The Goods

The pelvic floor: Where is it, when to worry and how to work it

Pelvic health physiotherapist Julia Di Paolo explains how these muscles are key to your health and wellbeing.

Pelvic health physiotherapist Julia Di Paolo explains how these muscles are key to your health and wellbeing.

(Credit: iStock/Getty Images)

Most of us don't even know what our pelvic floor is, let alone how to take care of it. In fact, 1 in 3 women suffer from a pelvic floor disorder, and of those that are attempting to exercise this overlooked part of the body, almost 80% are not doing the exercises correctly. Thankfully, more knowledge and proper instruction can go a long way toward improving this common issue. So pelvic health physiotherapist Julia Di Paolo stopped by The Goods to break down the details and explain why we all need to pay more attention to our pelvic floors.

The pelvic floor has 5 really important functions.

  • It stabilizes and controls the pelvis.
  • Supports the organs (which is super important when we start to talk about pelvic organ prolapse).
  • Keeps you continent (so that no urine leaks).
  • Has a sexual role (in both men and women).
  • Acts as a sump pump through breathing.

So to do all of that, the muscles need strength, endurance, timing, control and coordination. And that takes effort!

Where it is

The pelvic floor starts around the pubic bone, comes around the urethra, vagina and anus, and then spreads out to the sitz bones, the bones in your lower bottom that you'll feel touching a chair when you're sitting.

When to worry

It's time to visit your health care provider if you experience things like constipation, or pain that doesn't go away in the lower back, hips, pelvis and genital and rectal area. A feeling that something isn't right down there is reason enough to get checked out. People might also experience pelvic muscle spasms, a frequent or urgent need need to urinate, painful intercourse, including anxiety or fear of pain with penetration, urine retention, a sensation of pressure in the vagina or rectum or feeling a bulge at the opening of the vagina. Having trouble with tampons falling out or not being able to insert them could also be a sign of poor pelvic health and Julia recommends seeking help in those instances.

Who's at risk

Anyone who has given birth is at risk, and the more children you have, the greater the risk. But men are also prone to this. People who are overweight, lift heavy objects often, have had abdominal or pelvic surgeries, or are even elite athletes can all experience pelvic floor dysfunction, as well. Your genes can also have a significant effect, but poor posture and alignment can also be to blame.

Mom's don't have to suffer

A lot of people believe that it's normal to pee a little when you cough or sneeze after childbirth. Julia says that that can be fine for a couple of weeks immediately postpartum, but that's it. If it's not cured by 12 weeks, you have a 92% chance of still having it five years later. Approximately 30% of women will have stress urinary incontinence after birth and that number goes up to 45% after 5 to 7 years. So yes, you can develop this condition as time goes on.

The good news is that the cure rate is 80% with pelvic physio. Experts examine those muscles internally to find out what's wrong and help you to do your exercises correctly. Luckily, once you treat the cause, it goes away. But it won't go away without proper treatment.

How to work it

The first thing you want to do is find the right muscles. Place your hands on the sides of your hips and find the bone on either side that sticks out. Apply pressure. Alternatively, you can also apply pressure with two fingers on your tailbone if you'd like to get even closer to your pelvic floor. Or apply pressure on your perineum by sitting directly on your palm.

Since it's such a difficult area to target, Julia recommends visualizing picking up a small object, such as a blueberry. Now breathe in. You'll feel your sitz bones go wide, and your tailbone or perineum will drop into your fingers, and your pelvic floor with lengthen. On the exhale, pick up an imaginary 'blueberry' and firmly draw it up and into your body with your vagina. Draw the 'blueberry' into your body and then put it down.

Once you have learned how to find your pelvic floor, you need to learn how to use it in real life. So, starting from standing, inhale as you go down into a squatting position. Exhale as you pick up the 'blueberry' and return to a standing position. Repeat. Try to do this when you stand up out of a chair. Ideally, this action will become automatic without you having to think and breathe through it; in general, you'll feel results in about six to eight weeks.

This exercise might be tricky if your pelvic floor is already tight. You're not going to go to the gym with tight shoulders and try shoulder raises – instead you're going to relax and do something like yoga to ease that tension. So you first want to release the floor. Don't pick up 'blueberries' until your floor is totally released and relaxed. Then you can start picking them up, but if you can't put them back down again, you need more practice.

If you're planning on becoming pregnant, it's best to do these exercises before and after having the baby. And realistically, you should get assessed to find out if you're doing the exercises correctly. But it's never too late to fix your pelvic floor. Julia has cured patients that are well into their 80s, so no one has any excuses not to exercise those muscles.

Prolapse problems

Cystocele prolapse occurs when the organs start to descend into the vagina, creating a bulge. Some people notice a feeling of heaviness or that something isn't quite right.

It can take 20 to 30 years to develop and some people are asymptomatic in the early stages, but this is also when pelvic physio can make the biggest difference.

There are several degrees of prolapse and 50% of women over 50 will have a prolapse. Grade one isn't a huge issue, but it's when professionals prefer to treat because they're easy to fix. Grade two comes about halfway down, and professionals can really improve them without too much worry. Grade three prolapse means that you can feel the bulge when you're wiping, but in grade four the organs are actually out of the body and surgery is required.

Managing pressure is an effective way to help prevent prolapse. So when you're working out or lifting, don't bear down every time. Instead, pick up your 'blueberries' when picking up the groceries or other tasks. Constipation is another contributing factor because it causes you to bear down, so eat healthy, drink lots of water, and avoid things that you know constipate you because everyone is unique.

That's a lot of information, so to keep it simple, here's a handy checklist of three things you should do to take care of your pelvic floor:

1) Get assessed by a professional.

2) Integrate your pelvic floor into your daily activities.

3) Tell everyone you know!