If you’ve heard of the pelvic floor, there’s a good chance it’s been in the context of pregnancy or childbirth. After all, the pelvic floor holds the uterus, which holds the baby, and after delivery, women can experience pelvic floor dysfunction.
Although all of that is true, it’s only a sliver of what the pelvic floor is and why it’s important, particularly for cyclists.
What is the pelvic floor?
The pelvic floor is a group of interlacing muscles that span the distance between the tailbone and the pubic bone, explains pelvic floor specialist Paul Tulikangas, M.D., director of urogynecology at Hartford Hospital. These muscles support the bowel and bladder in men and women, and the uterus and vagina in women.
Because humans are upright, the strength and tone of the pelvic floor muscles are imperative in keeping the organs in place, Tulikangas explains.
The pelvic floor has a lot of responsibilities in the body, and with that comes some confusion. So we’re here to set the record straight on the common misconceptions linked to this important group of muscles.
Pelvic Floor Misconceptions You Should Know
Misconception #1: Men Don’t Have a Pelvic Floor
Men might be less likely to experience symptoms related to pelvic floor dysfunction—an umbrella term that refers to certain conditions, including incontinence, overactive bladder, painful intercourse, and pain while sitting—but they certainly have a pelvic floor.
Men are also less likely than women to seek medical attention for symptoms related to pelvic floor issues, Tulikangas tells Bicycling.
“Symptoms tend to occur in men over 50 and are often related to prostate disease,” he says. “Those symptoms might be dribbling after urination, getting up more frequently at night to use the bathroom, and a slow stream.”
Men may also struggle with erectile dysfunction or incontinence after a prostatectomy to treat prostate cancer. “Pelvic floor therapy can be really helpful in those cases,” Tulikangas says. Pelvic floor therapy is a form of physical therapy, with specialized therapists working to treat the strength and tone of the pelvic floor muscles.
Misconception #2: Everyone Should Be Doing Kegel Exercises
The kegel exercise is an important tool in training your pelvic floor, but only if it’s done correctly, explains Lauren Garges, P.T., W.C.S., director of the women’s health program at St. Luke’s University Health Network in Bethlehem, Pennsylvania.
Quick squeezes of the pelvic-floor muscles—those used to stop urine midstream—can strengthen the fast-twitch muscles that prevent leaking while sneezing, for example. Longer, slower, squeezes focus on slow-twitch muscles that are required to keep organs in place and prevent leaking during exercise or other movement.
To properly do a kegel exercise that focuses on those slow-twitch muscles: Breathe normally as you tighten your pelvic floor muscles for 10 seconds, then relax them for 10 seconds. Perform three sets of 10 repetitions a day.
If you can’t fully relax your muscles, that might be a sign that your pelvic floor is too tight, Garges tells Bicycling.
“Squeezing can make [a tightness] problem worse,” she says. For these people, many of whom present with feelings of pain in the pelvic floor, kegel exercises are not an appropriate form of treatment.
“Pelvic floor therapy is about strength and tone, as well as being able to relax those muscles,” Tulikangas says.
Misconception #3: Urinary Leaking is Normal
Pelvic floor specialists and therapists want you to hear them loud and clear: Leaking is common but not normal. And because it can be an embarrassing symptom, many people—men and women included—don’t seek medical attention to treat it.
“Throughout history, people have often tolerated many issues associated with aging,” Tulikangas says. “For example, someone might have a bad knee and just use a cane. But now there is better medical intervention, and you can have a knee replacement and get back to vigorous activity.”
The same can be said for urinary incontinence, he says. Aging might be a risk factor for leaking, but it can be addressed through pelvic floor therapy. The key is going to see your doc and chatting about the issue.
Misconception #4: Cycling Doesn’t Affect the Pelvic Floor
Runners, particularly female runners who’ve delivered children, understand the high-impact nature of running and the toll it takes on the pelvic floor. But low-impact cycling isn’t risk-free when it comes to pelvic floor concerns, Garges says.
The pudendal nerve is a major nerve in the pelvic area, responsible for sending movement and sensory information from the genital area, according to the Cleveland Clinic. The nerve runs through the pelvic floor muscles and ends at the external genitalia.
There have been a handful of studies, Tulikangas says, that suggest cyclists who spend a lot of time on the bike could have a decreased function in the pudendal nerve. Signs that you might have an issue with the pudendal nerve include pain in the backside, sciatic pain, increased urination, pain after ejaculation, or erectile dysfunction.
A review published in the Journal of Functional Morphology and Kinesiology in 2021, concluded that bike and saddle design can mitigate pressure on the pudendal nerve, and proper posture may help decrease risk of pudendal neuralgia—pain or numbness in the pelvis and genitals.
Tulikangas notes that much of the data concerning cycling and pudendal neuralgia is a decade old, and improvements in saddle, bike, and short design can help alleviate the problem. But if you experience any of these symptoms, it’s also a good time to chat with your doctor about it. A professional bike fitting is smart too.