Ashlee Williams, MD (Host): Most people have heard of the pelvic floor, but many don't know its purpose. The pelvic floor works 24 hours a day, seven days a week to support your bladder, your colon, your rectum, and your sexual organs. These muscles are working hard and should remain strong and active just like any other set of muscles. But how do you strengthen these muscles and why is it important?

Welcome to the Healthier You podcast. I am Dr. Ashlee Williams. And today, I'm joined by Dr. Carolyn Gorman, a board-certified OB-GYN at Kaiser Permanente and a sexual health expert. Today, she will explain more about the pelvic floor and how to keep it strong. Welcome, Dr. Gorman.

Carolyn Gorman, MD: Thank you, Dr. Williams, for having me. I'm excited to be here and speak about this topic.

Host: Yes, we are so excited. So, let's get started with the basics. What is the pelvic floor?

Carolyn Gorman, MD: Sure. Think of the pelvic floor as a group of muscles that acts like a hammock to all the organs you mentioned earlier, so your bladder, your bowel, your rectum and then, for a woman, your vagina, your uterus, your ovaries, and they're just holding them 24/7.

Host: That's a lot of work.

Carolyn Gorman, MD: Yeah, it's a lot of work for muscles and we don't give them much credit. We don't really focus on them at all. So again, I love the fact that we're having a podcast on this.

Host: So, how do we know how strong our pelvic floor is?

Carolyn Gorman, MD: It's not an easy question. A lot of times, we really notice when our pelvic floor is not strong. Our symptoms develop when we might have a weak pelvic floor, such as urine leakage, whether that's with cough, laugh, sneezing that we call that a stress incontinence. And there's also a type of incontinence that we talk about that comes with just an urge and an inability to control that urge. We call that urge incontinence. So, it's that kind of feeling where you get, "I got to go, I got to go, and I got to go right now." So, all of those can be signs of weaker pelvic floor. And then, there are also, you know, problems with bowel movements. And unfortunately, there are some people that have leakage of stool and that can also be a factor or be a symptom of having a weaker pelvic floor.

Host: Right. So, it sounds like it's pretty important to have a strong pelvic floor. Can you talk more about the importance of it?

Carolyn Gorman, MD: The pelvic floor helps you with urination, with bowel movements. It's important in sexual functioning. It's important in standing and sitting. So again, really in so many different movements. When you're playing sports, we think about our core. Our core includes the pelvic floor. When you think about strengthening your core, we should be including all those muscles as well because they help in everything we do all day long.

Host: Right. And I know a little later you're going to give us some tips on how to strengthen that pelvic floor, but how do you know when you have an issue related to your pelvic floor? Like when should patients come in to see a doctor about their pelvic floor?

Carolyn Gorman, MD: So, this brings up a really important point that having a weak pelvic floor will lead to symptoms, like I mentioned. That's the urine leakage, problems with having bowel movements. There's also prolapse for women that they might feel almost like a heaviness, a fullness in their vagina. They might feel a bulge that's their bladder or rectum, or even they might even feel their cervix at their vaginal opening. These are all types of prolapse, which isn't typically a medical emergency, so it's not a 911, "I have to see my doctor this afternoon," yet it can be quite scary for a lot of women when they feel something and they have no idea what it is.

The other important point is that sometimes pelvic floor muscles can be almost too tense. And that can lead to problems with painful intercourse. So, think of, you know, you have a back muscle that's super tense, and you've got back pain. And you go to a massage, and they work on it, and they massage it and, you know, you get that pain when they hit it at the right spot, and they're like, "Ooh, that really hurts." Well, that can happen during intercourse as well, like those muscles are super tense. So especially for women that have pain with sex, I would want them to see their gynecologist because the last thing I want them to do is to try to strengthen and tighten those pelvic floor muscles. For those women, I actually want them to work with the physical therapist to get the muscles to lengthen and relax. So, it's going to be very important that we know what the problem is with the muscles, too weak, too tense, to give them the right exercises to do.

Host: That's a great point. So, it sounds like there's a difference between an overactive versus an underactive pelvic floor. Can you tell us more about that?

