A woman performs yoga.
When performed regularly, yoga can help strengthen the pelvic floor. (For Spectrum Health Beat)

Strapped up like a hammock at the base of our pelvic structure is a three-layer group of muscles called the pelvic floor.

If these muscles are happy and working properly, we don’t give them much thought. Life is good.

But if this muscle group is too weak or too tense, we can run into trouble.

That’s because these muscles have a big job. They not only support the pelvic organs and control the openings of the anus, urethra and vagina, they also play a role in sexual function and help stabilize the pelvis and back.

When the pelvic floor muscles slacken or tighten, we can start seeing symptoms such as bladder or bowel leakage, pelvic organ prolapse, sexual dysfunction, pelvic pain, constipation and even back pain or abdominal pain.

Problems like this crop up in men and women—and in adolescents, too—but adult women tend to be more vulnerable to pelvic issues.

“Not only is a woman’s structure different, but what the structure has to do—namely, give birth and carry pregnancies,” said Jennafer Vande Vegte, a physical therapist with the Spectrum Health Pelvic Rehabilitation Program.

Although pelvic floor research is getting a lot of attention these days, it’s important to remember that the pelvic floor muscles don’t function independently.

“Consider the pelvic floor muscles as the captain of a whole team of muscles that work together,” said Christine Eardley, also a physical therapist at Spectrum Health’s Pelvic Rehabilitation Program.

Let’s look at all the players:

  • The deepest layer of abdominal muscles (transverse abdominis)
  • Deep back muscles (multifidi)
  • Hip muscles (external rotators, glutes and adductors)
  • Diaphragm, or breathing muscle
  • Pelvic floor muscles

“All of these muscles coordinate in an unconscious way to keep us functioning well,” Eardley said. “When we talk about strengthening the pelvic floor, doing a pelvic floor contraction or a Kegel, we can no longer talk about strengthening the muscle in isolation, because the emerging research is very clear: The pelvic floor works in coordination with all of the core muscles.”

Of course, a leaky bladder isn’t always a sign of muscle weakness.

“Some women and men may have symptoms of bladder leakage and suspect they have a weak pelvic floor when they actually have the opposite problem: overly tight pelvic floor muscles,” Vande Vegte said.

These patients will need to lengthen and relax the pelvic floor before doing strengthening exercises. Working with a pelvic floor therapist can help.

Here are some of Eardley and Vande Vegte’s suggestions for how to strengthen the pelvic floor:

Traditional Kegels

A Kegel exercise, or pelvic floor contraction, has two parts: a squeeze using the first two layers of muscle, and then a lift using the third layer. Eardley and Vande Vegte let their patients choose a position—sitting, standing or lying—and they give cues like these to help them activate the pelvic floor:

  • Imagine you have a marble in your pelvis, and then try squeezing the marble and lifting it up to your nose.
  • Imagine bringing your tailbone and your front pelvis bone closer together.
  • Try pulling your two sitting bones closer together.
  • Pretend you’re holding back gas.
  • Draw the genitals and then the anus together, and then lift them up.
  • Sit on a chair and lift the perineum (the space between the genitals and the anus) up off the chair.
  • For men: Try pulling in and lifting the base of the penis.

Two words of caution about Kegels: First, many people think of Kegel exercises as stopping the flow of urine. This can be a good trick to help people find their pelvic floor muscles, Eardley said, “but we don’t recommend that you actually use your muscles to stop the flow of urine while you are urinating, because this can cause a dysfunctional voiding pattern—the bladder does not empty completely.”

Second, studies show that when women are given written instructions for how to do Kegels, 60 percent of them will do the exercises correctly. The rest will not, said Eardley, “and 25 percent will do them so incorrectly that they may make themselves worse.”

If you have questions about your muscle performance, ask your health care provider or a pelvic floor physical therapist for an evaluation.

Strengthening programs

Janet Hulme, a physical therapist and researcher in Montana, has developed exercise programs using the muscle team approach for women and men with pelvic floor weakness. Her “Abdominal Core Power” and “Roll for Control” videos are available online.

Technology for women

If you have a hard time finding the muscles, technology can help. The kGoal is a $150 device for intravaginal use. It senses your pelvic floor muscle contractions and communicates via Bluetooth technology and a cell phone app to give you biofeedback on how well you’re doing the Kegel exercises. “It’s a neat gadget for women that are interested in a tool to help them,” Vande Vegte said.

Electrical stimulation

For women and men who have significant weakness or who simply cannot contract their muscles, electrical stimulation may be an option. Electrical stimulation involves placing a probe in the vaginal or anal canal and using an electrical current to contract the weak muscles. You can do this at home using a rented device, but be sure to get usage instructions from your medical provider or pelvic floor physical therapist first.

The Knack maneuver

Research shows that when women with pelvic floor weakness do a Kegel just before sneezing or coughing, they don’t leak as much. This preemptive trick is called the Knack maneuver.

Pilates and yoga

Consistent practice of Pilates or yoga can improve posture and core strength, which may have a positive impact on the pelvic floor, Vande Vegte said.