The Pelvic Floor: What It Is & Why It Matters | OB-GYN Guide

According to a landmark 2008 JAMA study by Nygaard and colleagues — one of the largest population-based investigations of pelvic floor health in the United States — 23.7% of women over the age of 20 (almost one in four) have symptoms of at least one pelvic floor disorder.

What You'll Learn

What Is the Pelvic Floor?

The pelvic floor is a three-dimensional musculo-connective tissue structure that closes the outlet of the lesser pelvis. Its main function, as the lower wall of the abdominal cavity, is to counteract constantly changing intra-abdominal pressure. At the same time, it helps maintain the correct anatomical relationships between the pelvic organs and creates the conditions needed to retain the contents of the bladder and rectum.

To make this easier to understand, imagine a hammock stretched between the pelvic bones. The weight of the bladder, uterus, and rectum constantly rests on it. Every time we cough, laugh, sneeze, run, or lift something heavy, the pressure on this "hammock" sharply increases. The pelvic floor holds the organs in place and helps them continue to function properly.

The main load falls on the muscular component of the pelvic floor, especially on the group of muscles known as the levator ani muscle. It forms the posterior vaginal wall and plays the leading role in supporting the pelvic organs.

In addition to the muscles, the fascia and ligamentous structures also play an important role. These are strong connective tissue structures that help hold the pelvic organs in place and distribute the load evenly.

The main and most important functions of the pelvic floor are:

Any significant change in the position of the pelvic organs can primarily affect their function. For example, with bladder prolapse, or cystocele, a woman may experience urine leakage, a feeling of incomplete bladder emptying, difficulty urinating, or frequent urges to urinate. With rectal prolapse, constipation and fecal incontinence may occur. When the vaginal walls or uterus descend, a woman may feel pressure, heaviness, or a foreign body sensation in the vagina. These symptoms often limit physical activity, worsen sexual life, and significantly reduce quality of life. In severe cases, they can lead to organ protrusion outside the vaginal opening.

What Is Pelvic Floor Dysfunction?

Pelvic floor dysfunction, or pelvic floor disorders (PFD), is a group of conditions that includes pelvic organ prolapse, urinary incontinence, impaired bowel control, and other disorders caused by impaired function of the pelvic floor muscles, fascia, and ligamentous structures. These conditions may also be accompanied by sexual dysfunction and chronic pelvic pain.

However, the biggest problem is not only the high prevalence of these conditions, but also the fact that most women do not seek help. As Chen and colleagues concluded in their 2019 review published in BMC Family Practice:

"Despite these social and fiscal consequences, fewer than half of women with significant pelvic floor disorder symptoms seek care."

They also reported that 81% of women do not consider urinary incontinence a disease and perceive pelvic floor disorders as a natural consequence of pregnancy or aging.

Pelvic floor dysfunction is very common, but the main problem is that many women ignore their symptoms, accept them as normal, and avoid examination or consultation with a specialist.

Is there ever a time when symptoms such as urine leakage, constipation, or a foreign body sensation in the vagina can be considered relatively normal? Yes. In the last weeks of pregnancy and immediately after childbirth, such symptoms may indeed be considered relatively normal during the first 12 weeks after delivery, as noted in the American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 736 on Optimizing Postpartum Care (2018). However, if symptoms persist beyond this period, they should no longer be considered normal and require consultation with a specialist.

How Severe Are Your Symptoms?

It is not always easy to understand whether existing symptoms are a variation of normal or already require treatment. That is why validated questionnaires are used worldwide to help objectively assess the severity of symptoms and their impact on quality of life.

They do not replace a medical examination, but they help determine how significant the problem is and whether it is worth seeking professional advice.

It takes only a few minutes. After completing it, you will receive a preliminary assessment of your pelvic floor condition and personalized recommendations for next steps.

button:Take the free Pelvic Floor Symptoms Quiz

How Does a Doctor Assess the Degree of Prolapse?

