By Allison Danish, MPH

Ahhhh, the pelvic floor. A group of muscles that do a lot for us, but are rarely talked about outside of the context of kegels and having babies. And that’s kind of a problem. 

See, everyone has a pelvic floor—and it helps us do some of life’s most important functions like peeing, pooping, walking, having sex, and carrying on the human species. And as with most of the other muscles in our body, they can be weak, tight, or shortened. This is called pelvic floor muscle dysfunction—and it’s super common, especially among people with vaginas. Research estimates that 1 in 10 in their 20s and 1 in 3 over 40 are affected by a pelvic floor disorder in the US. Holy moly, right?!

And these pelvic floor troubles can lead to common signs and symptoms like:

• Pain during sex—entry pain, pain deeper inside the body, and vulvar pain
• Pain during gynecological exams and/or when inserting tampons
• Sexual dysfunction
• Leaking pee or poo (this is called urinary and fecal incontinence, respectively)
• Needing to pee often or super urgently
• Constipation or difficulty urinating
• A feeling of heaviness in your pelvis (pelvic organ prolapse)
• Pelvic pain
• Low-back pain

While major culprits of pelvic floor dysfunction are giving birth and getting older—there are loooooots of everyday things we do that can negatively impact our pelvic floors. To help us get an understanding of the most common ones, we talked to Dr. Corey Hazama, PT, DPT, OCS, CFMT, PRPC, WCS.

What common activities are hurting my pelvic floor?

1. Crossing your legs

Yes, you read that correctly. Literally everyone does this. I am forcing myself not to do this as I write this blog. 

Crossing your legs (the “lady-like” knee-over-knee variety) is a no-no because it “creates asymmetry in the pelvis,” Dr. Hazama says. “It forces you to rotate the pelvis forwards on the side of the leg that’s crossing over.” This means you’ve got one butt bone (sitz bone) pointed a little more inwards, and one that’s pointed outwards. 

Aaaaand you know what happens when the alignment of your skeleton is cattywampus? Your muscles follow suit! Because your pelvic floor, hip, and booty muscles aren’t in the proper position when you’re crossing your legs, over time they get worse at performing their normal duties. 

Fun fact, Dr. Hazama says, “most people have a preferred side. Because you’ve created a pattern of pelvic asymmetry that doesn't reverse and go the other direction, it feels weird to cross the other leg over.” 

2. Sucking it in

This is another suuuuper common one, and it’s not great because it “inhibits the ability for your diaphragm to expand fully,” says Dr. Hazama.

When we breathe in, the diaphragm (the hiccup-muscle) contracts, allowing our lungs to expand and fill with air. The pelvic floor and abdominal muscles follow suit, relaxing so you can let that sweet, sweet O2 in without squeezing the bejeezus out of your internal organs. Buuuuut, when we’re sucking the belly in instead of letting it relax as we breathe, we’re “potentially creating rigidity in the pelvic floor.” If the abs can’t move freely, the diaphragm can’t either. And if the diaphragm can’t expand fully, neither can the pelvic floor.

Dr. Hazama also says, “if you’re not using your diaphragm, you need to use other muscles to breathe. Typically people will choose their neck muscles—so you could end up with neck pain if you’re sucking those abs in!”

3. Wearing pants with a tight waistband

Just like when you’re sucking in your guts, a “too-tight waistband inhibits abdominal expansion,” explains Dr. Hazama. “It physically blocks the diaphragm from expanding fully.”

And not only is breathing disrupted, Dr. Hazama says, “if [the waistband] is really tight, it can constrict and create tension and immobility of abdominal fascial layers as well as your organs.” Having restrictions in the fascia (connective tissue that holds muscles, bones, nerves, etc. in place) can result in pain and stiffness. 

4. Squatting over public toilets

Alright, alright. Put away your pitchforks. I get it, public toilets are gross. But unless you’re rocking open sores on your bum or resting your genitals on the toilet seat itself, you’re not gonna catch anything. If you’re still worried—put some tissue down on the seat!

Sitting your booty down instead of hovering is important because “in order to pee fully, we need the pelvic floor to relax,” Dr. Hazama says. “If you’re hovering over a toilet you are using all your leg muscles to keep you from falling down, which will also result in your pelvic floor muscles contracting to assist with stabilization—so you’re peeing while contracting the pelvic floor muscles!  This may not allow full emptying and may also force one to push out pee (see “power peeing” below).” 

5. Peeing just-in-case

“You have to pee already? Why didn’t you just go at home?” This is one most of our parents had ingrained in us since we were kids. And unfortunately it’s not great for our bladder hygiene.

See, “when we pee just-in-case…we create a neural program that tells our bladder that we pee when there are only a few drops in the bladder,” Dr. Hazama explains. “Bladders are very fast learners (even if it’s learning a bad habit), so it quickly starts telling you to pee every time there are just a few drops in there.” 

