Quick Answer
There is no conclusive evidence that squats directly weaken the pelvic floor muscles. However, performing squats with improper form can put extra pressure on the pelvic floor which may contribute to weakness over time. Proper squatting technique, pelvic floor exercises, and core strength training can help prevent pelvic floor issues.
Do Squats Weaken the Pelvic Floor?
The pelvic floor muscles support the bladder, uterus, and rectum. Weak pelvic floor muscles can lead to incontinence and prolapse (organ droop). Many women worry that doing squats could put too much pressure on these muscles and cause them to stretch or weaken over time. However, research has not found a direct link between squats and pelvic floor dysfunction.
Here is a brief overview of what the research says:
– Squats do not seem to directly weaken or damage the pelvic floor muscles in most women, especially when done with proper form.
– Some studies have found certain pelvic floor issues, like prolapse, are more common in female athletes who regularly perform high-impact exercises like squats. However, these studies are observational and cannot prove cause and effect.
– Women with existing pelvic floor dysfunction may find their symptoms aggravated by heavy squats. Those with severe prolapse, incontinence, or diastasis recti should modify or avoid deep squatting exercises.
– Squats performed with poor form can potentially put more pressure on the pelvic floor region. Common technique mistakes like rounding the lower back, letting the knees cave in, straining, and holding the breath may contribute to pelvic floor symptoms over time.
So in general, for women without existing pelvic floor conditions, research suggests squats are safe as long as they are performed correctly. However, caution is warranted for those with a history of prolapse, incontinence, or pelvic pain. Monitoring for symptoms and modifying exercise programming as needed is advised.
Proper Squat Form to Protect the Pelvic Floor
While squats may not directly harm the pelvic floor in most women, using proper form can help minimize pressure on the pelvic floor and core region during this exercise:
– Maintain a neutral spine. Do not round or arch the lower back. Brace the core throughout the movement.
– Push the knees outward to keep them tracking over the toes. Do not let the knees cave inward.
– Initiate the squat by pushing the hips back rather than just bending the knees. Focus on “sitting back”.
– Keep the chest lifted to avoid excessive forward lean. Gaze forward or slightly upward.
– Spread the feet about hip-width apart or slightly wider for balance.
– Descend slowly under control. Do not bounce out of the bottom position.
– Breathe normally. Do not hold the breath, strain, or bear down forcefully at any point.
– Keep the weight and depth appropriate for your current fitness level.
Modifications like using a wide-stance sumo squat, box squat, or squat with a band around the knees can also help take pressure off the pelvic floor area. Reduce load and range of motion if you experience any pelvic/abdominal heaviness, bulging, or discomfort.
The Role of Pelvic Floor Muscles in Squats
Although squats do not seem to directly impair the pelvic floor muscles, these muscles do still play an important role in stabilizing the core and controlling intra-abdominal pressure during the exercise.
Here are some key functions of the pelvic floor muscles during squats:
– Contracting before and during the squat to stabilize the lumbar spine and pelvis in a neutral alignment. This helps transfer force effectively from the legs to the upper body.
– Coordinating with the transverse abdominis muscle to increase abdominal stabilization and stiffness. Together they help maintain intra-abdominal pressure.
– Preventing the abdominal contents from bulging downward into the pelvic cavity during exertion.
– Supporting the added weight and pressure placed directly above the pelvic floor region in the bottom squat position.
– Working eccentrically to control the descent into the squat position.
– Helping lift the body back to standing by contracting concentrically.
Keeping the pelvic floor muscles strong and responsive is important for maintaining proper alignment and breathing patterns during squats. Specific training of the pelvic floor muscles can improve their coordination with the core muscles for better functional fitness.
Can Squats Improve Pelvic Floor Strength?
Given the role of the pelvic floor muscles during a squat, some speculate that squatting could strengthen and tone the pelvic floor. However, research has not found squats or other core exercises to be particularly effective for directly strengthening the pelvic floor.
Here are some key points on the effects of squats on pelvic floor strength:
– Squats primarily train the large muscles of the legs, glutes, and quads. They do not strongly activate the small pelvic floor muscles.
– While squats may incidentally encourage some co-contracting of the pelvic floor, the muscles are not working hard enough during the exercise to increase their strength or endurance.
– Those with very weak pelvic floors to begin with may find their symptoms aggravated by heavy squatting. Overzealous squatting too soon can overwork the muscles before they have developed adequate strength.
– Isolating and actively contracting the pelvic floor muscles during squats may confer some benefit. But it requires training the brain-muscle connection to the pelvic floor first.
