Meet your hammock
You use it every time you laugh, lift or sneeze. Here it is in 1 picture, with its 3 jobs and a 60-second way to feel it.
Picture a hammock.
It stretches from your pubic bone in front to your tailbone in back. Your bladder, your uterus and your bowel rest on it.
That hammock is your pelvic floor: a group of muscles at the base of your pelvis, the bowl of bones between your hips.
It has 3 jobs.
Job 1: hold everything up
When you stand, cough or lift a toddler, the pressure in your belly rises. The hammock takes that load.
A firm, springy hammock keeps your organs where they belong.
Job 2: keep the exits closed, then open them
3 openings pass through the hammock: the urethra (the short tube that carries urine out), the vagina and the anus.
The muscles wrap these exits. They squeeze to keep things in. They relax to let things out.
Both halves matter. The International Continence Society counts relaxing as part of normal pelvic floor function, right next to squeezing.[2]
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Job 3: sex
The same muscles play a part in sensation and orgasm. They also need to relax for comfortable sex.
Pain during sex is common. It is still worth a visit to your doctor.
It moves with your breath
On an in-breath, your diaphragm and your pelvic floor both move down. On an out-breath, both move up.[1]
That finding comes from MRI scans of 8 healthy women. So treat it as a useful picture from a small study.
It is also why I teach the lift on the out-breath.
Why this matters for leaks
A leak happens when the pressure on your bladder beats the hammock's hold. You have 2 ways to win:
- A stronger, faster hammock. That is training.
- A hammock that lifts before the pressure hits. That is the Knack.
Pelvic floor muscle training is the first treatment guidelines recommend for stress leaks.[3] It starts with knowing where the muscle is. Now you do.
Next step: learn the Kegel the right way.
Before today, when did you last think about your pelvic floor?
Quick answers
What does the pelvic floor do?
It has 3 jobs. It holds up your bladder, uterus and bowel. It keeps the urethra, vagina and anus closed, then relaxes to let urine and stool out. And it plays a part in sexual sensation and orgasm.
Where is the pelvic floor?
At the base of your pelvis. It stretches like a hammock from your pubic bone in front to your tailbone in back, with your pelvic organs resting on top.
How do I know I am contracting my pelvic floor?
You feel a gentle squeeze and lift inside, like holding in gas, while your buttocks, thighs and belly stay soft and you keep breathing. If the lift still feels unclear after 2 weeks of practice, see a pelvic floor physical therapist.
Written by Dr. Dana Kivlin, DO, board-certified urologist. Updated . Every number links to its source below. This letter teaches; your own doctor diagnoses.
Sources
- Talasz H, et al. Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing: a dynamic MRI investigation in healthy females. International Urogynecology Journal, 2011. link.springer.com
- Frawley H, et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourology and Urodynamics, 2021. ics.org
- NICE guideline NG123. Urinary incontinence and pelvic organ prolapse in women: management, 2019. nice.org.uk
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Turn the letter into a habit.
Pelvic Health Class: for Women: Dr. Dana’s class on your phone. 6-week programs, 1 short lesson a week, 1 guided exercise a day.
- 5 minutes a dayA guided session with a breathing ring and a timer. The cat lifts with you.
- 1 lesson a weekWritten by a urologist, in plain words, with every source.
- Your log stays on your phoneYour answers, notes and photos: only you see them.
