Eight Myths and Facts About the Pelvic Floor

Woman doing pelvic exercise, holding her baby

Every now and then, you hear advice that’s just absurd.

“Sleep when the baby sleeps." Sure. And should I do dishes when the baby does dishes, too?  

“Don’t squat! It’s bad for your knees.” Okay. But how should I sit down on the toilet if I’m not allowed to squat?

“Do 100 Kegels, twice per day. That’s the only way to get stronger.” Wait, what? Would you do 200 reps per day of any other exercise? I doubt it! 

These examples are pretty obvious, but most of us just don’t know enough about the pelvic floor to be able to tell what pieces of advice are true and which are nonsense. After all, the pelvic floor is tucked away where we can’t see it, and we hardly ever talk about it outside of pregnancy or when something goes wrong.

Let’s bring it out into the light. The pelvic floor is a group of muscles that sit inside the pelvic cavity. That’s it – just a group of muscles, like any other muscles in our bodies. These muscles are responsible for supporting our pelvic organs and stabilizing the pelvis alongside other core muscles for dynamic tasks like walking or balancing. Though they play a role in sexual function and orgasm, these muscles are far more than just “sexual”. They are essential to our everyday lives. 

We pulled together the top myths we’ve heard about the pelvic floor and debunked each one, plus a bit about what to consider instead.

1. Myth: The pelvic floor is something only pregnant and older women need to worry about.

Fact: Everyone with a pelvis has a pelvic floor. That includes men, women, young, old, pregnant or not, and everyone in between. Just as we take care of our bodies in other ways, we can also take care to keep the pelvic floor healthy and happy throughout our lifespan. 

Female athletes are at particularly increased risk of urinary incontinence, even well before they ever experience pregnancy. Studies show that specific exercise for the pelvic floor can help reduce symptoms in incontinent athletes, which can keep them participating in their sport longer (and drier) than they might otherwise be able to. 

Men can also have concerns that are related to pelvic floor function, including urinary or fecal incontinence, pelvic or back pain, constipation, and sexual dysfunction. Each of these concerns (plus many more) can also be treated with an individualized approach. 

Though pregnancy is a risk factor for pelvic floor dysfunction, it’s certainly not the only factor that can affect the health of those particular muscles during a lifetime. It may be helpful to think of the pelvic floor as exactly what it is... Which is just another muscle group. Yes, the pelvic floor is closely related to other systems of the body (urinary, gastrointestinal, reproductive, for example) but at the end of the day, it’s there to help you move and function throughout your day, much like your quads, your abs, or your shoulders. Why not take care of it?

2. Myth: The pelvic floor should be activated all day in order to be effective in supporting organs.

Fact: The pelvic floor functions just like any other muscle group in the body. Would you grip your biceps, your jaw, or your abdominal muscles all day long on purpose? Probably not. The pelvic floor is no different. 

The pelvic floor cycles on and off all day long according to what you’re doing and how much support your body needs. Imaging shows that your pelvic floor actually moves slightly up and down in the same direction as your diaphragm as you breathe. If you’re breathing and moving at the same time, the pelvic floor anticipates your movements. Just like your eyelids blink at exactly the right moment when something is heading toward your face, your pelvic floor kicks on at the right moment (for instance, just before your foot strikes the ground) without any additional effort on your part! 

If your pelvic floor is in a gripped or activated position all day, it may struggle to move freely and support your body. Ideally, we want to build pelvic floor awareness, strength, and coordination during exercise just like any other muscle group, and then allow the muscles to return to their baseline and do their jobs (without extra effort) for all the other hours of the day. 

There are many reasons why someone might find that they “grip” or “clench” their pelvic floor – pain, trauma, habit, and structural issues can contribute to a tendency toward tension. To get to the root cause and the best solution for you, see a pelvic PT in person.

