Pelvic Floor Health Is for Everyone—Here's How to Strengthen It at Any Age

Your guide to a strong, healthy, functioning pelvic floor.

Often overlooked and underappreciated, the pelvic floor is an unsung hero of the human body: one of those parts that tends to be neglected (or even unheard of) until something goes wrong due to weakness or dysfunction. Ideally, though, this wouldn’t be the case—and we can all put more thought and effort into supporting and strengthening our pelvic floors.

While practically every human body has a pelvic floor, we’re going to focus on bodies that support a vagina and uterus, in addition to a bowel and bladder. We spoke to experts, including a pelvic floor physical therapist and a urogynecologist, to get the inside scoop on the foundation that keeps all the organs in and around the pelvis in place.

Here’s what to know about this important group of muscles, including how to strengthen your pelvic floor at any age.

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What is your pelvic floor—and what does it do?

The “pelvic floor” describes the entire set of nerves, muscles, and connective tissue, spanning between the tailbone and pubic bone, that work together to support the pelvic organs: vagina, uterus, bladder, rectum, bowel, and anus.

“The nerves make the muscles contract and relax, and the connective tissue connects the organs to the muscle,” says Jill Maura Rabin, MD, a New York–based Northwell Health physician specializing in urogynecology, and the author of Mind Over Bladder: A Step-by-Step Guide to Achieving Continence. “So for example, the connective tissue surrounds the bladder and the muscle, and connects the bladder to the muscle. The same is the case with the vagina and the uterus and the rectum.”

In a healthy pelvic floor, the nerves, muscle, and connective tissue all work together and keep the pelvic organs in place and functioning properly. “But if the muscle tissue is too weak to support the bladder, the bladder may leak,” Dr. Rabin explains. “Or, if the muscle is too strong or tight, it could lead to pelvic floor spasm or pain. Think of it as the ‘Goldilocks and the Three Bears’ interpretation of the pelvic floor: You don't want it to be either too contracted or too relaxed, but just right.”

That said, she notes it’s far more common to have a weak pelvic floor than one that’s too tight.

“It’s important to have a well-functioning pelvic floor that’s not only strong and able to support your organs to prevent issues like urinary and bowel leakage, but able to relax when needed, so you can actually [go to the bathroom] easily and pain-free,” says Liz Miracle, a physical therapist with expertise in the pelvic floor, and the head of clinical quality and education at Origin, a virtual physical therapy platform focused on pelvic floor health.

Pelvic floor issues may come up most frequently in the context of pregnancy and/or childbirth, but that doesn’t mean everyone else not experiencing pregnancy is off the hook. “While pelvic floor dysfunction is extremely common around pregnancy and childbirth, it does not discriminate based on age or life events like pregnancy,” says Miracle. “It’s important to care for your pelvic floor, even if you never plan on bearing a child.”

Plus, as she points out, for many people, pelvic floor dysfunction is present as an overlapping condition related to other existing diagnoses—like irritable bowel syndrome, polycystic ovarian syndrome, painful bladder syndrome, or endometriosis—and can show up as tension in the pelvic floor muscles, causing pain or dysfunction. Low back pain has also been closely associated with pelvic floor weakness and/or dysfunction, since the pelvic floor muscles play a large role in supporting and stabilizing the spine and pelvis.

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Serious Signs of a Weak Pelvic Floor

According to Dr. Rabin and Miracle, some common symptoms of a weak pelvic floor include:

• Bladder or bowel leaks (no matter how small)

• Urinary urgency or frequency

• Pain with vaginal penetration (gynecological exams, tampon insertion, penetrative sex)

• Pelvic heaviness, or the feeling of your organs falling out

• Seeing or feeling a bulge in your vagina

• Pelvic pain

“If you are experiencing any of these symptoms, it is not normal, and you should tell your doctor,” says Miracle. “If your doctor tells you they’re normal, keep asking until you find someone that will listen.” Once your doctor has ruled out any serious conditions that could be contributing to your symptoms, they will then recommend a treatment plan, which often involves physical therapy.

Signs of a Tight Pelvic Floor (That Needs Relaxing)

Meanwhile, the signs of a less-common tight pelvic floor are basically the opposite, Dr. Rabin says. “The muscle is so tight that you may not be able to empty your bladder or your bowel well, because it's squeezing the exit strategy—which is the urethra for the bladder, and the tushy for the rectum,” she explains. “The other symptoms are pelvic floor spasm and pelvic floor pain.”

Healthy Habits for Pelvic Floor Strength

If your pelvic floor is functioning properly, you definitely want to keep it that way. Fortunately, doing so doesn’t require expensive devices or treatments, but it does involve developing habits that benefit your body anyway.

It’s worth noting that these are tips for maintaining a healthy pelvic floor, and shouldn’t be seen as ways to fix problems that already exist. If you’re currently dealing with a pelvic floor that’s too weak or tight, it’s best to consult a medical professional. With that in mind, here are a few expert-backed strategies for strengthening your pelvic floor and keeping it in great shape.

Eat your fiber.

Preventing constipation is an important way to maintain a healthy pelvic floor. As Dr. Rabin points out, constantly pushing as you try to go can end up damaging your pelvic floor in the long run. Most of the time, this can be done by choosing the best foods to avoid constipation.

According to Riva Priel, DPT, physical therapist, founder of Revitalize Physical Therapy, and author of The Inside Story: A Woman’s Guide to Lifelong Pelvic Health, the goal is to consume 25 to 30 grams of fiber each day while drinking plenty of water (more on that below). Eat plenty of plant foods, which are excellent sources of fiber: fruits and veggies, nuts and seeds, beans and legumes, and whole (unrefined) grains with their fiber still intact.

