Why Should I Care About My Pelvic Floor?

And what does Pilates have to do with it?

What Is The Pelvic Floor?

Maybe you have heard about the pelvic floor, maybe not. And even if you have heard about it, are you REALLY sure what it does? If you’re not, don’t worry - most people don’t. Even when I was starting out as a fledgling Pilates instructor, I still had a vague notion of the importance of the pelvic floor. I knew that we talked about it a lot, and I knew we told people to engage it with each Pilates breath. But the why was more vague.

It wasn’t until I went more in-depth with my Pilates training that I really started to grasp how important this little group of muscles can be to our health and our quality of life.

So let’s dive in, and ask ourselves: What the heck is the pelvic floor, anyway?

The pelvic floor is a group of muscles located at the bottom of the pelvis, right where you sit. There are 14 different muscles that make up the pelvic floor, so it is actually quite a complex structure. For these muscles to do what they are supposed to do, the have to be both strong and supple.

The main function of the pelvic floor is basically to hold all of our organs inside our bodies. Seems pretty important, right? There are two other vital functions that these muscles perform. The first is to control the flow of your pee, poop, and gas. The second, and very important in regards to pregnant and postnatal women, is that the pelvic floor muscles must stretch a lot to allow the baby to pass through the pelvis during a vaginal birth. Thus, it is normal and expected for the pelvic floor to be stretched and weakened after pregnancy and birth.

Pelvic Floor, Pregnancy, and Postnatal

As we saw earlier, the pelvic floor is responsible for keeping our organs where we want them - inside our bodies. So for all people there is a certain amount of weight pressing down on those muscles, and they have to do a certain amount of constant work to keep everything functioning well.

During pregnancy, the weight that these muscles have to bear increases dramatically. The uterus starts out weighing about a sixth of a pound before pregnancy. By the end of pregnancy the uterus, extra fluids, and baby can weigh as much as 14.5-17.5 pounds! That’s an extra 14-17 pounds for your pelvic floor to have to hold up, all the time.

With that constant extra load, it’s no wonder that the pelvic floor can become weakened during pregnancy. Add to that the fact that these muscles must stretch a great deal to allow the baby to pass through the birth canal and out into the world, and it is clear that the pelvic floor is stretched to its limit during this exciting and magical time.

Now, our amazing bodies are built to help us through the process of pregnancy, labor, and delivery. BUT if we return too quickly to high-impact exercise, have had a particularly difficult birth, or just have poor luck, our pelvic floor muscles can end up either too weak or too tight, which will lead to problems down the road.

Why Does It Matter?

What kind of problems, you ask? Some of the most common pelvic floor dysfunctions that can happen as a result of an improperly conditioned muscle group are incontinence (peeing a little when you cough, run, jump, etc), pain with sex, pelvic organ prolapse (when your organs start to slip down from their normal position, sometimes even slipping out of the body), and chronic pain. These issues can significantly impact your quality of life and may lead to embarrassment and discomfort.

I have heard from many women (even Pilates instructors!) that after having kids, peeing a little when you run or jump is “just a part of life.”

This. Is. Wrong.

Incontinence is a symptom of pelvic floor dysfunction, and it can be fixed! There is absolutely no need to assume that you’ll have to deal with “a little leaking” for the rest of your life, just because you are pregnant or have had a baby in the past.

So… I Just Have To Do Kegels, Right?

If you have heard of the pelvic floor, it was probably in relation to Kegels, where you repeatedly squeeze the pelvic floor muscles. Kegels are often touted as the go-to pelvic floor exercise, but they're not the only solution, nor are they suitable for everyone.

Remember when I said the pelvic floor needs to be both strong and supple? Kegels are great for tightening the pelvic floor, but they don’t help to create flexibility. In some cases, overdoing Kegels may even lead to an overly tight pelvic floor, causing more harm than good. The key is to find a balanced approach to pelvic floor conditioning that addresses both strength and flexibility.

