The pelvic floor is a group of muscles and connective tissue that stretches across the bottom of the pelvis like a hammock, from the pubic bone at the front to the tailbone at the back. It holds up the bladder and bowel, and the uterus in women; it keeps the urethra and the back passage closed until you choose to go; and it relaxes to let you pee, poop and have sex, and stretches to let a baby through at birth. Everyone has one, women and men. These are muscles you can control, so they can be trained, and Kegel exercises are that training.
Where the pelvic floor is
Picture the bony ring of your pelvis. The pelvic floor closes its lower opening: the pubic bone at the front, the tailbone at the back, and the two sit bones at the sides. If you sit on a firm chair, the muscles lie in the space between your sit bones. At rest the floor is shaped like a shallow dome, a lot like the diaphragm you breathe with.
The main muscle is the levator ani, a sheet made of three parts that run from the pubic bone and the side walls of the pelvis back toward the tailbone, with a smaller coccygeus muscle behind it. Below that sit thinner layers and the rings of muscle around the openings, the sphincters. The urethra and the anus pass through the floor in everyone; in women the vagina does too. The organs rest above it: the bladder at the front, the bowel at the back, and the uterus in women or the prostate in men in between.
What the pelvic floor does
It has four everyday jobs.
- Support. It holds the pelvic organs up against gravity and against the pressure inside your abdomen.
- Control. It keeps the urethra and anus closed, tightens when pressure rises, as in a cough or a jump, and relaxes so you can empty your bladder and bowel.
- Sex. The same muscles contract during orgasm in women and men, and they need to relax for comfortable sex.
- Stability and breathing. It works with the diaphragm, the deep abdominal muscles and the back muscles to steady the trunk and manage pressure, so it moves a little with each breath and switches on when you lift.
In pregnancy it carries extra weight, and in a vaginal birth it has to stretch and let go, which is why recovery after birth so often starts here.
The same muscles in women and men
Men have the same muscle group in the same place. The differences are in what passes through and sits above it: there is no vaginal opening, the urethra is longer, and the prostate sits just above the floor. That is why pelvic floor training comes up for men after prostate surgery and with bladder control, and why men's pelvic floor is a topic in its own right.
When it isn't working well
Pelvic floor problems are common. In a US survey of almost 2,000 women, about one in four had symptoms of at least one pelvic floor disorder, rising from about one in ten in their twenties and thirties to about half from age 80. Pregnancy and birth, menopause, age, prostate surgery, a long-term cough, constipation and heavy lifting all put load on the floor.
A floor that is too weak may let urine leak when you cough, laugh or run, struggle to hold back a sudden urge, or let the organs sag, which can feel like heaviness or a bulge. A floor that is too tight causes different trouble: pelvic pain, pain with sex, or difficulty starting to pee or emptying the bowel. The two need opposite approaches, so the cause matters more than the symptom. The signs of a weak pelvic floor are a good place to start.
More squeezing isn't always the answer.
If you have pelvic pain, pain with sex, a feeling of heaviness or something coming down, or trouble emptying your bladder or bowel, have the floor assessed before you start strengthening. A pelvic floor physical therapist can tell whether you need to strengthen it, relax it, or both.
How to find and train it
To find the muscle, imagine stopping yourself from passing gas, or gently stopping the flow of urine: the soft lift and tightening inside, separate from your buttocks and belly, is your pelvic floor. Training it means lifting up and in, holding for a few seconds, and then letting go completely; the release matters as much as the squeeze. Pushing down instead of lifting is a common mistake. The step-by-step guide covers technique and how many to do.
Where you start depends on why you are training: bladder leakage, pregnancy, recovery after birth, menopause, or men's pelvic health.
Where Kegelia fits
The movement is invisible, so it is hard to know whether you lifted or pushed. The Kegelia app shows the direction: a jellyfish whose bell draws up and in as you lift and opens as you release, with a haptic on every lift. Sessions take one, three or five minutes, and it works the same way for women and men. It shows the movement; it does not measure your muscles, diagnose a problem or replace an assessment.