- Women of all ages should consider working out their pelvic floor muscles before something goes wrong.
- Younger women can strengthen their pelvic floors with core exercises, while women who have given birth should focus on isolating their pelvic floor muscles.
- Yoga and pilates can help elongate the pelvic floor muscles for all age groups.
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Few people think about their pelvic floor health until something goes wrong, according to Jessica Shepherd, OB/GYN.
Almost one quarter of women deal with urinary incontinence or prolapse (where one or more of the pelvic organs presses into the vagina) in their lifetimes, typically in the months and years after giving birth. Men have pelvic floors, too, but, without the stress of pregnancy, they’re statistically less likely to experience pelvic floor disorders.
But you shouldn’t wait until you’ve had children or you can’t hold in your pee to start thinking about strengthening those muscles.
This sheet of muscles that stretches like a hammock from the pubic bone to the tailbone (or, coccyx), and into the hip rotators, is key for supporting your balance, your bladder and bowels, and your joints over time. That’s the case whether you’ve been pregnant or not, said Allison Ball, DPT, a physical therapist who works with pelvic floor patients.
“Starting to focus on your pelvic floor early on is really important for the general health of your muscles and your joints and the ability of your body to support itself throughout a lifetime,” Ball said.
For people who haven’t been pregnant, core exercise will sufficiently activate the pelvic floor muscles
Starting pelvic floor exercise early doesn’t mean going straight to Kegels. Exercises that target core strength will also benefit the pelvic floor muscles as they co-contract with the back and abdominal muscles.
Jessica Shepherd, OB/GYN, named planks, squats, and lunges as core exercises that activate the pelvic floor muscles. She also recommended adding weight to those exercises to further strengthen the framework of the body.
Ball said these general exercises are usually enough of a pelvic floor workout for women of any age who haven’t given birth. While those women could go through their lives without experiencing pelvic floor problems, it is possible for older women who have not been pregnant to develop some weakness due to regular wear and tear of the pelvic muscles.
Yoga and pilates help stretch the pelvic floor muscles at any age
Strengthening the pelvic muscles is only half of the job, Ball added. You also want to make sure your muscles can lengthen all the way.
“If we’re doing a bicep curl, we want to be able to go from where your arm is straight, all the way until your arm is fully bent, and then back down to straight,” she said. The same goes for pelvic floor muscles.
Ball recommends yoga and pilates because they incorporate diaphragmatic breathing (the belly breathing associated with meditation and relaxation techniques), which helps move the pelvic floor muscles through their natural range of motion.
Certain yoga poses specifically work the pelvic floor muscles, Ball said:
- Pigeon pose: This stretches the hip rotators connected to the pelvic floor. From kneeling, you should bring one leg forward with your calf flat on the ground and your front ankle in line with your back hip, with the back leg extended behind you.
- Happy baby: Lie on your back with your legs in the air, knees bent, and grab the insteps of your feet. This is a good stretch for the muscles at the opening of the vagina.
- Figure-four stretch: This elongates the back of the pelvis. From sitting or lying down, you can cross your ankle over your knee and either press lightly on your top knee (if sitting) or pull your back knee towards you (if lying down).
- Butterfly pose: This reduces tension in the pelvis overall. Sit with the soles of your feet pressed together and your knees dropped to the sides as far as they will go.
Women who have had a baby should focus on isolating their pelvic floor muscles
Recommendations for postpartum exercise will vary depending on how the birth went, but in any case, Ball suggests starting to isolate the pelvic floor muscles during this period.
Pelvic floor exercises aren’t limited to the basic Kegel squeeze and release. Ball said she typically walks patients through quick contractions of the muscles and 10-second holds to work different types of muscle fibres.
She also teaches postpartum patients how to activate their deep core muscles. You can try that at home by placing your hands on the inside of your hip bones and trying to draw them toward each other – you should feel a tensing of muscles deep in the core.
Those activation exercises can be done sitting or lying down, and in general, new mums should wait six to 12 weeks before trying anything beyond low impact exercise.
Ball said yoga is particularly helpful during this time because it helps relax and stabilise the muscles that were traumatized during pregnancy and delivery.
“People will have pelvic floor problems after delivery a lot of the time, even if it’s through the abdomen [via C-section], because they still had a baby sitting on their pelvic floor for nine months,” Ball said. “So their pelvis has still worked really hard for a while.”
For women over 65, learning how to activate the right muscles may be the biggest challenge
Women over 65 may seek professional help for pelvic floor dysfunction such as incontinence and uterine prolapse.
With this population, Ball said there can be a lack of body awareness around how to activate the muscles in the pelvic floor. She typically tells patients to squeeze their muscles as if they’re stopping the flow of urine.
Once someone is able to activate those muscles on cue, the physical therapist can get a better picture of how the muscles are working together.
“It’s all about finding the muscle imbalances, and how we address those can look really different person to person based on what we find,” Ball said. “If someone’s having any issues, we highly recommend having it assessed because it can be a little more complicated than people think.”