1,2,3,4 We like our Pelvic Floor!

If you’re interested in reading more on ideas presented in the article below, I suggest reading Diastasis Recti. If you’d like movement instruction via video, start with Nutritious Movement for a Healthy Pelvis.

Kara Thom, author of See Mom Run, and an expert on Keeping Fit during pregnancy and motherhood (sounds easy) interviewed me on the exciting mechanics of the Pelvic Floor (PF). I love the Pelvic Floor (kinda creepy, right?) And, as Kara reports, my position on the Kegel as a pelvic floor-weakening exercise is 180° from wide-spread belief, but, what can I say? Science is not based on public opinion.

The PF muscles run between the sacrum (the triangular bone at the base of the spine) and the pubic bone (the bottom-front of the pelvis). Ideally you want the PF to be long, supple, and taut, to generate long-term forces that hold up your organs, as well as have enough motor skill to open and close your bathroom muscles as needed. When the PF is too tight, it can pull the sacrum out of alignment, bringing it forward, into the bowl of the pelvis.  Bye-Bye strong PF muscles, Hello Pelvic Floor Hammock. Hammocks are for vacation and have not promoted the notion of long-term force generation for some time.


A nice, taught (but supple!) pelvic floor
When the sacrum moves, it puts slack (and creates weakness) in the PF
The red arrows are the the Kegel Contraction. See how the long-term result will always be slack? Eventually there is no more contraction to get and stuff starts falling down (and out!)

The gluteal muscles (your butt!) keep the PF in check, preventing the sacrum from collapsing and provide leverage for the PF to contract. The secret to perfect pelvic floor tone is supple and strong glutes and PF muscles — not one stronger than the other.

Oh, and P.S. This goes for you too, Dudes. You have a pelvic floor too, and although your organs won’t prolapse or peek out of your vagina (vagina. vagina. vagina.  Anyone uncomfortable?), they will settle down onto your prostate. For your prostate, this is about as comfortable as being trapped underneath a large bookcase.


The squatting exercise progression from You Don’t Know Squat (click here to view) should be done a few times a day, even in a modified form, until the tension in the knees, hips, back, and feet allow you to settle in. Then, keep doing this bathroom squat on a “regular” basis. Get it?

To read Kara’s interview and my follow up click here:  http://mamasweat.blogspot.com/2010/05/pelvic-floor-party-kegels-are-not.html

Follow up questions: http://mamasweat.blogspot.com/2010/05/pelvic-floor-encore.html

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21 thoughts on “1,2,3,4 We like our Pelvic Floor!

  1. Glad I am not the only one not too embarassed to use proper terminology for anatomical parts. When my 16 year old (daughter) was a toddler, she got confused and thought she had a wenis. Ironically this one stuck and embarassingly, the general public became identified by her as either having a wenis or a penis.

  2. The more I read your blogs – The happier I am that I am male- I may have many problems but a least I don’t hang out!

    We speak of a male ancestor, a masculine scent, and a manly activity, but only of women as mannish.

  3. When I was in the Peace Corps (in Malaysia), I had a squat toilet. It was out back and as I found out form bowel movements. I had a bathroom in my flat with a sink and shower only. Typical American I was using the toilet out back to pee also and about the 3rd time I went out back to pee in one day (a day off from my PC job), my neighbor took me aside and after checking to see that I didn’t have diarrhea or dysentery, told me that I should be peeing on the bathroom floor and washing it away by sloshing water around to wash it away–down a drain in the floor if your house was “fancy”–if , like mine, out under the walls into an open drain that ran around the entire 2-flat house. I know–this doesn’t sound sanitary, but since I was in one of the 3 wettest places in the world–we got over 200 inches of rainfall per year–it was probably okay. (Of course about once a day or so, you did need to scrub the floor with soap to keep odor at bay). This bathrooming was great and convenient–especially if I got up at night to pee. Both activities required squatting for bathrooming and I really found I liked it.

    When I came home, I tried to continue squatting to bathroom, but this required standing on the porcelain rim of toilets which was pretty tricky. Unfortunately I suffered a knee injury and didn’t get great treatment (stop squatting and take it easy–bad advice). So I lost the ability to squat. I have worked on it off and on since then but since I now have arthritis (“enough” in doc-speak), I was not very successful. I am anxious to put Katy’s solutions into practice for the good of my pelvic floor. I do have incontinence big time.

