When it comes to strength training, we’re au fait with squatting for stronger glutes or bicep curls for more powerful arms. We think about the pelvic floor, however, far less. Pilates aside, most of us think of pelvic floor exercises (also known as kegels) are only being important for women who have had babies or are approaching menopause. But, overwhelming evidence shows we could all benefit from training our pelvic floor, regardless of age or childbirth status.

Concealed at the bottom of our abdomen, these muscles are a key part of our anatomy that protect our internal organs such as our bladder and bowel.  “If you have a pelvic floor, which we all do, then you should absolutely strengthen your pelvic muscles,” confirms Emma Brockwell, pelvic health physiotherapist and author of Why Did No One Tell Me?. “Your pelvic floor is like any other muscle, if you don’t train it, it will get weaker and you’ll be more likely to experience pelvic floor dysfunction.” 

“One in three women will experience urinary leakage during their lifetime, one in two will experience a pelvic organ prolapse and one in 10 women will experience accidental bowel leakage – pelvic floor exercises can prevent and treat these conditions,” adds Myra Robson, physiotherapist and co-founder of #pelvicroar, a campaign aiming to break the taboos surrounding pelvic health issues.

Given how key this set of muscles is to our day-to-day lives, why is it so shrouded in secrecy? One reason, perhaps, is the shame and embarrassment that come with things like prolapse and incontinence. It’s one thing talking to your colleagues about pulling a hamstring and quite another to admit that you’re living with incontinence issues. It also doesn’t help that the pelvic floor muscles are inside your body. Exercising muscles you can’t actually see can feel a bit pointless, particularly when you’re not sure what the benefits are.

Don’t know much about the pelvic floor? You’re not alone; according to a 2020 survey commissioned by Always Discreet, one in six women don’t know where these muscles are, and of the 1,000 women surveyed, nearly a quarter didn’t know the purpose of the pelvic floor.

So, we’ve roped in a bunch of experts to shed some light on this hidden muscle group, including where it is the body, its main functions and how we can strengthen it to prevent problems later down the line. 

“The female pelvic floor is made of muscles and connective tissue that form a ‘sling’ or ‘hammock’ across the base of the pelvis. The urethra (the tube that passes urine), vagina and anus pass through the pelvic floor,” explains Brockwell.

Dr Hazel Wallace AKA The Food Medic says that it’s key role is keeping all the pelvic organs (bladder, uterus and rectum) in place, ensuring urinary and faecal continence, and supporting increases in intrapelvic and abdominal pressure (eg when you cough or lift heavy weights). “The pelvic floor muscles also help to stabilise the spine and pelvis, they provide additional support during childbirth and finally, a strong pelvic floor can improve your sex life by enhancing clitoral sensitivity and orgasm.”

Fail to work on your pelvic floor and you might run into issues such as:

• Urinary leakage (sudden urgency to wee and increased frequency of needing the toilet)
• Bowel incontinence
• Pelvic organ prolapse
• Painful sex
• Pelvic pain

There are a number of risk factors for developing pelvic floor dysfunction, the most obvious being pregnancy, childbirth and ageing (which is associated with loss of muscle tone). According to Brockwell, other common causes of a weak pelvic floor include hormonal changes during perimenopause, smoking, chronic coughing, ongoing constipation and strenuous exercising.

Evidence shows that women who do high-impact sports such as gymnastics, trampolining, triathlon and running are at higher risk of urinary incontinence and other symptoms, because of the constant and excessive pressure that these activities put on the pelvic floor. And lifting very heavy weights can also cause complications if you’re not careful.

“When you lift weights, pressure in the abdomen increases so your core muscles, which include your pelvic floor, have to perform a balancing act,” says Brockwell. “If the pressure from above is too high or support from below is too low, pelvic dysfunction can occur.”

Does this mean we should steer clear of the gym? Absolutely not, says Megan Vickers, physiotherapist, pilates instructor and author of Stronger. “There are heaps of new research papers which advocate weight training even in the presence of pelvic floor prolapse,” she tells Strong Women. 

