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Do You Know the Importance of Strong Pelvic Floor Muscles?

Analysis by Dr. Joseph Mercola Fact Checked

importance of strong pelvic floor muscles

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  • Your pelvic floor muscles support your pelvic organs, including your bowel, bladder and uterus; they form one piece of your core muscle group and are important to men and women to protect your lower back, reduce your risk for sexual dysfunction and improve bowel and bladder control
  • These muscles may be damaged during pregnancy or childbirth, with increasing weight gain, chronic constipation or through lifting heavy objects such as children, groceries or during strength training without first being strengthened
  • Before training your pelvic floor muscles, it's important to identify the movements used to contract them; never contract them during urination to strengthen them as it may weaken the muscles and alter your bladder function

The benefits of consistent exercise are many. Research has demonstrated it improves your mood1 and decreases feelings of depression and anxiety.2 Exercise may reduce stress3,4 and, while your nutritional intake is most important to your weight loss efforts, exercise may help you stay motivated.5

Strong muscles reduce the risk of injury6 and a strong core reduces problems with lower back pain.7 Regular exercise helps to boost your energy levels8 and reduces feelings of fatigue.9 The bottom line is exercise offers an incredible variety and number of health and lifestyle benefits.

Some muscle groups can be easily overlooked, however, such as your pelvic floor muscles. As these muscles weaken with age and lack of use, they may affect urinary continence, core strength and sexual health. Maintaining a strong pelvic floor is easy to accomplish and reaps several benefits.

Your Pelvic Floor Muscles Are Often Ignored

Located at the base of the pelvis are the pelvic floor muscles. These add a layer of support to your pelvic organs, including the bladder, bowel and uterus. They are stretched between the tailbone and the pubic bone, and side to side between the ischial tuberosities, or the sitting bones, much like a trampoline.10 

Normally these muscles are firm and thick to support your organs, and form one piece of your core muscle group. In the center is space for the urethra, anus and vagina to pass through. The anatomy of the pelvic floor muscles is the same in men and women, with differences only in the sexual organs.

The pelvic floor muscles are wrapped around the urethra and anus to help keep them shut, along with the urethral sphincter and anal sphincter.11 Although you can’t see them, you may control and strengthen them. As you contract the pelvic floor muscles it prevents the passage of stool and urine.

There are several factors that may contribute to weakening, and subsequently experiencing symptoms. Many believe these symptoms are only experienced by women following childbirth, but other factors triggering challenges include obesity, age, heavy lifting, constipation and chronic coughing.12

Damage to these muscles is common in women from childbirth, pregnancy or hormonal changes during menopause. Weakness in the pelvic floor affects your intraabdominal pressure, which in part supports your lower back.13,14,15 Laxity may result in uterine or bladder prolapse and urinary incontinence in women and sexual dysfunction and urinary incontinence in men.16

Pelvic Floor Dysfunction Differs From Weak Pelvic Floor Muscles

According to Cleveland Clinic,17 you may experience pelvic floor dysfunction, or the inability to control contraction and relaxation of the muscles in a coordinated fashion. The organs the muscles support then may not function appropriately, reducing your ability to effectively empty your bowel and bladder.

Those with pelvic floor dysfunction may contract the muscles as they attempt to relax them. This results in difficulty evacuating your bowels, or leaking urine or stool throughout the day. Most causes of pelvic floor dysfunction are unknown. Some have experienced traumatic injuries or complications from a vaginal childbirth.

