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The Pelvic Floor & High Intensity Exercise

I love to do high impact/ high intensity exercise. It is no secret that I love running, jumping, and lifting heavy weights.

Did you know that those factors alone place me in a higher risk category for pelvic floor dysfunction? You might be thinking.... well you lift weights, doesn't that make everything stronger?... Nope!

We wouldn't expect our biceps to get stronger by doing more squats. Likewise with the pelvic floor, if we don't specifically work on these muscles, they don't magically improve. (I'd love that to be true... could someone work on that for me?)

Evidence suggests that strenuous physical activity increases the risk for pelvic floor disorders. This doesn’t mean that we should skip strenuous exercise, it means that we need to ensure that our level of strength and support matches the level of physical intensity that we would like to perform.

Are you at a higher risk too?

Risk factors for Pelvic Floor Dysfunction

  • Men and women who are significantly overweight

  • Men and women who regularly lift heavy objects (for work or for exercise)

  • Women who are currently pregnant

  • Women who have delivered with a vaginal delivery

  • Older women. Especially those who are going through, or have been through menopause

  • Women who've gone through a hysterectomy

  • Men who've had prostate surgery

  • Men and women who do high impact exercises on a regular basis

  • Men and women with chronic back pain

  • Men and women with chronic cough (COPD, cystic fibrosis, chronic bronchitis, etc)

  • Men and women who've experienced a previous pelvic injury

  • Men and women who have persistent constipation


The pelvic floor is the bones, connective tissue, and muscle that comprise the base of the pelvis.

The pelvic floor is the foundation of movement due to the function it serves in posture, balance, stability, and strength. If the pelvic floor is not working properly, other muscles will often compensate to help out. This can cause back pain, balance and stability concerns, and decreased athletic performance, especially noted during exercise that requires high intra-abdominal pressure like gymnastics, volleyball, jumping, and high intensity weight lifting.


Pelvic floor dysfunction includes incontinence (leaking urine or stool) and pelvic organ prolapse (the descent of the pelvic organs).

Balance issues, back pain, anterior pelvic tilt, incontinence, and pelvic heaviness are common symptoms of pelvic floor dysfunction.

Pelvic floor dysfunction affects 25% of women.


I'm at risk. When you say "work on it" what does that mean? What can I do?

A healthy pelvic floor should expand and contract. Pelvic floor weakness and lack of support can be problematic. A pelvic floor that cannot relax can also be problematic. Just as in other muscles, we need strength and flexibility.

As you breathe in, expand and relax the pelvic floor muscles.

As you breathe out, lift and contract the pelvic floor muscles.

If you can only briefly engage your pelvic floor muscles, don't feel discouraged, but keep practicing. Try to hold as long as you can, and use that time as the new goal for future contractions.

4 Specific Exercises to Target the Pelvic Floor Muscles

  1. Levator Ani Lift (Muscles involved: Puborectalis, Illiococcyeus, Pubococcygeus, & Coccygeus) Focus on contracting and lifting the entire floor of the pelvis. Hold this for a 10-30 second count, and gently relax. Repeat 10 times.

  2. Urethra Contraction Squeeze and hold the muscles that cut off the flow of urine. Hold this for a 10-30 second count, and gently relax. Repeat 3 times.

  3. Anal Contraction Squeeze and hold the muscles that you use when you cut off the flow of stool. Hold this for a 10-30 second count, and gently relax. Repeat 3 times.

  4. Vaginal Contraction Squeeze and hold the muscles that contract your vagina. Hold this for a 10-30 second count, and gently relax. Repeat 3 times.

The pelvic floor should be strong and able to support all activities that we want to do. There are different core exercises that can also engage the muscles of the pelvic floor.

Consider working on the basics and focus on perfecting the contraction of the various muscles of the pelvic floor, and adding in higher intensity exercise gradually until you can perform any exercise you choose, without symptoms.

Recipe for success:

  • Use the right exercise stimulus.

  • Eat the right nutrition, that promotes healing

  • Reduce inflammation

  • Drink plenty of water

  • Maintain low internal pressure while you build strength

  • Rest

  • Repair!

In case you were wondering, urogynecologists and women's health physical therapists are experts in this field. If you need personalized help, I encourage you to seek them out!

If want to know more information, I co-wrote an entire 4 week program for core and pelvic floor health called "Ab's, Core, and Pelvic Floor" with Natalie Hodson. If you'd like to know more, please click HERE

You can do hard things!

Loving you today,


About the Author

Dr. Monique Middlekauff is a Registered Clinical Exercise Physiologist (RCEP) through the American College of Sports Medicine (ACSM), and a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association (NSCA). She has been a certified personal trainer with the NSCA, ACSM, and the National Academy of Sports Medicine (NASM) for over 10 years.

She is a certified Higher Education Teaching Specialist (HETs) and has instructed courses ranging from introductory to graduate level including Kinesiology, Exercise Physiology, Exercise Physiology Lab, Resistance Training, Fitness Foundations, Aging and Exercise, and Skeletal Mechanics.

She is a former NCAA DI volleyball athlete and loves to exercise outdoors. Monique is certified in Advanced Cardiac Life Support (ACLS), and is an Exercise is Medicine Level 3 credentialed provider. Monique works for a major health system in Idaho.

Her goal is to pursue health and overall wellbeing through evidence-based practice. Physical wellness comes in many forms, and she seeks to celebrate where you are, and challenge you to be better!

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