    A year or so I bought a Welles Step which is supposed to mimic squatting, –what is your take on this device? As a former bathroom squatter, I have to say it is not the same, but better than the alternative of just sitting.

    I miss that simple bathrrom and the squat toilet.

  4. Will squating help the PF muscle if you already have pelvic organ prolapse? I am only 36 and have enough to have to use a pessary to be comfortable with day-to-day activities. I have talked to many doctors and done a little researh and the only answer I ever find is surgery, which is unacceptable to me. Katy, what do you think?

  5. Wow, is all I can say! I’d would like to know what evidence you have to show that the force angle/moment arm and tension generation of the pelvic floor muscles can do as you state?

    How did you test the position of the sacrum before and after to detemine this?

    How did you measure the tension in the PF?

    What makes you think that the glutes will counter this?

    1. All good questions, Simon.
      It is pretty easy to figure out moment arms and the resulting skeletal displacement using muscle attachments and trigonometry (this is what the study of biomechanics is). The resulting action would obviously be slightly more complex than is presented in the blog world, however if you consider that the PF muscles attachments are on the anterior wall of the sacrum, then there’s no physical possibility of the sacrum going any other way but following a vector with a forward component.

      I am not currently researching PF as I was in graduate school (I have decided to spend more time in public education who really need this basic info.) In the literature, however, sacral depth is measured by a MRI (you can measure the distance between the coccyx and different points on the sacrum relative to the pubic symphysis (it’s called pelvic telemetry.)

      PF, like all muscles emit an electrical force, so to measure force generation of a muscle (force is a much more correct term than strength and tension) you can use EMG. Also, the laws of physics and muscle tissue state very clearly the relationship between muscle length and force generation (Force/Length relationship). The shorter a muscle the lower the EMG. You should be able to find a F/L graph in any basic muscle physiology or biomechanics text book.

      Again, the gluteal muscle attachments will provide the direction of action the muscle will have on the skeleton. Muscle anatomy and “functional biomechanics” has been oversimplified, so many people forget basic things like every muscle contracts in two opposing directions – when the feet are connected to the ground, the primary action of the glute max is to pull the sacrum posterior. I “think” the glutes counter the action of the PF because the bony attachments, direction of the muscle fibers, and principles of muscle elecrto-biomehanics say it is so!

      Good day, and thanks for the great questions!

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  7. Katy – I blog at “A Pregnant Pause” came upon Crunchville’s post and my response: “Oh my God, I should have listened to my parents!”

    FYI, I’m Chinese and the squat toilet has been a part of our culture for ages. During my first pregnancy, I spent a lot of time at my parents’ home and forced to use a squat toilet. Although I griped about it, it got easier each time and I had a problem-free natural delivery to an 8.5 lb baby

    I couldn’t spend much time at my parents’ home during my second pregnancy i.e. no squats and obviously, no time for Kegels or anything either as I had my hands full with the first child.

    The second child was premature via emergency C-section, which was nothing at all like my first delivery. I’d like to share your findings i.e. Kegels are useless with my readers: could I interview you?

    Nina: I’m a Malaysian and would just like to clarify that not all Malaysians pee on the bathroom floor even if all we have is a basic toilet.

    The basic toilet in the rural areas is an outhouse (a squat toilet) – people who pee on the bathroom floor are just plain lazy and do not need to do the regular cleaning! And they are just a small minority 😉

  8. Hi KB! i have a question. i feel like the idea of the glutes being the anatomical check and balance on the PF muscles imp. but more indicative of people who walk around in posterior pelvic tilt. is that right? you know how (i started watching the course!) you emphasize that the two attachments of a muscle move towards each other – could the pubic bone move towards the coccyx too in a pubococcygeus contraction? i ask b/c my husband has prostatitis and has an anterior pelvic tilt. i just took a prenatal pilates workhop…and he kinda has a similar posture to a prenatal woman (don’t tell i said so!). he also has GI issues. oh. and a diastasis recti. 🙁 i think he’s got a lot of pressure built up in his abdomen squeezing on his prostate compounded by his tight PF (assuming the pubic bone can move towards the coccyx in a tight PF) – and he runs around like a maniac playing soccer 2x week. i wanna create a little program for him, but i just wanted to check that PF tightness is not exclusive to a posteriorly tilted pelvis.


