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A quick scroll through a CrossFit athlete’s Instagram (Hi, Tia and Mat!) or 5- second clip of the CrossFit Games is all the proof you need that the sport of functional fitness does some serious work on athletes’ muscles.
But did you know that can include the pelvic floor muscles? Yep.
Here, three pelvic floor specialists explain everything you need to know about your pelvic floor muscles, including how to recognize pelvic floor dysfunction.
Plus, they explain how CrossFit can exacerbate — and in some instances, even cause — pelvic floor dysfunction.
“The pelvic floor muscles span all around the pelvic floor bowl like a supportive hammock,” says Anthony Lo (aka The Physio Detective), an Australia-based musculoskeletal physiotherapist and CrossFit Level One Coach.
The pelvic floor muscles have a number of roles, he says, including:
- holding up the pelvic organs like the prostate, uterus, rectum, and bladder
- helping us pee and poop when we want to (and not when we don’t!)
- supporting sexual pleasure and function
- circulating blood around the pelvic organs
With the pelvic floor muscles, there’s a Goldilocks zone. You don’t want them too weak, and you don’t want them too active.
If they skew in either direction, it’s considered pelvic floor dysfunction.
Pelvic floor weakness
The pelvic floor muscles can become weak due to things like:
This is the most well-known pelvic floor condition.
As Emily McElrath, a pelvic floor therapist who specializes in CrossFit athletes, puts it: “I can’t tell you how many people come to see me who think they have a weak pelvic floor but have a totally different issue — overactivity.”
Pelvic floor overactivity
The pelvic floor muscles, like all muscles in the body, are designed to contract and relax.
Sometimes these muscles aren’t able to relax and instead are constantly in a contracted position.
This is also known as having non-relaxing pelvic floor muscles.
Common causes include:
“When we’re talking about the pelvic floor being in a constant state of contraction or constant state of relaxation, it’s important to understand these things are happening subconsciously,” says Lo.
Your subconscious, he says, is shaped by all sorts of factors including:
- where you grew up and how you were raised
- who your friends are and have been
- what you currently believe
- what you currently believe about the pelvic floor
- past pleasurable or traumatic experiences
When you want to strengthen or relax other muscles in your body, like your biceps, for example, you can pick up a weight and do bicep curls or straighten out your arm.
But strengthening and relaxing your pelvic floor muscles typically isn’t that easy.
“Sometimes to address pelvic floor issues, people need to address an underlying psychosocial contributing factor that’s causing an unconscious reaction in their pelvic floor muscles,” says Lo.
And the symptoms can vary person to person, pelvic floor to pelvic floor.
That said, common symptoms may include:
- pain during urination
- constant need to urinate
- feeling of incomplete bladder emptying
- chronic constipation or pain during bowel movements
- pain in pelvic region, lower back, or hips
- pressure or heaviness in the pelvic region
- pain during penetrative sex
- urinary or bowel incontinence
- leakage during high-impact movements
Every person has a pelvic floor and pelvic floor muscles. Meaning, pelvic floor dysfunction can affect people of any gender or genitals!
However, according to Battles, pelvic floor dysfunction is most common in vagina owners due to the fact that most can, will, or have give(n) birth.
CrossFit generally doesn’t cause pelvic floor dysfunction.
Rather, it exacerbates symptoms of pelvic floor dysfunction in folks who are already experiencing it (whether they know it or not).
That said, according to McElrath, “CrossFit can lead to pelvic floor dysfunction in people who have never experienced pelvic floor dysfunction.”
“However, CrossFit isn’t more likely to cause pelvic floor dysfunction than other high-impact, high-intensity, or heavy-lifting sports,” says McElrath.
There are a few reasons it can exacerbate (or cause) pelvic floor dysfunction.
CrossFit is a high intensity exercise
“Any high-intensity exercise is going to put a high demand on your pelvic floor,” says McElrath.
And, well, that includes CrossFit.
After all, CrossFit’s ~whole thing~ is constantly varied functional movements executed at high intensity.
CrossFit incorporates strength training
The sport of functional fitness incorporates strength sports like Olympic lifting and powerlifting.
This is a good thing! After all, strength training = muscle mass = many health benefits.
The trouble is, many CrossFitters use weightlifting belts in ways that aren’t considerate of their pelvic floor while lifting.
McElrath explains: “Breathing into the belt, as many folks are taught to do, puts a lot of pressure on the pelvic floor muscles, which puts folks at increased risk of injuring their pelvic floor muscles.”
CrossFit emphasizes core bracing
“Whether it’s walking lunges or toes to bars or one rep maxes, in CrossFit we’re told to constantly brace our bellies,” says Battles.
