.

Here, a urologist breaks down why it's so important to keep your pelvic floor in tiptop shape, some telltale signs your pelvic floor could be weak and uncoordinated, and the steps you can take to support the muscle group's health.

The importance of a strong, coordinated pelvic floor

The health of your pelvic floor influences three major bodily functions: peeing, pooping, and experiencing pleasure, explains Fenwa Milhouse, M.D., a board-certified, fellowship-trained urologist and specialist in female pelvic medicine and reconstructive surgery.

"[The pelvic floor] is important for us to have coordinated emptying control of our bladder, to have coordinated control of our pooping, and to be able to enjoy sex," Milhouse explains. 

The key word here is "coordinated," says Milhouse. A strong pelvic floor that can fully contract is necessary to prevent incontinence, but these muscles also need to be able to relax at the appropriate time to allow you to urinate, defecate, and have pain-free penetrative sex, she says. "That coordination is more important than total strength," she adds.

As you get older, though, your pelvic floor may begin to weaken and become uncoordinated, says Milhouse. Other risk factors for pelvic floor weakness include weight gain and chronic coughing, both of which increase the pressure on the muscle group, as well as pregnancy, says Milhouse.

People with disorders that affect the quality of their ligaments and connective tissues, such as Ehlers-Danlos syndromes, are also at higher risk for pelvic floor weakness, notes Milhouse.

Signs of a weak pelvic floor

When the pelvic floor weakens or becomes uncoordinated, you may have trouble controlling your bladder or bowels, causing you to leak urine or stool when you're not attempting to go to the bathroom (such as when you cough, sneeze, or laugh), says Milhouse. Sex may also be painful, keeping you from orgasming from penetrative intercourse.

"I think too often our world has convinced us these symptoms are normal or are just a part of life, but sex being painful is not normal," she says. "Sneezing and losing some urine after you've had a kid, that's not normal."

You may also experience pelvic organ prolapse, says Milhouse. When the pelvic floor muscles and tissue aren’t strong enough to support your pelvic organs, they may drop or press into the vagina, according to the National Institutes of Health. The uterus and cervix, for example, can lower into the vagina and potentially pop out of the vaginal opening.

"That can manifest as, 'I feel like things are falling down through my vagina,'" says Milhouse. "You feel like a ball is just coming down—organs are actually descending, like a hernia, through the vaginal opening." Rectal prolapse can also occur, during which your rectum slips outside of your anus, she adds. 

In individuals with a penis, pelvic floor weakness may also manifest as weak ejaculatory force, a sign that's more discreet, says Milhouse.

How to support pelvic floor strength and coordination

Unless you're pregnant or recently delivered a baby, doing pelvic floor muscle training (aka Kegels) without a known issue can actually do more harm than good.

"The average individual without symptoms who's doing Kegels just because might put themselves at risk of developing a dysfunctional pelvic floor issue," says Milhouse. "Too much of a good thing can be a bad thing." Over time, for example, you may struggle to allow your pelvic floor to relax and, in turn, have trouble releasing a bowel movement or experience pain during sex. 

If you suspect your pelvic floor muscles aren't functioning properly, consider booking an appointment with a pelvic floor specialist or urogynecologist; these professionals can provide you with a personal assessment to get to the root cause of your concerns, says Milhouse. 

Here are a few ways to build and maintain a strong pelvic floor if you suspect yours could use some extra support:

Taking a collagen supplement may also support your pelvic floor (as well as help out your skin, nails, and gut health).

Collagen makes up the structure of your pelvic floor tissue, so increasing your intake could potentially offset some of the effects of a weakening pelvic floor (though more specific research on oral collagen supplementation is needed). 

Folks with a confirmed pelvic floor weakness or a lack of coordination may be advised to perform Kegels. For individuals with vaginas, getting the hang of Kegels involves putting a finger in their vagina, then "[pretending] like you're holding in a fart," she says. "If you do that right, you'll feel a squeeze on your finger, like it's getting a hug." You'll hold that "hug" for three seconds, counting Mississippis, relax, and repeat for a total of 10 reps or so.

Once you get the hang of it, you can practice the Kegels without your finger three to four times a day, such as when you're brushing your teeth, driving to work, or reading a book, she suggests. 

Aside from Kegels, you can support your pelvic floor health by exhaling—not holding your breath—while you lift heavy objects, whether it be a barbell or a moving box. Doing so will ensure you don't put additional pressure on your pelvic girdle, says Milhouse. 

The takeaway

Just like the muscles in your legs or core, your pelvic floor muscles can get out of whack. If you experience any signs of a weak, uncoordinated, or dysfunctional pelvic floor, don't ignore them. Seek a professional opinion and start to build a strong, coordinated pelvic floor with the help of the proper exercises and nutrition.