The Number One Muscle Women Neglect to Strengthen

You probably already know that strength training and building muscle has a lot of health and other benefits. It helps increase bone density and decrease the risk of osteoporosis. It helps control your weight and helps you look and feel better.

But there's another muscle—a hidden one—that many women often neglect to strengthen. Exercising this one isn't about fending off osteoporosis or having Michelle Obama's sinewy, toned arms.

This one is about working a muscle you can't see. And sometimes out of sight equals out of mind—thus the neglect.

You can't see your pelvic floor muscles, but they play a really important role in your health. They're the muscles that support your pelvic organs: your uterus, bladder and rectum.

What's going on down there?

The obvious joys of childbirth and the dubious joys of aging … can you guess the connection? A weakening in the pelvic floor muscles.

These are changes that other people can't see. Only you (and possibly your gynecologist and your partner) know about.

A quick anatomy lesson: Your pelvic floor muscles are made up of ligaments, connective tissues and nerves. They work like a hammock or sling to support your pelvic organs. These muscles stretch from your pubic bone (at the front) to the base of your spine (at the back) and give you control when you urinate, defecate or pass gas.

Blame childbirth, hysterectomy, obesity or menopause for this unwanted slackness. The risk increases with multiple pregnancies and vaginal deliveries, especially if you've had an episiotomy or suffered vaginal tears.

The wrath of weakness

• Urinary incontinence
• Fecal incontinence
• Pelvic organ prolapse (The uterus, bladder and bowel "drop" onto the vagina and bulge through the vaginal canal—kind of like a hernia.)
• Reduced sensitivity during sex

I'd say this could greatly impact a woman's quality of life. Yes, hardly a pretty picture.

Why the hush-hush?

Many women—and medical professionals—are hesitant or embarrassed to talk about this health issue, although the problem is very common. It's estimated that more than one-third of women in the United States are afflicted with a pelvic floor disorder (PFD), and about 377,000 had surgery in 2010, with that number expected to significantly increase over the next several decades.

PFD can be easily diagnosed with a physical exam. Sometimes, during a routine pelvic exam, your health care provider will spot or feel a telltale bulge that suggests prolapse. Or, you may already be reporting symptoms like trouble with bladder or bowel control.

There are other more sophisticated tests that can follow an initial physical exam, too. You can read about them here.

What you can do

Kegel exercises are the only prevention, but most women don't know how to properly do these, says women's health expert and advocate Donnica L. Moore, MD. In addition, the exercises are not always effective, especially once the problem is more advanced.

I'm betting you know about Kegels. But I'm also betting that, like so many of us, you forget to do them regularly, if at all. It's one of those things that are just not often top-of-mind. Some women (if they remember) sneak them in while waiting in line, at a red light or while trying to fall asleep. But the key is to remember to do them and hopefully, they'll become a permanent part of your daily routine.

A how-to from the Mayo Clinic

To get started:

1. Find the right muscles. To identify your pelvic floor muscles, stop urination in midstream. If you succeed, you've got the right muscles. Once you've identified your pelvic floor muscles you can do the exercises in any position, although you might find it easiest to do them lying down at first.
2. Perfect your technique. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
3. Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
4. Repeat three times a day. Aim for at least three sets of 10 repetitions a day.

It's best not to practice your Kegels when you urinate, by starting and stopping its stream; the danger is that it can actually make you retain urine, leading to the risk of a urinary tract infection.

More reading:
Exercises for Your Pelvic Floor Muscles
Sexercises: Workouts to Work You Up
Q&A With a Bladder