There is no doubt that regular exercise has positive impacts and implications on health and aging well. We know that regular exercise is preventative against chronic health conditions and diseases such as diabetes, hypertension, osteoarthritis, coronary artery disease, chronic kidney disease, dementia, etc.
The role of exercise when it comes to the pelvic floor has been less clear, almost muddy, in research conclusions over the years. The aim of this blog post is to sort through some of the confusion on the research, and provide more of a clear recommendation on exercise and the pelvic floor.
Does the pelvic floor automatically engage with exercise?
The answer is yes.
The contingent factor is yes it does in those who do not have pelvic floor dysfunction or damage to their pelvic floor. Pelvic floor dysfunction being incontinence (leaking urine, feces, or gas at an inappropriate time unwillingly), pelvic organ prolapse (weakening of the pelvic floor muscles and ligamentous support where organs start to descend downward), and pain.
The pelvic floor co-contracts with your core when performing physical activity. Meaning if your core turns on, the pelvic floor turns on. However this is the ideal scenario, and while it happens in healthy men and women (who do not have pelvic floor dysfunction already) it may not be the case if you do already have an issue.
Intra-abdominal pressure is the pressure associated with any type of movement, whether it's running, getting up off the couch, or even coughing & sneezing. Our organs in our abdomen can only be compressed so much, so pressure builds and the demand on the surrounding muscles are to either stretch with the pressure or hold firm against it. Pressure is going to go to the weakest point in the abdomino-pelvic cavity. So if you already have a weak pelvic floor, and the pressure builds in your abdomen, and your core is so tightly turned on that the pelvic floor cannot keep up, the higher the risk for "failure" of support. Whether that means increasing pelvic organ prolapse prevalence or just leaking urine when you don't want to.
Summary and thoughts: If your pelvic floor is already weak and cannot properly contract with the core, or it inappropriately relaxes when the core is engaged, your risk for dysfunction is higher. This may be why there is a significantly higher prevalence of urinary incontinence (UI) in women who regularly exercise. However if your pelvic floor is strong, you can properly brace your core when exercising and don't push pressure downwards, you're a lot less likely to experience symptoms of dysfunction during vigorous activity.
Recommendations: Learn how to properly brace your core, especially during weight lifting, as well as regularly incorporate proper breathing mechanics into your exercise routine. For example, exhaling upon exertion (blowing out upon exertion) will allow the pressure in the abdomen to escape through the diaphragm and not the pelvic floor.
Is exercise protective against pelvic floor dysfunction?
Here's what we know:
Mild to moderate physical activity appears to decrease your risk of urinary incontinence.
Regular heavy weight training decreases your risk of a pelvic organ prolapse, or symptoms of heaviness and bulging in the vaginal area.
Women who worked a more physically demanding job (nursing for example) had a larger risk of pelvic organ prolapse, EXCEPT when they regularly strength-trained with the appropriate abdominal bracing technique.
Regular exercisers have been found to have stronger pelvic floor muscles than non-regular exercisers.
Exercise is not predictive of pelvic floor dysfunction. Those who are most likely to experience pelvic floor dysfunction are those who already have experienced it before.
It is very, very hard to study pelvic floor muscle contractions and strength in the middle of exercising. Using EMG does not tell us strength, rather just the amount of recruitment for muscle fibers ,which is not the same thing.
Recommendations: Keep exercising, and don't let the fear of pelvic floor dysfunction stop you. If you have pelvic floor dysfunction or symptoms of it, it's better to seek help to mitigate the issue than stopping exercise altogether. Stopping exercise doesn't then stop the problem, it just predisposes you to weakening of all other major muscle groups that are important for health and wellbeing.
In conclusion, no, exercise is not bad for your pelvic floor. Ultimately we cannot make a sweeping statement like that anyway, there simply isn't consistent research to say so. However, research does support regular activity as a preventative tool in a lot of health conditions including urinary incontinence. If you are having symptoms of leaking, heaviness or bulging in the vaginal area, or pain, don't wait to see if the problem will go away on it's own. Seek out a pelvic floor physical therapist to help you so that your quality of life and ability to exercise is not affected.
TLDR:
There is not enough research to say exercise is bad for your pelvic floor, however many studies have come out in support of regular exercise and the prevention of pelvic floor dysfunction.
Your core and pelvic floor will co-contract when exercising or being physically active automatically. However if you're experiencing symptoms like leaking, your pelvic floor may either not be strong enough to withstand the pressure of activity or it may not be co-contracting after all.
It is important to work out with good form, because just a change in form can make all the difference. If you leak with inappropriate abdominal bracing during weight lifting, you may not when coached how to breathe differently.
Seek help for symptoms rather than waiting or quitting the activity that's causing your symptoms altogether. Stopping exercise does not solve the problem, whether it's pain or leaking. The benefits of regular exercise far outweigh the risks.
Other resources and reading material:
About the Author:
Caroline Gamwell, DPT is a Doctor of Physical Therapy specializing in Women’s Health and Orthopedics. Dr. Gamwell earned her doctorate at Northwestern University in Chicago, IL with a focus on chronic pain rehabilitation. Dr. Gamwell owns Worth It PT, LLC, a boutique physical therapy practice based in Denver, CO focusing on all things Women’s Health. She holds post-graduate certifications in Pelvic Floor Physical Therapy, as well as in treating pregnant and postpartum athletes. Her passions lie with helping others embrace body changes throughout the decades, whether it’s pregnancy and postpartum or simply aging well.