While pelvic floor dysfunction is not ideal for anyone—after all, these deep stabilizer muscles support sexual function, bladder and bowel control, sound posture, plus arm and leg power, among other tasks—for people who like to pick things up and put them down (i.e. lift weights), it can lead to improper movement mechanics, as well as leakage mid-lift.
So if you regularly hit the weight room with the goal of getting stronger, doctor of physical therapy Corey Hazama, DPT, an expert with Pelvic Gym, a pelvic health education platform, says properly strengthening and engaging your pelvic floor is as important as any other muscle group you’re training. Below are six things you should know about the pelvic floor and its function if you lift —including exactly how to brace your core and breathe while strength training in order to optimize your efforts and avoid injury.
1. First thing’s first: Everyone has a pelvic floor
Before diving into the specific relationship between lifting and the pelvic floor, let’s get on the same page about who has pelvic floors. Spoiler alert: all of us. As Dr. Hazama explains, your pelvic floor is a collection of 14 muscles that stretch from the tailbone to the pubic bone, and hip to hip sort of like a trampoline or hammock. They are not sex specific.
The only difference amongst people of different sexes is which organs the pelvic floor muscles support, according to doctor of physical therapy Heather Jeffcoat, DPT, author of Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve. For instance, if you have a uterus, that will be one of the organs this muscle group supports, otherwise the organ line-up will include your bladder, small bowel, and rectum, she says.
2. The pelvic floor is part of your core
Many people are surprised to learn this, says Dr. Jeffcoat, but understanding this connectivity helps uncover why lifting can impact the health of the pelvic floor for better or for worse.
Whether you exercise in a group fitness class or in a one-on-one, a trainer has likely told you to “brace your core” at some point. That’s because an engaged core helps keep you balanced and your spine stabilized when you transfer load, explains Dr. Hazama. If you’re not including your pelvic floor muscles in this engagement, then you’re not getting the most supportive starting positon your can for lifts. It’s important to know how to engage your core properly during reps, and how to relax it between efforts, she says. More ahead.
3. Your pelvic floor muscles need to be able to contract and stretch
“Just as we wouldn’t want to walk around all day with our biceps contracted (elbows bent),” says Dr. Jeffcoat, “we don’t want to keep our pelvic floor muscles contracted at all times either.
Unfortunately, because so many trainers cue people to keep their cores tight while they lift, some people become less apt at relaxing their pelvic floor muscles. Over time, this can result in pelvic floor muscles that are constantly engaged, even outside of the gym. Medically, this is known as a having a hypertonic pelvic floor or non-relaxing pelvic floor, and is often accompanied by painful penetrative, pelvic floor cramping or pain during exercise and sex, and urinary leakage.
If you already have (or think you have) a non-relaxing pelvic floor, Dr. Jeffcoat suggests working with a pelvic floor specialist, which you can find through this pelvic floor therapist directory. If you’re looking to avoid this issue, she says you need to learn how to properly use your breath to support your pelvic floor.
4. Engaging your core properly is key
Sorry, but clenching your core like you’re pulling on a pair of tight pants (sound familiar?) isn’t the best way to engage your core, including your pelvic floor, while you lift.
Dr. Jeffcoat offers a better, pelvic-floor friendly way to recruit the muscles in your midsection. “Before touching the weight, you want to inhale. Then, exhale,” she says. “Then simultaneously perform a pelvic floor contraction and transverse abdominal muscle contraction,” to put your core and pelvic floor in the optimal position to move, she says. To do this, think about the lifting sensation of holding in pee while simultaneously drawing your belly button back toward your spine. Now, perform the first portion of the lift.
Next, you have two options, depending on the specific movement, she says. “You can inhale as you return the weight to the start position, exhale, and then repeat for a second rep, or you can inhale, pause your movement, and then exhale as above as you lower the weight back to the ground.”
5. Valsalva maneuvers are *not* your pelvic floor’s BFF
In case you’re not familiar: The Valsalva maneuver is a breath-holding technique some lifters employ ahead of a lift under the false impression that it will increase intra-abdominal pressure and help them lift more. Don’t hate the messenger, but research shows it’s unsafe, and Dr. Jeffcoat says it’s bad for your pelvic floor.
“You have to breathe through the lift,” she says. “Repeated holding your breath, (doing the valsalva maneuver) will put you on the fast track to pelvic floor prolapse, urinary incontinence, hernias or hemorrhoids.”
6. It is *not* healthy to be leaking while you lift
Over the last few years it has become increasingly common for female Olympic lifters and CrossFit athletes to post photos and videos of themselves maxing out, a puddle of pee between their legs and a caption normalizing it. But peeing while you lift (or jump rope, TBH) is usually a sign that your pelvic floor health needs a little TLC, according to Dr. Hazama. “It suggests that your pelvic floor is not working as efficiently as it could be,” she says. Or, that you’re using suboptimal form.
Her suggestion: Rather than hiding leaked with black leggings, hire a pelvic floor therapist who specializes in working with athletes. They’ll be able to look at your movement patterns and assess any mechanics that could be improved, as well as offer a series of breathing or PT exercises you can do ahead of your strength sessions to keep your pelvic floor healthy over your lifetime.