The pelvic floor is an often-overlooked part of a woman's body, yet its condition has a significant impact on overall health and comfort. Properly functioning pelvic floor muscles support not only urinary and bowel functions but also movement stability, sexual health, and comfort during the menstrual cycle.
We spoke with Mgr. Klára Vomáčková, founder of the physiotherapy facility Fit and Tasty, which specializes in uro-gynecological physiotherapy for women and men and also cares for the youngest, about how the pelvic floor affects women's health, how to work with it, and how to recognize potential problems.
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Klára, can you tell us what exactly is hidden under the term "pelvic floor"?
We can imagine the pelvic floor as a kind of "funnel" that fills the lower part of the pelvis. These are not large muscles like biceps or thighs, but rather a set of finer muscle layers, or sheets, let's say, that have various functions.
From an anatomical point of view, we distinguish three parts – superficial, middle, and deep – and all are important. In practice, it is almost impossible to engage just one of them, even if we try, but we usually tend to engage the superficial layer (the sphincters) more. However, the middle and deep layers are particularly crucial for the stability of the pelvic organs.
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What is its function in women? Why is the pelvic floor so important for the female body and how does it contribute to daily functioning?
The pelvic floor has several functions. Mechanically, it contributes to the stability of the entire body and acts as a counterweight to, for example, the diaphragm. It also participates in movement, breathing, childbirth, where it helps the baby to come into the world, and sexual function as such. And, of course, also in sphincter function – i.e., the ability to hold or release urine and stool.
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How do we recognize its dysfunction? How does a weakened, overloaded, or otherwise dysfunctional pelvic floor manifest itself? What problems do you most often encounter in your practice?
Recognizing dysfunction is not easy, as the same symptom can have different causes. For example, incontinence can arise from both weakening and increased muscle tension. In practice, I most often encounter problems such as incontinence, painful menstruation, or painful intercourse.
Weakening can result from long-term pressure on the muscles, for example in obesity, or after vaginal birth, when the muscles are stretched for several hours, or injury can also occur. This can contribute to weakening, but it can also, conversely, lead to increased tension.
Conversely, increased tension often manifests as pain during intercourse or menstruation and can be caused by, for example, inappropriate exercise, rough gynecological examination, sexual trauma, or psychological stress.
These are probably the most common problems I address with women in practice. In addition, I also focus on care during pregnancy, preparation for childbirth, and recovery after pelvic surgeries.
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If someone suspects pelvic floor dysfunction, what are the first steps you recommend?
The first step should be a visit to a gynecologist to rule out organic causes. If nothing is found, it is advisable to seek a physiotherapist – some problems are functional and cannot be seen by a gynecological examination, especially when increased tension causes pain or discomfort during the examination. In cases of significant tension or vaginismus, a psychologist or other specialists may also be involved.
For example, even the aforementioned painful menstruation does not always have to be related only to the musculoskeletal system. It can have hormonal causes or be a result of a lack of certain minerals. In more serious diagnoses, such as endometriosis, physiotherapy may not cure the problems, but it can relieve discomfort or help in preparation for surgery or in postoperative care.
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What can cause pelvic floor dysfunction? Are there any habits that women might unknowingly do every day that harm them?
Long-term sitting, especially on a hard surface or in an inappropriate position where the pelvis is tilted backward and the tailbone is irritated, can play a role. Some types of sports, such as intense strength training, improper breathing, or frequent impacts, can also cause problems. Furthermore, lack of fluids, overweight, unbalanced diet, or even poorly chosen menstrual products.
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Do the menstrual cycle and fluctuating hormones have any effect on the condition of the pelvic floor?
Hormones generally affect the body, not just the cycle itself, but they also have an impact on the pelvic floor. In the first phase of the cycle, when estrogens predominate, the tissues are better supplied with blood, more elastic, and a woman may perceive the pelvic area as more relaxed and comfortable. In the second part of the cycle, progesterone comes to the forefront, which has a more inhibitory effect on the muscles. This can lead to slight swelling, pressure in the lower abdomen, those common symptoms that women often describe about a week before menstruation.
During menstruation, the levels of both hormones drop, and the uterus contracts to shed its lining. This can slightly increase sensitivity to pain, partly due to the action of prostaglandins and partly due to the drop in estrogen and progesterone itself. It's definitely good to work with this and not try to just overcome the pain at all costs.
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What do you think can help women?
