Every woman can benefit from this pelvic floor workout

NEW YORK – The pelvic floor muscles may be the most important muscles you never target with a workout.

Like a trampoline that sits at the base of your pelvis, these muscles contribute to overall core strength and hold several organs in place – including the bladder, bowel and, for some, the vagina and uterus – ensuring they work properly.

Yet many people do not even know these muscles exist, said Dr Amy Park, head of female pelvic medicine at the Cleveland Clinic – at least, not until they stop working properly.

“There’s a general lack of awareness about the pelvic area,” she added. “I educate women multiple times a day about the fact that we have pelvic floor muscles.”

They may not be visible like the triceps or quads, she said, but they are vital for everything from basic bathroom functions and sexual health to sitting and standing – and they benefit from a fitness programme.

The pelvic floor is “just as important in your daily life as your Achilles tendon is for running, because we use it for everything”, said Ms Liz Miracle, head of clinical quality and education at pelvic floor physical therapy provider Origin.

Historically, talking about this region of the body, even with one’s physician, has felt off-limits to many.

This prudishness has led to years of unnecessary suffering, said Ms Evelyn Hecht, a pelvic floor physical therapist in New York City who began practising in the 1990s.

Many conditions could be treated or avoided entirely if women felt freer to discuss their symptoms, or if the public were better informed about the pelvic floor.

Nearly one in three American women suffers from a pelvic floor disorder, most commonly in the form of urinary incontinence, bowel incontinence, pelvic pain, pelvic organ prolapse or some combination of these problems.

When the pelvic floor is strong and flexible, the muscles work together – or “co-contract” – with the core muscles to let you live your daily life with ease and stay active as you age, said Ms Hecht, who now runs digital pelvic health provider PelvicSense.

The pelvic floor helps with balance and mobility during sports and exercise too.

Pelvic floor problems can be caused or exacerbated by anything that puts pressure on the muscles over time, leading them to tear or weaken. That includes running, dancing, chronic constipation or even regular coughing, pregnancy and childbirth.

Injuries can also arise when the muscles become too tight, which can be caused by regularly “holding it in” when you feel the urge to go to the bathroom, by overtraining the core, or even by long-term stress and anxiety. (When stressed, many people reflexively clench these muscles.)

Recently, pelvic floor specialists have reported an uptick in disorders resulting from tight pelvic muscles – a trend they have called pandemic pelvis, since the most common cause appears to be stress combined with too much sitting.

But pelvic floor problems are not inevitable. Many pelvic issues can be prevented or mitigated by regularly stretching and strengthening these muscles.

Most people could benefit from “a personal trainer for our pelvic floor”, said Dr Lauren Streicher, medical director of Northwestern University’s Centre for Sexual Medicine and Menopause.

Ms Miracle, herself a physical therapist and a kind of personal trainer for the pelvis, recommended that all women who are not suffering from a pelvic floor disorder or injury incorporate six foundational exercises into their fitness routine, aiming to do them at least three times a week.

1. Diaphragmatic breathing

Learning how to move the diaphragm is key to connecting with and then conditioning your pelvic floor muscles.

2. Pelvic floor lengthening exercise

Relaxing and lengthening the pelvic floor muscles, so they are capable of a full range of motion, is especially important for basic functions like using the bathroom without strain (think: avoiding constipation) and having penetrative sex without pain.

Imagine the aforementioned balloon expanding 360 degrees in all directions on the inhale. One of those directions is downwards between your legs and towards the perineum (the area between the vagina and anus). As the belly rises passively, the perineum will also balloon down and out passively. Repeat 10 times.

3. Seated Kegels

While the previous exercise helps you to relax the pelvic floor muscles, Kegels train you to contract them. This exercise helps people hold in urine, stool or gas when they feel the urge to use the bathroom. It also works to build endurance in the pelvic floor muscles, so they are able to hold up the organs and balance out pressure put on the abdomen throughout the day.

4. Quick flicks

This exercise builds on Kegels by training the pelvic floor muscles to contract quickly – a skill that allows them to respond effectively to sudden, automatic bodily functions that create pressure inside the abdomen, such as coughing, sneezing or laughing. (It can also help to prevent incontinence, or “leaking”, in the face of this pressure.)

5. The knack with a ‘shhh’ sound

While quick flicks train the pelvic floor muscles to respond quickly to the bodily functions that put pressure on the abdomen, this exercise helps build strength and endurance in the face of this pressure.

6. Belly lifts

This exercise targets your transverse abdominis muscles, which sit in the lower abdomen and support the core. These muscles work with the pelvic floor muscles to help you with sitting, standing and doing any workout that requires balance or stability.