The pelvic floor: functions, weakness and what you can do

What is the pelvic floor?

The pelvic floor is a sheet of muscle and connective tissue that closes off the bottom of the pelvis. It stretches between the pubic bone, the tailbone and the two sitting bones and consists of several layers. The urethra, the rectum and, in women, the vagina pass through it.

Women and men both have a pelvic floor. In women it is anatomically somewhat more open and therefore more susceptible to strain, for example from pregnancy and childbirth.

What does the pelvic floor do?

• Support: it holds the organs of the abdomen and pelvis, i.e. the bladder, the uterus or prostate, and the bowel.
• Closure: it supports the sphincters of the bladder and bowel, especially when abdominal pressure rises suddenly, for example when coughing, sneezing, laughing or lifting.
• Relaxation: it has to let go deliberately when passing urine and stool.
• Stability: together with the abdominal and back muscles it stabilises the trunk and spine.
• Sexual function: it contributes to sensation and function in both women and men.

Why does the pelvic floor become weaker?

Like any muscle, the pelvic floor can lose strength, endurance or coordination. Common influencing factors include:

• pregnancy and childbirth
• hormonal changes during menopause
• increasing age
• excess weight
• chronic coughing, frequent heavy lifting or strong straining due to constipation
• surgery in the pelvic area, for example on the prostate, uterus or rectum
• lack of exercise and prolonged sitting

How do you notice a weakened pelvic floor?

Typical signs are involuntary loss of urine when coughing, sneezing or exercising, frequent or sudden urges to urinate, difficulty holding back wind or stool, and a feeling of pressure or heaviness in the lower abdomen. Many people do not talk about it out of embarrassment, although such symptoms are very common.

What helps? Targeted pelvic floor training

Pelvic floor training is one of the basic conservative measures for pelvic floor weakness and is often recommended by doctors and physiotherapists. The aim is to become aware of the muscles, to contract them in a targeted way, to relax them again and to build up strength and endurance.

The challenge: the pelvic floor lies deep inside the body and cannot be seen from the outside. When exercising, many people tense their buttocks, thighs or abdomen instead, or even push downwards. Biofeedback can help here by making the muscle work visible. Read more in our article Biofeedback in pelvic floor training.

This article is for general information only and does not replace medical advice, diagnosis or treatment. If you have symptoms, please consult your doctor.