3. Myth: Impact exercise is bad for the pelvic floor.

Fact: Have you ever heard that running or jumping is bad for the pelvic floor? Or that you can permanently damage the pelvic floor with these activities? Though high-level athletes often experience incontinence, so do individuals who are sedentary. As with all things, there’s a balance. 

Studies that have looked at high-level athletes and pelvic floor function show that their pelvic floors are not necessarily stronger or weaker than the general population, and athletes who were interviewed years after their competitive training days were over were not more likely to be incontinent than the general population. This suggests two things: endurance or impact activity like running or jumping won’t necessarily make your pelvic floor super strong, and it also won’t leave it super damaged or weak for the long term. 

It’s still a good idea to address any impairments you might notice as you increase your impact-type exercise. For example, if you’re leaking or feeling pressure or heaviness, a little emphasis on the pelvic floor strength, endurance, timing, coordination, and surrounding muscles may help reduce your symptoms and protect other pelvic structures without compromising your training plan.

4. Myth: Kegels are the only way to exercise your pelvic floor.

Fact: Kegels are an umbrella term for an isolated contract-and-relax of the pelvic floor. That doesn’t give us much direction, does it? But just like any other muscle group, you can train the pelvic floor according to your individual goals.

Did you know that your pelvic floor contracts slightly before all kinds of movements? It does this as part of your core stabilization system so that your body is ready for whatever it is you’re about to do. Catch a ball? Check. Pick up a heavy box? Check. Laugh with your friends? Check. 

You can see that these tasks don't necessarily require max capacity of the pelvic floor. Strength is only one aspect of a healthy pelvic floor – other essential functions are endurance, control, and reflexive support. If all these functions are working well you’ll be able to use those muscles just the right amount and at just the right time. 

For example, you may need to practice timing and coordination, such as quickly contracting before a cough or sneeze, or practicing a pelvic floor lift immediately before your foot hits the ground. If you’re leaking when you lift heavy things, you may need to strengthen pelvic floor coordination with that particular movement. If you’re feeling pressure or heaviness after a good laugh with friends, you might be experiencing more of an endurance issue. 

The pelvic floor is one piece of the broader puzzle of your body, so “doing your kegels” at every stoplight might not necessarily get you where you want to go. Consider your whole-body goals and exactly when you’re experiencing symptoms, and see how you can bring awareness of the pelvic floor (and all its many skills) into the bigger picture.

5. Myth: Painful sex? You just need to relax.

Fact: There are many reasons why sex might be painful for both men and women, and some of those reasons may be related to pelvic floor function. However, there’s nothing less relaxing than feeling pressure to “relax.” If you’ve heard this advice before, don’t despair – there are many different approaches that can help address this common concern. 

Mobility of the pelvic floor muscles is essential for circulation, arousal, comfort during penetration, and even reaching/enjoying a pain-free orgasm. Some people hold more tension in those areas than others, which can make penetrative, or even nonpenetrative arousal or orgasm, a painful experience. 

If your pelvic floor is tense and tight, having a glass of wine to relax may not actually be your best solution. Your mental state does play an important role since the pelvic floor muscles tense up when we experience fear or stress. That said, for most people who experience painful intercourse, there’s more we can do to get those tissues moving, hydrated, and happy so that you can finally relax for real. 

Some interventions might include manual therapy (think deep tissue massage) to release any specific trigger points in the muscle or nerve entrapments that might be contributing to painful sensations. Along similar lines, circulation keeps tissues healthy and improves lubrication, so sitting on a heating pad, using vibration regularly, and doing hip stretches and pelvic floor release exercises can also be incredibly helpful. 

If dryness or tissue elasticity is the issue, you may want to try different lubricants, daily moisturizers, or vulvar estrogen cream (by prescription) to boost tissue health and reduce friction. Deeper discomfort with penetration can be modified using buffer tools like the OhNut. 

And at the end of the day, there are many ways to enjoy sexual intimacy without pain for either partner. 

