Pelvic floor health is rarely covered in school PE or even in standard GP appointments. The result: a third of women experience some pelvic floor dysfunction (incontinence, prolapse, painful sex) by age 50, and most don't realise it's treatable.
What the pelvic floor actually is
A sling of muscles between the pubic bone and tailbone. Supports the bladder, uterus, and bowel. Coordinates with the diaphragm during breathing. Engages during lifting, jumping, coughing, and bowel movements. When it weakens, organs can prolapse downward; when it tightens too much, pain and bowel problems result.
Both ends of the dysfunction spectrum
Weak (hypotonic): leakage when laughing/coughing/jumping, sense of pelvic heaviness, less sensation during sex. Common postpartum, post-menopause.
Tight (hypertonic): pelvic pain, painful sex, urinary urgency, constipation. Common in younger women, runners, those who do excessive Kegels without learning to relax.
Kegels are the wrong fix for tight pelvic floors. Lots of women incorrectly add Kegels to address symptoms that are actually hypertonic — making it worse. Assessment first.
The baseline routine that suits most women
Diaphragmatic breathing 5 minutes daily (belly rises on inhale, falls on exhale — relaxes pelvic floor at end of exhale). Kegels only if you've been assessed as hypotonic: 3 sets of 10 contractions daily. Avoid: long-held isometric core work (planks for minutes), excessive crunches, holding breath during lifting.
Hourly desk reset: stand, take 3 diaphragmatic breaths, do 5 slow squats. Cumulative effect over months is substantial.
Pelvic floor problems aren't an inevitable part of being a woman. They're usually treatable — but only after assessment, and only with the right approach for which type of dysfunction you have.