There are a lot of myths and misconceptions out there about pelvic floor health, from “kegels are the answer” to “stress incontinence is just what happens when you get older or give birth”. The pelvic floor is often an area that is overlooked and undervalued in medical care, even in holistic healthcare. When I went to massage school back in 2011, there was zero education on the musculature of the pelvic floor, pelvis and how this area inter functions with your core and breathing diaphragm. Even though we wouldn’t be learning to massage this area, it still seems like a key aspect of physiology to include in a program about treating soft tissue.
Pelvic floor health isn’t just a women’s issue, either. People of all orientations have a pelvic floor, the pelvic floor’s functions are the same for everyone and can be treated the same, especially in regards to movement protocols. Largely, however, women seem to be the most affected by pelvic floor and core dysfunction, mainly due to pregnancy, childbirth, hormonal changes, lack of education about female anatomy, and being disproportionately vulnerable to sexual assault.
Whether you are interested in healing a current pelvic floor imbalance, learning more about your body, or simply looking for how to work with your pelvic floor while doing what you do, this blog is for you.
Here are 5 facts about pelvic floor health that I hope brings you greater awareness of your pelvic floor and how to move towards strength and healing. At the end of this blog, I have a list of different symptoms you may experience if you have hyper or hypo tonic pelvic floor.
Structural Alignment is Key
The relationship between bones and soft tissue is very important. Soft tissue injury and tension can impact your bones’ positioning and likewise, the position of your bones can greatly impact the tensegrity of your muscles and fascia. Think of tent fabric over a frame. The fabric will be affected - taught or loose - depending on the position of the posts and beams. Equally so, if the fabric is pulled too tight or not tight enough, the stability of the posts and beams can also be compromised. Now, let’s take this analogy to your pelvic floor.
Your pelvic floor is a diaphragm. It is comprised of many bands of muscle/fascia that are suspended between the lower bony landmarks of your pelvic bowl. Your pelvic floor muscles attach front to back between pubic bone and tailbone and side to side between sits bones. Check out the image to get a visual. Your pelvis is home to 6 distinct joints that are affected by your regular movement patterns - 2 hip joints, 1 pubic joint, 2 SI joints and one sacrococcygeal joint (between sacrum and tailbone). That’s a lot of movement to stabilize and hold space for!
top view of pelvis and pelvic floor muscles. looking down into the pelvic bowl from above. If you have a hyper or hypo-tonic pelvic floor, pelvic pain, tail bone pain, stress incontinence, lower back pain, painful sex or any other type of pelvic dysfunction symptoms, it is essential to address structural alignment as part of an overall treatment plan. The positioning of your feet, knees and pelvis greatly impacts your pelvic floor. Your alignment patterns in these areas can ricochet up the body and also affect your spine, head and jaw. As you strengthen areas that help you maintain pelvic alignment, you free up your pelvic floor to function as it is meant to and take the pressure off other muscle groups that are overcompensating.
Your structural alignment is determined by your regular movement patterns. The forms you take most often become the patterns your body adheres to. For instance, if you sit all day every day for work or always tilt your head to one side while on the phone at your office, your fascia will start to adapt to fit your demands of it. Certain muscles will become strong and some weak in order to compensate, all to help you do the tasks you do most of the time. Alignment can also be impacted by acute injury and mental/emotional dispositions as well. Every body has asymmetries and movement compensation patterns. It’s simply helpful to be aware of these patterns as they can be contributing factors in sensations or joint, pelvic floor, core and other soft tissue issues you may be experiencing.
Kegels are Outdated and Not For Everyone
Kegels are often the most ‘prescribed’ exercise to address pelvic floor issues, however they are not always the most appropriate tool and can actually make issues worse for many. This is because kegel exercises focus on the contraction of pelvic floor muscles under the misperception that this will strengthen the pelvic floor muscles and therefore remedy a “weak” pelvic floor.
For most with pelvic floor dysfunction, however, the problem is not that the tissues lack tone, but that they are actually hypertonic. This means that the pelvic floor muscles are actually in a constant state of contraction and unable to release or eccentrically load. For folks with hypertonic pelvic floor, kegels can make symptoms worse. Just because a pelvic floor may be hypertonic, or high tone, doesn’t make it strong. These tissues can be tense and weak and this is what contributes to stress incontinence specifically. With hypertonic pelvic floors, there is limited mobility in the pelvic floor to handle changes in pressure in the core and breath. Learning how to release the pelvic floor and synchronize breath and core strategy will help your pelvic floor find a balanced tone.