In other cases, it may be the result of learned behavior developing into incoordination of the muscles. If you experience any of the symptoms listed below of pelvic floor dysfunction, discuss them with your physician as a complete physical exam may be able to determine the cause so appropriate treatment may be initiated.18

A feeling of needing to have several bowel movements during a short period of time

Feeling stool is remaining in your bowels or you are unable to evacuate

Constipation

Pain with bowel movements

Leaking stool or urine with or without being aware

Frequent need to urinate during which you start and stop many times

Painful urination

Pain in your lower back unexplained by other causes

Ongoing pelvic pain, or in the genitals or rectum

Pain during intercourse (women)

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Common Urinary Challenges Triggered by Weak Pelvic Floor Muscles

Not all urinary challenges are triggered by weak pelvic floor muscles. Many experience problems with urination, ranging from incontinence and urgency to nighttime urination. The severity may be mild or debilitating, and cause embarrassment or anxiety, keeping sufferers from socializing and enjoying their lives. Some of the common conditions include:

Stress incontinence (leaking urine while laughing, coughing, sneezing) — This may be triggered by physical changes resulting from pregnancy, childbirth and menopause.19

Urge incontinence (leaking urine after feeling a sudden urge to urinate) — This may be caused by abnormal nerve signals causing bladder spasms and may be associated with certain medical conditions like uncontrolled diabetes and hyperthyroidism.

Other health conditions may also impact your bladder nerves and muscles, leading to urge incontinence. This includes multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke and injury.20

Overactive bladder — This may develop when nerves send signals to your bladder at the wrong time, causing it to contract and leading to frequent urination, urgency, incontinence and nighttime urination.21

Lower urinary tract symptoms in men — These may include urinary hesitancy, weak stream, dribbling or leaking, along with more frequent urination (especially at night). The symptoms may be caused by an enlarged prostate22 affecting the flow of urine.

Men and Women Benefit From a Strong Pelvic Floor

Strong pelvic floor muscles benefit both men’s and women’s health issues. In one review study,23 researchers examined the complex relationship between male sexual function, pelvic floor function and pelvic pain. The aim was to demonstrate how improving pelvic floor function could be used in the treatment of a variety of sexual dysfunctions, including erectile dysfunction.

Their results suggested a close relationship and a potential therapeutic benefit for men who suffer from erectile dysfunction, ejaculatory and orgasmic dysfunction, chronic prostatitis and chronic pelvic pain syndrome. According to the authors, pelvic floor physical therapy may be a significant tool to a24 “more comprehensive bio-neuromusculoskeletal-psychosocial approach to the treatment of male sexual dysfunction and pelvic pain.”

A second study25 enrolled 40 men aged 19 to 46 years with a lifelong history of premature ejaculation. The men underwent pelvic floor muscle rehabilitation, at the end of which 33 had gained control of their ejaculatory reflex, and 13 of the 33 patients maintained significant control at six-month follow-up. The researchers recommended pelvic floor muscle rehabilitation as a viable therapeutic option.

Many of the benefits for pelvic floor muscle exercises for women are more well known. Strong pelvic floor muscles improve control over bladder and bowel functions and reduce the risk of prolapsed internal organs into the vagina.26 Women with strong pelvic floor muscles also recover more quickly after childbirth and surgery.

With reduced problems associated with bladder leakage, comes increase social confidence and quality of life. These muscles are also important for a woman's sexual function, as they increase sexual sensation and orgasmic strength.

Memorial Sloan-Kettering Cancer Center27 recommends Kegel exercises (described below) to help relax vaginal muscles, reducing pain during sexual intercourse. The exercise also improves blood circulation, which may increase sexual arousal and makes it easier for a woman to reach orgasm.

Strong Pelvic Floor Reduces Lower Back Discomfort

According to national estimates of incontinence prevalence in the U.S., including noninstitutionalized respondents and those in a residential facility, researchers found 50.9% of those living in the community over age 65 reported urinary leakage.28

Weak pelvic floor muscles also affect your lower back and hips. Your spine begins at your tailbone. Muscles that support your pelvis and tailbone include your pelvic floor. When it is not assessed and treated properly, it may result in low back pain. For some, one of the first symptoms is sciatica or other types of low back pain.29

According to pelvic physical therapist at Pelvic Sanity,30 the major role of the muscles in your pelvic floor is to stabilize your lower back. However, as you experience pain, these muscles may tighten, causing the muscles to overwork and trigger points to form.

