Your Pelvic Floor’s Role in Exercise and Why You Should Care

by Dr. Shravya Kovela, PT, DPT, OCS on November 15th 2021

If you enjoy an active lifestyle — running, crossfit, weight training, or high-impact sports, you might be surprised to learn that you may be at greater risk of bladder leaks (called stress urinary incontinence or SUI). Studies show that urinary incontinence is common among women who exercise. In fact, exercising women have 3 times the risk of experiencing leaks! Other factors, such as a physically strenuous job or childbirth trauma to muscle tissue, may increase your risk of other conditions such as pelvic pain and pelvic organ prolapse.

That being said, we know there are a multitude of benefits to leading an active lifestyle. So is the answer to stop exercising? Probably not!

These conditions can occur for various reasons, but one of the contributing factors could be your pelvic floor. If you haven’t heard of the pelvic floor, or maybe you’re familiar with the term but don’t know much more than that, you’re not alone. Our society shies away from topics surrounding the pelvic floor and I’m here today to start the conversation with the PCC community!

So let’s jump into it. What is the pelvic floor anyway?

The pelvic floor is a group of muscles that connect from the pubic bone to the tailbone and from sit bone to sit bone. They create a “hammock,” “sling,” or “bowl” at the base of our pelvis. Now the important thing to remember is…these are muscles! Just like how we have muscles on our thighs to help us kick and walk or muscles in our shoulders to help us lift our arms, we have muscles in our pelvis that do…a lot.

A few of the main functions of the pelvic floor are:

• Sphincter Control: the ability to time and coordinate the opening and closing of our sphincters (including urethral and anal), that allow for the holding back and release of gas, urine, and bowel movements
• Organ Support: the supporting and lifting of our vital organs including bladder, rectum, and cervix/uterus
• Stabilization: the structural stability of our spine, pelvis, hips, and overall trunk during daily activities such as lifting, bending, twisting and recreational activities such as exercising, high-impact sport, or otherwise
• Sexual Function: the sensations we feel during sexual intimacy, ability to orgasm, or tolerance to vaginal or anal penetration
• Circulation: Just as the ankle muscles act to pump the foot up and down to help with lower leg swelling, our pelvic floor muscles also act as a way to improve circulation and lymph flow of the pelvis – if this “sump pump” action is not functioning adequately, it can contribute to swelling and congestion in the pelvis
  

Sooo yes. They do a LOT. In fact, our pelvic floor muscles are one of our four main core muscles. When we think “core”, a lot of us may think about crunches or 6-pack abs. But our core actually does so much more than that – it gives us the support and stability we need to manage forces applied to our body.

What does this mean exactly? Well, when we sneeze, cough, or laugh – we put pressure forces through our trunk (ever laughed so hard, your abs get sore?). When we lift things, we put pressure through our trunk. When we run or jump, or even get out of a chair, we put pressure through our trunk. So our core plays a vital role in supporting our trunk to do our every day activities.

The pelvic floor muscles are just one part of your core. Your other muscles in your core include your:

• Diaphragm: a dome-shaped muscle that helps you breathe with your belly and moves in conjunction with your pelvic floor muscles
  
• Lumbar Multifidus: little muscles in your back that help stabilize your spine and pelvis
  
• Transverse Abdominus: a deep corset-shaped muscle that wraps around our entire abdomen! This muscle often anticipatory in action, meaning it turns on before we do things (like a sneeze!)

Having strong and coordinated muscles is key for your body to function properly and manage the pressure that goes through your trunk with all sorts of activities. So what can you do to make sure you’re doing this?

• Exhale with exertion: your diaphragm and your pelvic floor work very closely together. If you are not breathing properly (or if you’re holding your breath) during an activity, then you are mis-managing the pressure in your trunk. This can contribute to low back pain, pelvic pain, urine leaking, or pelvic pressure. Exhaling during any exertion (for example, lifting an item off the floor or when squatting) will better distribute this pressure.

• Squeeze before you sneeze: Leaking urine with a sneeze? Cough? Laugh? Lifting? Gently squeeze your pelvic floor muscles (perform a gentle Kegel) before and as you do one of these things. Make sure you exhale throughout, if you can, and relax your muscles afterwards.
  
• Check your form: Landing hard on your feet while jumping, running, or walking can exacerbate the force , leading to things like leaking or pain. So be sure to pay attention to your how you are performing your movements.

• Advocate for yourself: Pelvic floor symptoms are never normal. If you have pain with penetration (tampon, sex, OB/gyn visit), difficulty emptying your bladder or bowels, pelvic pain (including vulvar or anal pain), urine or fecal leaking, pressure in your vaginal or rectal area, impaired sexual function, or anything else that feels…abnormal or unpleasant? You are not alone and you DO NOT have to live with it!! Seek care.

There are so many resources and options out there that can truly help improve your quality of life. If you find yourself struggling with any of the above symptoms, break the stigma about talking about pelvic health and take the first step in caring for yourself – seek help. And continue educating yourself and others on the importance of these muscles!

You can check us out at www.flytetherapy.com for additional educational content, follow us on Instagram @flytetherapy for additional pelvic health information, and listen to our free podcast Pelvic Floor At Its Core on Spotify, Google, or Apple Podcasts. You can also schedule a free consultation with a pelvic PT on our website or talk to Marissa here at PCC. She is invested in caring for the whole person and will help guide you to what is best for you based on what you need.

About the Author: Dr. Shravya Kovela, PT, DPT, OCS

Shravya is a pelvic floor physical therapist and board-certified orthopedic specialist. She is the Business Development Manager at Flyte by Pelvital, a women’s health medical device company with a product and service Flyte, clinically shown to improve by regaining pelvic floor muscle strength and tone. Shravya is passionate about increasing education and awareness about anything and everything pelvic health-related and aims to increase access to pelvic health care for all.