Pelvic Floor Health: What It Is, Does, and How To Strengthen Your Pelvic Floor
Authors: Therabody Scientists: Michelle Darian, MS, MPH, RD, LDN; Tim Roberts, MSc; Rachelle Reed, PhD, MS, ACSM-EP
Expert contributors: Dr. Brittany Leboeuf, MS, PhD; Dr. Kristen Lettenberger, PT, DPT, CSCS
You probably haven't given much thought to the muscles that keep your core stable during a strength workout, or the coordinated effort it takes to sneeze without any surprise leaks. Until they’re no longer supportive or an accident happens.
These daily functions rely on your pelvic floor — a group of muscles that work tirelessly behind the scenes to support your core and control how your body functions.
Pelvic floor dysfunction is surprisingly common, affecting nearly 1 in 3 women and 1 in 6 men. [1, 2]
A reported 83% of women experienced at least one pelvic health symptom in the past year, impacting their quality of life. [3, 4]
Understanding what your pelvic floor is and does, recognizing when something's off and it's time to reach out to your provider, and knowing how to strengthen these muscles, can improve your daily comfort and confidence.
What is the pelvic floor?
Your pelvic floor is a group of muscles, ligaments, and connective tissue at the base of your core. It’s home to the bladder, urethra, vagina (in females), prostate (in males) rectum, and other organs. The pelvic muscles are the support structure that holds everything in place. [5]
What does your pelvic floor do?
Your pelvic floor works around the clock. “The pelvic floor is at work all day to keep us upright while sitting, gently contracting to support our organs,” says Dr. Kristen Lettenberger, PT, DPT, CSCS.
It’s responsible for the coordinated control of urinating, bowel movements, and experiencing pleasure.
Like other muscles, healthy pelvic floor muscles can contract and relax, and they have a range of motion. You can voluntarily squeeze (contract) these muscles, like when you’re holding in your pee, and release (relax) them, like when you’re going to the bathroom.
The pelvic floor serves several purposes throughout the body. “It helps support our pelvic organs, aids in the stability of our pelvis, provides sexual function, sphincteric control to keep us continent, and helps move fluid from our lower limbs back to our heart,” explains Dr. Lettenberger.
Despite its importance, you likely don’t notice your pelvic floor’s influence until something goes wrong.
What is pelvic floor dysfunction?
A weak or tight pelvic floor can lead to pelvic floor dysfunction, a condition where you can't coordinate the relaxation and contraction of your pelvic floor muscles.
“Think of your torso as a box, and your pelvic floor is the bottom. If the box has a weak or “soggy” bottom, things will start to shift down. The muscles will strain to hold everything up, leading to greater dysfunction and weakness,” shares Dr. Lettenberger.
When these muscles are too weak (or too tight), you may experience symptoms.
What leads to pelvic floor dysfunction and what are common symptoms?
Several factors are associated with the weakening of the pelvic floor, including key physiological changes for women, like:
- Pregnancy
- Age (particularly menopause)
- Hormonal birth control [6]
There are several contributing risk factors in men and women, including: [5]
- Weight gain
- Chronic coughing
- Chronic constipation
- Disorders that impact ligaments or connective tissues
Men and women can experience some particularly noticeable symptoms of a weak pelvic floor, though they can vary widely person to person. According to Dr. Brittany Leboeuf, MS, PhD, these can include:
- Trouble controlling your bladder/bowels
- Leaking urine or stool when you cough, sneeze, or laugh
- Pain during intercourse
- Feelings of heaviness or a “dragging” feeling
- Pelvic pain
- Core instability
- Low back pain
Let's look more closely at some of the common causes for women: pregnancy, menopause, and hormonal birth control.
Pregnancy and childbirth put stress on pelvic floor muscles
You've likely heard pregnant women mention that they have to pee often and are worried about laughing or sneezing too hard in public. That’s because between weight gain, constipation, and hormonal shifts, pregnancy and childbirth put stress on pelvic floor muscles.
“The pelvic floor is placed under more stress and pressure throughout each trimester. For 9-10 months, you’re growing a human inside you, creating a whole new organ (the placenta) in the process,” explains Dr. Lettenberger. “Your uterus expands, fluid accumulates, weight is added to your frame, and there are changes to your musculoskeletal system.”
