Looking After Your Pelvic Floor: Dos & Don'ts

Pop quiz: which group of muscles performs an essential role in your body but often gets ignored until something goes wrong? Yep - your pelvic floor.

Despite its importance, many of us don’t know what the pelvic floor actually does or how to look after it… until symptoms like leaking when you laugh, jump or run, painful sex, or a heavy feeling “down there” start showing up. Let’s change that.

We spoke to Rosie Dumbrell, the Director of Everform Therapywear, about the importance of pelvic floor health. As a women’s physiotherapist, with specialist training in women’s health, strength and conditioning, and pre and postnatal rehabilitation, she’s an absolute pro on the matter.

Why does your pelvic floor matter?

Your pelvic floor is a sling of muscles, ligaments and connective tissue that forms a hammock-like support at the base of the pelvis. This 3D animation from the Continence Foundation of Australia is a great place to help visualise it.

The pelvic floor is responsible for:

• Supporting the bladder, bowel and pelvic organs

• Controlling continence

• Sexual function and pleasure

• Childbirth

• Everyday stability and core function

And here’s the important part: pelvic floor health isn’t just about being “tight” or “strong.” Like every skeletal muscle, it needs to contract and relax, move through its full range of motion, fire quickly (e.g. when you sneeze) and maintain low-level activation throughout the day.

We rarely think about these muscles - until they stop working well.

Signs your pelvic floor isn’t working as well as it should

A pelvic floor disorder (PFD) can occur when the muscles are weakened, stretched or too tight. A 2015 review in Current Opinion in Obstetrics and Gynecology estimated one in four American women experience at least one PFD.

Signs your pelvic floor may need attention include:

• Leaking urine when you cough, jump or sneeze - known as stress urinary incontinence (SUI). A 2017 study in the International Urogynecology Journal found SUI is the most common urinary complaint among women, and 15–75% of athletic women leak during impact sports.

• Accidentally passing wind or leaking from your bowel.

• Not getting to the toilet in time, or feeling like you can’t empty your bowel or bladder.

• Suffering a prolapse, which is when one of the organs normally held in place by your pelvic floor and pelvic ligaments drops down into your vagina. You might feel it as a bulge or a heaviness.

• Painful sex

• Pelvic pain

If you’re experiencing any of the above, it’s best to see a women’s health physiotherapist or doctor for advice and support.

What causes a weak pelvic floor?

There are a range of reasons why many women and those assigned female at birth suffer (often in silence) from pelvic floor problems, including:

• Pregnancy and childbirth — one in three Australian women who’ve had a baby experience incontinence

• Weight gain

• Estrogen changes during menopause

• Chronic constipation or coughing

• Regular heavy lifting

• High-intensity exercise

Women who exercise at a high intensity can also be at risk. This 2020 meta-analysis published in the Journal of Human Kinetics found that female athletes often suffer from leakage and that high-impact sport can increase the risk of stress urinary incontinence for many women.

Pelvic floor exercises to support your body

At Sweat, we love celebrating the resilience of your body, and pelvic floor training is a perfect example. Specific, simple exercises can make a huge difference, whether your pelvic floor is weak or overactive.

Even better: most pelvic floor exercises need no equipment and can be done anywhere.

The American College of Physicians recommends pelvic floor muscle training as the first-line treatment for any woman experiencing urine leakage.

The key to success with pelvic floor exercises (also known as Kegels) is having the correct technique, something people often find tricky at the start. Here are some step-by-step tips:

• Start by lying down or sitting to do these exercises, before progressing to standing as your strength improves

• Relax your thighs, buttocks and stomach

• Keep breathing normally, and then on an exhale breath, squeeze and lift your back passage, then your vagina, then try to lift those muscles up and in further, like an elevator rising. Hold for up to five seconds.

• Use the inhale breath to further relax the pelvic floor muscles and allow them to release completely. A good visual is like a flower opening or blooming.

• Do three sets of up to 10 Kegels and stop when your muscles get tired or you feel like you aren’t able to keep up a good technique

If you’re finding it hard to get these right, consult a pelvic floor specialist, especially if you aren’t seeing progress or your symptoms worsen with pelvic floor muscle training.

Once you have mastered the kegel action lying down, you can progress to sitting or functional exercises. This could mean exhaling and lifting your pelvic floor when you pick up a heavy weight, or before coughing or sneezing (also known as “the knack”).

Future-proof your pelvic health

A 2015 Obstetrics & Gynecology review found the lifetime risk of surgery for stress urinary incontinence or pelvic organ prolapse is 20% by age 80. The good news? There is so much you can do to support your pelvic floor.

