The pelvic floor consists of muscles that we can actually strengthen and relax, just like any other muscle that you exercise when working out. The difference is that in some pelvic floor dysfunction cases, the issue has to do with the lack of ability to relax. It is important to note that sometimes it is the over contraction of a muscle that makes that muscle tired, therefore weak and then there are times that the muscle in question does not get to ‘play’ as often and then gets weak for being de-conditioned. Either case needs proper attention which has to come not only in working it out but also in looking at what makes it weak. The concept behind proper pelvic floor exercises is the same for both men and women and people of all gender.


What is the Best Exercise for Pelvic Floor Dysfunction?


The best exercise is Breathing and if you think you have gotten that down, you are fully mistaken! I am not talking about all the different variations of breathing we hear these days such as:

  • Power breathing
  • Abdominal breathing
  • Etc.

We are talking about biological breathing- the breathing that all babies do authentically without being coached; the kind that we lose as adults and shared among everyone with pelvic floor dysfunction.

When studying babies ALL OVER THE WORLD, we see that they breathe in such a fashion that not only do they maximize the volume of space available to take in air but as a result of that done correctly, with every breath there is a ‘barrel’ that is created to support the skeletal structure. Why babies? Because all babies all over the world, regardless of their differences follow the same patterns of breathing and movement which is the foundation of what I do with all of my patients with pelvic floor dysfunction; you see, if we all do the same thing without being trained, automatically, then that ‘thing’ must be programmed into us and since everything in nature is in sync with each other when putting the two together, you see that the only right way to start the correction is to go back and find out where we deviate.


What is the Anatomy of Breathing?


We are programmed to breathe through our noses- not mouths. We are programmed to engage the pelvic diaphragm which is where the pelvis is located and this engagement is constant. The three diaphragms:

  • Vocal at the throat
  • Abdominal at the bottom of the chest bone
  • And pelvic at the pelvis

Are to be parallel to each other and stacked on top of each other.

posture correction


What is the Right Way to Breathe?


To put it simply, we breathe in through the nose which pushes the vocal diaphragm down and fills up the lungs; that in turn pushes the abdominal diaphragm down, increasing the inner abdominal pressure (IAP). This will move the internal organs south and toward the pelvic diaphragm and push that down which now reverses to push the abdominal diaphragm up to push the air out of the lungs. This will be accomplished by exerting an upward pressure against the vocal diaphragm and exiting the air through the nose.

When going from the abdominal to the pelvic diaphragm, most people push their chest out which is in fact incorrect. The movement in the chest should be to expand between the rib cage and not push the chest up and down which is the movement of the spine vs the diaphragm. Watch this video to see where you go wrong.

Now that you know how to breathe so you do not “feed” your pelvic floor dysfunction, you need to learn what other exercises are necessary for all types of pelvic floor dysfunctions.

What Other Exercises to do for Pelvic Floor Dysfunction?

If pelvic floor dysfunction was the name of a “book”, incontinence, sexual dysfunction, pelvic pain, tailbone pain, lower back pain, hip pain, sacroiliac pain, and poor posture are examples of some of the “chapters”. What matters is that we should not be treating the ‘floor’ when the ‘house’ is unstable and that is the mistake that I see happening when it comes to the treatment of pelvic floor dysfunction. We are looking at the site of the problem as if it exists by itself and so partial treatment only brings a temporary solution; blaming age, medical history, and looking around to see many having similar issues does not help because there are plenty of people who do NOT have that. What is the difference? Giving up and doing nothing about it only makes matters worse and changes the future of aging to something worse than it needs to be. The best exercises for pelvic floor dysfunction should include the follow traits:

  • Strengthen the Weak Body Part(s)

Don’t be all focused on the pelvic floor! After all, this is the ‘floor’ to a ‘house’ and the ‘house’ is unstable so before attending to the ‘floor’ check what is unstable about the ‘house’.

The only way to determine this is to do a functional movement assessment. Are you moving functionally or dysfunctionally? Let me clarify: if two drivers are driving from point A to B, one sober and the other intoxicated, assuming they both make it to the destination, you can see that one drives functionally and the other dysfunctionally. Just because you can move does not mean that you are moving functionally. In my practice, this assessment is performed as a part of my exam and re-assessed at every re-exam to see exactly what the progress has been.

After the right type of examination (not every physical medicine provider such as PT, DC or Physiatrist MD does the correct type of exam), chances are your hips, lower back, sacroiliac joints, and pelvis positioning have to be addressed. My go-to method of correction is Dynamic Neuromuscular Stabilization (DNS) with the video below showing an example of what the exercise looks like.

  • Involve the whole body

Your pelvic floor is not suspended in the air and is a part of your whole body, influencing and being influenced by the rest of you. Don’t treat it by itself because that does NOT work!!

The pelvic floor and pelvis are part of your body’s stabilizing system so it and the whole body (minus the arms and legs) need to be able to stabilize and stay stabilized while the arms and legs do their job. Most often, it is the legs that pick up the tab of what the pelvis does not do so when they have to do the legs’ job, the integrity of pelvis stabilization goes down. The exercises that focus on the whole body movement and stabilization are those of DNS or Dynamic Neuromuscular Stabilization which is what babies do automatically from birth till about 2-3 years of age.

If all babies follow the same patterns of movement without being coached or trained, no bands, weights, or straps are needed to go from helpless to the running toddler, then we must be programmed to move that way. The correction has to be done the same way so first find out what is going on and then correct it using DNS. I have explained this in detail on my website related to functional movement which you may want to visit now. Some of these exercises resemble yoga moves but they are not. I know for example the happy baby pose that I did for many years mechanically resembled a DNS move but sadly far from correct when done at yoga studios I have visited.

  • Incorporated into the daily routine

You have to be realistic about exercises of all kinds. If it is not incorporated into our daily routine, we will do them until the pain or symptoms obvious to you go away- then you forget. That is why I like to make the exercises into a flow of exercises I do once or twice a day on the floor and then I sprinkle my day with the ones that are more important to MY situation. When it comes to my patients, I create the exercise flow for them and come up with doubling situations with moves or poses to continue conditioning them. For instance, every time I face a counter (kitchen, bathroom, store, etc), I pay close attention to my spine to make sure it is neutral. This means that no matter what is going on in my life, I do not forget to do my exercises. Where the attention goes, the energy flows, right?

Perhaps the most important factor in treating pelvic floor dysfunction is whether or not the physical medicine provider that is treating you is too focused on the muscles of your pelvic floor or treats the ‘house’ that the pelvic floor is the ‘floor’ of. If you need help with your pelvic floor dysfunction, you can always contact me to see how to start living life the way you wish to enjoy it.

Dr. Shakib