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Understanding the problem

Understanding a problem is the first step in over coming it. If you understand why your pelvic floor isn't working as it should, you can understand what needs to be fixed and, from there, how to going about fixing it.

So please read on and take the time to get that all-important understanding. It may take a little while to read and understand everything, but it will save you time later on and improve your outcome.


First, to understand what it's all about, we have to think a little about the anatomy.

Your trunk (or torso) is a big cylinder of muscle that keeps your body stable, protects and supports your spine and organs and connects your head and limbs.

Pelvic floor

Your pelvic floor is at the bottom of your torso: it is the foundation, everything else sits on top of it.

A lot of books will describe the pelvic floor as a hammock - if yours is a hammock, then you really do have a problem! Hammocks don't provide any stability - have you ever tried standing up on one? Well, we don't suggest that you do!

Instead, imagine a really strong, boney pelvic ring at the bottom of the trunk that is strong enough to protect delicate bits inside and to which your legs are  securely attached. This pelvic ring is floored out by a round springy trampoline of taught, strong muscles. These muscles have to work all day to stop the weight of your insides falling out! These muscles are your pelvic floor.

Abdominal core

Moving up the body, imagine a cylinder above the pelvic ring wound round and round all the way up with bungy cord - this cylinder is your deep abdominals that hold everything in. Wrapped over the top of your abdominals are other strengthening muscles, your 6 pack etc; this strong, muscular wall forms the sides of the cylinder.

Picture this as a can full of soft, squidgy stuff, but rather than being made of tin, it is made of rubber. Left on its own it will hold its shape, but when you squeeze it in one place, it bulges in another!

Diaphragm and above

At the mid point of the cylinder, there is another sheet of muscle, anchored all the way around - this is the diaphragm. Your heart and lungs sit on your diaphragm. Your shoulder ring sits above that with your arms attached.

Under pressure

Now let's focus on your abdominal core, the lower half of this cylinder of muscle below the diaphragm, which is packed full of organs: stomach, colon, kidney, liver, uterus, vagina, bladder and more.

The muscles that form this cylinder hold everything in place and need to cope with the forces that are exerted on it. These forces include:

  • internal forces
    • the continual weight of your organs
    • the regular pressure of breathing
    • irregular stresses like coughing, sneezing and laughing
  • external forces
    • general movement - sitting, standing, turning
    • active movement - running, jumping

All of these forces squeeze your core, putting extra pressure on your muscles which bulge as they work to cope. Any weaknesses in your core will feel this pressure the most.

An in-built weakness

Unfortunately, there is an obvious, inherent weakness in your pelvic floor - it has 3 holes in it, your urethra, vagina and anus. When pressure is exerted on your pelvic floor, it creates stress on these weak points that are normally well supported by the tight trampoline of your pelvic floor muscles. If these muscles aren't fit and healthy, they won't provide that support and you are at risk of incontinence and prolapse.

Your pelvic trampoline

First think about that trampoline in the bottom of the cylinder, then think about the trampoline that may be in your garden (that one you are scared to bounce on!).

Imagine putting 2, 3, 6, 10 kids on it to bounce over a period of years. How long will it last under the strain? Or imagine putting a little weight on it, just a few breeze blocks, but leaving them there for a few years.

Over time, the trampoline will tend to lose its taughtness, becoming less elastic, less able to bounce back when it is put under a constant strain.

Now imagine the kids' dad getting on and wanting to show them how high he can jump. Here comes a sneeze!

Overload factors

Over time, your pelvic floor is exposed to a number of factors that can leave their mark, either temporarily or permanently.

Pregancy - During pregnancy there are hormonal changes in your system that make the whole pelvic ring a little less stable.

Childbirth - The trauma of delivering babies puts an enormous strain on your pelvic floor that can cause significant damange.

Menopause - Like pregnacy, the menopause causes hormonal changes that make things less stable.

Age - As you age, all of our muscles lose strength and taughtness naturally every year with age.

Obesity - Extra weight puts extra pressue on your abdominal core and, so, onto your pelvic floor.

(For more detail on these overload factors, go to our website Stress-Incontinence.info)

Trigger events

Your pelvic floor is designed to cope with the rigours of daily life, providing effective support no matter what you throw at it. The weaker your pelvic floor becomes, the more likely it is to fail under stress. That failure shows itself most obviously as incontinence and prolapse.

These failures may be mild at first and easy to manage, but if they are ignored, over time they will get worse and what started out as an inconvenience can turn into a life-effecting condition.

Don’t despair, it's treatable

We are talking about muscles here and the great, brilliant and fantastic thing we know about muscles is that we can make them stronger: muscle tissue is changeable, trainable, improveable, we can make them work more effectively, we can make them more efficient.

Pelvic floor exercises can put things right!

Next: a guide to pelvic floor exercises

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