Pelvic Floor Muscles

What are pelvic floor muscles?

Your pelvic floor consists of muscles and connective tissues that support important organs in your pelvis, like your bladder, bowel (large intestine) and internal reproductive organs. Your pelvic floor muscles hold these organs in place while also providing the flexibility to assist with bodily functions like peeing, pooping and sex.

Along with other key muscle groups in your torso, or core, your pelvic floor muscles allow your body to absorb outside pressure (from lifting, coughing, etc.) in a way that protects your spine and your organs. At the same time, these muscles help you control your bowel and bladder function (continence).

What do pelvic floor muscles do?

Your pelvic floor muscles hold the major organs in your pelvis in place and protect them. Muscle control — the ability to squeeze and relax your pelvic floor muscles — helps you move waste from your body. Pelvic floor muscles coordinate with organs like your urethra, the tube that carries pee out of your body, and your anus, the organ where stools pass. Squeezing your pelvic muscles narrows these passages so that waste material can’t escape. Relaxing these muscles widens these passages so that you can pee or poop.

Healthy pelvic floor muscles allow you to squeeze and relax automatically. You can also control these muscles deliberately, much like flexing a bicep.

Your reproductive parts affect how your pelvic floor muscles function. Pelvic floor muscles operate differently depending on whether you are assigned female at birth (AFAB) or assigned male at birth (AMAB). AFAB people include cisgender women and some transgender men and nonbinary individuals with vaginas. AMAB people include cisgender men and some transgender women and nonbinary individuals with penises.

Pelvic floor muscles in people who are AFAB

Your pelvic floor muscles:

• Support your bladder, urethra, vagina, uterus, bowel (large intestine), rectum and anus.
• Squeeze and relax so that you can control when you pee, poop or pass gas.
• Help with blood flow and vaginal contractions during sex and orgasm.
• Support vaginal delivery during childbirth.

Pelvic floor muscles in people who are AMAB

Your pelvic floor muscles:

• Support your bladder, urethra, prostate, bowel (large intestine), rectum and anus.
• Squeeze and relax so that you can control when you pee, poop or pass gas.
• Help you get an erection and ejaculate during sex.

Where are your pelvic floor muscles located?

Your pelvic floor muscles form the base of a group of muscles known as your core. Your core muscles include your pelvic floor muscles, abdominal muscles, back muscles, and diaphragm (the muscle that controls breathing). Together, these muscles attach to your pelvis and spine, creating stability throughout your body’s center.

Your pelvic floor muscles stretch from your pubic bone in the front of your body to your tailbone (coccyx) in the back. The muscles extend outward on both sitting bones (ischial tuberosity) on the right and left sides of your pelvis. Several pelvic floor muscles intertwine to form a single sheet of layered muscle with openings (anus, urethra, vagina).

You can feel where your pelvic floor muscles are by squeezing these three openings.

• Vaginal opening: Insert a finger or two inside your vagina and try to squeeze them.
• Urethra: Imagine that you’re peeing and squeeze as if you were stopping the flow midstream.
• Anus: Squeeze your anus as if you were preventing yourself from breaking wind.

In each case, you should feel muscles inside your pelvis pull inward and upward. These are your pelvic floor muscles.

What are the main pelvic floor muscles?

Your pelvic floor consists of layers of muscles and connective tissues connecting those muscles (ligaments). Two main muscles intertwine to form your pelvic floor muscles:

• Levator ani. The levator ani composes the bulk of your pelvic floor muscles and consists of three separate muscle components: pubococcygeus, puborectalis and iliococcygeus. The levator ani wraps around the entirety of your pelvis.
• Coccygeus. The coccygeus is the smaller muscle component in your pelvic floor muscles. It's located toward the back of your pelvis.

What are the common conditions and disorders associated with pelvic floor muscles?

Multiple pelvic floor disorders can result from having overly relaxed or weakened pelvic floor muscles. But, excessively tight muscles cause problems, too. The goal is balance. Your pelvic floor muscles should be strong enough to stabilize your core and secure your organs but flexible enough to stretch and relax.

Weak (too loose) pelvic floor muscles

Pelvic floor muscles can weaken as a result of injury or trauma, including childbirth and surgery. They can become stressed during pregnancy or from overuse (repeated heavy lifting, chronic coughing, constipation). They may grow weaker due to hormone changes during menopause and lose strength as a natural part of aging. Conditions like diabetes may also play a role in weakening pelvic floor muscles.

Weak pelvic floor muscles can lead to the following conditions:

• Stress incontinence: Peeing or dribbling when you laugh, cough, sneeze or lift. It’s more common after childbirth, following prostate surgery or when there’s been an injury to your pelvis.
• Urge incontinence: Feeling the frequent urge to pee and being unable to hold it.
• Fecal incontinence: Struggling to control bowel movements.
• Anal incontinence: Struggling to control when you pass gas.
• Pelvic organ prolapse: Unsupported pelvic organs, like your uterus, rectum and bladder bulging into your vagina or causing a protrusion from the opening of your vagina. This condition is most common among AFAB people, such as cisgender women, after menopause.