Above all, painful intercourse is an excellent reason to seek out a pelvic floor physical therapist. There may be more going on than you can figure out on your own (plus more tools available that you haven’t heard of yet), so don’t stop seeking support after you’ve tried “relaxing." That’s not the end of the road.

6. Myth: It's normal to leak after babies.

Fact: Though urinary incontinence (leaking urine) is a very common experience for postpartum women, it’s not something you have to live with. 

Studies show that 20-40% of postpartum women experience urinary incontinence after babies and 10% experience fecal incontinence. It’s “normal” in the sense that you’re certainly not alone. But living with it forever? No thanks. 

The good news? It’s totally treatable. 

Even a small amount of urinary incontinence is a sign that there is some kind of imbalance in the systems related to the pelvic floor, and a pelvic floor physical therapist can help you figure out where that imbalance lies. For example, you might experience leakage if you have a strength impairment, nerve injury, bladder irritation, changes in postural alignment and downward pressure, or a combination of these and many other causes. 

There are also several types of urinary incontinence that require different strategies for treatment. Stress urinary incontinence describes a situation where the pelvic floor is not able to stop the flow of urine due to increased pressure demand. Think leaking with a cough, sneezing, laughing, jumping on a trampoline, or urine loss with exercise. Urge urinary incontinence is also a common concern and describes the intense urgency and frequency associated with bladder irritation that sometimes leads to leaking. Many experience mixed incontinence, which represents a sneaky combination of the two. 

As you can see from all of these causes and types, an individual approach to treatment is essential. Many postpartum moms need to build strength following pregnancy and delivery, so although kegel exercises can certainly help they’re not the only solution. An individualized evaluation and treatment plan with a pelvic floor physical therapist is always your best approach if you’re experiencing postpartum urine leakage that’s bothering you.

7. Myth: Kegels didn’t work, so now I probably need surgery.

Fact: Studies show that up to 50% of people don’t perform kegels correctly, especially if they’ve never been instructed in person. Before you schedule surgery, it’s worth taking the time to see a pelvic floor physical therapist for at least a few visits, so that you can ensure you’re using your muscles in the most effective way. Even if you end up choosing surgery down the road, your body will thank you for putting in the work ahead of time to maximize your chances of success.

8. Myth: You must have a physician’s referral to see a pelvic floor PT.

Fact:  There is no longer a requirement to see your physician before heading to a physical therapist. As a patient, you have direct access to a physical therapy evaluation and some amount of treatment without a physician's referral in all 50 states. Your physical therapist will be able to inform you of any requirements specific to your state. 

This development has allowed patients to access physical therapy care faster and with fewer steps (and expenses!) along the way. 

Pelvic physical therapy is simply a specialty service within the broader scope of physical therapy care, so the benefit of direct access still applies. Some facilities may require a referral before scheduling you for specialty services, but that’s usually the exception and not the rule. You can find out more about your local requirements by calling the physical therapy provider directly and asking what you need to do to get started. 

At the end of the day, what’s important is simply understanding that the pelvic floor is a muscle group like any other. We all have one, even men, kids, and athletes! We can make adjustments to the way we use them, according to our needs at that time, and in many cases, we can even reduce or eliminate symptoms. 

There are lots of resources available depending on your needs, so if you’re noticing symptoms related to the pelvic floor, seek support from a pelvic health physical therapy specialist. They can help you get to know this muscle group as it relates to your needs and navigate the next steps to get your body moving as smoothly as possible.

About the Author

Dr. Samantha Spencer, PT, DPT, is a Medical Advisor with Aeroflow Breastpumps. Dr. Spencer is a physical therapist who specializes in pelvic and perinatal care in the Asheville, NC, area where she offers in-home physical therapy to prenatal & postpartum individuals. She also developed the Strong Beyond Birth 28-Day Course to guide and support moms as they return to exercise, and offers virtual consultations to women everywhere.

Information provided in blogs should not be used as a substitute for medical care or consultation.