For too long, conversations about pelvic floor health have been confined to hushed discussions about pregnancy or ageing, often simplified to a vague instruction to perform Kegel exercises. However, specialists now stress that daily maintenance of this crucial muscle group is essential for everyone, regardless of gender or age.
Understanding and Engaging Your Pelvic Floor
The pelvic floor comprises the muscles at the base of the pelvis, extending from the pubic bone at the front to the tailbone (coccyx) at the back. Lisa Birmingham, a senior physiotherapist and director of All Women’s Health in Brisbane, explains it is responsible for supporting the bladder, bowel, and, in women, the uterus. It's a foundational structure that "pulls everything in from below."
Contrary to popular belief, pelvic health is not just a women's issue. Shan Morrison, a specialist physiotherapist and director of Women’s and Men’s Health Physiotherapy in Melbourne, notes that 10% of men experience persistent pelvic pain at some stage in their lives.
The first step to strength is learning to engage the muscle correctly. For women, Birmingham describes a two-part movement: "Squeeze at the front as if you’re holding onto a wee and an anal squeeze at the back which feels like a lift." A helpful visualisation is imagining you're in a crowded lift "trying to hold in a fart." For men, Morrison advises the cue is to "lift up the testicles."
Experts recommend aiming for 10 repetitions of 5–10 second holds. Crucially, relaxation is as important as contraction. Angela James, founder of the Sydney Pelvic Pain Clinic, warns against the "overzealous gripping" sometimes seen in pilates, noting many people "chronically over-engage their core muscles" for posture, which can create excessive tension and pain.
Daily Habits for a Stronger Foundation
Beyond isolated exercises, daily behaviours are paramount. A key technique is "the knack": bracing your pelvic floor muscles just before a cough, sneeze, or laugh to counteract sudden abdominal pressure. Birmingham suggests "habit stacking"—linking the exercise to an existing routine, like performing a hold every time you stand up from the toilet.
Toilet habits themselves are critical. Constipation is a major stressor for the pelvic floor, says Dr Millie Mardon, a pelvic pain researcher at Western Sydney University. The straining it causes creates damaging pressure. "The rectum is not a storage facility," Birmingham states bluntly, warning against ignoring the urge to go. Using a footstool to mimic a squatting position can alleviate strain.
Nutrition plays a direct role. To support healthy bowel function, aim for five servings of vegetables and two of fruit daily, plus at least a third of a cup of lentils or chickpeas, Birmingham advises. Mardon champions "adding colour to your plate" for fibre and suggests gut-friendly options like chia seed pudding. Morrison emphasises that regular fluid intake is also vital.
Movement, Breathing, and Knowing When to Seek Help
"There is no such thing as bad posture," asserts Mardon. The real issue is stillness. "Our pelvic floor muscles love to move." She recommends simple changes: getting off the bus a stop early, taking the stairs, and shifting position regularly at a desk. Morrison advocates a "balanced movement diet" of cardio, stretching, and strengthening, which can include gentle walking, swimming, or yoga.
Surprisingly, heavy weight lifting is recommended to counteract muscle decline after 30. Birmingham assures that for those with leakage or prolapse concerns, it "does not worsen those symptoms" and can instead increase strength in the area.
Breathing patterns are also key. Morrison notes that shallow chest breathing from sedentary work can increase body tension and affect pelvic floor function. Diaphragmatic (belly) breathing calms the nervous system and promotes healthy pelvic movement.
Finally, experts urge people not to normalise pelvic pain. Mardon states it is not "'part of being a woman'," referring to any pain between the navel and thighs. Morrison warns against delaying care, citing the six-and-a-half-year average wait for an endometriosis diagnosis. "Early intervention is much more effective," she says.
If you experience leakage or pain, Birmingham recommends seeing a specialised physiotherapist, assuring that internal exams are never mandatory if you are uncomfortable. As Angela James summarises, good pelvic health is something you don't think about—it just works. When it doesn't, it profoundly impacts your quality of life.