Pelvic floors can also be hypo-tonic, the opposite of hypertonic, wherein the tissues have a hard time contracting and lack tone and feeling. In this instance, kegels can be a beneficial exercise as they help strengthen the ability of the pelvic floor muscles to contract. However, kegels should be part of a broad spectrum rehab plan. Those with hypo tonic pelvic floors also benefit from awareness of breath and core strategy while doing strengthening exercises that promote alignment in order to help the pelvic floor integrate and respond to weight bearing and pressure changes in the body. - More about this in #5!
Your Pelvic Organs Naturally Move Around; Prolapse is a Soft Tissue Issue
Like every other part of your body, your pelvis, pelvic floor and pelvic organs are part of your fascia network. Fascia lines every cell, connects all parts and systems of your body, protects your brain and spinal cord, lines your nerves, and acts as your body’s ‘universal communication network’. Fascia is a hydro-collagen rich tissue that requires fluidity to function optimally. Your fascia maintains fluidity through proper hydration and varied movement, as well as through releasing stagnancy on an emotional and mental level.
Your abdominal and pelvic organs are ‘held’ in their places by fascia; it’s like a sticky webbing. Trauma, surgery, scar tissue, pregnancy, exercise, movement habits and posture can all influence and affect your organ placement, even if only to slight degrees. Even your breathing patterns create pressure changes in your abdomen that can influence pelvic floor function and pelvic organ placement. About one third of women experience some degree of pelvic organ prolapse although prolapse is not only a women’s issue.
So what happens if you have prolapse? Prolapse is when a pelvic organ descends, tilts or becomes positioned in a way wherein it puts pressure on other organs, has compromised function or even ‘falls’ down and out of your vagina or rectum. Sometimes surgery is recommended or other tools such as pessaries which help hold organs in place, however symptoms can largely be managed with massage, exercise and core/breath strategies that mitigate intra-abdominal pressure, prioritize alignment and help to strengthen the supporting muscles and fascia.
One of the biggest triggers to prolapse symptoms is actually stress. Chronic stress is known to increase inflammation in the tissues. This inflammation affects the fluidity of fascia which then creates an environment that is more stagnant, rigid and therefore weak. If you are experiencing prolapse, know your symptoms can be managed and can even go away entirely with consistent practices and bodywork that help you to strengthen, release, align and de-stress. This takes time, but thousands have found relief through methods that prioritize alignment, fascial release, breath and core strengthening strategies.
Bulging, Bearing Down and Bracing Could be Setting You Back
My journey with pelvic floor awareness and healing began when I started experiencing symptoms after going to the gym. I knew I needed better core strength since childbirth, so I was focusing on pilates moves for the core and was also strength training. When I began getting pelvic symptoms, I dove deep into research to find out all I could about the pelvic floor in order to understand why I was experiencing what I was. From my background in bodywork, I knew in lieu of any other diagnosis, that this issue was structural and soft tissue related (as well as psycho-somatic). The main symptoms I experienced were pelvic pain, uti like symptoms and stress incontinence (which I had since the birth of my son). Moms and women especially are taught that this is all ‘normal’ and although it may be normal and widely experienced, this doesn’t mean it should be something endured without support.
As I researched and eventually found Restore Your Core - a method I’m now trained to teach - I learned that excess intra-abdominal pressure can instigate and perpetuate pelvic floor dysfunction symptoms. Excess intra-abdominal pressure is created when exercises are done that force the lower abdominals to bulge or causes the core to bear down or brace when loading weight. Excess pressure can also be created by breathing patterns that include a lot of belly movement versus rib cage movement especially while exercising. It all clicked for me and as I practiced Restore Your Core diligently, some symptoms went away immediately and others took months, but I am now totally symptom free and stronger than ever!
Exercises that force bulging in the lower abdominals include crunches, sit ups, double leg raises while laying down etc. The lower abdominals push and ‘bulge’ out, creating excess pressure, and this pressure is transferred down to your pelvic floor. Bracing is when the abdominals ‘brace’ as if you are about to get punched in the stomach and bearing down is when there is a sensation of pushing down in the lower abdominals and pelvic floor when attempting to lift a weight your core and pelvic floor aren’t equipped to handle. This excess and downward pressure on the core and pelvic floor can exacerbate prolapse symptoms, diastasis recti and bring hypertonic/hypotonic pelvic floor tissues to light.
