Pelvic Floor 101
We’ve all heard of the pelvic floor — but what exactly is it, and why does it matter so much?
What It Is
The pelvic floor is a group of layered muscles, ligaments, and connective tissues that span the bottom of your pelvis, forming a supportive hammock. These muscles cradle and support key pelvic organs — the bladder, uterus, vagina, bowel, and rectum — while helping maintain control over urination, bowel movements, and sexual function.
When your pelvic floor muscles contract, they lift and support the internal organs, close the openings of the urethra, vagina, and anus, and help stabilize your spine and core. When they relax, they allow for urination, bowel movements, and comfortable sexual activity.
They also help absorb and manage internal pressure — from coughing, sneezing, laughing, lifting, or exercise — to protect your organs and spine.
Where It’s Located
The pelvic floor sits at the base of your core, which also includes your diaphragm, deep abdominal muscles, and lower back muscles. Together, these form a pressure system that supports posture, breathing, and organ stability.
The pelvic floor stretches from the pubic bone in the front to the tailbone (coccyx) in the back, and outward to the sitting bones on each side. Think of it as a layered sling or bowl supporting everything inside your pelvis.
What Does It Do
The pelvic floor has five main functions:
Support
The pelvic floor acts like a hammock, providing support for your pelvic organs – including the bladder, uterus, vagina, bowel, and rectum. This support helps keep everything lifted and in place against gravity and internal pressure from daily activities like standing, coughing, lifting, and even breathing.
When these muscles are weak or overstretched (such as after pregnancy, chronic straining, or surgery) it can lead to a sense of heaviness, pelvic pressure, or pelvic organ prolapse (when organs begin to descend lower in the pelvis).
Sphincter
Your pelvic floor muscles play a crucial role in continence – controlling when you urinate, have a bowel movement, or pass gas. These muscles contract to close the openings of the urethra and anus, and relax when it’s time to release.
When they’re functioning well, they allow you to control these bodily functions effortlessly. When they’re weak or not coordinating properly, it can lead to leakage (incontinence) or difficulty fully emptying the bladder or bowels.
Sexual function
A healthy pelvic floor is vital for sexual health and pleasure. These muscles increase blood flow to the pelvic region, contribute to arousal and sensation, and contract rhythmically during orgasm.
If the muscles are too tight, it can cause pain with intercourse, difficulty with penetration, or decreased sensation. If they’re too weak, it can lead to reduced tone and diminished sexual satisfaction.
Balanced, responsive muscles help make intimacy more comfortable and pleasurable for all genders.
Stability
Your pelvic floor is a key part of your core stability system, working in harmony with the diaphragm, deep abdominal muscles, and spinal stabilizers. Together, these muscles manage intra-abdominal pressure, helping you move, lift, and breathe efficiently.
The pelvic floor moves with your diaphragm – when you inhale, your diaphragm lowers and your pelvic floor gently lengthens; when you exhale, both lift and engage. This rhythm helps support efficient breathing, core control, and relaxation.
When your breathing pattern and pelvic floor function are out of sync (for example from chronic stress, poor posture, or breath-holding), it can affect not only your stability but also your nervous system and digestion.
Sump pump
This often-overlooked function helps with blood and lymphatic flow in the pelvic regions. When your pelvic floor muscles contract and relax, they act like a pump, promoting healthy circulation and reducing fluid congestion in the pelvis and lower limbs. This is especially important during pregnancy, postpartum recovery, and periods of prolonged sitting or standing. A well functioning “sump pump” helps decrease swelling, improve tissue healing, and maintain overall pelvic health.
Muscles That Make Up the Pelvic Floor
There are three layers of pelvic floor muscles:
Superficial layer: supports the openings of the urethra, vagina, and anus and helps with arousal and orgasm.
Middle layer: controls urinary and bowel continence.
Deep layer (Levator Ani group):
Puborectalis – helps maintain fecal continence by creating a “sling” around the rectum.
Pubococcygeus – stabilizes and supports pelvic and abdominal organs.
Iliococcygeus – helps elevate and lift the pelvic floor and anal canal.
Coccygeus – supports pelvic organs and flexes the tailbone after bowel movements.
Each of these muscles needs to work in coordination — not just strength alone — to maintain healthy pelvic function.
Function & Common Dysfunctions
A healthy pelvic floor is both strong and flexible. It should contract, relax, and lengthen through a full range of motion.
A weak pelvic floor can lead to:
Urinary or fecal incontinence
Pelvic organ prolapse
Core instability or back pain
A tight/overactive pelvic floor can lead to:
Constipation
Pelvic, back, or hip pain
Painful intercourse
Difficulty urinating or feeling of incomplete emptying
Urinary urgency or frequency
Many people assume pelvic floor issues are always due to weakness — but that’s not always true. Sometimes the muscles are actually too tight, holding constant tension and unable to properly relax.
Why Kegels Aren’t Always the Answer
While Kegels (pelvic floor contractions) can help strengthen weak muscles, they aren’t right for everyone. If your pelvic floor is already tight or overactive, doing Kegels can actually make symptoms worse — like increasing pain, urinary urgency, or pelvic pressure.
The key is coordination and balance, not just strength. Before starting Kegels or any pelvic exercise routine, it’s best to be evaluated by a pelvic floor physical therapist.
When to See a Pelvic Floor Therapist
A qualified pelvic floor therapist can:
Assess whether your muscles are weak, tight, or both
Guide you through exercises to properly relax and strengthen
Address posture, breathing, and core coordination
Provide hands-on treatment and education tailored to your symptoms
You don’t need to wait until symptoms are severe — proactive care can help prevent issues and support long-term pelvic health.
The Bottom Line
Your pelvic floor is small but mighty — it’s the foundation of your core, your continence, and your confidence. Understanding it, caring for it, and getting personalized guidance from a pelvic health therapist can make a world of difference in how your body feels and functions.