Pelvic floor health is a vital part of every woman’s overall well-being, whether postpartum, premenopausal, or even if she has never had children. The pelvic floor is responsible for supporting several essential functions, including bladder control, sexual health, and core stability. When the pelvic floor muscles become weak, overly tight, or uncoordinated, women can experience issues like incontinence, prolapse, or pain during sex. In this guide, we’ll explore pelvic floor health across different stages of life, provide insight into common issues, and offer strategies to strengthen and relax these muscles, emphasizing a holistic approach to treatment.

Common Pelvic Floor Issues

• Incontinence: Involuntary leakage of urine during activities like sneezing, coughing, or exercise.
• Prolapse: The descent of pelvic organs into or outside of the vaginal canal, causing discomfort, pressure, and potential bladder issues.
• Pelvic Pain: Pain during intercourse, menstruation, or general pelvic discomfort, often linked to overly tight or dysfunctional pelvic floor muscles.
• Bladder Frequency or Urgency: The frequent or urgent need to urinate, even if the bladder is not full.

These symptoms often arise from pelvic floor dysfunction, which can be linked to pregnancy, childbirth, hormonal changes, or even stress. However, pelvic floor issues are not limited to postpartum women—many women who haven’t had children experience similar problems due to lifestyle factors, injuries, or improper muscle coordination.

Pelvic Floor Muscle Tension: The Hidden Cause

At our clinic, we’ve found that the majority of women initially present with over-tight pelvic floor muscles. These muscles are in a chronic state of contraction, which leads to issues like bladder frequency, incontinence, painful sex, and even prolapse. Rather than focusing on strengthening these muscles through repetitive contractions like Kegels, the first goal is to release tension and reconnect with proper breath patterns.

When the pelvic floor is constantly contracted, it loses the ability to fully relax and coordinate with the diaphragm and abdominal muscles, creating a host of symptoms. Teaching the body to soften and lengthen these muscles is the key to resetting the system and establishing healthy function.

Breath and Core Connection: The First Step

The pelvic floor is part of the deep core system, which includes the diaphragm, abdominal muscles, and pelvic floor. These muscles should work in harmony, softening on the inhale and drawing upward on the exhale. However, many women have lost this natural coordination due to over-tightness or poor muscle patterning.

How to Reconnect with Your Breath:

1. Start with Breath Awareness: Lie on your back with your knees bent. As you inhale, feel your belly and pelvic floor soften and expand. As you exhale, feel the pelvic floor lift gently as your deep core draws in and upward.
2. Avoid Repetitive Contractions: Instead of focusing on tightening the pelvic floor (Kegels), concentrate on the relaxation and the full expansion of the breath. Learning to soften the muscles with each inhale is critical to restoring proper function.

Regaining Healthy Muscle Patterning

Once you’ve begun reconnecting with your breath and understanding the lengthening of the pelvic floor, the next step is to regain healthy muscle patterning. The deep core muscles need to work together as a team to manage pressure and support movement.

A common observation in our clinic is that many clients struggle to coordinate their deep core muscles while lying on their backs. This position often makes it harder for the diaphragm, abdominals, and pelvic floor to work in harmony. However, when shifting into positions like side-lying or hands and knees, the deep core muscles naturally coordinate better.

Self-Assessment Techniques:

• Balloon Blow Test (Back Lying): Lie on your back and try blowing up a balloon. Observe whether your belly bulges out or in and if your pelvic floor bulges or draws in. Ideally, the belly should draw inward, and the pelvic floor should lift up.
• Balloon Blow Test (Hands and Knees): Repeat the same test in a hands-and-knees position and observe the difference. You may find that your deep core muscles coordinate better in this position.
• Cough or Throat Clear Test: If both balloon blow tests are difficult, try a softer demand by simply clearing your throat while on hands and knees. You should feel your belly lift slightly toward your spine as the core engages.

Find Your Best Starting Position:

The position where you feel your deep core muscles connecting most effectively is where you

should begin practicing. For many women, this may be in side-lying or hands and knees. Start here and work on coordinating your breath with your pelvic floor and core. Over time, you can progress to more challenging positions, such as sitting or lying on your back.

Increasing Intensity: Progress with Purpose

As you become more comfortable with deep core coordination, it’s time to gradually increase the challenge to further strengthen your pelvic floor and core system. Here’s how to progress:

• Balloon Resistance: Start by blowing through a balloon with a small slit cut at the end for added resistance. This helps strengthen the coordination of your breath and core, while increasing the demand on your pelvic floor.
• Blow Up an Intact Balloon: Once you’re comfortable with the slit balloon, try blowing up an intact balloon. This adds much more resistance, making it an excellent way to assess how well your deep core engages with increased demand. Try this in various postures, such as sitting, standing, or on hands and knees, to see how your core responds in different positions.
• Back Lying Retest: After practicing in different positions, return to lying on your back and attempt to blow up the intact balloon. This is a great way to reassess both your core patterning and strength. If your belly draws inward and your pelvic floor lifts as you exhale, you’re locking in the proper patterning.
• Increasing Intensity with Breath Coordination: Once you can blow up the balloon in various postures, increase the intensity by practicing more forceful coughs or quicker throat clears while maintaining control of your deep core muscles.
• Challenge with Hip Strength Work: As your deep core patterning becomes stronger, introduce hip strengthening exercises such as:
• Hip hinges
• Deadlifts
• Lateral lunges
• Squats
• Lunges
• Side-lying leg lifts

Strong hips provide additional support for your pelvic floor and overall core stability, ensuring a well-rounded and functional core strength program.

The Whole-Body Approach

It’s essential to remember that your pelvic floor and deep core are part of a larger system. A skilled pelvic floor physical therapist can assess your body as a whole and address contributing factors that may be affecting your pelvic health. This holistic approach ensures that your pelvic floor is supported by the rest of your body.

Treatments often include hands-on therapy to release areas of excess tension in the back, hips, legs, feet, and even the upper back and neck. By addressing these tension points, we create more balance and alignment throughout the body, which supports pelvic floor function. Additionally, we develop a personalized home program for you, incorporating exercises and practices that help maintain progress between sessions.

Lifestyle modifications are also a key part of treatment. Your pelvic health is connected to your overall health, so we may discuss nutrition changes or adjustments to daily habits that can further support your healing process. This could include adding magnesium-rich foods, improving hydration, or managing stress to reduce tension in the pelvic floor.

Conclusion: Restore, Strengthen, and Thrive

Understanding and strengthening the pelvic floor is a journey that requires attention to both relaxation and strengthening. While Kegels can play a role, focusing first on releasing tension, coordinating your deep core, and retraining your muscle patterns is key to long-term pelvic health. Whether you’re postpartum or have never had children, investing in pelvic floor health will not only improve symptoms like incontinence or pain but will also enhance your overall well-being. A skilled pelvic floor physical therapist can guide you through this process, helping you restore balance and strength to your entire body.