Here are Rosie Dumbrell’s top six tips:

1. Practice good posture. Poor posture (rounding, or overarching your back) increases intra-abdominal pressure and the downward force on your pelvic floor and organs. By simply sitting, standing and moving with good posture, you significantly reduce the pressure and stress on the pelvic floor.

2. Practice good bathroom habits. Straining on the toilet is a significant stress on the pelvic floor - especially if it’s a chronic habit. “If you are constipated and regularly straining, or finding it difficult to pass a bowel motion, it is worth seeking the advice of your health professional to work out if it’s a dietary issue or a structural blockage like a rectal prolapse,” says Rosie. She also notes how important it is to relax the pelvic floor to pass a bowel motion - something perhaps not commonly understood! Using a squatty potty or footstool to elevate your hips and knees can help make passing a bowel motion much easier, as well as understanding when your pelvic floor needs to relax, rather than tighten!

3. Eating a high-fibre diet can help significantly to keep bowel movements soft and regular.

4. Drink plenty of water. This can seem counterintuitive (especially if you have bladder urgency or leaks), but avoiding fluids can actually make your symptoms worse. Frequently drinking small amounts is best, especially if you have urinary urgency symptoms.

5. Move your body! “The pelvic floor is part of a connected system - movement of your body in general encourages stretching and strengthening of your pelvic floor muscles and tissues. The old adage ‘use it or lose it’ applies here, too!” says Rosie.

6. Wear targeted support daily or for high-impact exercise, like Everform’s Pro Support and LBL Briefs, which are designed to optimise intra-abdominal pressure during exercise and support improved pelvic health.

Which exercises should you avoid?

If your pelvic floor feels weak or you’re experiencing leaks, heaviness or pain, avoid high-impact or high-load exercises until your symptoms improve.

These can include:

• Running

• Skipping

• Jumping

• Heavy weightlifting

Lower-impact options like walking, Pilates, yoga and barre can help you rebuild strength safely.

“Building pelvic floor strength can be as easy as becoming aware of your pelvic floor in daily activities,” says Rosie. “Think an exhale and lift of your pelvic floor muscles when you are walking up the stairs, lifting something heavy at home or in the gym, as well as practising good posture and bowel habits.” 

The Continence Foundation of Australia also recommends 10 steps for protecting your pelvic floor, including:

• Use the exhale breath to lift and engage your pelvic floor, especially before the hardest part of the movement. 

• Avoid aggravating exercises or machines until you have built up the strength to perform them without symptoms. You may swap out high-impact exercises for low-impact options (like skipping for step-ups), which will help build up your core and glutes and take pressure off the pelvic floor. 

• Always activate your pelvic floor before and during resistance exercises

Check with your healthcare provider for advice on pelvic floor safe options that suit you!

The best Sweat programs for you

Sweat has great pelvic floor and core-focused workouts like Core and Restore, which are a great place to start.

On top of this, we also have Pilates, barre and yoga programs, as well as low-impact on-demand workouts that are great when executed whilst engaging your pelvic floor muscles. Remember: these workouts alone won’t help to strengthen your pelvic floor, but do include movements designed to assist you in engaging this group of muscles.

If your healthcare provider has cleared you to return to exercise after having a baby, we recommend chatting to them about our program options and what would be best for you.

• Britany Williams’ Post-Pregnancy Core & Restore program is a fantastic way to rebuild your strength and confidence after pregnancy. Britany has designed a gentle and progressive program to help improve and minimise common postnatal issues such as diastasis recti, pelvic floor and core dysfunction, back pain, poor posture and muscle weakness.

• Kayla Itsines’ Post-Pregnancy program includes four foundation weeks that focus on rebuilding your core and pelvic floor strength before progressing into more complex movements

• Sarah Smith has also created her progressive Post-Pregnancy program to help women rebuild their strength and embrace feel-good movement after pregnancy.

• The first four weeks of Kelsey Wells’ PWR Post-Pregnancy program focus on the transverse abdominis and pelvic floor activation.

Building habits for life

The evidence from a range of studies, including this 2019 review in American Family Physician, is clear: Kegels do work, both as prevention and treatment. However, they need to be done effectively and consistently every day. 

Awareness and seeking help are crucial: the 2018 National Poll on Healthy Aging in the US found that while 50% of women over 50 couldn’t completely control their bladders, two-thirds had never spoken to their doctor about the issue, and only 38% were practising Kegels.

It’s time to change the conversation. With a few minutes a day (about the time it takes to scroll social media or make a coffee), pelvic floor exercises can be genuinely life-changing.