Common signs and symptoms of having weakened pelvic floor muscles include struggling to control when you pee, poop or pass gas (incontinence).

Too tight pelvic muscles

Less is known about the conditions associated with having pelvic muscles that are too tight, also known as hypertonic pelvic floor. But having pelvic muscles with too little give can lead to constipation or difficulty moving your bowels, pelvic pain, back or hip/leg pain, painful intercourse, and difficulty peeing, urinary urgency/frequency.

Pelvic muscles that are too tight may be associated with sexual trauma, other types of trauma or accidents, childbirth, stress, and other gynecologic conditions.

What are the common treatments for conditions involving weak pelvic floor muscles?

Pelvic floor exercises, or Kegels, are commonly used to strengthen pelvic floor muscles. Kegels require routinely squeezing and relaxing your pelvic muscles to slowly build control.

Kegels can also be used to treat incontinence issues. Your provider may use biofeedback during Kegel exercises to help you train your muscles. With biofeedback, a sensor in your vagina measures which muscles you’re contracting when you squeeze and how strongly you’re squeezing.

Depending on your condition, you shouldn’t try to do Kegels without your provider’s guidance. For instance, you shouldn’t attempt Kegels if you’ve recently injured or strained your pelvic floor muscles (ex. during childbirth).

Other treatments include:

• Managing constipation. Many of the treatments used to relieve constipation (diet, exercise, medications, etc.) can prevent you from stressing your pelvic floor muscles when you go to the bathroom.
• Vaginal weights/Kegel balls. Inserting specially designed balls into your vagina and holding them into place during normal day-to-day activities can gradually strengthen your pelvic floor muscles.
• Medical devices. Devices, like a vaginal pessary, can hold your pelvic organs into place if your pelvic floor muscles are too weak to provide adequate support.
• Physical therapy. A trained physical therapist specializing in treating pelvic floor muscles can help you coordinate and strengthen key muscle groups in your core, including your pelvic floor muscles.
• Surgery. Pelvic organ prolapse may require reconstructive surgery to secure your pelvic organs into place or an obliterative procedure like colpocleisis. With colpocleisis, your vaginal walls are sewn together to prevent organs from extending outside your vagina.

What are the common treatments for hypertonicity (too tight pelvic floor muscles)?

For pelvic floor hypertonicity, treatments include physical therapy, breathing/relaxation techniques, injections into your pelvic floor muscles, medications and cognitive behavioral therapy.

What simple lifestyle changes can you make to keep your pelvic floor muscles healthy?

Depending on your health, you can benefit from doing Kegel exercises regularly to strengthen your pelvic floor muscles. The benefits include improved muscle control to help with continence and increased sexual function. Historically, most people have thought of Kegels as increasing sexual satisfaction for people with vaginas. Recent research suggests that the sexual benefits may apply to everyone, regardless of gender.

It’s essential that you’re exercising the correct muscles when you’re doing Kegels. Follow the guidance of your provider or a physical therapist to ensure you’re exercising the right muscles and contracting/relaxing them the right way.

You can exercise your pelvic floor muscles while you’re seated, standing or lying down.

1. Squeeze your pelvic floor muscles for eight seconds, taking care not to squeeze your butt, thighs or any other muscle. Be intentional about breathing freely as you squeeze.
2. Relax your pelvic floor muscles for eight seconds. The relaxation part of Kegels is just as important as the squeezing part. Continue to breathe freely.
3. Complete this sequence (squeeze for eight seconds, relax for eight seconds) eight more times.

Repeat this exercise three times a day. Work in your Kegels when they’re most likely to become part of a routine you’ve already established such as while you’re brushing your teeth in the morning, when you’re checking social media during lunch or when you’re driving home from work, etc.

At first, you may have to aim for three seconds of squeezing and relaxing instead of eight seconds. Over time, you may increase your time from eight seconds to 12 seconds of squeezing and relaxing as you improve. Start slow and gradually increase your time to avoid straining your muscles.

Within four to six months, you should notice more strength in your pelvic floor muscles.

A note from Cleveland Clinic

Most people don’t think about their pelvic floor muscles until they’re dealing with a medical issue. Don’t wait for a problem to arise, like incontinence or prolapse, to start taking care of your pelvic floor. Exercising your pelvic muscles gives you more control over your bladder and your bowel function. Pelvic floor exercises can potentially improve sexual function, arousal and the intensity of your orgasms, too. Make maintaining your pelvic floor muscles part of your exercise routine.