For these reasons, exercises wherein you can’t help but bulge/bear down are contraindicated for those with prolapse, hyper/hypo tonic pelvic floor, pelvic pain, diastasis recti, interstitial cystitis and other pelvic issues that are affected by intra abdominal pressure. Thankfully, there are plenty of exercises that are pelvic floor/core friendly.
Your Pelvic floor is Meant to Respond
As mentioned above, your pelvic floor is a diaphragm - meaning it’s a series of transverse tissues that spans a gap between bony landmarks. It’s almost like a trampoline or hammock that supports your pelvis, pelvic organ functioning, childbirth etc. Just as your breathing diaphragm raises and lowers when you inhale and exhale, your pelvic diaphragm is also meant to respond in this way. An ideally functioning pelvic floor is meant to lift on an exhale and lower on an inhale. This movement may be imperceptible as it is largely responsive and not an ‘active’ or conscious movement per se.
This is important to know about the pelvic floor, because this implies that it isn’t a muscle group that you would isolate in order to strengthen (unless you are hypo-tonic in which case some targeted exercises like kegels can be helpful). Restoring strength to the pelvic floor is about restoring its functioning as a responsive, reflexive support structure. If you have hyper or hypo tonic pelvic floor symptoms, this indicates that the pelvic floor is ‘stuck’ and cannot fully respond to pressure changes and is weak to one degree or the other - either weak in concentric contraction or eccentric loading.
Here’s the difference: concentric contractions are when you do a bicep curl with a weight. Your bicep is squeezed, or contracted, as you flex. Eccentric loading is like if you held a weight in an outstretched arm. Nothing is flexed or contracted, the muscles are being strengthened at their long range.
Your pelvic floor needs to be able to contract and release (eccentrically load) in order to function optimally and be truly strong. The best way to retrain the pelvic floor to be responsive is to use breathing techniques that help engage the lower abdominals while performing exercises that help the pelvic floor bear weight concentrically and eccentrically - slowly over time.
Your body is incredible and is so genius at finding ways to compensate, pulling strength and stability from adjacent areas when others are weak or compromised. This is often what happens with pelvic floor dysfunction. Your hips, lower back and SI joints often bear the brunt of a compromised pelvic floor, core and pelvic alignment. One of the other most common areas I see affected by pelvic floor and pelvic misalignment is the jaw and neck. TMJ is a painful issue I see many mothers develop postpartum and there is a big connection between the pelvis, pelvic floor, alignment, stress, self expression and the jaw.
Other modalities that can be helpful include internal pelvic work, vaginal steaming, meditation and abdominal massage/cranial sacral therapy. There is a big nervous system component when working with pelvic floor issues - it is a sensitive, intimate area that is greatly affected by stress and nervous system deregulation.
Movement is always medicine, however, and in between any bodywork sessions I always advise you do what you can at home to work with alignment, fascia health, strength and mobility to set yourself up for success.
If you are interested in learning more about your own compensation patterns, looking to build strength and heal pelvic floor and core imbalances, I recommend checking out my Restore Your Core 1:1 pelvic/core alignment assessments. Awareness is step 1, and together we will explore what pelvic alignment feels like, you’ll learn a breathing strategy to bring your pelvic floor along for the ride and receive tailored exercises to help you build strength, remedy compensation patterns and heal.
Also stay tuned for group Restore Your Core series classes coming late Spring 2025!
BONUS!
Some symptoms you may experience with hyper or hypo tonic pelvic floor.
Hypertonic:
-pelvic pain
-uti like sensations - burning, tingling, aching in bladder/urethra area
-tailbone pain
-butt gripping/tension
-painful sex
-constipation, inability to release
-vaginismus/vulvadynia
-the area feels 'tight' or 'tense'
-stress incontinence or urgency
-low back and hip tension
Hypotonic:
-unable to contract muscles
-feeling of 'looseness'
-lack of sensation in pelvic floor
-leaking/incontinence
-kegels seem to help
-low back/hip discomfort or limited mobility
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