6. Wearing high heels

Some of you might be saying, “You can pry my high heels from my cold, dead fingers.” Fair enough, do what brings you joy. But this advice is really for the folks who wear 4-5” heels on the regular.

Dr. Hazama says “A 1-3” heel (the thicker the better) would be okay if you have good range of motion in your ankle. But most people’s ankles don’t bend enough to allow you to be well-centered over the ball of your foot in a 4” heel.” So, what happens when your weight isn’t centered over the ball of your foot? In short: you make due by changing your posture (and not for the better). 

“If this is the case, you have to compensate by hyperextending the knees, pushing the pelvis forwards, arching the lower back, and tilting the ribcage backwards,” explains Dr. Hazama. A lot of people find this silhouette flattering because it can accentuate the booty and the boobies, if you’ve got ‘em. Buuuut, as Dr. Hazama says, “it creates a lot of dysfunction through the ribcage. The trunk should really be like a cereal box, with no backwards bending or breaking at the high waist area.

“This posture inhibits our core muscles from activating to support our spine. Plus, when you have to throw the pelvis forwards and the ribcage back, that causes the lower glutes (booty muscles) to shorten, which also shortens the posterior pelvic floor.” This means the back of your pelvic floor gets shorter while the front part gets longer. Not ideal. 

In clinic, Dr. Hazama says she sees this show up in patients who have pelvic pain, difficulty pooping, and may be struggling with pee problems like incontinence, urgency, and frequency. 

7. Slouching

Same as with the heels, slouching changes the shape of the torso! 

“When we slouch, we change the shape of our torso,” says Dr. Hazama. “It should look like a cereal box, or a soup can—not bent in the middle. This posture inhibits our core muscles and changes the symmetry of the pelvic floor, which impacts how it can function, and can potentially lead to pain.”

8. Wearing the wrong kind of underwear

It’s pretty well-known that synthetic underwear isn’t super great for you because it doesn’t breathe, leaving you more susceptible to yeast infections and BV. But what we don’t talk about is wearing underwear that’s too tight. 

Dr. Hazama says, “If underwear is too tight, like around the leg holes, this can constrict blood flow as well as irritate some of the nerves that innervate the skin and vulvar area, resulting in pain.” 

Yikes! It’s time to invest in properly-fitting cotton underwear, folks. 

9. Power peeing

In the words of Dr. Hazama, “You are never supposed to push pee out.”

While pooping requires a bit more effort, peeing is as easy as falling in love. Isn’t that how the saying goes?

“Our only job [when we pee] is to relax the muscles and sphincters around the bladder to let the bladder muscle do its job,” Dr. Hazama explains. “When you increase the intra-abdominal pressure to push the pee out, you could inadvertently be contracting the muscles you actually want to relax.” Which could then contribute to pelvic floor muscle dysfunction, which (as we’ve discussed before) is a capital “P” Problem. 

10. Straining to poop

Am I calling you out? It’s okay, you’re safe here. Straining to poop means “tightening around your butt, holding your breath, or sucking in your abs to push poop out,” says Dr. Hazama. “All of these strategies are not optimal because it puts a lot of pressure on our pelvic floor muscles. These muscles really need to be relaxing and elongating during the pooping process.”

Most of your pooping power should come from your diaphragm (the breathing muscle) and your deep ab muscles. These push the pressure downwards while your pelvic floor opens up like a beautiful, pooping flower. Dr. Hazama says, “I explain it like a tube of toothpaste where the cap is your external anal sphincter (butthole). Nobody likes it when you squeeze at the middle of the tube or too close to the cap—like, come on! Instead, you gotta remove the cap first (relax your pelvic floor muscles) and squeeze at the end of the tube.”

“Also, when we strain,” Dr. Hazama continues, “you could be potentially putting yourself into a tucked position; this position has been shown to put tension (or traction) on the pudendal nerve [a nerve that sends and receives movement and sensation information to much of your pelvis and genitals]. This could end in irritation of that nerve and possible injury.” Yikes! 

Wait—I do these! What do I do now?

Like me, you might be saying, “I do these all the time! What do I do now? Get angry and continue doing them anyway?”

Weeeell, in an ideal world, you’d stop doing all of these things—but it’s hard to break habits and sometimes slouching just feels too good to abstain. Plus, occasionally wearing tight pants or a pair of heels isn’t going to wreak havoc on your body. But it’s important to be aware of your pelvic floor and know that everyday activities have the ability to promote or hinder its health. 

Beyond our little learning sesh today, what else can you do to empower yourself and your meat hammock? Go to a pelvic floor physical therapist, of course! Espeeeecially if you’re having problems with peeing, pooping, or pain during sex. To find an in-person PT, check out these directories. You can also find online pelvic PT exercises at Pelvic Gym or make a telehealth appointment with Origin.