Carolyn Gorman, MD: Yeah. We're constantly using them, right? Sometimes we're sitting all day at a desk, sometimes we're on our feet, these muscles play a crucial role in everyday activities, and we're using them without realizing them. And they can be injured just like any other muscle can be injured.

You know, think of the most obvious example that I get asked about is childbirth, because it's quite a traumatic event, as you can imagine, for our pelvic floor muscles. And they can get weak, they can get strained, there can be pain afterwards. They can get stretched, but it's not just women that have had babies that have problems with pelvic floor. It could be somebody that is using them constantly and maybe they're too tense. So, think about a personal trainer, maybe somebody that just feels like they're doing CrossFit and they're working their core and they're exercising great and they're doing something wonderful with their body. That's awesome, and that's great, and now they're having pain with sex, and they have no idea that it might actually be related to some of the exercises that they are doing. So, that's an example of an overactive. Where maybe the woman that just had a baby and is having urine leakage might be an example of somebody that's having an underactive or weakened pelvic floor muscle system.

Host: Okay. So, what kind of advice do you give patients to exercise and strengthen their pelvic floor muscles?

Carolyn Gorman, MD: If you think of core exercises, a lot of those will also help strengthen the pelvic floor. And we think of also as Kegel exercises, okay? Kegel exercises, you know, a lot of women I've heard about them and they are using those muscles that you would use if you were going to stop the flow of urine, and tightening them and squeezing them. And when you do this, and when you practice this, it's really common to find that you're using also a lot of other muscles, like your abs or your buttocks. So, you know, you can kind of lay down and try to squeeze and see if you're squeezing all these other accessory muscles at the same time. But it's really those internal muscles, those muscles that you can't feel, you know, with your hands that are squeezing and becoming tight, and doing them just like a regular exercise program. So if you were going to do core three times a week, you could add these pelvic floor Kegel exercises at the same time.

And I think it's also reasonable when you go and see your OB-GYN to ask them to do an internal exam and see if they can feel that squeeze, because that's a good way of us as clinicians to identify whether there's a weakened pelvic floor musculature. That's one way.

Host: And there's even physical therapy, right?

Carolyn Gorman, MD: Yeah. As I mentioned, we have here at Kaiser Permanente that are pelvic floor physical therapists. So, these are usually women, but not always, women that have gone through physical therapy training and then specialized in the pelvic floor muscles. So, treating women and men with urinary issues. Whether that's incontinence, and sometimes if it's a hyperactive pelvic floor, maybe urinary retention or problems with prolapse, and then problems with painful sex, they can do an evaluation. Often there's an external and an internal component for them to feel these muscles. And they give you a home exercise program for you to do, like any other physical therapy program, and they'll check in with you regularly to see that you're making progress. And this is great to do in conjunction with whatever other treatment, if needed, you're doing with your OB-GYN. So, I refer to pelvic floor physical therapists all the time and they are experts in their field.

Host: Well, thank you, Dr. Gorman, for this great information. There is so much to learn about the importance of building pelvic floor strength and how it can improve your overall health.

To recap, your pelvic floor is working 24 hours a day, 7 days a week to support your bladder, your colon, your rectum, and sexual organs. This important set of muscles performs many vital functions and should be kept strong and active just like any other muscle. A strong pelvic floor is important for both men and women. It helps you have better control of your bowels and urine and can improve sexual function. There are many symptoms of pelvic floor dysfunction and it's important to talk to your doctor about any symptoms you're experiencing. Know your body. A doctor will help determine if you have an overactive or underactive pelvic floor or if the symptoms are caused by a different health problem. Pelvic floors can be overactive or underactive. Ideally, your pelvic floor falls somewhere in between the two ends of the spectrum. And Kegel exercises are the best way to strengthen your pelvic floor muscles. By strengthening your pelvic floor muscles, you can relieve many symptoms of pelvic floor dysfunction.

For more information about pelvic floors and pelvic floor function from our experts and other health advice, visit kp.org/doctor and listen to more episodes of the Healthier You podcast wherever you get your podcasts. If you enjoyed this episode, be sure to share it with others who may find it helpful. Thank you from all of us at Kaiser Permanente. Be well.