Pelvic Floor 101: Strength, Relaxation & Coordination

The pelvic floor is often described as a "sling" of muscles, but its function is far more complex than just holding things up. When we talk about having a "strong" pelvic floor, it's easy to assume that more Kegels and more tightness are always the goal. In reality, a truly healthy pelvic floor is one that exhibits three key qualities: strength, relaxation, and coordination. Neglecting any one of these can lead to issues like pain, leakage, or constipation. Understanding this dynamic is the first step toward achieving optimal pelvic health, and a pelvic health physiotherapist can guide you there.

Strength: The Foundation of Support

Strength, primarily measured in terms of muscle power and endurance, is vital for the primary role of the pelvic floor: support and continence.

• Support: Strong muscles help support the pelvic organs (bladder, uterus, rectum) against gravity and increases in intra-abdominal pressure (like when you cough or lift). This prevents symptoms of pelvic organ prolapse and pressure.

• Continence: When properly activated, strong muscles compress the urethra and anus, preventing urinary or fecal leakage—especially under stress (Stress Incontinence).

If your pelvic floor is weak, it often lacks the endurance to sustain support throughout the day or quickly respond to a sudden physical demand (like jumping or sneezing). This is where traditional Kegel exercises, when done correctly, can build power and endurance.

Relaxation: Essential for Function and Comfort

While weakness is a common problem, an inability to relax the pelvic floor muscles is arguably just as common, and often the root cause of pain. A tight, hyper-tonic pelvic floor can cause several issues:

• Pain: Muscles held constantly tight can develop trigger points, leading to chronic pelvic pain, pain with intimacy (dyspareunia), or pain during a gynecological exam.

• Urgency & Frequency: A tight pelvic floor can irritate the nerves that control the bladder, contributing to urinary frequency and sudden, strong urges.

• Bowel Issues: Inability to relax the muscles fully can lead to difficulty evacuating stool, contributing to chronic constipation.

If your pelvic floor is already tight, doing traditional Kegels will only make the problem worse. Treatment first involves identifying and releasing this tension through breathing techniques and manual therapy.

Coordination: The Link to the Core and Breath

Coordination is perhaps the most sophisticated element and involves the pelvic floor muscles working in harmony with the rest of the body's "core canister": the diaphragm (top), deep abdominal muscles (front/sides), and small spinal muscles (back).

• Breath Synchronization: The pelvic floor should naturally lower slightly on an inhalation (relaxing) and gently rise on an exhalation (contracting). Proper breathing mechanics are essential for core stability and pressure management.

• Anticipatory Firing: A coordinated pelvic floor should activate just before an increase in intra-abdominal pressure (e.g., before you lift a heavy object or stand up quickly). This quick, subconscious activation prevents leakage and protects the spine.

• Bowel/Bladder Function: Coordinated muscles know exactly when to contract strongly (to stop flow) and when to relax completely (to allow elimination).

Lack of coordination can lead to "bearing down" or holding the breath during tasks, which puts excessive pressure on the pelvic floor.

How Pelvic Health Physio Helps

Trying to assess your own pelvic floor—determining if it’s weak, tight, or uncoordinated—is virtually impossible. This is why specialized care is so vital. A pelvic health physiotherapist will conduct a thorough assessment to:

1. Diagnose: Determine the true state of your pelvic floor (often through a gentle, internal exam with your consent).

2. Individualize Treatment: If you are weak and coordinated, you'll focus on strengthening. If you are tight, you'll focus on relaxation and breathing first. If you lack coordination, you'll work on integrating the pelvic floor with your core and breath.

3. Ensure Proper Technique: Provide visual, verbal, and tactile cues (sometimes using biofeedback) to ensure your exercises are effective.

A strong, relaxed, and coordinated pelvic floor is the key to a body that moves without pain or leakage.

Ready to move beyond guesswork and achieve true pelvic health? Book your specialized pelvic floor assessment at Milton Physio Plus today.