As a pregnant woman, prenatal yoga teacher, and birth doula, I spend a lot more time than most people thinking about pelvic floors. Imagine my disappointment when I started to scour the internet for more information about one of the pelvic floor muscles—the pubococcygeus—and found a few dry medical encyclopedia entries, a bunch of articles about Kegels, and not much else.
All men and women have the pubococcygeal muscles, often referred to as the PC muscle. They’re part of the three levator ani muscles, which, along with the coccygeus, make up that sling of muscles that are the pelvic floor and support the pelvic organs like a hammock. The pubococcygei are two muscles that originate at the posterior side of the pubic bone and insert at the back of the pelvis into the anococcygeal raphe (a rigid fibrous median) just in front of the coccyx; they wrap around either side of the urethral and anal sphincters, as well as around the vaginal sphincter in women. I’ll focus specifically on these muscles as they pertain to the female pelvic floor here, but it’s important to remember that they exist in males and can be equally tight or underused.
Pelvic floor muscles become a topic of much discussion for women particularly around childbirth. Many pregnant women are instructed to do Kegels (a contraction of the pelvic floor muscles, specifically the pubococcygeal muscles), sometimes hundreds daily, in preparation for childbirth, in an effort to strengthen them. In fact, a much more apt preparation for childbirth would be to learn to relax these muscles on demand. Hypertonicity in the pelvic floor can actually impede the process of childbirth. Although many women have learned that they’ll need to actively engage these muscles in the pushing stage of delivery, in fact they need to learn how to let them release to let the baby out. Women who have a very lax pubococcygeus and be experiencing incontinence may indeed need to strengthen these muscles via this very concentrated contraction, but it’s not always a beneficial action to imprint into these muscles leading up to delivery.
Post-childbirth, it’s true that all the muscles of the pelvic floor may be overstretched, and it’s perhaps then that it makes sense to revisit the Kegel, to put that muscular sling back together so that it can adequately support the organs of the pelvis. However, as Katy Bowman points out in Jill’s recent pregnancy webinar, Healthy Pregnancy, Healthy Baby: Dispelling Myths of Pre-Natal Exercise, Diet and Self-Care, it’s good to question why we need Kegels in the first place. Hundreds and thousands of years ago, women weren’t doing Kegels post-birth to put their pelvic floors back together, but they also weren’t sitting all day long, weakening their pubococcygeal muscles along with all the other muscles of the pelvic floor. Perhaps a better approach is to incorporate regular movement into our days both before and after childbirth to engage and stretch these tissues without assuming that isolated contractions of one small muscle can really create pelvic health.
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Love this! Thank you for explaining that being able to relax the pelvic floor muscles on demand for birth may be an ideal focus for many. And that total body movement may be a better focus than the kegel obsession.
For years we (Yoga teachers) told our pregnant clients to practice kegels or mulabandha like crazy! Of course once the pelvic floor became a hot topic in Yoga a few years ago, we all backtracked. I get how important kegels are for after the birth in order to gain strength and muscle back into that area. Thanks for sharing so much info about all the sling muscles. It’s great info to have for pregnant students.
Thank you for demystifing Kegels for the world wide web! When I was pregnant and took Bradley Method classes, our daily homework assignment was to do up to 200 Kegels, with little instruction on what a Kegel even was. Thankfully for my yoga background and the advice of my Pelvic Floor PT, I decided to abstain from this portion of the homework! And so true that for a sedentary society that spends so much time sitting in a car or at a desk, our pelvic floor muscles can be weak, underutilized, and hard to access. As for birth, I definitely found my ability to let go and relax (both physically and mentally) were just as important as knowing how to push!
Interesting article, in my past trainings so much emphasis was on kegal exercises only. Your article shed some needed light that we can take on other forms of excersise to “relax the pelvis” . Your overview gave me more awareness to the pelvic floor and focus on the relaxation of the muscle . This will be helpful for my pregnant students as they prepare for labor. Kegals are not the only way and I will be sure to pass the word along!
