Your pelvic floor is part of a system, let's talk about how it works

Leaking when you sneeze, urgency on the way to the loo, or simply wondering whether your core is actually working — these things are worth talking about. All of them.

Recently I dedicated time in my group classes to talk about the pelvic floor and the response was wonderful. It turns out people are actually relieved to have an open conversation about something so fundamental to how our bodies work. So here's a longer version for anyone who missed it, or who wants to revisit what we covered. And before we go any further: this is just as relevant to men as it is to women. We all have a pelvic floor. They work in essentially the same way.

1. How you breathe is critical

The pelvic floor doesn't work alone. It operates in constant partnership with your diaphragm and if your diaphragm isn't moving well, your pelvic floor is already working at a disadvantage.

When we breathe with full diaphragmatic movement, the pelvic floor responds naturally: rising gently on the exhale, descending on the inhale. This rhythm is the foundation of good core function.

Try this now

Stand in front of a mirror and take a deep breath. Watch what moves. Good diaphragmatic breathing means you'll see expansion low down near your belly button, your ribcage widening under your arms, with little or no movement in your upper chest or shoulders. If it's the other way around, your diaphragm isn't moving as freely as it could be. Try placing your hands around the lower part of your ribcage — front, sides, and back — to feel for expansion in all directions. This 360-degree breathing is exactly what the body is designed to do.

The good news: improving your breathing is free, takes just a few minutes a day, and also happens to be one of the most effective relaxation tools available.

2. Decline isn't inevitable

There's a quiet cultural assumption that leaking, urgency, or poor pelvic floor function is just something women of a certain age, or those who've had children, have to accept. This isn't true and I'd like to push back on it.

Yes, there are moments in life that place particular demands on the pelvic floor: pregnancy, childbirth, perimenopause, and menopause among them. But the pelvic floor is a set of muscles. Like every other muscle group, it responds to exercise. If you sprained your ankle, you'd do rehab. The pelvic floor deserves the same approach.

A note for men

Pelvic floor muscle strength naturally begins to decline in your 40s and this often becomes noticeable in your 60s. The ideal time to start is before you experience any issues: proprioception (your brain's ability to sense where a muscle is) decreases with age if it's not actively practised, so the earlier you begin, the easier it is to develop that connection. There are several activities that you may do that increase demands on your pelvic floor: running, weight-lifting, cycling and contact sports.

3. The fluid paradox

When people experience urgency or frequent trips to the loo, the instinctive response is to drink less. It seems logical, but it may actually make things worse.

Less fluid means more concentrated urine, which is more irritating to the bladder lining. This irritation is what triggers the sensation of urgency and the feeling that you need to go when the bladder isn't actually full. If you've recently started restricting your fluids, it's worth considering whether gradually increasing your intake might actually help.

4. Learn to feel it

Most of the muscles we exercise are ones we can see, touch, and feel moving. The pelvic floor is different; it's internal, and building proprioception there takes patience.

Moving the pelvic floor increases blood flow to the area and gradually sharpens your awareness of it. One helpful way to start: sit on a mostly deflated soft ball, a large gym ball, or a wobble cushion. The gentle contact between your pelvic floor and the surface gives you tactile feedback as you practise gently lifting and drawing the muscles away from it, then consciously relaxing them back down.

Even if you feel your pelvic floor function is fine right now, developing this proprioception is a worthwhile investment. It becomes harder to find a muscle you've never consciously engaged, so the sooner you start, the better.

5. Pressure management and the role of the spine

Your core isn't just your abdominals. It's a team: the abs, obliques, certain back muscles, the diaphragm, and the pelvic floor. Together, they manage the changes in intra-abdominal pressure that happen every time you move: sitting down, standing up, lifting something, sneezing.

When the system is balanced, pressure changes are absorbed smoothly. When it isn't, the weakest link gives way and for many people, that's the pelvic floor. A slow, gradual pressure change might be manageable; a sudden one like a cough or sneeze can overwhelm an imbalanced system. This is why stress incontinence happens.

One often-overlooked factor: spinal mobility. If tight back muscles or a restricted diaphragm prevent your spine from moving freely (forwards and backwards, side to side, and in rotation) the whole core system loses efficiency. In Pilates, we work on all of these directions regularly, and this is exactly why.

6. Where Pilates fits in

Every session we spend together touches on at least one of these elements: breathing, spinal mobility, and core strength. The way I cue exercises is deliberately designed to give your breath, pelvic floor, and core the best conditions to work together. Because none of these elements functions in isolation: improving one tends to improve the others.

Pilates is a particularly well-suited approach here because it's progressive, non-forceful, and sustained. Slow and steady really does win this particular race.

There's plenty more to say about the pelvic floor, how to contract and relax your pelvic floor, for example, these are just a few of the highlights from our discussions. If any of this has raised questions, please find a way to ask them: a friend, your GP, a women's health physiotherapist, or me.

Pelvic floor health affects quality of life in real and significant ways. The more we talk about it, the better equipped we all are and the better we can help the generations that come after us.

Questions about how Pilates can support your pelvic floor? I'd love to hear from you.

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