Labor and delivery also strain the pelvic floor muscles — and can even injure them. This is particularly true during vaginal childbirth.
“A vaginal delivery stretches the pelvic floor and perineum more than ever before, especially for first-time mothers,” says Dr. Lettenberger. “This can be really intense for your muscles and support ligaments to recover from, depending on how long you pushed, how big your baby was, and if you let your pelvic floor relax.”
Studies show that approximately 10% of women who give birth each year require surgery for pelvic floor disorders after giving birth. [7]
Menopause can weaken pelvic floor muscles
Menopause can also put strain on pelvic floor muscles. During menopause, a woman’s estrogen levels deplete, resulting in a host of symptoms and health risks. “The decrease in estrogen can contribute to muscle and connective tissue weakness, which can impact pelvic floor function,” explains Dr. Leboeuf.
“This can make it challenging to feel, contract, and strengthen your pelvic floor,” says Dr. Lettenberger. The loss of estrogen can weaken pelvic floor muscles. This can lead to urinary incontinence and pain during sex.
Taking hormonal birth control may impact your pelvic floor
Similarly, certain hormonal birth controls can create a “low-estrogen state,” leading to pelvic floor dysfunction. [6]
“Some women don’t experience any symptoms, while others may notice many, like poor muscle contractility, increased vaginal dryness, and incontinence,” explains Dr. Lettenberger.
Men have a pelvic floor, too
It’s important to mention that men also have a pelvic floor that shouldn’t be ignored. As many as one in six men may be suffering from pelvic floor dysfunction, yet it’s not widely talked about as a condition men experience. “That’s perhaps because men don’t experience the same hormonal shifts that women do to trigger dysfunction,” Dr. Leboeuf hypothesizes. [2]
When the pelvic floor is too loose or too tight in men, it can lead to chronic pain (particularly in the groin), incontinence, and sexual dysfunction. [8]
Like the causes of pelvic floor dysfunction in women, chronic stress, constipation, holding in urine, injuries, and even overtraining can tighten pelvic floor muscles and weaken them. [9]
What to do to support and strengthen your pelvic floor
Here’s what to do (and what not to do) to support and strengthen pelvic floor muscles.
Try pelvic floor muscle training (also known as Kegels) with guidance from a professional
Pelvic floor muscle training, or doing a Kegel, is all about coordinating the relaxation and contraction of your muscles. When done properly, "they can be amazing tools to help strengthen the pelvic floor," says Dr. Lettenberger.
To perform a Kegel, imagine that you're sitting on a marble. Lift the marble upwards by gently squeezing your pelvic muscles as if you're holding in your pee, for three seconds. Focus solely on your pelvic muscles and repeat 10-20 times a day.
However, it's important to perform Kegels correctly, or else they can actually tighten the pelvic floor, leading to or worsening pelvic floor dysfunction.
If you're just getting started with Kegels, consult with a healthcare professional to ensure proper form. "Think of Kegels like any other individualized care. What's okay for one woman could contribute to unwanted symptoms in another woman, even from the same exercise, like Kegels," says Dr. Leboeuf.
Kegels can be a powerful tool in maintaining core stability in both men and women and have particularly gained popularity among pregnant women.
"My number one piece of advice for pregnant women is to learn to relax your pelvic floor. If you can do that, during pregnancy, the baby can come through the birth canal more easily, and your muscles won't resist as much," explains Dr. Lettenberger. "Relaxing your pelvic floor allows your muscles to expand and adapt."
In fact, a study found that women who completed a pelvic floor muscle training protocol from 34 weeks pregnant had a smaller decline in pelvic floor health than a control group. [10]
That said, Kegels aren't recommended for everyone
"I highly recommend women not perform Kegels in the third trimester of pregnancy since we need the pelvic floor to relax so the baby can come through," says Dr. Lettenberger.
This underscores the need for individualized care for pelvic floor health.
Eat a balanced diet and drink plenty of water
Food affects just about everything that goes on in our bodies. And its relationship with your pelvic floor is no different. As a group of muscles, protein, vitamin D, and getting enough calories overall impact the health of pelvic muscles.
