Transcript of What is Your Pelvic Floor And What Does it Do | Mel Robbins Clips

So when anybody used to say pelvic floor, I would throw that term into a giant word casserole with like Kegels and with your abdominals. I really didn't even know what people were talking about. And so I want to get really granular just because, again, you said this is a very important part of your anatomy that we don't talk about enough, that has an impact on everything from normal Normal urinary function, normal pooping, your orgasm, all of it. And so the way you just described it, it almost sounds like it is this web of muscle that goes from what? Like the top inner part of your legs and all around? Is it like a hammock down there?

What is it? It's like a hammock. It's a bunch of different muscles. There's actually layers to it. So if you look at a pelvis, there's the outer layer, and then you peel it back. There's more layers deep inside. But to give you an example of how we assess the pelvic floor that maybe help you in three dimensions. So when I assess a pelvic floor for a female, I'll actually insert a finger in the vagina and say, squeeze my finger with your vaginal muscles. And I can assess if they're working appropriately or if they're weak or they're strong or they're tense. For men, we do this exam through the rectum because there's no vagina. And so that's how we can feel the pelvic floor muscles there.

Got it. Okay. So if I'm sitting in this chair right now, am I sitting on my pelvic floor? Yeah. Okay. Okay.

It's engaged.

It's engaged. Okay. And it's holding organs in place. It's helping with the proper function of all the organs in that region of your body. And what happens in a woman's body when your pelvic floor muscles are weak?

Well, so why do they get weak? First of all, let's talk about that, right?

Because we work hard to lift weights, and all of a sudden you see definition in your bicep. And so I got strong bicep muscles. Are we born with strong pelvic floor muscles, or is this something that we're supposed to be working on?

So because you're using them all the time, you're activating them with steps, you're always using them. But it's a matter of, are they going through their full range of motion, or Are they tight or are they weak? And you can't really put them through their full range of motion. So there can be causes that can make them too tight, and there's causes that can make them too weak. Let's start with weakness. So weakness most commonly happens because of childbirth. You're carrying a baby, whether you have a vaginal delivery or a C-section, you're still carrying that extra weight for nine months. That can put strain on those muscles. Also, if you have a vaginal delivery, that's another yet insult to the pelvic floor that can cause weakness. Then say you have a job where you stand a lot. Say you're on your feet like a hairdresser, a nurse, you're on your feet all day long, or you have a chronic cough, or you have a neurologic condition, or you have a genetic condition. All these things can affect the pelvic floor and cause it to be Now, what does that mean? Who cares if it's weak?

The most common thing you'll see is that women will have leakage. So they'll leak with cough, with exercise, with bending over, with standing up, or even as little as very small exercise, depending on how weak their pelvic floor is. And I want to reassure you that it's not dangerous, but it can be very uncomfortable and inconvenient.

How does childbirth impact the functioning of the pelvic floor?

I describe When I describe the pelvic floor, sometimes think of it like a boat, right? A boat that's held up by a rope, and then you've got the water below it, right? Okay. And so think about the muscles as the water below it holding it up. Oh, hold on.

Let Can we just see if I'm tracking? Yeah. So the boat is actually like your bladder and your vagina and your rectum and all that stuff that's in there, and your pelvic floor is the water it's floating in.

Right. So think about when the water goes down, everything is coming down. Or the water can stay reasonably strong, but those ligaments can stretch, those ropes that are holding from having childbirth. Those ligaments can stretch and get weak, and that can then cause problems. So there's two different ways you can see pelvic for problems. They're both related to childbirth. One is your muscles get weak because they've been carrying this heavy thing around, and then you have a traumatic childbirth. I'm glad you talked about forceps and vacuum deliveries. Those things can also increase your risk, maybe even episiotomies. Back in the day, they used to use those routinely. Everyone got an episiotomy, and so that can weaken the pelvic floor as well. So all these things can affect your strength of your pelvic floor. For those people who have these issues, strengthening your pelvic floor, as you mentioned, can be very helpful. But people are like, Okay, how do I do that? So people will hear about Kegels and they'll be like, How do I even do that? We think that as women, we know how to do that. But I will tell you, nine times out of 10, I'll have a woman come in and I'll be like, This is how you do a Kegel.

And she's like, Oh, my God, I wasn't doing it right. Sometimes it's very helpful to see a certified pelvic floor physical therapist. It's like going to the gym with a trainer. They're going to actually guide you on how to do these exercises and monitor your progress. But basically what it is, is you're squeezing up and in those muscles. So it's like if you were peeing and you stop the flow of urine or if you're holding in a fart. Those are the muscles you're contracting, but you You don't want to squeeze your belly and your butt. You just want to focus on those vaginal muscles.

See, I just tried one and I squeezed my butt. It's like butt cheeks. No, okay, but that's not a clean- It's very hard to do, right?

It's not that easy. And so it actually requires some training and to make sure you're doing it correctly. And people think, Oh, I got to do hundreds of them, right? When you go to the gym, you don't do hundreds of bicep curves on the first day, right? So I tell people, Do it lying down first.

And what do I do? So I'm lying down.

You lie down, you focus on trying to contract those muscles, like visualizing I'm like, Oh, I'm squeezing, holding fart in, but I'm not squeezing my butt. How the hell do you...

How do you hold a fart in without squeezing your butt? Well, I mean- Doesn't your butt block the... But what about... Because you mentioned something about as a doctor, when you're doing an exam- So yeah, I put a finger in the vagina and I have them squeeze it.

So if you put your own finger and you can actually feel the squeeze and the relax. Or you can... So you can do that. You can also, when you're peeing, just to get a sense, stop the flow of urine. Don't do that all the time. I don't want you doing Kegels every time you pee, but just to understand where the muscles are, right? Got you.

