Pelvic floor exercises in women are not different from pelvic floor exercises in men, however, people with a vagina vs a penis may experience the dysfunction in the pelvic floor differently. For instance, the dysfunction can lead to incontinence which may be more complicated in men given that for instance their urethra runs through the prostate and is much longer with more chances of issues along the longer path!

In order to understand the exercises for pelvic floor in women, we first need to learn the anatomy of the area but I promise to make it short and relateable.

Anatomy of the Pelvic Floor

The pelvic floor, unlike what most people think, is more than the area where the vagina or penis, anus, and the tissue in between is. The pelvic floor involves the inner lining of the pelvic inlet as well. The pelvic inlet is like a 3-piece-bowl and these muscles line the bowl holding the bladder, uterus, ovaries, and intestine which can get ‘squished’ or compressed by the pressure coming from above. This pressure is influenced by our breathing, posture (and postural distortion), spinal abnormalities such as Scoliosis, Pectus Excavatum (pushed in chest), and Pectus Carniatum (pushed out chest).

Since the bowl has 3 pieces that meet as 2 joints in the back forming the Sacro-iliac joints (or SI joint between Sacrum and Ilium), and in the front to form the Pubic Symphysis or the pubic bone, the alignment and health of these joints play a role and in women, because of pregnancy and childbirth, they can get compromised.

Pelvis bones (courtesy of https://orthoinfo.aaos.org/)

The hips form a joint with the Acetabulum or Socket, and the lower back sits on top of the pelvis; their direct attachment to the ‘bowl’, and the impact of the lower portion of the mid-back on the lower back directly influences the integrity of the alignment of the bowl. If you are thinking that the pelvic floor is unstable and weak, that is not true by any means. The joints are reinforced by an intricate network of connective tissue and the flexibility of these joints is quite strong so you should look at it like an earthquake-resistant building that can withstand quite a bit but the building should be inspected after each jolt and if minor fixings are taken care of, it will be well prepared for the next jolt.

Pelvis and Earthquake

Exercises to Strengthen the Pelvic Floor

To summarize what was discussed above, the following areas need to be focused on when it comes to all issues related to the pelvic floor; that means that even if no exercise is going to help and surgery is needed, these exercises have to be done following the surgery in order to give the strength and integrity back to the pelvic floor.

• Breathing
• Lower Mid-Back Exercise
• Lower Back Exercise
• Sacroiliac Exercise
• Hip Stability and Movement Exercise
• Kegel Exercise

Breathing and Pelvic Floor

There are different types and styles of breathing that we are familiar with or heard of, but when it comes to the ‘true’ breathing, what makes sense is to look at children- newborn to toddler stage specifically- to see how they innately breathe. Given that all children on this planet essentially breathe the same way, that must be the way we are programmed to breathe, what our breathing software must be.

The video below explains it all.

Lower Mid-Back and Pelvic Floor

When people think of the pelvic floor, they almost never look at the mid-back because we tend to be tunnel-visioned! Let’s explore the mid-back and pelvic floor for a moment. The pelvic floor, as explained above, is the inner lining of the pelvis and while the mid-back is not directly connected to the pelvis, it is directly involved in breathing and directly influences the state of the lower back which is connected to the pelvis.

The mid-back area gets quite burdened by our sedentary lifestyle of sitting and posturally speaking, most people have some sort of postural dysfunction in their middle back, either with a hunch back or military chest (chest sticking out). It is easy to not pay attention to the mid-back when addressing the pelvic floor but this lack of attention becomes problematic down the road.

Mid-back, Breathing, Posture and Lower back

Lower Back Pain and Pelvic Floor

Other than the obvious directly bony correlation of the lower back and pelvis, the connective tissue, and muscular system connecting the lower back and pelvis is quite complex. The stability (or lack of) of the lower back or lumbar region and pelvis go both ways so not only, for instance, the postural presentation of your lower back impacts the pelvis alignment and posture but also how neutral your pelvis is, influences what the lower back region has to manage.

An arched lower back for instance goes hand-in-hand with the so-called anterior tilt of the pelvis which then takes away the neutral or balanced leveling of the pelvis where the pelvic floor resides.

Connective Tissue interdigitation

Sacroiliac Joint and Pelvic Floor

As explained earlier, the Sacroiliac joint (SIJ) consists of the ileum and sacrum. If you run your hands to down both sides of the back of your pelvis and bend forward, the area where you feel movement under your hands is the SIJ. The sacroiliac joint is directly involved in walking, sitting, and all movements of our pelvis. An intricate lattice of connective tissues keeps it together and connects different parts of the bones involved in this joint to other parts in the vicinity and yes, every single one of those connections has value in keeping the stability. In my blog on the role of Coccyx (tail bone) on the pelvic floor, you learn how some providers disregard the impact of the tailbone in the health on the pelvic floor, and in cases of mismanaged pain, some people resort to its removal.

The two specific muscles, Obturator Internus and Piriformis, specifically are the muscles of the pelvic floor that need to be addressed. While Obturator Internus can be accessed both internally and externally, the piriformis muscle is only available externally. The great news about all of the muscles that impact the pelvic floor is all of them can be strengthened and stretched through the Developmental Kinesiology (DNS) exercises that will be discussed later on in this blog.

Pelvis ligament courtesy of drlaurenkeller.com

Hip Joints and Pelvic Floor

When it comes to the hip joint(s) and the pelvic floor, most people think they don’t have any pain in their hips or don’t recall any injuries so to them, addressing the hip joint(s) is not their issue. With all pelvic floor weakness, hip joints, as well as all that is mentioned above, have to be addressed.

The pelvic floor is like a hammock and is not free-floating. The hip joints are directly in contact with the hip sockets that are a part of the pelvis where the pelvic muscles line. When it comes to pelvic floor dysfunction, my exam always includes functional mobility assessment of the hips, pelvis, and lower back areas. It is hard to make the floor strong when the attachments pull, push, and tweak the structure that made up the floor.

Hip stability exercises are a must-do and hardly ever get done by people with a weak pelvic floor. If you are thinking that you need to go to a gym or start doing yoga to address them, you are mistaken. Yoga when done correctly does marvels, however, I see more yoga-gone-bad when people don’t understand the requirements and simply mechanically duplicate what the yoga instructor does. Here is an example of what I am talking about.

Kegel Exercise and Pelvic Floor

Kegel exercises done by yourself or with the help of a pelvic floor therapist (physical therapist, chiropractor, nurse, or medical doctor) focuses primarily on a specific part of the pelvic floor and frankly can be evaluated by the astute therapist as far as the practitioner is able to feel with the index finger internally. What if we could have a device that is designed to scientifically contract the WHOLE pelvic floor muscles?

Thankfully BTL Emsella is an FDA-approved incontinence machine that provides 400 Kegels per minute which at our clinic we use for almost all pelvic floor dysfunction cases. You can learn about the Emsella chair on the website or read the blog on Kegel exercise and see if it is right for you.

The Best Exercise for Weak Pelvic Floor and Its’ Influencers

The best exercise type is what we all do automatically as helpless infants, going through different stages of movement to become the never-resting toddlers. In fact, that is exactly when the best conditioning and strengthening exercises we have ever done take place.

We are talking about Dynamic Neuromuscular Stabilization (DNS) exercises which are essentially doing movement exercises with mindfulness. While the video below explains it more, I suggest you visit my Youtube video on the channel that focuses on the Neurology behind posture (postural neurology) and functional movement.

If after having read all this blog has discussed and suggested for you to look into, you need help, don’t hesitate to contact me with your questions or schedule a one-on-one session to explore your situation.

Dr. Shakib