Even if you don’t have pelvic floor dysfunction, it is important to stretch these important muscles, as well as strengthen them. It’s also important to understand how to release the pelvic floor after you tighten it. A healthy and balanced pelvic floor is important for everyone, but it is especially important if you are thinking about becoming pregnant, you are pregnant, or if you have been pregnant in the past. Like we saw earlier, these muscles are extremely challenged during pregnancy and birth. The good news is that a few simple exercises can help the pelvic floor to prepare for, and to recover from, this period in your life.

How Can Pilates Help Condition The Pelvic Floor?

First, let’s say that if you do feel like you have some sort of pelvic floor dysfunction, it’s a great idea to go to a pelvic health Physical Therapist. They can examine you and determine whether the problem comes from a pelvic floor that is too loose, or one that is overly tight. Pilates instructors cannot diagnose what is wrong as part of our scope of practice, but we can help to resolve the problem once we know what it is!

In Pilates, we focus on core strength, breath control, and precise movement, all of which contribute to a healthy pelvic floor. Pilates can teach you how to feel your pelvic floor, how to contract your pelvic floor, and how to release your pelvic floor. As a bonus, the breathing that accompanies every Pilates exercise will naturally integrate pelvic floor engagement, providing a balanced approach that goes well beyond traditional Kegels.

There are also specific stretching exercises that are used in perinatal Pilates to create suppleness in the pelvic floor that is so crucial throughout the perinatal period.

Pilates emphasizes whole-body health. By strengthening and lengthening the core and surrounding muscles, learning to move efficiently, and finding your best alignment, your body will be best able to support the pelvic floor.

There are several peer-reviewed articles that demonstrate the benefits of Pilates for strengthening the pelvic floor and avoiding incontinence and injury. A 2023 study by Urer, et all., found that prenatal Pilates reduced the incidence of incontinence in the postnatal period. A 2021 study by Feria-Ramirez, et al., found that prenatal Pilates significantly reduced the risk of pelvic floor injury during birth. Another study from 2016 by Gomi, et al., found that Pilates improves pelvic floor muscle function, along with a host of other benefits for pregnant women.

So. Why Should You Care About Your Pelvic Floor?

Although it is often overlooked, the pelvic floor is an essential part of our overall health. When we understand more about how it works and what we can do to keep it healthy, we can set ourselves up for success during pregnancy, after birth, and in everyday life! If you do have a problem resulting from pelvic floor dysfunction, don’t worry! Your pelvic floor is resilient, just like the rest of your body.

There is no need to think that you have to deal with leaking, pain, or excessive pelvic pressure for the rest of your life. If you take steps to regain a strong and supple set of muscles, you can return to normal, healthy function! Even if you feel like things are fine down there, working to maintain a healthy pelvic floor is essential for overall health. If you start to take care of it now, your body will thank you later!

Remember. YOU have the power to thrive.

Want to learn more? Contact Shauna Grasso of Bump to Baby Pilates - shauna@bumptobabypilates.com.

Shauna Grasso is a Nationally Certified Pilates Teacher and Perinatal Pilates Specialist. She has been teaching Pilates since 2014 and is constantly amazed by the power of Pilates and the resiliency of the human body. She lives in the Nevada mountains with her husband, their dog, and their two beautiful children.

References

Urer, E., Ozen, N., & Terzioglu, F. (2023). Effect of pilates performed during pregnancy on postpartum stress urinary incontinence in primipara women. Journal of Bodywork and Movement Therapies. https://doi.org/10.1016/j.jbmt.2023.04.022

Feria-Ramírez, C., Gonzalez-Sanz, J. D., Molina-Luque, R., & Molina-Recio, G. (2021). The effects of the pilates method on pelvic floor injuries during pregnancy and childbirth: A quasi-experimental study. International Journal of Environmental Research and Public Health, 18(13), 6995. https://doi.org/10.3390/ijerph18136995

Gomi, et al (2016). Effect of Pilates on pregnant women's posture, lumbar and abdominal muscle thickness, and pelvic floor muscle strength. Journal of Physical Therapy Science, 28(5), 1669-1673