The pelvic floor is part of the core, so this means the pelvic floor is in a contracted position throughout the entire class.
“It isn’t wrong for the pelvic floor muscles to be working while you’re working out,” says Lo.
But, he says, it’s important to be able to relax your pelvic floor while you’re not using it!
For example, during Fran CrossFit — unless you’re a Games Athlete — chances are you’re taking a breather mid-WOD.
“When you do take a breather, you want to put your hands on your knees and let your legs, tummy, [and] back relax and breathe before getting back on the bar,” explains Lo.
Ever seen someone shake and shimmy their arms after doing a large set of pullups or barbell snatches to relieve the muscle tension? This is the pelvic floor version of that.
The type of personality CrossFit attracts
Of course, anyone can enjoy CrossFit. But, says McElrath, “Due to the nature of the sport, many of us CrossFitters just happen to be competitive, Type A, high stress, intense, and go-go-go.”
Generally speaking, these types of people are less likely to take time to decompress and more likely to hold tension in their muscles, she says.
And while some people may hold tension in their traps, neck, jaw, and chest, others (unknowingly) hold it in their pelvic floor muscles.
And people who hold tension in their pelvic floors? Well, they’re more likely to experience pelvic floor symptoms no matter what their sport of choice is.
After pregnancy, many CrossFitters don’t scale properly
“CrossFit is about way more than just the physical activity,” says Lo. “The community — and atmosphere — is a big part of it.”
So it makes sense that many CrossFitters would want to return ASAP.
Returning to movement after childbirth in of itself isn’t a problem. The problem is that many fail to scale movements so that they’re suitable to their postpartum body when they do return, says McElrath.
“CrossFit is infinitely scalable,” says Lo. “So there are ways for the parents to return to the gym and move in a scaled and appropriate way.”
Regardless of whether you’re a CrossFit athlete, if you experience any of the aforementioned symptoms, you should schedule an in-person or telemedicine appointment with a pelvic floor specialist.
Even if your “only” symptom is leakage during high-impact movements like double-unders or box jumps.
Incontinence may be common in CrossFit boxes, but it’s a sign that your pelvic floor isn’t as healthy or as efficient as it could be, says McElrath.
McElrath also recommends seeking out a pelvic floor specialist if you’re experiencing any ongoing hip or glute issues that orthopedic specialists haven’t been able to figure out.
Sometimes, hip or glute pain on one side is a symptom of pelvic floor cramping or overactivity on that side. Fascinating, right?
“Generally, my position is that you don’t need to quit CrossFit or take a break from it while remedying the symptoms,” says Lo. “After all, your pelvic floor isn’t going to get stronger or more coordinated with you just lying in bed.” Fair point!
Battles adds: “As practitioners, we have to set our patients up for success, and that means keeping them in the fitness environment that they love but teaching them how to do movements slightly differently within that environment.”
That might mean:
- breathing more intentionally
- loading movements differently
- working through a greater range of motion
- planning more deliberate warmups that target the pelvic floor muscles before class
“Quite often, it’s just a technique change that’s needed,” says Lo.
“Obviously, treatment is going to vary for every athlete,” says McElrath. But it could include one or more of the following.
Hands-on pelvic floor manipulation
Some pelvic floor specialists offer hands-on work that allows them to provide muscle tension relief in folks with overactive pelvic floor muscles.
“[This] functions similarly to how deep tissue massages in your back might work,” says McElrath.
There are also pelvic floor release wands (like this one) that you can purchase and use on your own for a similar sensation.
Working with a pelvic floor specialist
Don’t love the idea of having someone’s hands inside you?
Good news: “Even though an internal examination might be helpful, it isn’t an absolute necessity,” says Lo.
Many pelvic floor specialists have tools in their toolbox that allow them to provide relief without touch.
“Folks with pelvic floor overactivity need to learn how to relax,” says McElrath, who recommends folks incorporate 20–30 minutes of intentional relaxation practices into their day.
“Sure, that relaxation can be meditation,” adds McElrath. “But it can also be listening to a podcast in the bath, watching a documentary, or doing RomWod and working on deep breathing and relaxation.”
Vulva owners who experience pain during penetrative play or who have extreme overactivity may also use vaginal dilators, says McElrath.
Vaginal dilators are tools that are inserted into vagina for a period of time.
“Breathing with the dilator inside you can help your pelvic floor slowly learn to relax,” explains McElrath.
If you’re experiencing symptoms of pelvic floor dysfunction, talk with a doctor or other healthcare provider.
“Pelvic floor dysfunction is common, but it isn’t healthy,” says McElrath. “A ton of pelvic floor specialists and coaches are out there who can really help.”
And who won’t force you to quit your beloved sport as part of treatment. #Bless.
Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.