During such days, techniques that a woman can do at home herself usually work best, such as rest, breathing, isolated movements in the pelvic area to relieve increased tension. Nutritional supplements like magnesium can also help. And, of course, stress management, work, sleep regimen, suitable exercise, and more are also part of it.
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Let's pause for a moment on pain. How do you know when discomfort or pain during menstruation is still normal and when it's time to address it?
Pain is a very subjective matter, but "normal" is considered a state where a woman can function normally, or she takes one painkiller and it helps, or she only has pain on the first day of menstruation. Menstruation can be uncomfortable, but it must not disable a woman from her daily routine. If the pain is so severe that it causes vomiting, diarrhea, or makes work impossible, it needs to be addressed. It doesn't have to be endometriosis, polyps, fibroids, or other problems right away, but it requires attention.
Besides pain, it is also important how the bleeding looks – whether the blood flows naturally, and not in large clots, it is not excessive bleeding, and it does not lead to anemia. For some menstrual problems, gynecology often offers analgesics or hormonal contraception, which does not always completely solve the problem. It's good when someone thinks of physiotherapy, but it's not just about the exercises; diet, psyche, sufficient rest, and similar factors also play a role.
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Is it advisable to do pelvic floor exercises even during the menstrual phase, especially if a woman suffers from pain or tension in the pelvic area?
During the menstrual phase, it is ideal to rather relax the pelvic floor. Increased tension can hinder menstrual flow and increase discomfort. Relaxation techniques, gentle abdominal massage, or personally, I like to use a soft spiky ball. Activation and strengthening are better left for periods outside of menstruation.
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What about exercise in general during menstruation?
There are various opinions on whether and how to exercise during menstruation, and studies are not entirely conclusive. In general, however, there is no reason to automatically skip exercise. Some women find it helpful to relax their body more during menstruation, while others prefer training because it releases various hormones that can even alleviate menstrual pain. The key is to follow your own feelings. Some women will prefer to slow down during menstruation, while others will feel most energized during this period. So it's important to perceive what makes you feel good and what doesn't.
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You also mentioned menstrual products, so what about them? Are some of them more or less suitable in relation to the condition of the pelvic floor? Or is it primarily about individual comfort?
No product in itself is inherently bad. However, some of them may be less suitable for some women in certain situations. Menstrual cups and discs, for example, create a vacuum that can excessively stretch tissues in a weakened pelvic floor, and in a tense pelvic floor, they can irritate the cervix area or cause an unpleasant feeling of pressure.
For tampons, the composition and structure matter a lot, as they can irritate the intimate area or dry out the mucous membrane, and with weakened muscles, they can "slip," which leads to the woman subconsciously clenching her muscles to keep the tampon in place – thus increasing tension in the pelvic floor area. For women with increased sensitivity or tension, menstrual panties, for example, may be more comfortable because they do not irritate or create tension in the pelvic area.
It's also important to think about what we wear; a hard elastic band on pants, leggings, or underwear can also increase tension by essentially "cutting the abdomen in half." So even something like that can contribute to discomfort, especially in the first days of menstruation.
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Is there anything you would like to tell or advise women in conclusion?
The main thing is to monitor your problems over time and notice what affects them. It's not just about the pelvic area itself; stress, diet, and movement as a whole often play a role. If problems arise, it's good to address them in time and not just mask them with analgesics. Most of the time, they won't disappear on their own and can gradually worsen.
Many thanks to Klára for sharing valuable information and tips on how to achieve a healthy pelvic floor. 🤍
What else to read on Femspace?
- Do hormones and cycle affect how we experience pain?
- 5-minute massage for menstrual pain relief
- 7 tips for women's intimate hygiene
- How menstruation changes with age
- Menstrual symptoms you might not know about
- Pad rash: What causes it and how to avoid it
Femvie products that can help you
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Frequently Asked Questions
How long does a normal period last?
A healthy period lasts 3 to 7 days. If you bleed longer or shorter repeatedly, consult a gynecologist.
Why is menstruation painful?
Menstrual cramps are caused by prostaglandins—substances that contract the uterine muscles. Magnesium, heat, exercise, or natural patches can help.
Are organic pads and tampons safer?
Yes. Organic cotton products do not contain pesticides, plastics, or bleaching chemicals commonly found in conventional menstrual products.
What affects the regularity of the menstrual cycle?
Stress, diet, exercise, sleep, and hormonal balance—all of these affect the length and regularity of your cycle. Tracking your cycle can help you identify patterns and any deviations.
