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Updated: Sep 9, 2022

The pelvic floor, or perineum, is a very important muscle group usually related to pregnancy but too little related to other phases of a woman's life, such as menopause.

Even women of all ages who practice a lot of high-impact sports, such as running for example, can suffer the consequences of a hypotonicity of this muscle group. So let's take a closer look at what is important to know about it.

The pelvic floor. Facts.

The pelvic floor is a complex muscular system that ensures continence and support of the organs of the small pelvis (urethra, bladder, rectum) as well as sexual well-being, also playing an important role in reproductive function.

I always visualize it as a hammock that gently supports everything above it.

Its main functions are as follows:

- Supportive function of the pelvic organs

- Fundamental importance during natural childbirth

- Containment function: urethra, sigmoid, rectum, bladder, uterus in women and prostate in men

- Biomechanical function: it is part of the pelvic girdle, so its functionality is connected to that of the pelvis bones, muscles, ligaments and is crucial for the stability of the body

- Sexual function: a reduced perception and awareness of one's perineum results in a reduced ability to feel pleasure during sexual intercourse

A lack of awareness of one's pelvic floor leads to its inevitable and progressive hypotonicity and consequent loss of functionality, sensitivity and control of the same, causing discomfort and symptoms that can come to be truly delibiting and inhibiting for the person who is affected.

These are topics that are still too little talked about and that we tend not to face out of modesty and shame.

Also gynecologists, urologists and / or proctologists should inform patients (men and women) and sensitize them by explaining how important it is to keep this muscle group strong and toned, to talk about it serenely and above all by making it clear that IT IS NOT A TOPIC RELATED TO PREGNANCY ONLY, but it is to the whole life of the woman.

Pelvic Floor and Menopause

Menopause is a time of hormonal shifts. Estrogen levels begin fluctuating downward during perimenopause, continue to drop throughout menopause, and then level out postmenopause.

These changes in estrogen levels can have an impact on the pelvic floor. Estrogen plays an important role in controlling the synthesis and breakdown of collagen, as well as in assisting with the function of the detrusor muscle (the smooth muscle of the bladder that holds or releases the flow of urine). This may mean that females post-menopause are more susceptible to incontinence and overactive bladder due to the reduction in estrogen.

These changes may also play a role in increasing women’s risk of some types of pelvic organ prolapse.

Additionally, half of all postmenopausal women experience vaginal atrophy (thinning of the vaginal wall), which may cause symptoms such as vaginal dryness, irritation, itching, and painful intercourse.

Pelvic floor disorders like these can significantly affect women’s daily activities and their quality of life.

They can also make some women hesitant to exercise for fear of exacerbating their symptoms during the part of their lives where EXERCISE becomes SO CRUCIAL instead.

The contraction of the pelvic muscles is perceptible but not visible: this is the peculiarity that too often leads this part of the body to be forgotten, neglected, and which makes training more difficult in the initial phase ..

You have certainly heard of pelvic gymnastics and here I like to guide you into this world, because this is where you start PUT ACTION.

The right approach is always to visualize the problem and then take action to solve it.

Do not underestimate pelvic gymnastics for other reasons: in addition to improving the containment and support function of the pelvic organs, it improves sensitivity and sexual pleasure, and helps to obtain a toned abdomen: it is a fundamental element when it comes to training "over40".


The first step from which we start is AWARENESS.

Before starting to train the actual muscles strength, a re-education to full awareness and perception of the genital area, pelvic muscles and pelvis is necessary. This rule is valid at any age for both women and men.

Pelvic floor exercises should be performed for preventive purposes without waiting for the onset of problems due to their weakening, so integrating them into the fitness routine AT EVERY AGE can make a difference.

But it is not too late if their hypotonicity is already creating problems for you: you can start strengthening these muscles at any time, as is the case with any other muscle group.

The kind of breathing that is used is the diaphragmatic one. Anyone who practices Yoga or Pilates certainly knows what it is.

Diaphragmatic breathing contributes greatly to the knowledge, awareness and management of the pelvic muscles: in this sense, it is essential to perform pelvic floor exercises.

As children, diaphragmatic breathing is natural but growing up most people lose this attitude. To relearn how to use the diaphragm muscle correctly, you need to train, breathe slowly, deeply, feel the air swelling your belly like a balloon, exhale for a long time.

In the video I will explain how to activate it.

Let's start with the best known exercises.


Aimed at strengthening the pelvic muscles, Kegel exercises are particularly suitable for urinary incontinence, genital prolapse, pregnancy (preparation for childbirth), overactive bladder syndrome and for improving sexual and procreative function.

The most classic exercise should be done in this way:

- empty your bladder;

- lie on your back with your arms along your body (with your legs bent by lifting your knees);

- inhale with the diaphragmatic breathing technique and contract your pelvic muscles for 5-10 seconds as if you want to hold your pee. You will feel the sensation that these muscles tighten and lift inwards. Don't squeeze other muscles and avoid holding your breath. Keep your legs, buttocks and abdominal muscles still;

- exhaling, slowly relax your muscles for 10 seconds.

- Repeat the exercise 10 times for at least 2-3 times a day.

Initially, work gradually from a 5 second contraction to a 10 second contraction.

Pearl exercise

Of all the pelvic floor exercises discovered by Kegel, the pearl one is one of the least known.

It is very effective for preparing for childbirth, but not only.

In this case, the contractions of the pelvic muscles occur around an imaginary pearl placed inside the vagina.

The contractions must be performed gradually and be carried out on 5 levels during which the vagina opens completely and then closes completely.

Starting with the Kegels helps first of all to increase the proprioception of the pelvic area, that is to “feel” it, to find it again.

Be patient, it takes time. But by doing them for a few minutes every day (I do it even while I'm sitting at the computer for example) you will gradually regain control of these muscles.


This is the last, fundamental step: when we get back to feel and be able to control the contraction and release of our pelvic muscles, we are able to activate it during exercising together with the other muscles.

Performing a squat becomes an even more complete movement and where you will no longer experience pain or discomfort.

Planking will become one of the most effective movements for functional strengthening of the Core, including the pelvic floor (see video).

And in everyday life, actions such as lifting shopping bags, performing rapid movements and picking up our children or grandchildren, walking quickly or running, will no longer be potentially uncomfortable or even limited situations: on the contrary, they can become moments of further voluntary strengthening of the pelvic muscles.

As I often say: we always start from the BASICS, and from them we evolve and really improve our daily life.

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