The pelvic floor is one of those body parts we’ve all heard of, but few of us fully understand. But interest in this often-overlooked area – a group of muscles that form a supportive sling at the base of the pelvis – has risen recently, with Google searches for “how to tighten pelvic floor muscles” rocketing by 1,200 per cent in the past few months alone.
Interest should be high: from our toilet habits to sexual function, the pelvic floor is central to many aspects of our health. According to research by pelvic and bladder health brand, Jude, 94 per cent of women experience accidental leaks – many of which are linked to either a weak or overactive pelvic floor – making it increasingly important that we understand how these muscles function, and how best to care for them so we can move confidently through the world.
“Pelvic and bladder health is the final taboo in women’s wellbeing, despite the fact it dictates how women move, sleep and exist in their bodies every single day,” says Peony Li, Jude’s founder and CEO.
Vogue spoke to three experts to find out more.
What is the pelvic floor?
The pelvic floor is a group of muscles that sits at the base of your pelvis, stretching from the pubic bone at the front to the tailbone at the back. While many people only think about it in relation to pregnancy or accidental leaks, it actually performs several vital functions.
“It ensures the organs don’t fall out,” explains Miti Rach, pelvic health physiotherapy practitioner at Ovara Health. “It supports the bowel and bladder in both sexes, as well as the uterus in women.”
Beyond this structural support, the pelvic floor has a sphincteric role, helping to maintain continence. It also plays an important part in sexual function: these muscles contract rhythmically during orgasm, and a well-functioning pelvic floor can increase sexual enjoyment. Conversely, dysfunction can lead to pain during sex, difficulty reaching orgasm and erectile dysfunction in men.
Pilates enthusiasts may already be familiar with its importance for posture. The pelvic floor forms a key part of the body’s core system, working alongside the diaphragm, deep abdominals and back muscles to stabilise the spine and pelvis.
Osteopath and founder of Four Mamas, Olivia de Maigret, also points out that the area contains a complex network of nerves and blood vessels, including structures linked to the lumbosacral plexus, which influences movement in the legs and feet, as well as playing a role in digestive and reproductive function.
It would be easy to assume the goal should simply be to strengthen the pelvic floor, but problems can also arise when the muscles are too tight. “You can have a weak or an overactive pelvic floor, and both come with a different set of problems,” says Rach. “Under-activity is more associated with leakage and incontinence – whether from the bladder, bowels, prolapse or sexual dysfunction – while an overactive pelvic floor can cause difficulty emptying your bladder or bowels, or lead to pelvic pain.”
What causes an unhealthy pelvic floor?
Pregnancy and childbirth are among the most common causes of pelvic floor dysfunction. “The weight of the foetus can weaken the pelvic floor,” explains Rach. “Then if you have a vaginal birth or a traumatic delivery, that can also contribute.” Even those who have Caesarean sections may need pelvic floor rehabilitation afterwards, adds de Maigret.
Chronic constipation or regularly straining on the toilet can also weaken these muscles, as can persistent coughing. Essentially any repeated downward pressure on the pelvic floor can weaken it over time.
“Incorrect technique when lifting weights can also impact your pelvic floor, especially if you have underlying weaknesses,” says Rach. A sedentary lifestyle contributes too. If the wider core system (including the diaphragm, deep abdominals and lower back) is weak or underused, pelvic floor function can suffer.
Hormones are also a factor. “The pelvic floor and vaginal walls have hormone receptors, so changes during pregnancy, breastfeeding or perimenopause all affect the tissues,” says Rach. Reduced oestrogen levels, for example, can lead to weaker muscles, decreased tissue elasticity and a higher risk of prolapse.
Conversely, a tight pelvic floor can be linked to chronic stress and anxiety, past trauma, or habitually holding in urine.
Signs your pelvic floor may be unhealthy
- Bladder or bowel incontinence, including leaking when laughing, coughing or sneezing, or a sudden urgent need to urinate.
- Difficulty emptying your bladder or bowels.
- Pelvic pain or pressure.
- A feeling of heaviness or dragging in the vagina, which may indicate prolapse.
- Weak orgasm.
- Pain during sex.
How to strengthen your pelvic floor
Once you understand what the pelvic floor actually is, it’s helpful to assess whether yours is functioning well. According to experts at the Pelvic Obstetric & Gynaecological Physiotherapy board, one way to check if you’re contracting your pelvic floor correctly is to gently insert a finger into the vagina and then tighten the muscles; you should feel the muscle lifting and tightening around your finger.
If you suspect there’s something not quite right or experience pain, it’s worth booking an appointment with a pelvic health physiotherapist, osteopath or other healthcare practitioner.
Kegels – the practice of squeezing, holding and releasing the pelvic floor muscles – can help strengthen the area when performed correctly. “Tighten your pelvic floor muscles, hold them, then release and allow them to fully relax,” says Rach, adding that you should repeat the process until the muscles tire.
Short contractions are equally important: quickly tighten the muscles and immediately release them, always ensuring the muscles fully relax between repetitions. You can do these at any stage of life, even just after giving birth.
A good habit to introduce regularly doing 10 long squeezes (holding for around 10 seconds each time), followed by 10 quick squeezes, repeated roughly three times a day. They should not be performed while urinating. If you struggle to engage the muscles correctly, devices such as Elvie’s Personal Trainer can help guide you.
Crucially, relaxing the muscles – sometimes referred to as reverse Kegels – is just as important as strengthening them. “A lot of the messaging focuses on squeezing and pulling everything in, but that’s where problems can arise because people forget the muscles also need to relax,” says Rach. “It’s not just about strengthening – it’s about releasing and relaxing too.” Just as you wouldn’t hold a bicep curl for half an hour without relaxing the muscle, the pelvic floor also shouldn’t remain permanently contracted.
Our toilet habits can affect pelvic floor health. Constipation and straining place extra pressure on the muscles, says de Maigret, so posture on the toilet matters more than many people realise. “Using a small footstool to raise your feet helps relax the muscles and ligaments, allowing the bowels to empty more easily,” says Rach.
With sedentary lifestyles more common than ever, our pelvic floors are often underused. “We sit down a lot and don’t tend to engage our core muscles,” says de Maigret. Alongside cardiovascular exercise, spending time in deep squats and mobility work can help improve hip movement, release tightness in the pelvic region, and support blood flow and nerve supply to the area.
“Postural work, such as building foot strength, is helpful too,” she says. “The feet align with the pelvis and influence the entire chain above.” She recommends Pilates in particular, as it integrates the feet, core and pelvis, alongside stretching and controlled movement. Dancing, walking and swimming are other gentle ways to support pelvic floor health. And for targeted breath, core and glute work, pelvic health coach Baz Moffat has created a free Strength Method programme in partnership with Jude.
Maintaining a healthy weight, eating plenty of fibre and staying hydrated all support pelvic floor function by reducing strain on the muscles. This becomes increasingly important with age, says de Maigret, as tissue elasticity declines.
Smoking and excessive alcohol can also hinder tissue repair, so limiting both can be beneficial – particularly during the perimenopausal years.
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