There is a group of muscles that works silently every day of your life: it supports your organs, controls your continence, and plays a part in your posture and your sex life. And yet, it is the most forgotten part of the body. We are talking about the pelvic floor, that hammock of muscles and ligaments located at the base of the pelvis that almost nobody trains, and that people only talk about once it has already failed.

The good news: the pelvic floor can be assessed, trained and rehabilitated at any age, and the results of well-guided treatment are among the most rewarding in all of physiotherapy.

What exactly is the pelvic floor?

It is a set of muscles, fasciae and ligaments that closes off the bottom of the pelvis, working like a diaphragm. Resting on it are the bladder, uterus and rectum in women, and the bladder and rectum in men, and it also helps support the prostate. The pelvic floor performs three major functions:

• Support: it keeps the pelvic organs in their correct position.
• Sphincter control: it consciously manages the release of urine, gas and stool.
• Stabilization: together with the diaphragm and deep abdominal muscles, it forms the so-called central cylinder that protects your back and stabilizes every movement.

Signs your pelvic floor needs attention

The pelvic floor is discreet, but when it weakens or fails it sends very specific warnings. Pay attention if any of these situations sound familiar:

• Leaking urine when coughing, sneezing, laughing, jumping or exerting yourself (stress incontinence).
• Sudden urgency to reach the bathroom, with or without leaks.
• Feeling of heaviness or descent in the pelvic area, especially at the end of the day.
• Pelvic pain or discomfort during sexual intercourse.
• Recurrent lower back or hip pain with no apparent cause: a weakened pelvic floor destabilizes the whole postural chain.
• After childbirth: difficulty controlling the abdomen, separation of the abdominal muscles, or the feeling that “everything has changed down there”.

Who does it affect? (More people than you think)

Contrary to popular belief, the pelvic floor is not just “an issue for older women”. The groups most at risk of dysfunction are:

• Women during pregnancy and postpartum: the weight of pregnancy and the effort of labour stretch the tissues; a pelvic floor assessment should be as routine as the baby’s check-up.
• Women going through menopause: the drop in oestrogen affects muscle tone and supporting tissues.
• High-impact athletes: running, CrossFit, jumping or track and field multiply the impacts on the pelvic area; leaks among young female runners are common.
• Men, especially after prostate surgery, with chronic pelvic pain or sphincter control problems.
• Physically demanding jobs, chronic cough, persistent constipation or obesity: all of these place repeated pressure on the pelvic floor.

Why “doing Kegels on your own” does not always work

Almost everyone has heard of Kegel exercises. What almost nobody knows is that a large share of people do them incorrectly: squeezing the buttocks or abdominals or holding their breath, instead of contracting the right pelvic muscles. And a pelvic floor that is already too tense (very common in chronic pelvic pain) can actually get worse with generic contraction exercises.

That is why the first professional step is not training, but assessment: evaluating the tone, strength, coordination and relaxation capacity of the pelvic floor. From there, pelvic floor physiotherapy combines specific techniques:

• Personalized muscle training, with guided contractions and relaxations.
• Biofeedback: seeing your contraction on a screen helps you learn the correct movement within a few sessions.
• Manual therapy and myofascial release of the area.
• Hypopressive exercises and postural work integrated with the deep abdomen and breathing.
• Respiratory re-education: the diaphragm and the pelvic floor always work as a pair.

When to see a professional

We recommend a pelvic floor assessment if you are pregnant or have had a baby in the past year, if you experience urine leaks at any age, if you feel pelvic heaviness or pain, if you practise high-impact sport, if you are approaching menopause, or if you simply want to prevent the problem before it appears. A healthy pelvic floor goes unnoticed; but it is what makes it possible to cough, laugh, jump and live with complete peace of mind.

At SanySa del Levante, our physiotherapy unit performs individualized pelvic floor assessments and rehabilitation programs tailored to each person, in a private, friendly and professional environment. Your wellbeing starts with a firm foundation: today is a good day to start taking care of it.