The pelvic floor conversation we’re not having
Whether it’s my algorithm or a genuine shift in the conversation, core and pelvic floor content seems to be everywhere lately. And honestly? I’m here for it. We’re getting better at talking about and researching female health and more importantly, the recognition that there has been a lack of research into female diseases and the female body. Alongside endometriosis, PCOS and breast cancer finally getting the recognition they deserve, the taboos around pelvic floor disorders (including: urinary, bowel and rectal disorders, prolapse, pelvic pain and certain sexual dysfunctions) are quietly starting to lift too.
The numbers alone make the case. Globally, between one-in-three and one-in-four women will experience some form of pelvic floor problem in their lifetime.
Urinary disorders (losing urine against your will) is one of the most prevalent disorders of the pelvic floor. German clinical guidelines put the figure for urinary incontinence at around 30% of all women. That is an estimated 15 million people in this country alone. Between the ages of 20 to 30, around 10% of women are affected. By 40 to 50, this grows to 25%. For women over 80, we’re looking at +40% in the general population, and over 70% in care homes. I do wonder if these numbers are representative as a lot of women do not talk about it until it really influences their life. Instead we avoid jumping on the trampoline, and cross our legs when we sneeze. Women are up to four times more likely than men to be affected by a pelvic floor disorder overall. Most of us know that childbirth is one of the biggest contributing factors, but did you know that 50% of women report at least one pelvic floor disorder within ten years of their first delivery?
However pregnancy and birth are far from the whole story. Even in women who have never been pregnant, pelvic floor disorders affect up to 25% at any given time. And around menopause, the drop in oestrogen accelerates the weakening of both the muscles and connective tissue, making this a critical and often overlooked window where symptoms can appear or significantly worsen.
The German head start: postnatal recovery classes
This is not a niche issue. It’s an ordinary part of female anatomy that most of us are never taught to think about until something goes wrong.
I was pleasantly surprised to learn that Germany has implemented something that other countries do not have: Every new mother is entitled to postnatal recovery classes. Or as you call it here: the Rückbildungskurs and it is fully covered by health insurance.
But the course was designed for new mothers, which means it leaves out everyone else. And it raises a broader question: why aren’t we talking about this before the problems appear?
From what I hear in my work the experience varies, some women find these postnatal recovery classes valuable Others, often already active before pregnancy, find the pace too gentle or the content too basic to feel relevant. And some simply leave without really understanding why they were doing what they were doing. A course that doesn’t meet you where you are is easy to deprioritise, especially in those early weeks.
What the research actually shows
When looking into training the pelvic floor the research is actually pretty striking. A major Cochrane review, the gold standard of medical evidence, found that women who did supervised pelvic floor training were eight times more likely to report being ‘cured’ of stress urinary incontinence than women who did nothing. Eight times! And when training is combined with things like education and other physical approaches, cure and improvement rates can reach up to 97%. That’s not a number you see very often in medical research.
But here’s the catch that doesn’t make it into most conversations about pelvic floor health: those results don’t come from a six-week course. Clinical guidelines consistently recommend a minimum of three months of supervised training as a starting point, and the evidence is pretty clear that having guidance makes a meaningful difference to outcomes compared to exercising alone at home. Which brings me back to the Rückbildungskurs. Germany building postnatal recovery into the healthcare system is genuinely something to be proud of! Most countries haven’t got there yet.
It should cover pelvic floor awareness, basic strengthening, breathing, and relaxing exercises. Unfortunately a one weekly group session with a mixed group of fitness levels for six to ten weeks is unlikely to be enough on its own, based on what the research tells us about duration and guidance.
What I find interesting is that despite this course being offered to virtually every new mother in Germany, its outcomes have never been formally evaluated in a systematic review. For something so widely used, that feels like a conversation worth starting.
It’s not just about childbirth
Besides this the evidence increasingly points to the fact the pelvic floor cannot be treated in isolation. That is true for all women whether you’ve had children or not. The diaphragm and pelvic floor function as a connected pressure system, they work together constantly with every breath we take.
This pressure system can be disrupted by multiple factors. One of the main factors next to birth are sports.
High-impact sports place significant repetitive load through increases in intra-abdominal pressure. Pelvic floor dysfunction affects around 25% of runners, up to 80% of trampolinists and gymnasts, and between 41% and 54% of female weightlifters and powerlifters. Does this mean we should stop training? The answer is no, the pelvic floor needs to be included in our training.
The pelvic floor responds to everything happening in the body around it. Which is exactly why training the pelvic floor as part of a connected system consistently outperforms isolated Kegel exercises. A 2026 study found that women in an integrated core training group achieved 50% or more reduction in urine loss in 70% of cases, compared to 46.6% in the Kegel-only group. A 2025 randomised controlled trial concluded that core stabilisation enhanced pelvic floor strength and endurance more sustainably over time. Next to birth and sport, two other major reasons for pPelvic floor dysfunction are chronic coughing from conditions like asthma or COPD places continuous pressure on the pelvic floor through the same mechanism, with research showing these women are 55 to 63% more likely to develop severe urinary incontinence than women without chronic cough.
The second is psychological stress. Stress activates the sympathetic nervous system, causing reflexive pelvic floor tension that over time can lead to both tightness and weakness.
What all of this tells us:, the research on training, the role of sport, stress, hormones, chronic cough, is that the pelvic floor is not a postpartum problem. It is a lifelong part of female anatomy that responds to everything happening around it. And yet most women only encounter this information after something has already gone wrong. That’s what I’d like to change. Whether it’s through reels, seminars or simply talking about it more openly, I hope more women get this information, so we can make our own informed decisions.
And as someone who believes a better world starts with you: I’m planning a Core & Pelvic Seminar. Stay tuned. And if you’re postpartum: the Rückbildungskurs is a chance worth taking seriously.
