Signs Of A Weak Pelvic Floor & How To Strengthen Yours, A Urologist Explains

You don't need an anatomy degree to have a basic understanding of your body's major muscle groups. Most folks know that their biceps sit on the front of their arms, between their elbow and shoulder, and their quads make up the front of their thighs, for instance. 

It's more difficult to imagine and comprehend the pelvic floor, a group of muscles that act like a "hammock" in your pelvis to hold the bladder, urethra, vagina, rectum, and other organs in place for optimal functioning.

The health of your pelvic floor influences three major bodily functions: peeing, pooping, and experiencing pleasure, explains Fenwa Milhouse, M.D., a board-certified, fellowship-trained urologist and specialist in female pelvic medicine and reconstructive surgery.

"[The pelvic floor] is important for us to have coordinated emptying control of our bladder, to have coordinated control of our pooping, and to be able to enjoy sex," Milhouse explains. 

The key word here is "coordinated," says Milhouse. A strong pelvic floor that can fully contract is necessary to prevent incontinence, but these muscles also need to be able to relax at the appropriate time to allow you to urinate, defecate, and have pain-free penetrative sex, she says. "That coordination is more important than total strength," she adds.

As you get older, though, your pelvic floor may begin to weaken and become uncoordinated, says Milhouse. Other risk factors for pelvic floor weakness include weight gain and chronic coughing, both of which increase the pressure on the muscle group, as well as pregnancy, says Milhouse.

When the pelvic floor weakens or becomes uncoordinated, you may have trouble controlling your bladder or bowels, causing you to leak urine or stool when you're not attempting to go to the bathroom (such as when you cough, sneeze, or laugh), says Milhouse. Sex may also be painful, keeping you from orgasming from penetrative intercourse.

"I think too often our world has convinced us these symptoms are normal or are just a part of life, but sex being painful is not normal," she says. "Sneezing and losing some urine after you've had a kid, that's not normal."

You may also experience pelvic organ prolapse, says Milhouse. When the pelvic floor muscles and tissue aren’t strong enough to support your pelvic organs, they may drop or press into the vagina, according to the National Institutes of Health. The uterus and cervix, for example, can lower into the vagina and potentially pop out of the vaginal opening.

"That can manifest as, 'I feel like things are falling down through my vagina,'" says Milhouse. "You feel like a ball is just coming down—organs are actually descending, like a hernia, through the vaginal opening." Rectal prolapse can also occur, during which your rectum slips outside of your anus, she adds. 

Unless you're pregnant or recently delivered a baby, doing pelvic floor muscle training (aka Kegels) without a known issue can actually do more harm than good.

"The average individual without symptoms who's doing Kegels just because might put themselves at risk of developing a dysfunctional pelvic floor issue," says Milhouse. "Too much of a good thing can be a bad thing." Over time, for example, you may struggle to allow your pelvic floor to relax and, in turn, have trouble releasing a bowel movement or experience pain during sex. 

If you suspect your pelvic floor muscles aren't functioning properly, consider booking an appointment with a pelvic floor specialist or urogynecologist; these professionals can provide you with a personal assessment to get to the root cause of your concerns, says Milhouse. 

To support your pelvic floor, try your best to prevent straining while pooping. "That means if you're constipated, incorporate more fruits, vegetables, water, and fiber into your diet," she suggests. "Avoiding that straining goes a long way for your pelvic floor."

Folks with a confirmed pelvic floor weakness or a lack of coordination may be advised to perform Kegels. For individuals with vaginas, getting the hang of Kegels involves putting a finger in their vagina, then "[pretending] like you're holding in a fart," she says. "If you do that right, you'll feel a squeeze on your finger, like it's getting a hug." You'll hold that "hug" for three seconds, counting Mississippis, relax, and repeat for a total of 10 reps or so.