Pelvic floor exercises: Help for incontinence, sexual health, and more

Say the word "Kegels" and chances are it'll prompt an involuntary muscle contraction and a vow to add pelvic-floor conditioning to the to-do list. But Kegels, which strengthen pelvic floor muscles, aren't the only pelvic floor exercises you should be aware of. In fact, many people have overly tight pelvic floor muscles that can benefit from stretching and lengthening.

Another misconception about pelvic floor exercises is that they're just for women. But strong, well-toned pelvic floor muscles benefit both men and women by supporting bladder control, improving sexual health, and bolstering the core and its related functions. With a little guidance, it's easy to add pelvic floor exercises to your daily routine.

What are the pelvic floor muscles and what do they do?

The pelvic floor muscles span the bottom of the pelvis and provide support for the bladder, bowel, and core. In women, the pelvic floor also supports the uterus and contributes to sexual sensation and arousal. In men, these muscles are linked with erectile function and ejaculation.

When pelvic floor muscles aren't functioning as expected, though, both men and women can experience bladder leakage, bowel leakage, or both; sexual issues; and even lower-back pain.

Benefits of pelvic floor exercises

Pelvic floor muscles can be weakened or damaged as a result of childbirth, cancer treatments, gender-affirming surgeries, obesity, or chronic constipation. Aging can also impact pelvic floor function.

Pelvic floor exercises can help with symptoms related to pelvic floor dysfunction, says Dr. William Winkelman, fellowship program director in the urogynecology and reconstructive pelvic surgery department of obstetrics and gynecology at Mount Auburn Hospital, and assistant professor at Harvard Medical School.

He notes that people who focus on strengthening and toning a weakened pelvic floor — such as postpartum women — can experience significant benefits in a relatively short amount of time. By strengthening the muscles that support the urethra and rectum, it's possible to regain better bladder and bowel control, as well as improve sexual function.

Incontinence

Incontinence is common; in the US, an estimated 25 million adults have urinary incontinence, and 21 million have fecal incontinence. Some experience both conditions.

Women who have had a vaginal birth and men with prostate issues are especially prone to pelvic floor dysfunction, but anyone can experience leakage caused by a weak pelvic floor. An easy way to tell: if you leak urine — even a little bit — when you jump, cough, sneeze, lift heavy objects, laugh, or run, you may be experiencing stress incontinence. And while urge incontinence (also referred to as overactive bladder) has slightly different root causes than stress incontinence, pelvic floor physical therapy can help reduce leakage and improve quality of life for both.

However, overly tight (hypertonic) pelvic floor muscles can also cause incontinence. That's because tightly clenched muscles can't relax when they're supposed to. So, when the time comes to contract and control the flow of urine, they can't, because they're already tightly contracted.

In this case, stretching and lengthening hypertonic pelvic floor muscles helps with bladder and bowel control. Training these muscles to relax can significantly improve, if not resolve, symptoms. A qualified pelvic floor physical therapist can often help ease and relax a hypertonic pelvic floor.

Sexual health

Weak pelvic floor muscles can impact the sexual health of both men and women, as they're closely tied into the muscles that control sexual function. According to a recent review published in Sexual Medicine Reviews, pelvic floor exercises and manual physical therapy may improve premature ejaculation and erectile dysfunction in men, and while physical therapy should be monitored, this type of training is "simple, safe, and noninvasive," according to the study's authors.

And for women, particularly postpartum women, pelvic floor physical therapy — including, yes, Kegels — can help address pain associated with intercourse (dyspareunia). However, dyspareunia is more often associated with an overly tight pelvic floor. And for these patients, Kegels are not recommended.

"Sometimes we get patients who have tried doing Kegels or other pelvic floor exercises on their own and have actually made things worse," Dr. Winkelman says. "When people have a hypertonic pelvic floor, we recommend stretches aimed at tight hips or lower backs. Exercises such as yoga can help relax those muscles."

Pelvic floor exercises: Kegels and beyond

If a pelvic floor physical therapist recommends exercises to strengthen your pelvic floor, your workout routine will likely include Kegels. Developed in the 1940s by gynecologist Arnold H. Kegel, these exercises are simple — but finding the right muscles to target can be more of a challenge. (Here's a hint: no one should be able to tell you are doing a Kegel. If you are visibly moving, you're not engaging the right muscles.)

Learning to perform a strong and fast pelvic muscle contraction — sometimes referred to as "a knack" — just before and during actions that can cause incontinence (such as jumping, coughing, or sneezing) can help reduce leakage. Kegels can also help men prevent post-void dribbling.

When can pelvic floor physical therapy help?

A pelvic floor physical therapist can help identify and adjust your posture and body mechanics to help reduce bladder pressure, and can also suggest various stretches to help ease and relax an overly tight pelvic floor.

Dr. Winkelman often directs patients with hypertonic pelvic floors to a series of stretches (note: auto-download) created by the Pelvic Pain Foundation of Australia. Easy to perform at home, these stretches include exercises found in a typical yoga class, such as Child's Pose and Happy Baby, as well as cross-body stretches where opposite knee is drawn to opposite shoulder.

All the exercises are aimed at easing and relaxing overly tight muscles to regain bladder and bowel control and improve sexual function. And, just like a properly done Kegel, no one will ever suspect you're busily working on your pelvic floor function as you move through the postures.