Your Pelvic Floor
This entry synthesizes insights from 68 articles in the Library
"Your pelvic floor is not just about continence or childbirth. It's the seat of your center, your stability, your pleasure. It deserves your attention."
— Christine Mason
The Hidden Hammock
Deep in your pelvis, a hammock of muscles stretches from your pubic bone to your tailbone and between your sit bones. This is your pelvic floor—a muscular structure most women never think about until something goes wrong.
Your pelvic floor supports your bladder, uterus, and bowel. It plays a role in continence, sexual function, core stability, and even breathing. When it functions well, you don’t notice it. When it doesn’t, the impact ripples through your life.
What the Pelvic Floor Does
Support: The pelvic floor holds your pelvic organs in place against gravity and intra-abdominal pressure.
Continence: It controls the release of urine and feces. When you hold it or let go, pelvic floor muscles are involved.
Sexual function: These muscles play a role in arousal, sensation, and orgasm. The rhythmic contractions of orgasm are pelvic floor contractions.
Stability: The pelvic floor is part of your core—it works with your diaphragm, deep abdominals, and back muscles to stabilize your spine and pelvis.
Lymphatic and circulatory: Healthy pelvic floor tone supports blood and lymph flow in the region.
When Things Go Wrong
Pelvic floor dysfunction can mean muscles that are too weak, too tight, or uncoordinated. The symptoms depend on what’s happening:
Too weak (hypotonic):
- Urinary leakage when coughing, sneezing, jumping
- Difficulty holding urine when you need to go
- Pelvic organ prolapse (heaviness or bulging)
- Decreased sexual sensation
Too tight (hypertonic):
- Pain with penetration
- Difficulty emptying bladder or bowels completely
- Chronic pelvic pain
- Painful orgasm or difficulty having one
Uncoordinated:
- Symptoms of both
- Muscles that don’t know when to engage or release
Risk Factors
Several things can affect pelvic floor function:
Pregnancy and childbirth: The weight of pregnancy and the stretch of vaginal delivery can weaken or damage the pelvic floor. Tears, episiotomies, and instrument deliveries increase risk.
Chronic straining: Years of constipation and straining create downward pressure.
High-impact exercise: Repeated jumping and running create load on the pelvic floor.
Chronic coughing: Each cough creates pressure.
Hormonal changes: Estrogen affects pelvic floor tissue. Menopause-related estrogen decline can contribute to weakness and prolapse.
Surgery: Pelvic surgeries, including hysterectomy, can affect pelvic floor function.
Chronic tension: Stress, trauma, and habitual clenching can lead to hypertonic (too tight) pelvic floor.
Posture and core patterns: How you sit, stand, and breathe affects pelvic floor function.
Kegels: Not Always the Answer
Kegels—contracting and releasing the pelvic floor—are often prescribed as the default solution. And for some women with weak pelvic floors, they help.
But for women with hypertonic (too tight) pelvic floors, Kegels make things worse. If your muscles are already chronically clenched, strengthening them isn’t what you need. You need to learn to release.
This is why seeing a pelvic floor physical therapist for assessment is so valuable. They can tell you whether your floor needs strengthening, relaxing, or coordination work—and teach you the right exercises for your situation.
Finding Your Pelvic Floor
Many women aren’t sure they’re engaging the right muscles. Here’s how to find them:
The stop-pee test: While urinating, try to stop the flow. The muscles you use are your pelvic floor. (Don’t do this repeatedly—it’s just for identification.)
The internal sensation: Imagine picking up a marble with your vagina, or drawing a tampon up and in. That lift is pelvic floor engagement.
The release: Equally important is the ability to fully relax—to let the muscles soften and drop.
If you can’t feel these sensations, a pelvic floor PT can help you develop awareness.
Caring for Your Pelvic Floor
For a weak pelvic floor:
- Proper Kegel exercises (not just squeezing, but the full contract-hold-release cycle)
- Core-pelvic floor integration exercises
- Avoiding chronic straining
- Managing cough and constipation
- Working with a pelvic floor PT
For a tight pelvic floor:
- Relaxation techniques (reverse Kegels, diaphragmatic breathing)
- Stretches for hips and inner thighs
- Stress management
- Sometimes dilator therapy
- Pelvic floor PT for release work
For overall health:
- Don’t hover over toilets (this creates tension)
- Breathe properly—avoid breath-holding during exertion
- Maintain good posture
- Keep bowels regular
- Stay hydrated
- Consider the impact of high-impact exercise
Pelvic Floor and Pleasure
A functioning pelvic floor matters for sexual pleasure. Muscles that can both engage and relax allow for:
- Better arousal response
- More sensation during penetration
- Stronger orgasms (those contractions are pelvic floor)
- Reduced pain with intercourse
If you’re experiencing sexual pain or diminished sensation, your pelvic floor may be part of the picture.
When to See a Specialist
See a pelvic floor physical therapist if you experience:
- Urinary leakage
- Pelvic pain
- Pain with sex
- Feeling of pelvic heaviness or prolapse
- Difficulty emptying bladder or bowels
- Post-pregnancy recovery issues
Pelvic floor PT is specialized work—not all physical therapists are trained in it. Look for someone specifically credentialed in pelvic health.
Go Deeper
These are the original writings this entry draws from:
What Supports This
Physical expressions of this philosophy