And then you can go to your back because now you understand the motion that you're asking us to do.

So start lying down. Don't focus on standing, sitting. You're not using any other muscles. You're just really focusing on those. Five seconds, squeeze, five seconds, relax. Five seconds, squeeze, five seconds, relax. Do 10 to 15, and then do maybe once a day, then go to twice a day, then do a couple of sets of it. Once you get really comfortable, then And you can start doing it sitting, right? And then again, once you get really comfortable, you can do it standing. But it's just like going to the gym. It takes progression. You're not just going to be a skilled, amazing Kegler just because you heard about how to do it. And so that's why I really love people. If you have access to a physical therapist, they're gold. They're so helpful.

Well, I implore you to take Dr. Rena's advice because it was too late for that intervention for me because I had gone a decade and a half, and everything was so far destroyed from that birth trauma and a lack of any intervention on my part that I think it's really important. I want to ask quickly, though, because I know that women who have had a childbirth experience or carrying a child can have leaking issues and pelvic floor problems. But younger women who are in their 20s can They also have issues with leaking. Why does that happen?

So either it can be they have a weak pelvic floor because of a genetic issue or because of some other thing they've been doing. But more often, what happens is that their pelvic floor is very tight or very tense. We see this often in gymnasts or very active young women where the pelvic floor is very tense and they actually can't squeeze their Kegel when they need to. They can't squeeze those muscles when they need to because it's already so tense. And so they can't... So say they're going to do a stressful activity like jump on a trampoline, their muscle can't squeeze because it's already super tense. It can't move anymore. And so then they leak because of that. And so it can be either weakness or too tightness, but it can present in different ways. And sometimes it can just be like, yeah, they've smoked and they cough a lot, or they're getting other. It can be non-childbirth related, but they could be getting a lot of stress from other things that are going on in their life, whether it's a health condition or chronic cough or things like genetic issues. So it always needs to be evaluated because it's not like all young people have tight pelvic floors and all old people have weak pelvic floors.

It's very unique to the individual.

Got it. So do you see a tight pelvic floor more with athletes?

Yeah, probably. I think it's a function of like, they're doing a lot of exercises that sometimes may also be contracting the pelvic floor. A lot of times we'll see people are not breathing well when they're exercising. They're holding their breath, usually elite athletes know how to breathe and all that. But it's like, usually people who are not elite athletes and they're breath holding a lot. So when you exert, you know why trainers teach you, when you exert, you need to exhale. It's because your pelvic floor stabilizes when you exhale. And so you need your pelvic floor to be strong when you're lifting. And then when you relax, you can then inhale. And so you actually have to actively do that so that you're not straining your pelvic floor every time you lift.

So we've talked about the exercises, but are there ways to strengthen your pelvic floor to also reduce pain that you may feel in this part of your body?

If you have pain, I think before you start any exercises, please see someone who's an expert in female pelvic medicine or urogynecology because you may have a tight pelvic floor. And if you have a tight pelvic floor, Kegel exercises are going to make it worse. So it's really important. So if you have tension in your pelvic floor, you're just squeezing muscles that are already too tense.

How would you know if it's tense versus loose?

It's really hard for you as an individual to know. Like I said, I do an exam, I feel the muscles. You can feel the muscles and see if they cause tension. So I think ultimately it's really important to get evaluated appropriately because Kegels are not for everybody. And there's more than just Kegels. Let me just preface that. We talk about Kegels a lot, but there's many exercises you can do to strengthen the pelvic floor. A lot of yoga work and Pilates work is actually quite good for the pelvic floor. But if you have tension in the pelvic floor, you want to focus on muscles that stretch and elongate those muscles. So some of these can include things like happy baby pose or child's pose or a really low deep squat. So on my podcast, we interviewed a pelvic floor physical therapist and made a pelvic floor day. And so that was what we came up with in terms of these are things you can easily do at home, a few sets of them, 10 of them, and that will help you relax the pelvic floor as well. And so I think it's really important in those cases that this treat a lot of different issues.

Also, one I didn't mention is recurrent UTIs. So it's not that they're actually getting UTIs, but they're feeling pain when they urinate, which is very similar to a UTI, but the cultures keep coming back negative. And that could be due to an overly tight pelvic floor.

Wow. I have somebody in my life who's coming to mind who I think has a very tight pelvic floor. And I think it's why this person struggles with constipation and urinary tract issues.

Yeah. I hope that everyone can identify one person that they can tell to get evaluated, because that you could change their life.

So how do you know when leaking is something that's just like incidental versus something that is a problem?

So again, it's usually not a huge issue. It's more of a quality of life issue. But when you're starting to have recurrent infections, it may be a sign that you're not emptying your bladder well, and that's That's part of why you're leaking. So that's one thing. And two, your quality of life does matter. So what I worry about a lot in my patients is them waking up at night to pee. Because if you wake up at night, it's dark, you're navigating to the bathroom, something's in the way you fall. If you fracture your hip and you're a little bit older, your risk of dying in that year after a hip fracture is like 20%. So it is a big deal to wake up at night. It's not only just interrupting your sleep, but it puts you at risk for falls. I think it's really important if you're having a very challenging quality of life because you're waking up a lot at night or you can't even do your job because you're in the bathroom every 30 minutes. These are important things. It's not just a nuisance or something incidental. It's important.

What is the pelvic floor? You said this is a very important part of your anatomy that we don't talk about enough that has an impact on everything from normal urinary function, normal poop, your orgasm, all of it. Is it like a a hammock down there.