Pelvic floor muscles: doctor’s opinion

Tatyana Tsoy , medical doctor , gynecologist , women’s health , PFMs

Our expert collected the whole range of information you wanted to know about pelvic floor muscles. Additionally, here you will find the information about supporting and training methods to keep your PFMs all right. Below, there is the first part of this article.


Text and photo by: Tatyana Tsoy, obstetritian, gynecologist

Russian version

Before we start reviewing exercise machines for pelvic floor muscles, I would like to say some words about female anatomy and physiology as well. Without this information, my comments would be incomplete.

Females, as distinct from males, have a womb, naturally designed to accommodate a fetus and let it grow. During pregnancy, the womb increases in size 5 or 6 times while its weight, incredibly, grows 25 times! Can you imagine that? Such functionality requires a specially configured fixing system represented by a number of ligament and muscular systems, or complexes, as they are called in Anatomy.

1.     Suspensory. The most flexible (expanding) complex. Four couples of ligaments are similar to puppet’s strings or a safety net of an acrobat to support the womb, the fallopian tubes and the ovaries in position.

2.     Fixing. A complex of ligaments and fascia providing attachment of the cervix and the vaginal vault (the upper part) to sacrum and lateral pelvic walls. This helps to fix the womb in position, is able to stretch a bit during pregnancy ensuring limited mobility of the organ within certain range.

3.     Supporting. This is the major support for interior organs. Ligaments, muscles and joints directly shaping the pelvic floor ( in thickness and located at a depth of 1.5-2 cm from the vaginal entrance, equal to the length of 1-1.5 phalanx of your finger).

Can you think of a safety net placed to protect acrobats in a circus? This is the pelvic floor while the acrobats are represented by interior organs (womb, bladder, intestine, etc.)

Each level of this apparatus can grow weak, too stretched and be damaged. However, the only level we are able to train is that of pelvic floor muscles (PFMs).

The basic functions of PFMs are the following:
– supporting interior organs (bladder, womb, intestine);
– controlling urination and defecation (including retention of gases);
– sexual activity and childbearing;
– resistance against increased pressure within the abdomen and pelvis;
– involvement in supporting walking stability.

PFMs’ dysfunction can cause the following problems:
– urinary incontinence (at early stages being provoked by physical effort, sneezing, coughing, running, jumping, heavy lifting);
– stool or gas incontinence;
– constipation, difficulties with bowel evacuation;
– pain in the perineum;
– pelvic pain;
– descent of vaginal walls and/or prolapse of pelvic organs (womb, bladder, rectum);
– anorgasmia;
– dyspareunia (painful intercourse, also at the moment of penetration).

Saying “dysfunction” I not only mean weak or damaged PFMs, but chronic tension too. These factors affect your health and impede correct muscle functioning. It is also worth mentioning that both things can come together: weakness and chronic spasm. Long-lasting tension affects normal blood flow in muscles, the latter can provoke pain and make the atrophy progress.

Our body is a system, organs cannot act on their own, and PFMs are therefore tied to core muscles (muscle group supporting the body position):
– oblique, transversus and rectus abdominis muscles;
– back muscles;
– gluteus minimus and medius muscles;
– adductor muscles;
– hamstring muscles;
– diaphragm.

Why is this so greatly important?

Pelvic floor can get lax through a variety of reasons, not only due to pregnancy and childbearing. Still these latter are one of the core risk factors. Nulliparous women and women who delivered by C-section can also have lax PFMs and the consequent problems too.

Walking upright and gravity are to blame for daily pressure on our pelvic floor (remember that this is a diaphragm of 0.7-1 mm in thickness holding all organs within the abdominal cavity and pelvis), every ten years the risk of lowering and prolapse goes up by 40% regardless of whether there have been pregnancies and delivery.

Being overweight is also a risk factor (BMI>25 pushes the risk up by 40%, BMI>30-by 50%) as well as other factors increasing abdominal pressure: chronical constipation, lifting and carrying heavy loads (including children), neoplasm (large myomas, for example), chronic cough and other lung diseases (let's go back to core muscles-increased pressure within thorax affects the diaphragm and its correct contraction and pushes the abdominal pressure up).

Dysplasia of connective tissue is a genetically conditioned pathology taking place at the stage of connective tissue development (ligaments, joints, cardiac valves, vessels, etc.). We can suspect of this condition in patients who show extraordinary agility. If we talk about preserving women’s health and pelvic floor, extreme body agility proves to be undesirable because the ligaments become too loose and, unfortunately, still unable to contract to recover their initial size the way that muscles do.

Thus, when it comes to intimate exercising program or any other training method for PFMs, you should consider many things instead of focusing on training these muscles only. You should do exercises under breath control (contracting muscles as you exhale) and do not forget about the holistic approach towards your nutrition, lifestyle and exercises to induce strength (with non-stable support to train core muscles; plank, walking, swimming, etc.)

Important! Jogging and jumping are undesirable as they cause additional stress on PFMs. Alternatively, you can opt for elliptical machine or Nordic walking.

Crunches and doing sit-ups are likely to push your abdominal pressure up and cause diastasis. Planks can be an option.

CrossFit workout, powerlifting are undesirable too as they are related to lifting weight and include many exercises pushing the abdominal pressure up.

Rules to keep your PFMs ok:
– healthy lungs (seek to cure chronic cough, bronchial asthma, etc.);
– healthy intestine (proper nutrition programs, prevention of constipation and flatulence);
– body mass control;
– delegating heavy loads to vagina-free humans;
– moderate physical activity (avoid activities that affect PFMs);
– breath control (muscle tension and contraction must be made as you exhale – this is physiologically correct);
– during your PFMs’ training, pay attention to muscle relaxation, not to tension solely.

A brief checklist and recommendations

For correct training of PFMs, it is useful to look into diaphragmatic breathing technique:
– as you inhale, inflate your abdomen as it were a drum (to make it look round);
– as you exhale, deflate it the way you would do to fit into a pencil skirt or tight pants.

Doing it slowly, you will be able to feel your pelvic floor lifting up and in-a physiological phenomenon, pretty normal. But if we contract our PFMs as we inhale or hold our breath, we create excessive load on our PFMs due to increased abdominal pressure.

You can feel your PFMs after introducing the phalanx of one or two fingers into your vagina and trying to squeeze them (combine it with diaphragmatic breathing or just act the way you do to control your WC urge). If you do not succeed, you can start urinating and try to stop it (you can try it once but this is not recommended on a regular basis!)

It is important and necessary to contract your PFMs solely. Your abs, glutes and hips must stay relaxed, otherwise your training efficiency would be lower. Learning to relax your PFMs is equally important, and in cases of chronic spasms, pain, vaginism and dyspareunia this is mandatory and should be a priority.

There are some contraindications for training our PFMs:
– rupture or surgery on your perineum, until healing;
– mental disorders at times of escalation;
– acute inflammatory diseases of vagina and cervix.

To be continued...