The Pelvic Floor: Where It Is, What It Does, and Why It Matters

The pelvic floor defined. Everyone has a pelvic floor — the soft tissues (muscles, ligaments, fascia, nerves) that lie across the bottom of the pelvis between the coccyx (tailbone) and the pubic bone, in both women and men, literally forming the floor of the pelvis.

The roles of the pelvic floor:

• Anatomically, it acts as a hammock-like support for the bladder, rectum, intestines, uterus (women), and prostate (men), keeping them in place.
• Helps maintain bladder and bowel control.
• Helps stabilize the pelvis and lower back.
• Many of the body's biggest muscle groups (quadriceps, hamstrings, hip flexors, glutes, low back, abdominals) attach into the pelvis; when any are tight or weak, they can negatively affect the pelvic floor.
• Integral to sexual function.

Sometimes things go wrong. Pelvic floor dysfunction refers to any muscular issue that causes the pelvic floor to not work properly. Many people don't seek help due to embarrassment or the assumption it's an inevitable part of aging — some cope with urinary incontinence by limiting fluids or modifying wardrobe, and pads/protective garments can cost hundreds of dollars a year.

Common symptoms of pelvic floor dysfunction: leaking urine when coughing, sneezing, laughing, or running (stress incontinence); failing to reach the toilet in time (urgency/frequency); pelvic organ prolapse; pelvic pain; recurrent urinary tract infections; constipation and other bowel problems; orthopedic pain in the low back, hips, groin, or coccyx; painful intercourse.

Possible causes: pregnancy; vaginal childbirth (may overstretch muscles); excess pressure from obesity; chronic constipation/straining; constant coughing; some surgeries that cut the muscles (including prostate cancer treatment); lower estrogen after menopause; a fall or injury to the coccyx (even years earlier), since all pelvic floor muscles connect directly or indirectly to the coccyx.

So now what? Doing nothing should not be an option — these things don't resolve on their own, and there's very likely something you can do right now.

What is a Kegel exercise? Intentionally squeezing the pelvic floor muscles, as when holding back urine. To do it: lift and slowly squeeze the pelvic floor muscles, relax the abdominal muscles, don't hold your breath, and make sure you release fully each time — a helpful image is imagining the release like ripples opening in a pond. Improvement, if this is the right approach, may take 4–5 weeks; if not, the next step is a pelvic health physical therapist (extra training in pelvic floor problems).

To Kegel or not to Kegel. Assuming Kegels are the be-all-end-all risks oversimplifying — and possibly making things worse, since what's actually needed may be the "anti-Kegel." Only a physical therapy specialist can determine the right approach.

What is pelvic floor physical therapy? A comprehensive evaluation first; questions about medical history, symptoms, and concerns; examination that may include external and internal assessment of the pelvic floor and surrounding areas (hips, back) for strength, flexibility, and coordination; treatment may include specific exercises, manual techniques, and possibly biofeedback aimed at improving pelvic organ support, bladder/bowel control, and pain relief.

You can further improve pelvic floor strength by: losing excess body weight; preventing constipation with more fruit, vegetables, fiber, and water; seeking medical attention for a chronic cough.