According to the World Health Organization,31 low back pain is common worldwide and major cause of disability. Low back pain is often a complex issue as the anatomical structures in your lower back are affected by muscles in your pelvis, your abdominal wall and your middle back. Factors that may contribute to increasing lower back pain or incontinence until your pelvic floor is strengthened include:32,33

  • Obesity
  • Lifting heavy objects, including children, groceries or weight lifting
  • Constipation
  • Situps with straight legs or double leg lifts
  • Running, jumping rope, rebounder or other high impact activities

Simple Strategies to Identify and Strengthen Your Pelvic Floor Muscles

Guidelines from the National Institute for Health and Care Excellence in England34 now recommend pelvic floor muscle exercises as the first treatment for women who suffer from urinary incontinence or pelvic organ prolapse to reduce the amount of vaginally inserted mesh and tape required to treat stress urinary incontinence and pelvic organ prolapse.

Before being able to exercise your pelvic floor muscles, it's important to identify them. According to Memorial Sloan-Kettering,35 this may be done by sitting with the muscles of your legs, buttocks and stomach relaxed. Imagine you are urinating. Contract the muscles you would use to stop the stream of urine.

It's important you don't practice stopping your urine stream, especially if your bladder is full, as this may actually weaken your muscles. According to Pauline Chiarelli, Ph.D., an incontinence adviser, a functioning bladder is complex and goes well beyond the muscle control of the pelvic floor.36

Although these muscles influence bladder control, stopping the flow of urine as a practice may negatively alter the function of your bladder. Instead, sit on a chair with your feet flat on the floor and contract the muscles in your buttocks that you would use to keep from passing gas. However, concentrate on keeping your buttocks, abdomen and inner thigh muscles relaxed.

When done correctly, your body will not lift or shift, but you will feel the muscles of the floor of your pelvis lift. Using this technique, you may identify the muscles you are attempting to contract and relax during pelvic floor exercises.

If you feel any pain doing these exercises, stop, as they should not be painful.37 Once you have identified your pelvic floor muscles, consider these exercises to strengthen your pelvic floor muscles.38,39,40 All of these can be done by men and women alike.

Kegels — Kegel exercises may be done anywhere, including driving in your car or waiting in line at the grocery store. Begin by breathing through your nose and filling your abdominal cylinder, letting your stomach rise. Concentrate on relaxing your pelvic floor muscles as you breathe in.

Breathe out slowly through your mouth as you contract the pelvic floor muscles and keep them contracted for three to six seconds, until your muscles begin to get tired. As you breathe in release the contraction to relax the muscles. Allow the muscles to relax for six to 10 seconds before the next contraction and don't hold your breath. Repeat 10 times.

Rapid squeeze and release — This exercise builds the ability of the muscles in your pelvic floor to respond quickly. Sit in a comfortable position and quickly squeeze and release your pelvic floor muscles without trying to maintain a contraction. Rest for three to five seconds. Repeat up to 20 times, twice a day.

Bridge — This well-known exercise strengthens your buttocks, but also helps to work the pelvic floor. Lying on your back with your knees bent and your feet flat, move them approximately hip-width apart. Place your arms by your side, with your palms facing down.

Use your buttocks and pelvic floor to lift your buttocks several inches off the floor and hold for three to eight seconds. Relax and lower your buttocks to the ground. Repeat 10 times. This is one set. Rest and do one or two additional sets.

Squats — Squats are a full body exercise that may also promote a strong pelvic floor. A narrow stance and shallow squats more accurately targets the pelvic floor. Stand with your feet hip-width apart. Bend at the knees to bring your buttocks towards the floor as though you're sitting in a chair.

Keep your back straight and lean slightly forward; your knees should not go over your toes. Focus on tightening your buttocks and pelvic floor as you return to a standing position. This may be repeated for 10 repetitions and you should rest before doing any additional sets.

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