Health professionals say Pilates (above) helps strengthen and maintain pelvic floor muscles. Although both men and women can suffer from weak pelvic floor muscles, the condition is more prevalent among women after giving birth or going through menopause. Photo provided
By Jan Engoren
Since May is Pelvic Health Awareness Month, it’s time to focus on the pelvic floor — a seldom-discussed area containing muscles that act as a sling to support internal organs such as the bladder, bowel and uterus in women.
The pelvic floor consists of a thin sheet of muscle fibers and connective tissue underneath the pelvis between the pubic bone at the front and the tailbone at the back.
For these muscles to do their job efficiently, they need to be fit and adequately toned just like any other muscle in the body.
“Just as we need to lift weights in midlife to stay strong and mobile as we age, we also need pelvic-floor strengthening activities to prevent problems with the pelvic floor in the future,” says Ashley Watts Carlow, a pelvic health physical therapist at Gloria Drummond Physical Rehabilitation Institute, part of Baptist Health in Boca Raton.
Weak or dysfunctional pelvic floor muscles can lead to various disorders such as pelvic organ prolapse, chronic pelvic pain, urinary incontinence and chronic constipation. These conditions can significantly harm quality of life.
Weak pelvic floor can also increase your risk of injury due to instability in the pelvis and lower back.
Although caring for the pelvic floor is part of the postpartum regimen in countries such as France, in the U.S. — unless you are experiencing a problem with it from childbirth, hysterectomy, or just gravity or aging — you may not have even been aware that you have a pelvic floor.
While both men and women can suffer pelvic floor dysfunction and experience constipation or urinary incontinence, it’s most common in women when estrogen levels drop and muscle mass decreases, making the area more vulnerable to weakness and dysfunction. The Food and Drug Administration estimates that one in four U.S. women will experience a pelvic floor disorder at some point.
Disorders most commonly manifest in women between the ages of 40 and 70 when they may lose 25% of their peak muscle mass. At 75, a dramatic decline often results in the loss of around 60% of peak muscle strength and 30% of physical function, according to research conducted at Tufts University. (The source of these statistics is the Tufts University Nutrition, Exercise Physiology, and Sarcopenia Laboratory, largely popularized through the research and publications of Dr. Miriam Nelson and the Jean Mayer USDA Human Nutrition Research Center on Aging.)
To mitigate symptoms, experts recommend eating a fiber-filled diet with whole grains, leafy greens and protein, drinking more water and less caffeine, alcohol and carbonated drinks, avoiding spicy foods, and engaging in physical exercises that can strengthen the pelvic floor such as Kegel exercises, which simulate stopping urine flow, or Pilates.
Danielle Hollander, 42, owns Remix Modern Pilates in east Boca Raton. An attorney, she practiced Pilates for 13 years before opening her own studio in 2024 and becoming an instructor.
“It’s the best workout, both mentally and physically,” she says, noting that many women come to strengthen their core and pelvic floor.
She says the slow Pilates movements are intended to strengthen deep core muscles. She teaches breath work to engage and lift the pelvic floor.
“Pilates is a great way to strengthen your core muscles, and the pelvic floor is part of your core,” says Hollander, a mother of two.
“Especially as we age, it’s important to keep your core strong for balance, control and strength. One of the best ways to stay strong and train the pelvic floor is with Pilates and other similar exercises.”
Sigal Goldring, 64, a former pediatrician who now owns Dr. G Med Spa specializing in aesthetic medicine in east Boca Raton, has been going to Remix and doing Pilates three times a week for the past six months.
“I love it,” she says. “I carved out time from seeing patients so I can go to Pilates class. It’s that important.”
She wants to strengthen her core and abdominal muscles, prevent any pelvic floor dysfunction and get rid of her stomach “pooch.”
She says that as a physician, she saw many clients with pelvic floor issues and had friends her age who had issues with their bladder and pelvic floor.
“My body is looking and feeling better,” she says. “I feel stronger and more flexible. And because I delivered two children vaginally, I want to make sure I take care of my pelvic floor.”
Carlow acknowledges that pelvic floor issues are often stigmatized and rarely discussed openly. As a therapist, she focuses on reducing stress, teaching diaphragmatic breathing and helping patients regulate their nervous systems.
She says typical patients may present with urgency, frequency, leaking, constipation, or painful intercourse and may come in once a week for six weeks, learning strategies they can continue at home.
Exercises may include Kegels, “bridge” and “happy baby” yoga poses, squats, and the “bird dog,” where you extend opposite arms and legs while on hands and knees.
The Mayo Clinic makes this suggestion for doing Kegel exercises: Imagine you’re sitting on a marble. Tighten your pelvic muscles as if you’re lifting the marble. Hold for three seconds and repeat three sets of 10 three times a day.
Carlow says most people see significant improvement after therapy.
“Pelvic floor problems are a very common issue,” she says. “If you’re confronted with any of these symptoms, don’t suffer in silence. We can help.”
Jan Engoren writes about health and healthy living. Send column ideas to jengoren@hotmail.com.
Weak pelvic floor prevention and treatment tips
• Maintain a balanced diet rich in fiber and nutrients aimed at reducing inflammation.
• Incorporate foods rich in Omega-3 fatty acids and antioxidants.
• Avoid known triggers such as caffeine and spicy foods.
• Prioritize mental and emotional well-being.
• Engage in regular gentle exercises such as yoga and Pilates.
• Seek professional help from health care providers.
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