– For true pelvic floor strengthening, specific muscle training exercises are required. Kegels, bridges, and other low-impact exercises target these muscles more directly.
In summary, squats alone will likely not strengthen the pelvic floor muscles to a significant degree. However, when combined with targeted pelvic floor training, they can be a safe and effective part of a healthy exercise routine for many women.
Safe Squat Variations for a Weak Pelvic Floor
For women who find traditional back squats aggravate their pelvic floor symptoms, there are some squat variations that may be better tolerated:
– **Sumo Squat** – Turn the toes out wider and squat down in a plie position to open up the inner thighs. This wide stance helps take tension off the pelvic floor.
– **Box Squat** – Sit back onto a box or bench set at an appropriate height. This eliminates the deepest portion of the squat range of motion.
– **Banded Squat** – Loop a mini resistance band around the knees/thighs and push the knees outward into the band during the squat. This encourages better knee and hip alignment.
– **Goblet Squat** – Holding a dumbbell or kettlebell at chest height helps counterbalance the weight for a more upright squat position.
– **Smith Machine Squat** – The fixed bar path constrains motion to focus on the straight up and down squat movement without needing to balance the load.
– **Front Squat** – Holding the bar in front of the shoulders shifts the center of gravity and may feel more stable for some people.
– **Bodyweight Squat** – Squatting without any extra load may be more manageable for those with severely weakened pelvic floors.
Modifying technique, taking it slow, reducing range of motion, and minimizing load are all strategies to make squats more pelvic floor friendly as needed. Special populations like postpartum and postmenopausal women must take particular care.
Can Squats Cause Pelvic Organ Prolapse?
Pelvic organ prolapse is when the pelvic organs like the bladder, uterus, or rectum drop down from their normal positions and bulge into the vagina. Some women worry that the repeated intra-abdominal pressure from squats could contribute to prolapse. However, the potential association is inconclusive.
Here is an overview of what research has found on the possible link between squats and prolapse risk:
– Direct injury to the pelvic floor muscles, pregnancy, childbirth, and aging are the most well-established risk factors for pelvic organ prolapse.
– Some studies have found certain types of prolapse are more common in female athletes who regularly perform high-impact exercises. However, causation has not been proven.
– Squats and lifting place considerable downward pressure on the pelvic floor area. But with proper form, this alone does not appear to substantially increase prolapse likelihood in most women.
– Those with existing mild prolapse may find their symptoms aggravated by heavy squats. Modification is recommended.
– Technique flaws like breath holding and pelvic floor straining during squats may theoretically increase prolapse risk over time by chronically elevating intra-abdominal pressure.
– More research is still needed on how various exercises directly impact pelvic floor function long-term.
Overall, while squats do not seem to be a major risk factor for prolapse, women with symptoms should proceed with caution and seek guidance from pelvic health professionals as needed. Ensuring proper exercise form is critical.
Squats with Diastasis Recti
Diastasis recti refers to separation of the abdominal muscles along the midline. This condition is common during and after pregnancy. Some women worry that pressure from squats could make a diastasis recti worse or harder to correct.
Here are some tips on squatting safely with diastasis recti:
– Avoid deep, heavy squats that bear down forcefully through the abdomen. Go for partial range of motion squats until the diastasis closes.
– Wear an abdominal binder or splinting belt during squats to help minimize abdominal bulging and closing of the diastasis space.
– Maintain neutral spine alignment and do not hold the breath during squats.
– Check for widening along the diastasis during squats by palpating the abdomen. Discontinue if you feel substantial gaping.
– Work on diastasis-friendly core strengthening exercises between squat sessions like dead bugs and heel slides.
– Monitor for coning of the abdominal wall – if the belly puckers out during squats, modify the exercise.
With caution, most women with a small to moderate diastasis recti can safely perform a modified squat regimen tailored to their abilities. But if squats cause pain or obvious worsening of the diastasis, refrain from the exercise until the separation has adequately healed.
Squats and Pelvic Organ Prolapse Surgery
For women who have undergone surgical treatment for pelvic organ prolapse, recovery typically involves activity restrictions and pelvic rest for a period of time after surgery. Here are some guidelines on when squats may be resumed after prolapse repair:
– Avoid all squatting for at least 6 weeks post-operatively to allow adequate healing.
– After 6 weeks, begin with non-weighted squats to 90 degrees and progress very gradually. Use proper technique.
– Do not perform loaded barbell squats for at least 3 months following surgery to allow the pelvic floor to fully regenerate strength.
