Understanding the Connection between the Pelvic Floor and the Core

The hidden muscles: The Pelvic Floor as part of the core muscles play a key role during exercise, but did you know there are hidden muscles that require special attention? These are the pelvic floor muscles (PFMs), which form the base of the muscle group commonly known as the ‘core’. The PFMs stretch like a hammock from the pubic bone at the front to the coccyx (tailbone) at the back and side to side within the pelvis. These muscles work closely with the deep abdominal and back muscles and the diaphragm to support the spine and regulate intra-abdominal pressure.

Why Pelvic Floor Health Matters

The pelvic floor muscles play a critical role in bladder and bowel control, supporting the pelvic organs and contributing to sexual function in both men and women. During exercise, intra-abdominal pressure changes—rising when lifting weights and decreasing when the weight is lowered. Ideally, the core muscles, including the pelvic floor, respond automatically to these changes, maintaining stability and control.

This automatic regulation may fail if the core muscles, including the pelvic floor, are weak, too tight or damaged. In such cases, exercises that increase intra-abdominal pressure can overload the pelvic floor, potentially leading to pelvic organ prolapse or loss of bladder/bowel control. When repeated frequently during workouts, these issues can worsen over time.

Pelvic Floor Muscle Flexibility and Strength

To function well as part of the core, pelvic floor muscles must be strong and flexible. Constantly bracing the core muscles during exercise, a common practice among fitness enthusiasts, can lead to stiffness and tightness in the PFMs. Overly tight pelvic floor muscles can cause urinary urgency, leakage, pelvic pain, and pain during intercourse.

Abdominal Exercises and Pelvic Floor Safety

Your abdominal muscle strength may exceed your pelvic floor’s ability to cope. To protect your pelvic floor, especially if you are at risk of issues, consider these strategies:

• Avoid intense abdominal exercises that put excessive pressure on the pelvic floor.
• Reduce exercise intensity and opt for gentler core workouts.
• Exhale during the effort to prevent unnecessary intra-abdominal pressure.
• Maintain good posture without over-bracing.
• Engage the pelvic floor first, holding it during the exercise and relaxing afterwards.

Pay attention to how many repetitions your pelvic floor can handle before fatigue sets in. Rest as needed and gradually increase reps as your pelvic floor strength improves.

Special Considerations for Different Groups

If you are pregnant, postnatal, or recovering from gynecological or prostate surgery, it’s crucial to follow a tailored exercise program. Consult a Continence and Women’s Health Physiotherapist to determine safe exercises for your condition.

Building Pelvic Floor Control Before Intense Workouts

Before attempting more challenging abdominal exercises, pelvic floor muscle control is essential. This foundational work ensures you can safely progress to more advanced movements without risking injury or exacerbating existing issues.

Flat Abs: The Right Way

If you’re aiming for a flatter tummy, sit-ups and crunches may not be your best bet. These exercises primarily target the rectus abdominis (six-pack muscles) and can increase upper abdominal tension, sometimes causing a lower belly bulge. Instead, focus on:

• Low-impact aerobic exercise to reduce abdominal fat.
• Pelvic floor exercises combined with proper breathing and relaxed upper abdominals.

Are You at Risk of Pelvic Floor Problems?

Certain groups are at higher risk of pelvic floor issues, including:

• Pregnant and postnatal women
• Women who have had a baby or gynecological surgery
• Menopausal and post-menopausal women
• Men post-prostate surgery
• Elite athletes

Other risk factors include:

• Regular heavy lifting (gym or occupational)
• Chronic constipation
• Chronic cough or frequent sneezing
• Overweight or obese (BMI over 25)
• Pelvic trauma or history of back pain

Recognising Pelvic Floor Problems

Common symptoms of pelvic floor dysfunction include:

• Urine leakage during activities such as exercise, laughing, coughing, or sneezing
• Urgency or frequent trips to the toilet
• Difficulty emptying the bladder or bowel
• Accidental loss of feces or wind
• Prolapse symptoms (bulging, heaviness, or discomfort)
• Pelvic pain and pain during intercourse

Where to Get Help

Interested in enhancing your pelvic floor health? Check out my FREE 8-part Pelvic Floor series. This comprehensive program provides in-depth knowledge, safety tips, and effective strengthening exercises. It’s designed to help you better understand this crucial part of the body and its significance in daily function.

Pelvic floor issues are treatable and often curable. However, not all bladder or bowel control problems are due to weak pelvic floor muscles. Consult a GP or a continence professional for an accurate diagnosis and appropriate treatment.

For more information, contact the National Continence Helpline at 1800 330 066 or continence.org.au. You can also find resources on safe exercise practices at pelvicfloorfirst.org.au.