Chronic constipation is a common precursor to a weakened pelvic floor, so foods that support digestion and regularity help to defend these muscles. Focus on getting enough fiber (from fruits, vegetables, whole grains, and legumes), especially when you’re constipated, to reduce strain in the bathroom and make sure to drink plenty of water.
A study found that those who consumed fruits were 20% less likely to develop urinary incontinence. [11]
Try perineal yoga or Pilates
Practicing perineal yoga or Pilates can help to relax your pelvic muscles. A study conducted in pregnant women found that those who participated in a Pilates program were significantly less likely to suffer perineal trauma than a control group. [12]
Practice breathwork
Breathwork can help to relax the body, both mentally and physically. Deep breathing, particularly engaging your diaphragm, can help keep your pelvic muscles relaxed yet strong.
A small study showed that diaphragmatic breathing works, finding a correlation between the pelvic floor muscles and diaphragmatic motion during breathing. [13]
Avoid peeing “just in case”
As kids, we’re often taught to use the bathroom before leaving the house, “just in case.” But as adults, this may not be a sound approach.
Contracting pelvic muscles in the absence of needing to go can weaken the brain-muscle connection that controls how you know when it’s time to go. It also puts pressure on pelvic muscles to contract, potentially weakening them. Over time, this can throw off your bladder's ability to hold more urine and your brain’s ability to sense when a bathroom break is needed. [14]
When should you seek treatment for pelvic floor health?
If you’re experiencing symptoms related to your pelvic floor, it’s important to seek guidance from a healthcare provider, as they can provide individualized support.
“If you are struggling with pelvic floor symptoms (especially following childbirth), seek out a pelvic health physical therapist. They can help with assessment, strategies for symptom management, and even work collaboratively with their healthcare team if warranted,” says Dr. Leboeuf.
In fact, a review of 31 studies found that pelvic floor muscle training with a physical therapist helped to improve urinary incontinence, either reducing symptoms or curing it altogether. [15]
“Just because something may be common, like urinary incontinence when laughing or sneezing, does not make it normal. You shouldn’t have to live your life in fear of wetting your pants. You don’t have to grit your teeth through painful sex, constipation, or any pain in your pelvic floor,” shares Dr. Lettenberger.
“You know your body best. Always seek help when you know something is wrong.”
Key takeaways
- Your pelvic floor muscles support your organs and control bladder and bowel function, yet dysfunction affects nearly 1 in 3 women and 1 in 6 men.
- Common symptoms of pelvic floor dysfunction include incontinence, sneezing, pelvic pain, pain during sex, and feelings of heaviness or pressure on the pelvic muscles.
- Pregnancy, childbirth, menopause, and hormonal birth control are common factors associated with pelvic floor dysfunction in women. Men can also experience dysfunction.
- Pelvic floor muscle training (Kegels) can help when done correctly, but they’re not recommended for everyone.
- Pelvic floor dysfunction is common but not normal. Seek advice from a pelvic health physical therapist if you're experiencing symptoms.
*Perceptual claims from clinical trial with (NCT06749912 STUDY00008828) with State University of New York at Buffalo. Therabody, Inc. sponsored the trial, but execution, data analysis, and reporting of results were independent of the funding source.
References
- https://www.nature.com/articles/s41598-022-13501-w
- https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain
- https://www.theoriginway.com/2024-pelvic-health-study
- https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1495679/full
- https://www.ncbi.nlm.nih.gov/books/NBK559246/
- https://pubmed.ncbi.nlm.nih.gov/26407563/
- https://pubmed.ncbi.nlm.nih.gov/38168908/
- https://www.sciencedirect.com/science/article/abs/pii/S2050052115000025
- https://www.nature.com/articles/s41443-025-01034-5
- https://pubmed.ncbi.nlm.nih.gov/37657664/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11632885/
- https://pubmed.ncbi.nlm.nih.gov/34208859/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4540829/
- https://www.ncbi.nlm.nih.gov/books/NBK279430/
- https://pubmed.ncbi.nlm.nih.gov/30288727/
