Weakened pelvic floor is a risk even for women who have not given birth
When someone mentions "pelvic floor," most people immediately think of a topic that concerns women after childbirth. Rehabilitation, exercise, returning to normal life after having a baby – these are the associations most commonly linked to this term. And while pelvic floor care after childbirth is absolutely essential, there is a large group of women who are forgotten in this discussion: women who have never given birth. Whether because they haven't yet decided to have children, or because they never will. For them, the topic of pelvic floor health is no less important – it's just talked about far less.
The pelvic floor is a group of muscles and ligaments that form a kind of "hammock" at the base of the pelvis. These muscles support the bladder, uterus, and rectum, help control urination and bowel movements, and also play a role in sexual experience. They are muscles that work constantly, without a woman usually noticing. And precisely because their work happens quietly and unobtrusively, it's easy to overlook them – until they start sending signals that something is wrong.
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The myth that problems only arise after childbirth
One of the most widespread misconceptions is the idea that pelvic floor dysfunction exclusively affects women who have been through pregnancy or childbirth. Research, however, shows something different. According to data published in the academic journal American Journal of Obstetrics and Gynecology, various forms of pelvic floor dysfunction also affect women who have never been pregnant. Urinary incontinence, chronic pelvic pain, difficulties during intercourse, or conversely, excessively tense pelvic floor muscles – all of these can affect a woman regardless of whether she has ever given birth.
The causes are varied and often surprising. A sedentary lifestyle is among the most common. The modern woman spends a large part of her day sitting – at a computer, in a car, on the sofa. Pelvic floor muscles need movement, changes in position, and conscious activation; otherwise, they gradually lose tone. Paradoxically, overtraining has a similar effect: women who exercise intensively, particularly those who prefer strength sports or high-intensity interval training, may have chronically overloaded and shortened pelvic floor muscles. This is a condition that Kegel exercises – i.e., strengthening – will only worsen, not improve.
Another factor that doesn't get enough attention is chronic stress. Psychological tension very often manifests in the pelvic area. Women who live under long-term stress or have experienced traumatic events are at increased risk of pelvic floor hypertonia – a condition where the muscles are permanently contracted and unable to relax properly. This condition then causes pain, difficulties during sex, or problems with elimination.
Hormonal factors also play a role. Even without pregnancy and childbirth, women's bodies go through changes – the menstrual cycle, hormonal contraception, menopause. Each of these phases affects pelvic floor tissue, its elasticity, and its capacity for regeneration.
How to recognise when the pelvic floor isn't functioning properly
Consider the example of a thirty-year-old woman who has never given birth, works in an office, goes to CrossFit several times a week, and has been going through a demanding work period for the past year. She begins to notice that her lower abdomen hurts more than before during menstruation, sex is occasionally uncomfortable, and after intense training she feels pressure in the pelvic area. She visits a gynaecologist, who finds nothing serious, and she attributes the situation to stress or overwork. But the cause may lie elsewhere – in the pelvic floor, which is overloaded and needs professional care.
There are far more stories like this than one might think. The problem is that the symptoms of pelvic floor dysfunction are often non-specific and easily confused with other complaints. Among the most common signals a woman should not ignore are:
- urinary leakage when laughing, coughing, or jumping (stress incontinence)
- pain or discomfort during sexual intercourse
- chronic pain in the pelvic area, lower abdomen, or lumbar spine
- a feeling of pressure or heaviness in the pelvis
- difficulty emptying the bladder or bowels
- recurring urinary tract infections without an obvious cause
None of these symptoms should be trivialised or accepted as a "normal part of a woman's life." As physiotherapist Kari Bø, one of the world's leading experts on the pelvic floor, says: "Incontinence is not normal – it is merely common. And those are two very different things."
What to do and where to seek help
The good news is that pelvic floor dysfunction is treatable – and the sooner a woman begins to address her problem, the easier and more effective treatment tends to be. Physiotherapy focused on the pelvic floor plays a key role here. In the Czech Republic, this specialisation has grown significantly in recent years, and although regional differences in availability still exist, the number of specialists is increasing.
A physiotherapist specialising in the pelvic floor will first conduct a thorough medical history and functional examination. This may include an internal examination, which allows for a precise assessment of the muscles – their strength, tone, ability to relax, and coordination. Based on this, an individual care plan is then drawn up. It is important to emphasise that a plan for a woman with a hypotonic (weakened) pelvic floor will look completely different from a plan for a woman with a hypertonic (overloaded) pelvic floor. The blanket recommendation to "do Kegel exercises" is therefore far from sufficient – and in some cases can actually be counterproductive.
Alongside physiotherapy, lifestyle also plays a role. Regular physical activity with an emphasis on functional exercise, proper breathing – particularly diaphragmatic breathing – and mindful body awareness contribute significantly to pelvic floor health. Yoga, Pilates, or hypopressive exercise methods are approaches that focus on overall body tension and can be very beneficial for many women. It is equally important to pay attention to how a woman sits, how she lifts heavy objects, and how she breathes during physical exertion.
The psychological component must not be overlooked. If the difficulties are associated with chronic stress or trauma, care may also involve working with a psychologist or therapist. The body and mind are connected in the pelvic area far more closely than most of us realise. An approach that works with both dimensions simultaneously delivers better long-term results than purely mechanical exercise.
Information and education are the first step. Organisations such as the International Urogynecological Association or the Czech Společnost fyzioterapie offer resources that help women navigate the subject and find qualified assistance. Not being ashamed to ask, not making excuses, and not believing the myth that these problems are exclusively the concern of mothers or older women – these are attitudes that can genuinely improve quality of life.
The pelvic floor in women who have never given birth is a topic that deserves far more space in public discussion and in medical practices. Every woman – regardless of age, lifestyle, or reproductive history – has a pelvic floor that needs attention, care, and respect. And recognising its signals in time is one of the most important steps towards long-term health and wellbeing.