– Other complementary exercises like kegels, bridges, and core training will help recondition the pelvic floor before returning to intense exercises.
– If you experience pain, pressure, heaviness, or any symptoms of prolapse after squatting, stop and consult with your surgeon and pelvic floor physical therapist.
– Lifting limits prescribed by your surgeon should be strictly followed for optimal recovery.
– Some women may need to modify or avoid certain high impact exercises long-term if problems persist.
Have patience and compassion with your body – a full return to rigorous exercise can take 6 months or more after surgery. Listen closely and scale back activity if your body indicates it is too much, too soon.
Other Exercises to Avoid with Pelvic Floor Issues
Although squats may be reasonably safe when done correctly, women with weakened pelvic floors should also use caution and consider modifying these other high impact exercises:
– Heavy lifting – can spike intra-abdominal pressure and put excessive downward strain on the pelvic floor. Lift sensible weights in proper form without breath holding or bearing down.
– Jumping exercises like box jumps – involve intense impact and eccentric loading. Substitute with low or no impact options.
– Sprinting/running – the pounding up and down may irritate sensitive pelvic floor tissues. Try lower-impact cardio like the elliptical or swimming.
– Plyometric exercises like burpees – rapidly change direction and involve intense vertical impacts.
– Advanced yoga poses like inversions – place significant weight and pressure on the pelvic floor that may aggravate issues.
– Abdominal crunches – can potentially increase pressure on the pelvic floor depending on technique. Go easy and use modifications.
– Intense functional training circuits – avoid highly strenuous, grunting-type regimens.
Focus on safe exercises that do not cause symptoms or worsen prolapse. Also be cautious about activities involving heavy lifting, straining, or high abdominal pressure in daily life. Discuss concerns with your healthcare providers.
Pelvic Floor-Friendly Exercise Examples
Strengthening the pelvic floor and core with appropriate exercise is important for supporting pelvic health. Here are some examples of well-tolerated, pelvic floor-friendly workouts:
– **Walking** – Low impact and easy on sensitive pelvic tissues. Increases blood flow and promotes healing.
– **Swimming** – Allows gentle cardio exercise without gravity compressing the pelvic floor. Strengthens core muscles.
– **Modified Squats** – As described previously, partial squats with proper form and appropriate load are usually well-tolerated.
– **Hip Bridges** – Strengthens glutes and hamstrings while sparing downward pressure on the pelvic floor.
– **Kegels** – Directly strengthens pelvic floor muscles. Include long holds and eccentric training.
– **Heel Slides** – Safely activates transverse abdominis to pull in naval without bulging organs downward.
– **Bird Dogs** – Engages core in neutral spine alignment without direct pressure on the pelvic floor.
– **Wall Push-ups** – Modified push-ups strengthen the core with only partial range of motion.
– **Clamshells** – Targets outer hips and glutes important for alignment during squats.
Work closely with pelvic health professionals to develop a customized, symptom-free exercise routine that strengthens the muscles supporting the pelvic floor.
Should I Stop Doing Squats for Pelvic Floor Issues?
If you have symptoms of pelvic floor dysfunction like prolapse, incontinence, or pelvic pain, here are some factors to consider when deciding if squats should be temporarily stopped:
– **Are your symptoms worsening?** – If problems like organ bulging, heaviness, or leakage worsen noticeably with squats, take a break.
– **Do you have severe or advanced prolapse?** – Those with later stage prolapse often need to avoid exercises that bear down on the pelvic floor.
– **Is there pressure/pain during or after?** – Any exercise causing pelvic pain or discomfort should be modified or discontinued.
– **Are you unable to maintain proper form?** – Flawed technique like breath holding stresses the pelvic floor.
– **Have you been cleared by your provider?** – Check with your doctor and/or pelvic floor physical therapist before resuming intense exercise after recent childbirth or surgery.
– **Does your body feel ready?** – Respect symptoms of fatigue, heaviness, weakness – they indicate the pelvic floor needs more recovery time.
In contrast, if you have only mild issues and squats can be done carefully without symptoms, continuing squats alongside pelvic floor training may be beneficial. Communicate with your healthcare team.
Conclusion
While evidence does not show squats directly impair pelvic floor function in most women, those with existing pelvic floor conditions should take precautions and avoid anything causing worsening symptoms. For some, modifications like reducing weight and range of motion may allow safe continued squatting. Proper squat form, direct pelvic floor training, and avoiding breath holding/bearing down is imperative. Although more research is still needed, with appropriate precautions squats can often be included as part of an overall pelvic floor-friendly fitness regimen.
