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Why Did No One Tell Me About the Pelvic Floor?

Photo-Illustration: by The Cut; Photos: Getty Images

Hot Bod is a weekly exploration of fitness culture and its adjacent oddities.

Unless briefly mentioned in a yoga class or by someone who has recently given birth, “the pelvic floor” is a phrase rarely heard. “Imagine if you didn’t know that your lungs helped you breathe or your biceps supported arm strength,” says Dr. Sarah Clampett, the clinical director of Los Angeles’ Origin physical-therapy group. Everybody’s body has a pelvic floor. “The pelvic floor does so much and controls so much, but it’s taboo,” Clampett continues. “A lot of people have issues with it and don’t know it’s the source of their issues.”

The pelvic floor, which is really more in the shape of a bowl, refers to a set of muscles that rest in the base of your pelvis. They are responsible for holding you upright and stable, supporting your organs, sexual health and satisfaction, continence and bowel function, and maintaining lymphatic circulation. They are busy! And they’re ignored. As Clampett observed (and which I can verify): “In fitness classes, instructors skip right over it. They go straight from the core to the legs.”

Pick your pet theory for why the pelvic floor is taboo. Because the muscles overlap with the crotchal region and Puritan prudery still holds strong in this godforsaken country? Because it’s a set of muscles associated with women? Because concerns with the pelvic floor are thought to be territory of the elderly and postpartum? Because a rocking pelvic core isn’t a vanity muscle? Or because working on this muscle group doesn’t have any visible result, other than a lack of urine streaming down your thigh?

“It’s probably all of it,” says Dr. Carrie Pagliano, who founded Georgetown University’s pelvic physical-therapy clinical program and now runs her own practice. “We’re not having these conversations openly.” But maybe we’re starting to, she says, citing a recent cultural high point: “When the ‘WAP’ song came out, it was great. We’re normalizing [this general anatomical area] that, for so long, we just didn’t talk about. In creative ways, these taboo topics are getting brought out in the open.”

But when will “WAP” for a healthy pelvic floor emerge? Maybe when there are enough struggling pelvic floors that a generous rap icon sees it as her sworn duty to give them their anthem. Pagliano and other physical therapists report that pelvic-floor problems are on the rise. There could be many reasons for this; habits that weaken the pelvic floor — like stilted breathing, bad posture, and a furiously pumping sympathetic nervous system — also happen to be related to stress.

For a major culprit that’s probably stressing out the pelvic floor, Pagliano pointed to the increasing popularity of high-impact fitness (HIIT). If you’re doing a high-impact exercise or heavy lifting, and you don’t have correct core stabilization, the pelvic floor can deteriorate over time. But the signs of a compromised pelvic floor are actually praised in these hard-core communities. Unintentional urination is proof of intensity. “If you’re a CrossFitter, if you pee yourself, people are like, You had a good lift! You lifted to the point of peeing yourself!” says Clampett, doing a great voice. But your pelvic floor, she says, should be able to hold the load of whatever you’re doing safely.

As with anything that’s unmentionable, rumors and misinformation about the pelvic floor abound. The main incorrect assumption is that Kegels are the cure-all for pelvic floor issues. “Two people could have the exact same symptoms, like leaking while exercising, and it could be the opposite problem,” says Pagliano. “The treatment that’s going to work is different.”

The other big incorrect assumption is that an aggravated pelvic floor is a weak pelvic floor. For younger people who exercise frequently, it’s way more likely that they don’t have a “weak pelvic floor” but an “overactive pelvic floor.” “For anyone sucking in and holding in,” says Pagliano, “I always ask what sports people did growing up. If the answer is ballet, or anything with a lot of aesthetics, tucking, and precise movements, it’s likely to be an overactive pelvic floor. Basically the muscles are ‘on’ more than they should be, and you see leakage and pelvic pain. This person might try Kegels and say, ‘They didn’t help, I’m hopeless.’

“It’s really important for folks to realize that in these cases, you don’t actually want to start with Kegels right away,” says Clampett. “Rather, you should consult a pelvic-floor physical therapist so you can work on relaxing your pelvic floor before starting to strengthen with Kegels.” For relaxing your pelvic floor, Clampett says, the task can be very simple, like lying on your back and belly breathing for a while.

Depending on the details of your concerns, trainers are looking beyond Kegels to exercises like clamshells, deep squats, and glute bridges while pressing on a block between your thighs. And they’re recommending different ways to get the intense impact cardio that comes from a HIIT routine. “One of the best things you can do for your pelvic floor is rebounding, or bounce,” says Aly Giampolo, the head of movement and a co-founder of mini-trampoline studio the ness. As Giampolo puts it, “The dichotomy of pressing down through your heels on your trampoline while engaging your core to stay light on your feet allows you to find that elusive sensation of ‘lift’ in your pelvic floor without having to do a Kegel.”

Though continually ignored, the pelvic floor is always at work, stabilizing and containing, holding you steady. “When it comes to pelvic-floor strength, it’s cliché but true; you don’t know what you’ve got till it’s gone,” says Giampolo. “Although you may not be showing signs of pelvic health issues yet, giving your pelvic floor attention now can act as preventative, routine maintenance.” Paying attention to it, that’s all it asks; just a little acknowledgement; and maybe, a little appropriate rage that no one tells us that it exists.

Why Did No One Tell Me About the Pelvic Floor?