I want to introduce you to what is arguably one of the most important, but most underrated muscle groups in your entire body. Meet your pelvic floor! You use it every time you use the bathroom, have an orgasm, and most significantly when you have a baby. But have you experienced its full potential? Do you know where it is located and everything it can do? Let's get better acquainted.
If you could look at the pelvic floor (PF), you would see an interconnected sheet of muscles positioned like a hammock and connected to your coccyx (tail bone) in the back and the pubis in the front. Like a hammock, the PF cradles your bladder, uterus, intestines, and colon, and is an active participant in bladder, bowel, and sexual function. Running down the middle of the PF are three orifices (or openings) that offer breaks in the muscle sheet. In women, these orifices are the urethra, vagina, and anus. (Men have a PF too, but only two orifices: the urethra and anus.) The PF forms two muscle rings in a figure eight around these orifices: one ring around the urethra/vagina area, the other around the anus. These muscular rings control the functions of these orifices. Like any muscle in your body, the more toned and strong the PF rings are, the more control you have over your urinary and rectal functions, and most importantly, vaginal power (yes, power!). Want to know how to tap that power? Let's learn some more of the amazing things a powerful PF can do.
The Pelvic Floor in Sex
While our society may prefer to think of female sexuality as passive and even downplay its importance, our sexual physiology is anything but passive. During sex, the PF muscles and vaginal tissues become engorged, increasing tightness coordinated with active contractions as the PF muscles grip the penis. A strong PF does for sex what olympic training does for an athlete! The beauty of PF exercises is that sex is one of the best times to practice them. You get instant feedback from your partner and they improve your own sexual response as your PF muscles become stronger. How many other exercise routines are this much fun?
The second trimester of pregnancy is a time of heightened sexuality for most women due to increased engorgement of pelvic tissues at this time. This is the perfect time to practice PF exercises during sex, barring any medical contraindications. It's great for preparing for birth (which of course is a very athletic event), and you and your partner will enjoy them.
In her book, Essential Exercises for Childbearing Years, Elizabeth Noble provides examples of what she calls “sexercises” for couples to try (highly recommended!) as well as further discussion on the sexual benefits of a strong PF, such as female ejaculation. She also points to the connection between female sexuality and the birth experience, as both are very sensual, spiritual experiences, with similar progression, contractions, and benefits from making sounds (discussed further below).
The Pelvic Floor in Childbirth
The ability of the PF to enhance our sexual experience is impressive enough, but the true potential of the PF (and the vagina!) shines in childbirth. Part of what makes birth so powerful, and sometimes frightening, is that part of labor every unmedicated laboring women experiences when there is a sense that their body is acting without them. It can be frightening to feel like you've lost control, but it's also very powerful when you surrender to the power you feel and work with it rather than trying to fight it. It's an amazing, primal, spiritual time that really cannot be adequately put into words.
Here is a glimpse of the physiology behind what is happening during labor and the role of the PF. During the second stage of labor and leading into the actual birth, Oxytocin is produced in abundance by the pituitary gland to stimulate contractions. The pituitary gland receives its cues from the PF. As the baby's head descends, pressure increases on the PF. This information is then relayed to the pituitary gland, signaling the need for more Oxytocin. The lower the baby descends, the higher the PF pressure, the stronger the feedback of Oxytocin, the more powerful the contractions, until finally the baby is born. But, as Noble points out, this “urge to push is a reflex that unites nerve sensation with hormone production—only if you have no anesthesia.” (1) Epidurals and other labor anesthetics interrupt the natural feedback loop between the PF nerve sensations and oxytocin production, which in turn can cause contractions to diminish.