“Our pelvic floor doesn’t function on its own; it has to work with all of the other muscles in our body. Having strong abdominal walls, muscular thighs at the entrance and strong glutes at the rear is important.” But Vickers says that our pelvic floor needs to be strong enough for the task, and that means training those specific muscles.

The first step is strengthening your pelvic floor is to find out where the muscles sit. Brockwell says you can do this by stopping the flow of wee when you’re on the toilet but warns that “this shouldn’t be used as a way of exercising your pelvic floor as it can be harmful to your bladder”. Robson also recommends “pretending that you want to pass wind but you’re standing in front of the King. Imagine pulling the muscles around the anus and vagina up and in to stop you from passing wind – that’s your pelvic floor squeezing.”

Kegel exercises 

Perhaps the most simple way of strengthening the pelvic floor is via kegel exercises. You don’t need any equipment and no one is going to be able to tell you’re doing it – so you could do this whenever you find yourself waiting for a bus or Tube. Perhaps you could aim to do a set every time you go to make a cup of tea or while brushing your teeth.

1. Make sure you’re comfortable, preferably standing.
2. Squeeze the muscles around your vagina and anus as if you’re trying to stop yourself from passing wind.
3. Try to hold this squeeze for a few seconds, then let go and relax. As you’re holding this position, try to breathe normally.
4. Repeat this 10 times. Over time, you can work up to holding each squeeze for 10 seconds.
5. Follow this with 10 short squeezes, each for about one second. Make sure to slowly release and relax between each squeeze.

Aim to do these exercises at least once a day and up to three times a day if you have any symptoms. 

How do you know if you’re doing it correctly? “Being able to feel movement of the area around your perineum (the bit between the anus and vagina) is a good indication,” says Brockwell. “Avoid holding your breath, gripping abdominals and don’t squeeze your bottom or inner thighs. If you are aware this is happening or if you have pelvic floor dysfunction and the symptoms aren’t improving with pelvic floor exercises alone, you may benefit from seeing a pelvic health physiotherapist and getting help with your technique.” 

Strength training moves

As we’ve already established, having a strong pelvic floor is crucial before you start lifting heavy. Once you’ve strengthened your pelvic floor, Vickers says you can incorporate it into lifting activities such as squats and lunges. Personal trainer and fitness influencer Carly Rowena says that barbell squats are one of her favourite exercises to activate and strengthen the pelvic floor. Here’s how to make sure your form is correct:

1. Stand in an upright position with your feet slightly wider than shoulder-width apart and your toes pointed outwards. Ensure the barbell is rested behind your neck on your trapezius muscles.
2. Bend your knees and push your hips and your bum back as if you’re sitting down. Keep your chin tucked in and your neck neutral.
3. Drop down until your thighs are parallel to the ground, keeping your weight in your heels and your knees bowed outwards slightly.
4. Straighten your legs and return to an upright position.
5. Complete 15 reps.

To protect your pelvic floor while lifting, Rowena says it’s important to be mindful of your breathing. “A lot of the time when we’re in the gym, we hold our breath,” she says. “When you’re doing the most challenging part of an exercise, for example when you’re pushing up in a squat, you want to exhale, leaving your mouth slightly open.”

To reduce excessive downward pressure on your abdomen, avoid straining when lifting a weight as this puts excessive pressure on your muscles, explains Brockwell. “Don’t hold your stomach in, just relax and let it go, and avoid bracing your abdominals and pushing down on your pelvic floor when you lift,” she adds.

Remember to take things slowly with lifting weights, says Vickers. “Leaking urine and feeling pressure down below are signs that our pelvic floor can’t cope with the load we’re putting on and we should back off,” she explains. If you’re experiencing any symptoms, take the weight down to a level your pelvic floor can cope with to avoid injury. 

Fundamentally, it’s important to know that while pelvic floor dysfunction is common, it’s not normal and it should be addressed. Brockwell says: “If women are experiencing problems, they should seek help and treatment from a pelvic health physio.”

Images: Getty