I have also noticed that most problems with the pelvic floor are due to hypertonicity.this can be due to too much sitting in a slouched posture.so yes getting more active walking more when you are pregnant will certainly help.
Great post, I really like that you discussed the need to relax the pelvic floor muscles during labour. I had a friend who, during labour, had the doctor say ‘you yogis and your strong pelvic floor! Ugh’ I always stress the need to feel both the contraction and relaxation in my prenatal classes. Thanks for the good read.
Love that you highlighted that concentrating only on one muscle contraction in isolation to solve the health of the region makes little sense. As every movement has usually more than one agonist, synergists and antagonists…. and the fascia encasing these is connected to more fascia up and downstream it makes sense to consider the health of all of these when prescribing exercises. Love that YTU assessment poses can also be remedies, and love the coregeous and YTU balls as an adjunct. Great article!
I like to work the pelvic floor in concert with the lower abdomen and the adductors rather than only using Kegels. The pelvic floor can also be engaged as part of the tubular core which includes the diaphragm, the abdominals (transverse abdominals, internal and external obliques, rectus abdomenus, multifidus, quadratus lumborum, erector spine. The pelvic floor and the diaphragm work in concert. As you breathe in, the diaphragm and the pelvic floor both move down if you are taking a deep belly breath. On the exhale the diaphragm and the pelvic floor both move up. You can gently work the pelvic floor by gently pulling the perineum in and up on the exhale. This is a very gentle engagement. In some yoga traditions engaging the pelvic floor called mulabanda in yoga is a part of many poses. Many women have found that this practice of engaging too much and too often has resulted in chronically short and weak muscles in the pelvic floor. Sometimes pelvic comes with this overuse.
I loved how this article spoke to the idea of relaxing / releasing as the issue. I find in dominant culture we are very concerned with engaging and firming and as a result lose the idea that we should be equally able to relax muscles on demand. Although this article spoke to keels specifically I feel a lot of my misuse of muscles is the inability to relax on demand. Thank you for this article.
I am always surprise at how many women are not really in touch with their pelvic floor, I recently conducted a workshop and it appears that it was for most part a lack of anatomical knowledge, so it was more about; if you do not know where it is, you cannot engage or feel it. The muscles of the pelvic floor are of great importance in maintaining the health of our bodies as you know there is major changes in post natal and post menopausal women. The need for adressing a healthy pelvic floor is an essential component of any exercise regimen.
Great post- some women see kegel exercises as their one way ticket to pelvic floor health. I was lucky to have access to a “pelvic floor rehab” specialist after my deliveries and can say that there are many other functional positions to practice with pelvic floor engagement that are much more practical in daily life.
I had no idea there was so little information about this area of the body. I’m not a mother nor am I pregnant, but I used to babysit for a living and I’ve been around many expecting mothers who are in love with the Kegel. I never quite understood what it was or what it was supposed to do until now! It’s interesting that doing this one exercise over and over to help ease the birth process could actually be making the birth process significantly harder. It’s also interesting to me that we may not know for sure because of the lack of research and information about this part of the body.
I really liked how you broke down when a Kegel may or may not be appropriate. Many people seem to look at Kegels as the be all end all of pelvic floor therapy, but as you pointed out it’s only one of many tools. Very informative post!
As a relatively new mother (my daughter is 11 months old), I was particularly interested in your series of posts on Kegels. During my prenatal yoga classes we spent a few minutes of each hour focused on Kegel exercises. I wasn’t convinced that Kegels alone were going to be responsible for the strength of my pelvic floor during childbirth. I completely agree that the ability to relax your PC muscles should carry as much weight as strengthening them. I also firmly believe that regular exercise and pelvic floor awareness (whether it has a natural anterior or posterior tilt) are paramount in childbirth preparation.