If a doctor suspects pelvic organ prolapse during an examination, the international POP-Q (Pelvic Organ Prolapse Quantification System) is most often used to assess its severity. This system allows doctors to objectively determine the degree of pelvic organ descent and monitor changes over time.

TVL (Total Vaginal Length) is the total length of the vagina measured by a doctor during examination. This measurement is used only to determine stage IV prolapse and does not require self-assessment by the patient.

It is important to understand that the stage of prolapse and the severity of symptoms do not always match. Some women have almost no complaints even with stage II or III prolapse, while others experience significant discomfort even with minimal organ descent.

That is why a diagnosis is never made based only on examination findings. A doctor always evaluates not only anatomical changes, but also the patient's symptoms and how they affect daily life, physical activity, urination, bowel movements, and sexual function.

The good news is that most pelvic floor disorders, especially in the early stages, respond well to conservative treatment. That is why it is so important not to wait until symptoms become severe, but to consult a specialist when they first appear.

Can Pelvic Floor Dysfunction Be Prevented?

Yes, it is impossible to eliminate the risk completely. The condition of the pelvic floor is influenced by age, genetics, connective tissue characteristics, pregnancy, and childbirth. However, numerous studies show that many risk factors can be managed, and timely prevention and rehabilitation can significantly reduce the likelihood of symptoms and slow disease progression.

Why Is Postpartum Rehabilitation So Important?

Pregnancy and childbirth are among the most serious challenges for the pelvic floor muscles. Even if childbirth was uncomplicated, the muscles, fascia, and ligamentous structures undergo significant strain. That is why the first months after the birth of a baby are not only a period of uterine recovery, but also a time for pelvic floor recovery.

Unfortunately, many women pay a lot of attention to getting their figure back, but know very little about restoring the pelvic floor muscles. At the same time, this stage largely determines the risk of developing urine leakage, pelvic organ prolapse, chronic pelvic pain, and sexual dysfunction in the future.

It is important to understand that postpartum rehabilitation is not limited to Kegel exercises. A modern approach includes restoring proper breathing, deep abdominal muscle function, pelvic floor muscle coordination, gradual return to physical activity, and learning how to distribute load correctly in everyday life.

What Else Helps Maintain Pelvic Floor Health?

In addition to postpartum rehabilitation, simple daily habits are also important:

Even small lifestyle changes can significantly reduce the load on the pelvic floor and lower the risk of developing pelvic floor dysfunction.

The Most Important Thing Is Regular Training

Like any other muscles in our body, the pelvic floor muscles need regular and properly selected exercise. A 2014 analysis by Wu et al. in Obstetrics & Gynecology confirmed that consistent, guided pelvic floor training is one of the most effective strategies for reducing symptom progression in U.S. women.

"Women spend years taking care of their heart, spine, and joints, but rarely think about the pelvic floor until it starts reminding them of itself. Start taking care of it before symptoms appear — your body will thank you for it."

At the same time, it is important to understand that the problem is not always only muscle weakness. Sometimes the muscles are, on the contrary, constantly tense and need relaxation and restoration of normal coordination rather than strengthening.

That is why there are no universal exercises that are suitable for absolutely all women. A training program should take into account age, history of pregnancy and childbirth, symptoms, fitness level, and the current condition of the pelvic floor.

This is exactly why we created Leia Fit, an app designed specifically for women and the unique needs of their bodies. Unlike standard fitness programs, Leia Fit adapts daily recommendations based on your current condition: your menstrual cycle, postpartum period, pelvic floor dysfunction symptoms, and overall well-being.

The program includes pelvic floor exercises, breathing techniques, safe core training, recovery recommendations, and guidance for a gradual return to regular activity.

Not sure where to start? Assess your pelvic floor in 2 minutes and get tailored next steps based on your results.

A healthy pelvic floor is not the result of a few exercises. It is the result of regular care for your body. The earlier you start prevention, the greater your chances of preserving quality of life, avoiding symptom progression, and staying active for many years.

References

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