    1. I’d bet that he doesn’t have an anteriorly tilted pelvis once you start from the feet and work up, but a super-mean rib thrust. Either that, or he’s wicked pregnant. This rib shear often gets misread as ant.tilt (read “neutral pelvis”) for a better picture and make sure that you’re not just looking at the curved back. And, the pelvis can’t really move relative to the sacrum — to much anchorage elsewhere. Check his psoai too… KB out.

  9. The link for You Don’t Know Squat isn’t working. Is there somewhere I can find the exercises?

  10. Thank you, thank you, I keep half-assed doing the squats and stretches, and walking by shortening my hip muscles to lift the leg on the opposing side. Et voila, I am buying half as many pads, and not needing to stop every hour for a bathroom break, while driving. I am nagging my friends, on-line and off, but so far, no takers. I’m going to mention to my DH that having a weak pelvic floor is like balancing a book case on his prostate–maybe that will get his attention, lol.

  11. Katy,

    Boy, am I so happy I stumbled on your site, I was searching in google ‘kegels make me nauseous’ (which is totally true for me) and an article came up that linked me to your site, I have been reading it off and on all day! I have been doing your squats and stretching my piriformis a bunch today.

    My story is long so I’m not gonna bore you with the details. Suffice it to say, that I normally try to do the non medical intervention first. I the last few years tho, I was having crazy hip/butt pain on right side. After X-rays, MRIs and other tests it was confirmed that nothing was structurally wrong with me and I had no nerve condition problems. They did find sacralization (on both sides not just one) but was told that doesn’t always mean low back pain, which I also have HORRIBLY! I had 2 steroid injections into my piriformis and they did NOTHING!!! So, I decided that the only other thing I could maybe try (since Chriopractic did nothing and Physical therapy did nothing) was to go to a neuromuscular massage therapist. She has transformed my life in the last year. She was the one who said she has never worked on a body so tightl She does a lot of psoas work, which is great. I am extremely active…hiking with my 2 Siberian Huskies all over the place, Homeschooling my kids, and just being busy all the time. Her script for me was to STRETCH…which I have been, just not always successfully…coz I’m always worried I’m doing it wrong.

    But despite all that above, the reason I ended up finding your site was because I have been recently diagnosed with a cystocele, rectocele, prolapsed uterus (stg 1) and SUI (if I sneeze, cough or laugh too hard or run…I’m gonna wet my pants…always!) Of course, the first 2 docs (who were women!!) suggested hysterectomy! I’m 46. 5’7″, 140lbs. I have 3 kids 22 (c-sec), 16 (VBAC) 12 (VBAC) all of whom were over 81/2 pounds. I know with their births, my constant throat clearing from seasonal allergies, the ridiculous amount of heavy lifting I have done (if no one is around to help me move something I will move it myself…because I think in my head I’m still 25 and am invincible) and of course my Huskies pulling me over hill and dale on an almost daily basis, that I have done some real damage to my pelvic floor. And what it the first thing the docs say to do…kegel. Which I can’t, makes me sick. And the pelvic floor physical therapists first line of defense is kegels! Aaack!! Thus the reason for finding your site! Btw, I have 2 more docs to see. This time they are guys. One is running a urodynamic test. I’ll be interested to see what it says.

    In the meantime, Ii will continue to read this site, watch your youtube vids, squat and stretch and order a couple of your videos!!! I was wondering, though, could my prolapse be aggravating my sacralized sacrum. I’ve been making sure I don’t tuck my tailbone under. But I find that keeping that curve in my back really stars to hurt. Is that because I stretched it in the wrong direction so long? This may help you to see whati mean…the thing I love the most, when it comes to my back, is for me lie down and have someone put their hands just below my sacrum, kinda on the top of my glutes and press hard…it kind of stretches out my low back and sacrum. Is that bad? It feels so great…like all sorts of compression goes away. I feel like when I sit and stand the way you suggest that the compression is worsened. Am I doing something wrong?

    Thanks so much for your site and your work.

    Rachel in Atlanta

  12. Dear Katy,

    Is it possible that the sacrum could be too much out, e.g. as a result of a vaginal birth? My osteopath wanted to push it “back in”, which I asked him not to do as I feared it could be counter-productive (according to what I have been reading and understanding here), as I have prolapse problems. He explained that the position he aimed at corresponded to the physiological position that comes in the books. He found my wish weird, but consented :D. Might I be overloading your words? Should I leave the positioning of the sacrum to the action of the muscles only? Thanks!

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