For a Strong Core, Understand Your Pelvic Floor

May 23, 2022

Most people – professional athletes and weekend warriors alike – are familiar with the term “core muscles” and associate a strong core with physical fitness, increased stamina and an enhanced ability to perform a wide range of physical activities, including sports. And these associations are accurate – a strong core forms the foundation for all movement, balance, stability and flexibility and can reduce the risk of injuries while exercising, running or competing in athletic events.

But what exactly is the core?

More than Meets the Eye

Many think that the visible abdominal muscles are the core. Called the rectus abdominus, these muscles can be impressive to look at in very fit individuals (think washboard abs) but they are just surface muscles and not part of the core at all. The true functional core is actually made up of several muscles and muscle groups that lay deep beneath the surface. And, it may surprise you to know that the pelvic floor is one of those muscle groups – a pretty important one, in fact.

Pelvic Floor 101

The pelvic floor is a group of muscles, ligaments, and fascia that are positioned in the shape of a bowl to hold all the pelvic organs in place, including the uterus, bladder, vagina and bowel. Male and female pelvic floors are essentially the same - the main difference being there are three openings in a female pelvis (the urethra, vagina, and rectum) and only 2 in the male pelvis (urethra and rectum).

Whether male or female, almost every physical activity you do involves the pelvic floor muscles. A strong pelvic floor supports and improves your physical performance whereas a weak pelvic floor can lower your stamina and hinder your ability to react properly to mishaps, like falls – potentially leading to significant pain and injury.

What Can Go Wrong?

Over time, like any other muscle group, the pelvic floor can weaken and lose its tone and strength. Other than the simple passage of time, there are two major events/activities that are known to substantially affect the pelvic floor and potentially lead to dysfunction. These are:

Pregnancy
The most well-known cause of pelvic floor dysfunction is pregnancy. “The weight of a growing fetus and the changes in posture means your pelvic floor muscles have to work harder,” says Jessica Jenkins, Doctor of Physical Therapy at University Hospitals. “And, although vaginal birth certainly puts additional stress on the muscles, pelvic floor problems can also develop after a C-section. Surgical birth involves cutting through the abdominal muscles which work synergistically with the pelvic floor muscles so you are still at risk for some dysfunction,” adds Dr. Jenkins.
High Impact Sports
Strong pelvic floor muscles are essential for optimal sports performance. However, many high impact sports are also a primary cause of injury to the pelvic floor. The additional pressure placed on the pelvic floor muscles by sports such as running and gymnastics, can result in the weakening of the connective tissue that supports the bladder. Research shows that both men and women are at higher risk for incontinence if they engage in these types of exercise.

Additional potential causes of pelvic floor injury and dysfunction include chronic cough, constipation, poor lifting mechanics, menopause and any type of pelvic surgery, including prostate surgery in men.

Signs that your pelvic floor may be in trouble

The most common symptom of pelvic floor dysfunction is urinary incontinence or loss of bladder control. This can vary from slight leakage when sneezing, coughing or laughing to a complete inability to control urination.

Other symptoms may include:

Pelvic, lower back, tailbone, hip, or groin pain
Pain with intercourse or with any internal penetration like a tampon
Constipation and/or rectal pain
Fecal and/or gas incontinence
Urinary urgency/frequency
Urinary tract infection symptoms
Pain in the testicles or penis

People with one or more of these symptoms should talk to their doctor. If other potential causes are ruled out and pelvic floor dysfunction is suspected, you may be referred to a pelvic floor physical therapist.

How can pelvic floor physical therapy help?

There’s no one machine at the gym specifically designed to exercise your pelvic floor muscles. And certain exercises, like Kegels, can be difficult to do correctly and are not always enough to rehabilitate the muscles and/or make them stronger.

Pelvic floor physical therapists use a variety of strategies and techniques to target and strengthen these hidden muscles, including:

Biofeedback
Neuromuscular electrical stimulation
Stretching and strengthening exercises
Patient education

In addition, your pelvic floor therapist will teach you relaxation strategies, something that is often overlooked. “A strong pelvic floor is important but the ability to fully relax those muscles is equally important,” says Dr. Jenkins. “A tight pelvic floor does not equal a strong pelvic floor. In fact, tight muscles are usually weak ones,” she adds.