What is the pelvic floor?
Your pelvic floor is a group of muscles that sit like a hammock across the bottom of your pelvis. These muscles stretch from your pubic bone in the front to your tailbone in the back, and they help support your bladder, uterus, and bowel.
Primary jobs of the pelvic floor (the 5 S’s)
Sphincteric: control urine, gas, and stool by controlling your bowel/bladder openings
Support: support your pelvic organs like the bladder, uterus and bowel
Sexual: contribute to sexual function by relaxing (lengthening) to allow penetration and contracting (tightening) to help create orgasm
Stability: the pelvic floor muscles work with your core and deep back muscles to stabilize your spine and pelvis when you move. Overall, this helps manage pressure inside your abdomen (referred to as ‘intra-abdominal pressure’)
Sump pump: They work with your breathing to help push blood and lymph back up toward the heart
A healthy pelvic floor needs a balance of:
Strength: to hold things in and support you, to keep you continent and stable
Flexibility: to be able to relax and ‘let go,’ allowing you to be able to do things like use the bathroom and have sex
Coordination: to move rhythmically and with good timing between contractions and relaxations at the times we need it – like when running and jumping to avoid leaking
How the pelvic floor works with other parts of the body to manage pressure and reduce unwanted pelvic floor symptoms
The pelvic floor is part of what’s called your core canister. You can think of your core like a soda can:
The diaphragm, your main breathing muscle, sits on top of the soda can
Your deep abdominal muscles wrap around the sides of the soda can
Your deep back muscles support the backside of the soda can
And your pelvic floor forms the bottom of the soda can
So the diaphragm, deep abdominal muscles, deep back muscles and the pelvic floor are constantly working together as a system every time you breathe. When you inhale, your diaphragm moves downward, your rib cage expands, and your pelvic floor naturally lengthens and relaxes. Then as you exhale, your diaphragm rises back up, your deep core gently activates, and your pelvic floor naturally contracts and tightens. The core canister works together to manage pressure inside the abdomen (called intra-abdominal pressure), stabilize your spine and pelvis, coordinate breathing, support the pelvic floor, and help transfer force through the body
How pregnancy impacts the pelvic floor
During pregnancy, your pelvic floor muscles are working even harder because they’re supporting the increasing weight of your growing uterus and baby. Then, after birth, whether C-section or vaginal, many women feel a loss of sensation or awareness with their pelvic floor and/or experience pelvic floor-related issues, like:
Urinary leakage – leaking with coughing, sneezing, laughing, running, jumping, lifting
Urinary urgency/frequency – feeling like you always have to go or that it comes on quickly
Difficulty controlling bowel movements, or leaking bowel and/or gas
Pelvic pressure/heaviness – feeling like something is ‘dropping’
Pelvic organ prolapse – feelings of pressure, bulging, or like something is falling out of the vagina
Pelvic or vaginal pain
Pain with intercourse
Low back, hip, or pelvic girdle discomfort and/or pain
Which can bring up questions like:
Why am I still leaking months to years after birth?
Is this amount of pelvic pressure normal?
When can I start running or jumping again?
Will I ever be able to cough or sneeze without leaking again?
What can I do about painful sex to make it more comfortable?
Do I need to do Kegels or is it making my symptoms worse?
Will this get better on its own?
And pelvic floor dysfunction can affect more than just our physical health. It can lead women to:
Worry, feel embarrassed or self-conscious, impacting overall self-esteem and emotional health
Avoid exercising or significantly change their preferred way of working out
Stop doing the activities they love entirely
Hopelessly feel they need to accept it as their new normal
If pelvic floor function isn’t addressed over the years after birth and into peri/menopause, many women notice that leaking and dysfunction becomes more noticeable due to the hormonal and physical changes of those seasons
So where to even start to support pelvic floor health and function after birth?
Before we can know what to do, we first have to understand why. After birth, the pelvic floor needs time to heal, reconnect, and regain coordination. Many women are told they just need to ‘strengthen’ their pelvic floor with Kegels, and this advice can cause women to miss out on all the benefits that a holistic approach to pelvic floor health can offer them. Even after birth, the pelvic floor may already be tight, guarded, or overworked from pregnancy and birth, so just focusing on strengthening it may be missing all of the pieces of the puzzle – sometimes even worsening symptoms.
In early postpartum, we aim to gently reconnect back with your body, breath, and pelvic floor through awareness, relaxation, and gentle activation such as moving through pelvic floor contractions and relaxations. The goal is balance: learning to contract/strengthen, relax/flexibility, and coordinate the pelvic floor with your breath and core first, and eventually integrate into whole-body movement as you gradually rebuild strength, stability, and complexity
I like to think of supporting the postpartum pelvic floor in Tiers, where:
Tier 1 = nervous system regulation and body awareness
Tier 2 = breath, pelvic floor, and core connection
Tier 3 = core stability and control
Tier 4 = core and pelvic floor integration with whole-body, functional movement
Tier 5 = gradual progression with increasing whole-body demands (ie more load, volume, impact, intensity, and overall complexity)
So we learn to regulate, connect, build strength and control for stability, integrate these skills into functional movement, then progressively challenge your body. REGULATE → CONNECT → STABILIZE → INTEGRATE → PROGRESS
Jumping back into exercise and activity too quickly before your body and pelvic floor are ready can place more stress on tissues that are still healing and adapting. Building a solid foundation first – through breath, pelvic floor awareness, core coordination, strength, mobility, and gradual loading – can increase your body’s capacity to better tolerate higher-impact activities and reduce the likelihood of persistent or worsening symptoms like leaking, pressure, pain, etc
Here are the steps I like to recommend for supporting early and later postpartum pelvic floor health
Work with a pelvic floor PT/OT after birth who can assess how your unique pelvic floor is functioning in the context of your body and help address issues like leaking, pressure, pain, heaviness, prolapse, and whole-body function proactively
Engage in a pelvic-floor supportive lifestyle and daily habits. These are things like:
good breathing mechanics (ie send breath to both chest and belly and avoid consistent short, shallow chest breathing)
supportive posture & positioning (there is no perfect posture, but there are certainly less-helpful postures)
healthy bowel/bladder habits (ie knees slightly higher than hips, slight forward lean, avoid consistent bearing down/straining)
nutrient-dense nutrition (to support digestive and bowel health, as well as overall tissue healing, repair, structure, and elasticity)
stress management (for a healthy and resilient nervous system)
Rebuild through movement and exercise progression
Regulate
Reconnect
Stabilize
Integrate
Progress
How does this apply to working out and lifting to protect my pelvic floor and support leaking and other symptoms?
A simple rule to remember when lifting is to exhale during the hardest part of the exercise:
If you're squatting, inhale with a 360-degree breath as you lower down, then exhale as you drive through your feet to stand, allowing the lower abdominals to gently engage and the pelvic floor to contract naturally
If you’re doing a deadlift, inhale with a 360-degree breath then exhale with the lower abs on and pelvic floor gently contracted as you lift the weight up into standing position. Then, inhale again as you lower the weight back to the floor and repeat
If you're pushing a dumbbell overhead, exhale as you press up with the lower abs engaging and the pelvic floor lifting. Then, inhale as you return to starting position
Another rule of thumb is to continuously breathe throughout movements. We want to try to avoid consistently holding our breath and bearing down (or doing the Valsalva maneuver) as this consistent straining can lead to too much pressure on the pelvic floor and contribute to unwanted symptoms
I hope you feel more confident in understanding your pelvic floor and how it functions with the rest of your body, as well as feel more empowered in where exactly it is you need support in your rebuild journey
- Kasey