The pelvic floor is an often-overlooked part of the female body, yet its condition significantly impacts overall health and comfort. Properly functioning pelvic floor muscles support not only bladder and bowel functions but also postural stability, sexual health, and comfort during the menstrual cycle.
We spoke about how the pelvic floor affects women's health, how to work with it, and how to recognize potential problems with Mgr. Klára Vomáčková, founder of the physiotherapy center Fit and Tasty, who specializes in urogynecological physiotherapy for women and men, and also cares for children.
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Klára, could 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 muscular layers, sheets, let's say, that have various functions.
From an anatomical perspective, 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 (sphincters) more. However, for the stability of the pelvic organs, the middle and deep layers are particularly crucial.
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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 counterpart to the diaphragm, for example. It also participates in movement, breathing, childbirth, helping the baby come into the world, and sexual function as such. And, of course, in sphincter function – that is, 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, because 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 prolonged pressure on the muscles, for example, due to 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 lead to increased tension.
Conversely, increased tension often manifests as pain during intercourse or menstruation and can be caused, for example, by inappropriate exercise, rough gynecological examination, sexual trauma, or psychological stress.
These are probably the most common problems I address with women in my practice. In addition, I also focus on prenatal care, preparation for childbirth, and recovery after pelvic surgeries.
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If someone suspects pelvic floor dysfunction, what first steps do 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 are sometimes involved.
For example, even the mentioned painful menstruation may not always 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 with preparation for surgery or in postoperative care.
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What can cause pelvic floor dysfunction? Are there any habits that women may unknowingly do daily and harm themselves?
Prolonged sitting can play a role, especially on a hard surface or in an unsuitable position where the pelvis is tilted backward, irritating the tailbone. Certain types of sports can also cause problems, such as intense strength training, improper breathing, or frequent impacts. Furthermore, lack of fluids, overweight, unbalanced diet, or even inappropriately 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 influence the pelvic floor. In the first phase of the cycle, when estrogens predominate, tissues are better perfused, more elastic, and a woman may perceive the pelvic area as more relaxed, comfortable. In the second part of the cycle, progesterone comes to the fore, which has a rather inhibitory effect on the muscles. This can lead to subtle swelling, pressure in the lower abdomen, those common symptoms that women often describe about a week before menstruation.
During menstruation, levels of both hormones drop and the uterus contracts to shed its lining. This can slightly increase pain sensitivity, partly due to the action of prostaglandins and partly due to the decline in estrogen and progesterone themselves. It is definitely good to work with this somehow and not try to overcome the pain at all costs.
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What do you think can help women?
On such days, techniques that a woman can do herself at home usually work best, such as rest, breathing, isolated movements in the pelvic area to relieve increased tension. Dietary supplements like magnesium can also help. And, of course, stress management, work, sleep patterns, suitable exercise, and so on 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 needs to be addressed?
Pain is a very subjective matter, but "normal" is considered a state where a woman can function normally, possibly takes one painkiller and it helps, or only has pain on the first day of menstruation. Menstruation can be unpleasant, but it must not disable a woman from her daily life. If the pain is so severe that it causes vomiting, diarrhea, or prevents work, it needs to be addressed. It doesn't necessarily have to be endometriosis, polyps, fibroids, or other problems, but it requires attention.
Besides pain, it is also important how the bleeding looks – whether the blood flows naturally and not in large clots, whether it is not excessive bleeding and 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 great 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 appropriate to engage in pelvic floor exercises during the menstrual phase, especially if a woman experiences 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 the period outside of menstruation.
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And 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. Generally, however, there is no reason to automatically skip exercise. Some women find it helpful to relax their bodies more during menstruation, while others prefer training because various hormones are released during it, which can also alleviate menstrual pain. The key is to follow your own feelings. Some women will prefer to slow down during menstruation, while others will have the most energy during this period. So it's important to perceive what makes me 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 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 an overly tense pelvic floor, it can irritate the cervix area or cause an uncomfortable feeling of pressure.
For tampons, a lot depends on their composition and structure, as they can irritate the intimate area or dry out the mucous membrane, and with weakened muscles, they can "slip," causing a woman to subconsciously clench her muscles to keep the tampon in place – thereby increasing tension in the pelvic floor area. For women with increased sensitivity or tension, menstrual panties might be more comfortable because they do not irritate and do not create tension in the pelvic area.
It is also important to consider what we wear; a tight elastic band on pants, leggings, or underwear can also increase tension by essentially "halving" the abdomen. So even something like this 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 early and not just mask them with analgesics. Most often, they won't disappear on their own and can gradually worsen.
Many thanks to Klára for sharing valuable information and tips on how to have a healthy pelvic floor. 🤍
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