“Urinating and defecating should be passive processes: There should be no straining required,” she says. “If that’s not the case, I encourage you to speak with your friendly neighborhood pelvic floor physical therapist.”

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Stay sufficiently hydrated.

As Priel mentions, it’s especially important to drink enough water while increasing your fiber intake to keep your digestive system running smoothly. Exactly how much water are we talking about? Unfortunately, there’s no “magic number” when it comes to the number of ounces you need to get down in a day in order to stay sufficiently hydrated. Instead, listen to your body, and be sure to drink water throughout the day when you’re thirsty—but don’t wait until you’re too thirsty, which can be a sign you’re already slightly dehydrated.

Engage your diaphragm when breathing.

As a pelvic floor physical therapist, Miracle hears people ask her constantly what she thinks is the best pelvic floor exercise. Her response is consistent and simple:

“It’s breathing,” she says. “Your pelvic floor muscles and diaphragm move in concert to facilitate your breath,” she says. “This means that just by breathing, you can connect with—and gently move—your pelvic floor muscles.”

On a proper inhale, your diaphragm (inside your lower ribcage) should expand 360-degrees to fill with air while your pelvic floor naturally relaxes and deepens. On an exhale, both your ribcage and diaphragm should contract (get smaller like a balloon losing air) as your pelvic floor lifts up and contracts, too (if you pay close attention, you can feel your pelvic floor muscle bed lift and tighten—as if you’re trying to stop your flow of urine).

Strengthen your pelvic floor muscles with isolated exercises.

“We work out all the time and exercise every muscle but the pelvic floor—that's kind of weird, right?” Dr. Rabin questions. “If you’re dealing with a weak pelvic floor, you can see a physical therapist to maximize your pelvic floor strength, but most of the time, people can [strengthen their pelvic floor] on their own at home.”

To do this, she recommends contracting your pelvic floor (exhale and imagine stopping yourself from peeing) for between three and five seconds; then relaxing it for the same length of time (inhale and release any tension). Do this three to five times an hour. “It usually takes about six weeks to see a difference,” she adds.

You may have heard this type of isolated, contraction-relaxation pelvic floor exercise as a Kegel exercise, referring to Arnold Kegel’s development of pelvic floor strengthening exercises starting in the 1940s.

Once you establish a confident mind-to-pelvic-floor connection and can consciously activate and relax those muscles, use that activation while performing other workouts. Anytime you're told to "engage your core" for an exercise move, that fitness instructor is including your pelvic floor (and diaphragm), too. Exhale to engage and tighten your pelvic floor and diaphragm as part of engaging your entire core for exercises like planks, glute bridges, bird-dogs, push-ups, and more. Not only will you be training your pelvic floor, but helping to stabilize and fortify your spine, hips, and pelvis.

Related:How to Do a Proper Plank That Works All the Right Muscles

Stay on top of your overall health.

Dr. Rabin also stresses the importance of listening to your body and taking the necessary preventative steps towards maintaining a healthy pelvic floor. “Normalize your weight, try not to get constipated, and if you have a chronic cough, get it investigated,” she says. “An ounce of prevention truly, in this case, is worth a pound of cure.”

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Strengthen Your Pelvic Floor at Any Age

Your pelvic floor never stops working for you, so it’s in your best interest to keep it healthy and strong—especially as you age.

“As time goes by, one of the effects gravity has on the body is the increase in pressure on the pelvic floor muscles,” Miracle explains. “You can think of this as the pressure that gets placed on the pelvic floor every time you go from [sitting] to [standing], or jump up and down. This is why it’s so important to take preventative measures to strengthen your pelvic floor muscles as you age—remembering, of course, that a strong muscle is also a flexible muscle, and can fully relax, as well as generate force.”

Here are some tips from Miracle for ensuring your pelvic floor is in working order in your 20s, 30s, 40s, 50s, and beyond, as well as the signs of a potential issue down there:

In your 20s:

Something might be wrong if: You find sex painful or pleasure challenging.

Simple, everyday maintenance and strengthening tips: Try diaphragmatic breathing. As your diaphragm expands as you inhale, your pelvic floor muscles will expand and relax. Your diaphragm and pelvic floor will contract as you exhale. Repeat, breathing with focused awareness. This can help reduce tension in the pelvic floor related to painful sex and lack of pleasure.

In your 30s:

Something might be wrong if: You’re beginning to notice that sometimes you leak a little urine during certain activities. This may happen when you sneeze, start training for a longer-distance run than you’ve ever done before, or while dancing at your friend’s wedding.

Simple, everyday maintenance and strengthening tips: Learn how to squeeze your pelvic floor muscles in response to increases in pressure. Remember, squeeze before you sneeze!

In your 40s:

Something might be wrong if: It feels like organs are shifting, and perhaps you feel a bulge coming from the vagina that wasn’t there before.

Simple, everyday maintenance and strengthening tips: Ideally, at this point, you’ve already been working on pelvic floor endurance, but if not, it’s time to start. Begin by holding a pelvic floor squeeze for up to 10 seconds, then fully relaxing those muscles. Work your way up to doing 12 rounds of conscious squeezing then relaxing. If you begin to experience pain, stop and tell your doctor or physical therapist.

In your 50s and beyond:

Something might be wrong if: You experience symptoms of vaginal dryness or discomfort, urinary urgency, or pain with urination.

Simple, everyday maintenance and strengthening tips: Similar to discomfort with sex at other times in life, diaphragmatic breathing and learning to relax the pelvic floor can help. This is also a great time to talk to a doctor about the benefits of vaginal estrogen, or other over-the-counter options, like hyaluronic acid suppositories.

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