The pelvic floor may be the most neglected and underrated part of our anatomy—on the level of the pinkie toe or the back of the knee. But for sheer impact on our quality of life, we neglect the pelvic floor to our peril. Those muscles play a critical role in everyday function, like bladder and bowel control, orgasm, and keeping our organs where they belong.
Ergo, not a good idea to neglect the pelvic floor.
Maybe you noticed that you had less urinary control after the birth of a child. Maybe you noticed a slackening of the “vaginal embrace” during sex. Maybe lately you’re even feeling like you’re sitting on a stone “down there” or have a little bulging protrusion in your vagina. Maybe you have to urinate more often or you get more urinary tract infections. Maybe sex is more painful.
Did I mention it’s not a good idea to neglect the pelvic floor muscles?
The pelvic floor is like a sling that runs from our pubic bone in front to our tailbone in back and to our hip bones on either side. (Or—as one doctor put it: once, it was like a trampoline; now, it’s like a hammock.) It performs a fancy figure eight around the vagina, urethra, and anus, controlling, supporting, and maintaining good function in those unsung and important areas.
But it’s also a deep muscle that works in tandem with other muscles in the back and abdomen. And all these muscles have to be balanced and working harmoniously for us to be pain-free and without uncomfortable symptoms, such as that bulge that signals a uterine prolapse or that tendency to “laugh and leak.”
This is because the pelvic floor is subjected to unique demands compared to other body parts. It literally holds our organs in place, so pressure from childbirth, obesity, trauma, heavy lifting, even hard coughing, and, of course, simply getting older, can weaken the muscle and cause things to sag over time.
Further, as we lose estrogen during menopause, this muscle tends to lose tone. And since the pelvic floor surrounds the vagina, its ability to help out with orgasm and that nice, firm vaginal embrace is compromised, too. Darn it.
The crazy thing is that about half of women will experience some level of incontinence or prolapse in the course of a lifetime often without saying a word, sometimes for decades. Surgical procedures, in addition to carrying all the risks of major surgeries, are controversial and without good long-term outcomes. One-third of women who have had surgery for incontinence return for a second surgery.
Now, you could have surgery to fix incontinence or prolapse. But why not start with a safe, simple approach? Like maintaining a healthy weight. Like not smoking. Like exercise.
Like kegels. (You knew I was going there.)
Regularly exercising and toning your pelvic floor with kegel exercises is cheap, noninvasive, and incredibly effective in reversing the symptoms of incontinence and prolapse. Plus, a well-toned pelvic floor will have better blood flow and nerve pathways, which amounts to more sensation, stronger orgasm, and a nice, firm vaginal embrace.
The tricky part is to exercise the right muscles. You shouldn’t be tightening the abdomen or the buttocks. You shouldn’t be holding your breath. Our website has a little primer for correctly doing kegels. Kegel exercise tools, such as vaginal weights, may also help because you have to exercise the right muscles to hold them in place.
There are even some smart-phone apps to help you with the regimen. (You know it’s gone mainstream when there’s an app.)
First, discuss your symptoms with your doctor to make sure there aren’t any complicating issues involved. And then… start kegeling!
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.