Pelvic floor dysfunction has become a hot topic in both men’s and women’s health circles.  Diagnoses such as pelvic pain, urinary and fecal incontinence, pain with intercourse (dyspareunia), sexual dysfunction ( ED, testicular pain) and infertility are all becoming very common.  In addition, pelvic floor weakness has been linked to muscular pain such as low back pain, SI joint dysfunction and even headaches.  This first article will look specifically at the mechanics involved in activating the pelvic floor muscles and the problem with kegels.  Future articles will look at the the whole body, fascial connections of the pelvic floor and how you can be harming your pelvic floor muscles with improper exercise trends.

I have been treating chronic pain patterns for many years and have found that most people have an improper breathing pattern which is affecting the way they are activating their core muscles, which includes the pelvic floor muscles. Don’t think you are safe if you don’t have chronic pain.  An improper breathing pattern can be contributing to your recent onset of bladder urgency and frequency or any other seemingly unrelated pain.  Breathing is an automatic process.  We don’t think about it.  We just do it.  Take a moment here to check out your own breathing pattern.  Do you breathe correctly?   The inhale should be initiated at the lower abdomen with the belly expanding with the inhale and contracting with the exhale.  The pelvic floor muscles (a group of muscles contained in the pelvis) should drop down with our inhale.  The reverse happens with the exhale, the pelvic floor muscles lift up and the belly flattens, allowing air to move out of the rib cage..  Our pelvic floor muscles need to have normal mobility which means they need to be able to expand or drop with the inhale as equally as they lift or shorten with the exhale.

pelvicFloor muscles


1. Inhale breathing down to your lower abdomen. 

Your belly should expand out and your pelvic floor muscles drop down.

2. Exhale- your pelvic floor muscles lift and your belly flattens.

*Avoid initiating the breath with your upper chest muscles

Kegel exercises are a common prescription given to both men and women who complain of pelvic pain or urinary incontinence issues.  “Kegels” are an exercise which simply  involves a tightening of the pelvic floor muscles.  The problem  with using keels as an exercise prescription is that the pelvic floor muscle tone is generally not assessed to see if the pelvic floor muscles have proper mobility to be able to expand and contract. Breathing patterns are also generally not checked to make sure that the pelvic floor muscles are contracting on the exhale and properly relaxing and lengthening with the inhale.  Most people who are experiencing bladder or pelvic floor pain tend to clench this area tight to avoid the pain or urgency and leakage.  So many times kegels done without proper assessment and instruction will worsen the problem.

Pelvic floor muscle dysfunction not only affects the function of the pelvic floor but also can cause muscular pain patterns in the trunk, lower extremities and even the head and neck.  There is a prevalence of clenching the muscles of abdomen and pelvis, which includes the gluteals, which contributes to dysfunctional breathing patterns and pelvic floor muscle dysfunction.  This occurs in men and women, young and old, fit and unfit.  We can go a long time without having symptoms as our body is a self correcting mechanism.  Symptoms can show up seemingly without cause.  However, these poor habits contribute to the overuse and misuse of postural muscles.  Consider consulting with a practitioner trained in Myofascial Release and especially pelvic floor dysfunction.  The therapists at Verde Valley Myofascial Release in Northern Arizona and Hands On in Austin, TX are expert level Myofasical Release practitioners and have integrated pelvic floor muscle treatment into their treatment programs.

Jody Hendryx, PT, LMT