Pelvic floor training: For a strong core

Many people only appreciate their pelvic floor when they notice the first signs of pelvic floor weakness. But prevention is worth it

Pelvic floor training is no longer just a woman's job: a weak pelvic floor can also lead to incontinence in men

© Shutterstock / Mangostar

It appears that the problem only affects two groups of people.
fen: young mothers and old women. But appearances are deceptive. Because in fact, they're just the only ones who talk about it. Especially since the situation after pregnancy, childbirth, hormonal changes and with decreasing connective tissue is all too obvious. After all, who would want to admit that they just pissed their pants with laughter? Or when coughing? Or while jogging?

In research, things are a little different. For scientific purposes, women are more willing to admit their weakness and talk about their pelvic floor. And so, in addition to the young mothers and old women, there is a third group of people: the sportswomen.

Urinary incontinence in women athletes

For example, in a Swedish survey of 35 pro trampoline jumpers, 80 percent of the participants stated that they had already lost urine while exercising. And in a Danish survey of 291 professional athletes and dancers, 60 percent said they occasionally wear insoles for the same reason.

At the beginning of the year one came in the trade journal Uro News published a meta-analysis with around 1,700 female athletes at the end: every third woman who is active in sport suffers from urinary incontinence, regardless of whether it is a sport with hard contact with the ground or not.

The pelvic floor muscles essentially consist of three layers

© W & B / Dr. Ulrike Möhle

A weak pelvic floor is surprisingly common

Dr. Stefanie Burghaus, Senior Physician at the Women's Clinic of the University Hospital Erlangen, does not find the number surprising: "Pelvic floor weakness is more common than expected",
she notes. She knows from everyday clinical practice that not only mothers, senior citizens and athletes are affected: "We assume that a total of every third woman has a pelvic floor weakness."

One reason for this frequency is the female anatomy: "You can imagine the pelvic floor like an upturned umbrella stretched between the pelvic bones. It bears the entire weight of the abdominal cavity," explains Professor Christl Reisenauer, senior physician in the urogynecology section University Women's Clinic Tübingen.

"However, the structure, which consists of muscles, connective tissue and fat, has three weak points: it is interrupted by the urethra, the rectum and the vagina." In addition, the pelvic floor muscles of many women are not adequately trained due to constant sitting and lack of exercise.

Lots of toilet visits, less feeling during sex

Bladder weakness is just one problem caused by a weak pelvic floor. Recurring urinary tract infections can be another. Even if it takes forever in the toilet until the urine stream finally comes and it drips afterwards, this is a sign that everything is not all right with the inner umbrella.

Just like when you have to go to the bathroom all the time. "It's worth keeping a diary here," says gynecologist Burghaus. "Because if you have to do it six to eight times within 24 hours, you may have the feeling that it is very common. But it is absolutely within the framework."

Many women also feel uncomfortable during sex or feel too little during intercourse. Even with a weak pelvic floor, sexual stimulation causes the muscle to reflexively contract and the vagina to narrow - but a weak muscle only constricts slightly. Women with strong muscles feel their partner much more intensely. In addition, a firm pelvic floor increases blood flow to the sexual organs, which in turn leads to greater sensitivity.

Get a feel for the pelvic floor

But how do you train this muscle? "To do this, you first have to get a feel for where the pelvic floor is at all," explains urogynecologist Reisenauer. Because, unlike with biceps or triceps, you cannot see from the outside whether this muscle is tense or relaxed.

A first clue is to pretend to interrupt the urine stream. "If you are unsure, you should speak to your gynecologist about it during your next examination," says Reisenauer. "He can check whether the muscle can be tensed properly and can also demonstrate it on ultrasound: the position of the urethra changes depending on whether it is tense or loose."

Not a woman's business: pelvic floor training is also male

Prof. Sommer, do most men really not know that they have a pelvic floor?

That's the way it is. And they don't even know that they have two potency muscles in the pelvic floor. When I ask my patients, 'Do you know where the biceps are?', 93 percent can show me the muscle without thinking too much. When I ask, 'Do you know where your potency muscles are?, 95 percent look at me like a car.

And where are these potency muscles?

Between rectum and testicle. If you put your finger on the spot and control the muscles, you can feel them.

What do the muscles do?

They improve sexuality by firstly ensuring better stability and secondly by being able to delay the ejaculation reflex.

Does the strength of the pelvic floor also affect continence in men?

Men with a weak pelvic floor suffer more often from the so-called urge symptoms, urge incontinence: while the bladder fills, a strong one occurs
Urge to urinate with involuntary leakage of urine. That can be very uncomfortable.

And this is where pelvic floor training can help?

Exactly. Just like tension, you should also practice muscle relaxation. Pelvic floor training is no longer just a woman's job. Jürgen Klinsmann introduced it for the national team before the 2006 World Cup. With the so-called core training: Here the pelvic floor, stomach and lower back are trained. Because stable core muscles have a positive influence on almost all movement sequences.

Because many women have difficulty locating the pelvic floor correctly, it is important to choose a competent trainer. In certain cases, the gynecologist can prescribe physiotherapy specific to the pelvic floor. But it also works without a prescription: "There are many specialized physiotherapists who offer courses or individual therapies," says Stefanie Burghaus.

"I recommend this kind of training to every woman as a preventive measure - and not only when she has problems," says Christl Reisenauer. "Because pelvic floor training should actually be as common as visiting the gym."

Tips for a fit pelvic floor

In addition to targeted pelvic floor training, you can do a lot in everyday life for a strong core:

  • Simply tense and relax your muscles every now and then - maybe whenever you are at a traffic light, when you are on the phone or while you are waiting for the bus.
  • Consciously tense the pelvic floor during physical exertion.
  • Drink enough: 1.5 to 2 liters per day.
  • Go to the toilet calmly and not always "as a precaution" before leaving the house.
  • Ensure good digestion and prevent persistent constipation.
  • Make sure you feel healthy so that you don't put unnecessary pounds on the pelvic floor.
  • Avoid heavy lifting as much as possible.
  • Do not smoke - not least because frequent coughing damages the stability of the pelvic floor.


  • On the homepage of the Gynecology, Obstetrics, Urology, Proctology Working Group (AG GGUP) you can find physiotherapists who specialize in pelvic ode gymnastics via the list of therapists close to your home:
  • The German Continence Society lists certified pelvic floor centers and advice centers throughout Germany: