What women should know about pelvic floor vitality: Feel first, exercise later!

What strikes me most in working with women’s pelvic health is that we are very misinformed about what is going on in our bodies. For example in the context of urinary leakage, I believe this has to do partly with shame around the subject, but also with the fact that the right information is not always accessible. In recent years a lot of valuable research has been conducted that has given us many valuable insights in women’s health. Through my work I would like to share some of those insights that I feel would benefit women. 


25 - 50% of women will experience urinary leakage at some point in their lives.


Are you a young woman that experiences urinary leakage? You are not alone! There is a large group of women who experience symptoms of urinary leakage around pregnancy and giving birth (I talk from experience). Without the right education this same group will develop urinary leakage again around and after menopause. 

pelvic floor

Around 25-50% of women will encounter this problem at some point in their life. This number is far from accurate as in reality many more women suffer from this but never open up about it because of shame around the issue. This leads to many women with mild symptoms accepting the often unnecessary consequences instead of seeking help. Urinary incontinence is just one of the symptoms of pelvic floor dysfunction. Other symptoms can be: Prolapse, pain during sex, pelvic pain, persistent lower back-pain, and frequent bladder infections.

Urinary incontinence can be divided into stress-incontinence and urgency-incontinence. Stress- incontinence is the loss of urine when the pressure on your abdomen is high, for instance whilst coughing or sneezing, and when pushing or lifting something heavy. Urgency-incontinence is when all-of-a-sudden you feel the need to pee and are unable hold it in. You need to find a toilet asap! Often people suffer from these two types of incontinence at the same time which is referred to as mixed-incontinence.


If you live a modern lifestyle you are more likely to have an overactive pelvic floor, than a weak one.


The common (and very logical) misconception about urinary leakage is that when you are unable to hold your urine your pelvic floor muscles must be weak, when in actual fact it is often the opposite.

In modern society we tend to be stuck in our heads rather than present in our bodies, so we are unaware of the chronic tension we carry around all day. As a little test try this when you are standing in line at the supermarket: Connect to your pelvic floor (sense the area) and check if you are pulling your tail inwards. Also, when your attention is locked onto your computer screen to meet a deadline do you squeeze a bit down below? The answer is probably, yes. When you are stressed you pull up your shoulders because your muscle tone reflects your psycho-tone. This happens throughout your body. The midriff and the pelvic floor seem to particularly resonate how connected you are to your body.

Roughly 7 out of 10 women seeking help for pelvic floor dysfunction actually show signs of having an overactive pelvic floor, rather then a weak one. When your muscles are tired of contracting all day long they cannot generate the strength needed to keep your urinary tract closed. This can lead to urinary leakage in moments when the pressure increases like coughing, laughing, jumping and lifting something heavy.


Doing any random pelvic floor exercise is ineffective without body awareness, potentially exacerbating the problem.


Kegel exercises are exercises to train your pelvic floor muscles (also called PC-muscles and PC-muscle exercises). When you have an overactive pelvic floor, training your muscles for strength can actually increase your problems because it builds up tension that you are unable to release when you lack awareness on this. An overactive pelvic floor is also related to decreased sensitivity and lubrication and with that lessening sexual pleasure!

So, before doing any exercises you need awareness of what is going on in your body. Do you carry around tension and stress in your pelvic floor? Maybe you have areas that are weak or have lost the ability to make strong contractions. In my experience women often have an imbalance of muscle-tone, meaning they have both overactivity and weakness. When you start training, the stronger muscle fibers will take the majority of the load while the weak ones are left unaffected creating more imbalance.

Often I hear women complain that they should have been doing their kegels. Or, giving each other advice like; “Do 50 contractions whilst preparing dinner or feeding your baby”. Apart from not having assessed the status of the pelvic floor this is ineffective for another reason: Athletes do not get results by just contracting their muscles randomly while they prepare dinner. They have a training routine that is effectively suited to their specific needs.


Feel first, exercise later!


Firstly, for an accurate diagnosis you can get the status of your pelvic floor muscles properly assessed by a Women’s Health Physiotherapist (and if you have symptoms of pelvic floor dysfunction I would advise you to do so). 

Other than that there is a lot you can do before you even start to exercise. Remember what I said about not being present in our bodies? We need to look at our lifestyle and the way our body reflects the tension of our occupied minds. Train yourself in feeling your pelvic floor, your base. Can you be present and relaxed there, and maintain this throughout your day? You may find you need to slow down to be able to do this. 

Feel into the possibility that you might be squeezing your pelvic floor. Just like animals that pull in their tail, this is often related to fear. Ask your body why it is you do this. Are you protecting yourself? Areas of tension often relate to emotional tension. Numbness reflects you have cut off from your feelings in an area of your life. The pelvic space often carries traces of past experiences, pattern of engagement, shame, lack of support and boundary issues.

So, first priority is to increase your awareness before adopting any exercise routine at all.

Secondly: Pay attention to your toilet behavior. Read more about this in my next article: ‘Potty Training for Grown-Ups’. Take these moments to relax, release the tension and recalibrate; this greatly reduces the stress on your pelvic floor without having done any complicated exercise routines that may not fit into your busy schedule. Make full use of the time you spend in the little room by creating a healthy habit of relaxing and releasing.

Exercises are of little value without addressing pelvic presence and muscle tone imbalance.  Work on connecting with your precious body and do your emotional homework. A great way of doing both at the same time is to look for a practitioner that is trained in giving internal vaginal massage combined with emotional release techniques. You can check out the “sessions’ page of my website for more info on the Pelvic Awakening sessions. You can also learn how to do this yourself if you feel it is a too big a step.

If you are interested in creating more vitality and sensation in your pelvic floor, taking up a subtle practice with a jade egg is a beautiful way to do this. In the future I will write more about this, but if you would like to start investigating already I can highly recommend Dr Saida Desilets approach. She has beautiful online programs and shares an inspiring message of true empowerment through the subtle and deep connection with the body.


Much love,



Annemarie Reilingh