Experiencing urine leakage during activities like sneezing, coughing, or laughing is a common issue known as stress urinary incontinence (SUI). While often attributed to pelvic floor weakness, it’s essential to recognize that pelvic floor dysfunction can also involve muscle tightness or imbalance. Therefore, focusing solely on strengthening exercises like Kegels may not be appropriate for everyone.

Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice. If you are experiencing pelvic floor dysfunction, it is recommended to consult with a qualified healthcare professional, such as a pelvic floor physical therapist, for a personalized assessment and treatment plan.

How Does the Pelvic Floor Work?

Your pelvic floor is not just a set of muscles that contract and release—it is a dynamic, adaptable system that responds to movement, pressure, and breath. Blandine Calais-Germain, in her book The Female Pelvis: Anatomy & Exercises, emphasizes that the pelvic floor is part of a larger movement chain, consisting of multiple layers that move and slide over each other, working in coordination rather than just contracting in a binary fashion.

Key Functions of the Pelvic Floor:

• Support: Holds the pelvic organs (bladder, uterus, rectum) in place.
• Sphincteric Control: Helps regulate urination and bowel movements.
• Pressure Management: Works with the diaphragm and core to maintain intra-abdominal pressure.
• Mobility & Resilience: Moves in multiple directions, adapting to posture, movement, and load.

Why “Just Squeeze” Doesn’t Work

Many people assume that leaking equals weakness, so they try to stop it by tightening the pelvic floor. However, this approach can be counterproductive. According to Calais-Germain, the pelvic floor muscles don’t just contract—they glide, lengthen, and slide. Focusing solely on squeezing neglects how the pelvic floor functions in movement.

Common Issues with Over-Focused Squeezing:

• ❌ Too Much Tension: A constantly tight pelvic floor can weaken over time, reducing its ability to respond.
• ❌ Poor Timing: If the muscles don’t activate at the right moment (like before a sneeze or a jump), leakage can still occur.
• ❌ Lack of Coordination: The pelvic floor works with the diaphragm, core, and hips—if those aren’t functioning well together, leakage may persist despite doing endless Kegels.

A Different Approach: Sliding Activation & the Pelvic Sling

Instead of viewing the pelvic floor as a clenching muscle, think of it as a sling that moves and adjusts dynamically—not just tightening, but sliding and lengthening as needed. Calais-Germain describes how the pelvic floor muscles should slide over each other like sheets of silk, allowing for functional control rather than rigid tension.

How to Engage the Pelvic Floor More Effectively

1. Breathe for Pelvic Floor Mobility
• Purpose: The pelvic floor moves with your breath like a piston.
• How to Perform:
• Inhale: Diaphragm expands, pelvic floor lengthens and releases.
• Exhale: Diaphragm lifts, pelvic floor gently glides upward.
• Tip: Instead of forcefully contracting, exhale through pursed lips while visualizing your pelvic floor gently lifting and sliding together.
2. Sliding Activation Instead of Squeezing
• Purpose: Encourages smooth engagement of the pelvic floor muscles without excessive tension.
• How to Perform:
• Rather than “holding in pee,” imagine the pelvic floor muscles gliding toward each other in a smooth motion.
• Visualize closing a soft zipper or sliding doors rather than clenching.
• Tip: This subtle movement engages the muscles without excessive tension and improves reactivity, allowing the pelvic floor to respond quickly when needed (like before sneezing).
3. Engage the Pelvic Sling in Motion
• Purpose: Incorporates the glutes, deep core, and hip muscles to support pelvic floor function.
• Exercises:
• Bridges: Focus on gentle pelvic floor engagement on the exhale.
• Deep Squats: Encourage pelvic floor lengthening and mobility.
• Controlled Rolling Up and Down (like in Pilates): Train breath and pelvic coordination.

The Importance of Pelvic Floor Relaxation

A well-functioning pelvic floor requires a balance between strength and flexibility. Overactive or tight pelvic floor muscles can contribute to symptoms such as urinary incontinence, pelvic pain, and discomfort during sexual activity. Incorporating relaxation techniques can help alleviate these issues by promoting muscle release and improving overall function.

Techniques for Pelvic Floor Relaxation:

1. Diaphragmatic Breathing
• Purpose: Encourages relaxation of the pelvic floor by utilizing deep, diaphragmatic breaths.
• How to Perform:
• Sit or lie in a comfortable position with your body well supported.
• Place one hand on your chest and the other on your abdomen.
• Inhale deeply through your nose, allowing your abdomen to rise while keeping your chest relatively still.
• Exhale slowly and gently through your mouth, allowing your belly to fall. Let the air out of your upper lungs, relax your ribs, belly, and pelvic floor.
• Focus on the gentle rise and fall of your abdomen, promoting relaxation in the pelvic floor.
• Duration: Practice for 5–10 minutes daily.

Final Thoughts

Addressing pelvic floor dysfunction requires a comprehensive approach that includes both strengthening and relaxation techniques. By understanding the dynamic nature of the pelvic floor and incorporating appropriate exercises, you can improve its function and alleviate symptoms. If you experience symptoms of pelvic floor dysfunction, it’s crucial to consult with a healthcare professional for a tailored assessment and treatment plan.