During our pre and post natal discussion of my 200 hour yoga teacher training with Todd, we leaned about the direct correlation between intensive exercise during pregnancy and increased hours in labour. I personally was shocked, horrified and flat out scared for what my future pregnancy and labour might entail. The types of workouts I enjoy tend to be very intensive and competitive. I had always planned to work out like an absolute maniac, even more so than I do now when I become pregnant for fear of gaining weight. Many years of measuring, body suits and staring in mirrors as a dancer have cultivated an intense phobia of gaining weight. Upon considering this new information, it makes total and complete sense that constant contraction of muscles during exercise would decrease ones ability to relax the pelvic floor for childbirth. Im so happy to have been educated about this before becoming pregnant, as I feel that so many women, like me, feel the need to amp up the workouts while pregnant for fear of weight gain. Considering the stress of weight gain versus the stress of traumatic childbirth has made my question my own emotional maturity and readiness to become pregnant myself.
Thanks for this article. It is my understanding that part of (maybe the more recent) reasoning behind doing pelvic floor exercises like Kegels is to bring more awareness to the pelvic floor and focus on the relaxation of the muscle more than the contraction, so that when a woman is in labor and all her other muscles are tensing from the contractions and pain that she can (at least theoretically) relax the pelvic floor muscles when the baby is coming out. I realize that doing excessive Kegels or holding Kegels for long periods of time can overdevelop the muscle. But is it your understanding that doing them at all can be counterproductive for labor, at least for those women with “healthy” pelvic floor muscles to begin with?
As a pre & postnatal yoga teacher I have been surprised by the number of women I have met who have been diagnosed with a hypertonic pelvic floor. Thank you for pointing out the importance of learning how to relax these muscles. Although some women can really benefit from strengthening weakened pelvic floor muscles it is important to know that others may need to seek treatment for overly contracted pelvic floor muscles.
I’m very glad to have come across this before having any children. You constantly hear about kegels/locking the pelvic floor, which was confusing to me in regards to child birth, but I never asked. This article validated my initial thoughts on the matter and makes me so happy to hear that there is another side to just strengthening these muscles. Thanks Caitlin!
Love learning more about the pelvic floor. I just wish I would have known all of this before and during my pregnancies. However that doesn’t mean I can’t continue to work on my pelvic health.
As a woman who has recently struggled connecting with her pelvic floor (due to a surgery), this was an extremely interesting post to read. I have also tried digging through internet and found posts on the pubococcygeal muscle that were either a bit too complex, dry, or vague. Basically I did not get much out of them. But I truly appreciate this new found information you have given me, especially because I now know that learning to relax the pubococcygeal muscles is better preparation for childbirth than kegels. I will also begin to take into account that it will take more than one exercise to develop overall pelvic health.
Thank you so much for this post. Pelvic floor stability is very much on my mind lately. I recently saw a commercial in which Joan Rivers made a joke about how Betty White would leave a stain when getting up from a chair. It may seem funny to those under a certain age, but its very serious. (Personally I’m not sure how Joan could make fun of Betty for much of anything, but anyway…) Losing the ability to completely control your bladder is quite scary. I am hoping to be correct in asserting that it is not a forgone conclusion that every woman will have to accept this sitting down.
This was really interesting to read. Thanks for dispelling what a kegel really is and when it can be beneficial or harmful. I liked that you ended by questioning why there is such a focus on kegels and the need engage is some physical activity.
The diagram was great reference for understanding the pelvic floor muscles.
Thanks, Julie Ann! As a prenatal teacher, I am constantly referring women to PT’s and so wish that their doctors would do the same! It’s such a huge issue, and most women never even hear about their pelvic floor until they’re experiencing pain. My hope is that getting this information out there will help guide women to start exploring!
As a physical therapist, I feel as though the pelvic floor is a big mystery to the majority of my patients. Many women post childbirth complain of pain in the pelvic floor and their MDs are not even aware to refer out to a physical therapist trained in women’s health. This blog post is great and can be a great starting point to jump off for more information regarding this topic.