One of the greatest concerns for first-time moms about giving birth is how something as large as a baby is going to fit through their vagina. Again, this is where the strength of the PF is of greatest benefit. First, it is important to understand the tremendous elasticity of the vagina itself. A really apt description I've heard repeatedly is comparing the vagina to the neck on a turtleneck sweater. It seems like your head would never be able to fit through, but the material is designed to stretch around your head as you pull it through, then pulling tight again around your neck. Much the same way, the vagina is designed to stretch well beyond what you might think, gradually, to accommodate the baby's head and body. While it might seem like the less toned, more slack PF would stretch out of the way of a descending baby better than a tight, toned one, the opposite is true. Dr. Kegel (yes, that Dr. Kegel!) described how a strong, powerful PF will easily stretch and move as the baby passes through, whereas a weaker one is thinner and is more likely to be stretched past its limits and possibly damaged. (2)
I will again point to Noble's book, Essential Exercises, at this point as she provides a beautiful description of how the PF transitions from a strong supportive muscle sheet in pregnancy to controlled stages of relaxing to allow the baby to be born. All of this is made possible, and easier, with a well-exercised, strong PF.
While not directly using the term “pelvic floor”, Ina May Gaskin talks extensively about what she calls Sphincter Law as it applies to all sphincters of the body, including those used in birth. (3) In Ina May's Guide to Childbirth, she discusses the power of the mind/body connection that can affect sphincter function, whether speeding up a bodily process or shutting it down completely. All of this applies to labor, as well, and makes sense on a primal, survival level. If we feel afraid or threatened, the natural relaxation of the PF, the cervix, and the vagina are interrupted. We're prepared to stop laboring and move to a safer place. If we can't move to a safer place, labor might just halt all together and require further interventions. This warrants a much deeper discussion than I will go into here, but it suffices to say there is a strong connection between our minds and our bodies that allows us a very active role in labor, even when we feel like we're not in control, that is better facilitated as we learn more about what how our bodies function in labor and what we are capable of doing.
The Postpartum Pelvic Floor
The importance of exercising the PF postpartum, and having a strong PF prior to having your baby, comes into play as you are healing (from birth and from any perineal tearing, including episiotomies) and your body is returning to its pre-pregnancy state. Since the PF is so important in providing physical support to all of your organs in the pelvis, it is vital that the PF shrink and tighten to prevent organs from sagging out of place. If it is strong going into pregnancy, it will recover more easily. Likewise, a weaker PF will be pushed to its limits and may require more work to provide adequate organ support. In Essential Exercises, Noble points out that starting PF exercises as soon as possible after birth, even within the first week, can help speed overall healing, prevent or lessen common PF dysfunctions that many women assume are part of having children (such as urinary incontinence, hemorrhoids, and impaired sexual response). She provides a number of exercises beyond the basic Kegels for all stages of pregnancy, but particularly for this critical recovery postpartum period. (1)
It's easy to take for granted the importance of having strong, active PF muscles, and it's easy to assume that some common dysfunctions “down below” are just part of who we are with no way of fixing them. Most of us get the “Kegels” discussion from our OB/GYN, but not much explanation about why it's important to exercise the pelvic floor. If we're honest, our culture is not comfortable talking about female organs, especially in terms of their power. We get a pretty sterile, static education about our organs, their basic functions, and a very passive approach to what they are “allowed” to do outside of what we know they can do physiologically. Birth is allowed to be medical and physiological, but not powerful or spiritual.
But you don't have to move too far past cultural propriety or embrace that much of your primal self to understand the importance of self-knowledge. Knowing not simply how our bodies work on the physiological level, but how that physiology is interwoven with our spiritual side, our sense of self-worth, that is where our true power lies. That is what makes birth so much more than a biological, or as some perceive it, a medical event. Making society comfortable with the female body starts with being comfortable with it ourselves, and creating and spreading knowledge without fear.
(1) Noble, Elizabeth. Essential Exercises for the Childbearing Year, 4th Edition. Harwich: New Life Images, 1995.
(2) Kegel, Arnold. “Stress incontinence of urine in women: physiologic treatment”. J Int. Coll Surgeons 1956 (25) 487-99.
(3) Gaskin, Ina May. Ina May's Guide to Childbirth. New York: Bantam Books, 2003.
(4) McNeeley, S. Gene , MD. (2008, December). Pelvic Floor Disorders. Retrieved from http://www.merckmanuals.com/home/womens_health_issues/pelvic_floor_disorders/pelvic_floor_disorders.html