For women with osteoporosis or osteopenia, pelvic floor health is foundational to safe exercise. The pelvic floor sits at the base of the core, coordinating with the diaphragm, abdominal muscles, and back muscles to manage the internal pressure that builds during lifting, jumping, and weight-bearing impact. When that coordination breaks down, the same exercises that build bone density can trigger urinary leakage, pelvic organ prolapse, or low back pain.
Recognizing pelvic floor dysfunction, learning the difference between a weak pelvic floor and a tight pelvic floor, and rebuilding coordinated core engagement are essential steps before progressing to heavy lifting or jumping for bone health.
Many individuals living with osteoporosis are surprised to learn how closely bone health, core stability, and pelvic floor function are connected.
Pelvic Floor Expert: Dr. Brianne Grogan
I recently had the chance to speak at length with Dr. Brianne Grogan, a Doctor of Physical Therapy known to her global audience simply as Dr. Bri, about exactly this connection. Together we explored how the pelvic floor works alongside the core muscles to support posture, balance, and safe movement, all of which are essential for protecting bone health and preventing falls and fractures. We also discussed why pelvic floor dysfunction is so common among women with osteoporosis, and how learning to coordinate and strengthen these muscles can improve daily function and confidence.
I had referred one of my clients to Dr. Bri’s resources, and she came back so encouraged by what she learned that I knew this conversation was worth sharing with the MelioGuide community.
Why Pelvic Floor Awareness and Breathing Belong in Every Bone-Health Program
When my clients are first diagnosed with osteoporosis or osteopenia, one of the most common things they read is that they need to start an exercise program. Yet many begin without giving any thought to their pelvic floor. I weave the sequencing of breathing into every exercise in my book and my online program, but I wanted Dr. Bri to explain in her own words why this foundation matters so much.
She told me that pelvic health remains deeply under-discussed. It is something we simply do not talk about in society, and most of us received no education about it growing up. So for many people, it remains a mystery. When the conversation turns to breathing, Dr. Bri added, people often dismiss it, thinking, “Well, I know how to breathe.” They gloss over information that is, in fact, foundational to pelvic floor protection.
“From my perspective, breathing is so important for pressure management,” she explained, “really helping to manage the pressure that’s coming down on the pelvic floor and the pelvic organs when you’re exercising.” If a woman has what Dr. Bri calls the double whammy, not understanding her pelvic floor and not understanding the importance of proper breathing, she is missing out on some of the very things that would keep her safe when she begins to exercise.
How to Recognize the Symptoms of Pelvic Floor Dysfunction
I asked Dr. Bri what symptoms might make a woman aware that something was going on with her pelvic floor.
The first set she mentioned was the one most women will recognize: bladder leakage when jumping, laughing, sneezing, or coughing. Or that familiar urgency when you put the key in the door coming home from work or the grocery store, and suddenly you have to go so badly that you might not make it. Dr. Bri grouped these together as incontinence issues, along with fecal incontinence and trouble holding in gas, all of which are pelvic floor related.
But she went on to describe a much wider set of signals that many women would never connect to their pelvic floor. Painful intercourse, or pain inserting a tampon. A heaviness or dragging sensation in the pelvis. Low back pain. In fact, she said, low back pain and pelvic floor dysfunction are extremely correlated. Many people with low back pain are found to have pelvic floor dysfunction upon examination, so back pain itself can be an indicator that something is going on in this crucial central area of the body.
Difficulty with balance is another. As Dr. Bri put it, the pelvic floor is the floor, the bottom of the core. If it is not doing its job, balance can suffer too.
She also listed pain of any type in the pelvic area, a feeling of tension or clenching in the anus, glutes, or belly, and difficulty getting a full breath. And then she added one I had not expected, jaw clenching and grinding teeth at night. People with jaw tension very often have pelvic floor tension as well. The two areas, she said, are very connected.
So many potential symptoms, I observed, and she agreed. Unfortunately, there are.
Is Your Pelvic Floor Weak, or Just Too Tight?
Fortunately there are far more pelvic floor therapists today than there once were, but I still hear from women who simply cannot access one. I asked Dr. Bri to share some ways a woman might begin to determine for herself whether her incontinence is due to a weak pelvic floor.
Her answer surprised me, and it is one I want every reader to understand. When people think of a weak pelvic floor, she said, they imagine muscles that are loose or lax, and they conclude that they should tighten things up, strengthen the muscles, and do a lot of Kegels. But weakness can come from two very different sources. The muscles can be underused and a bit loose, yes, but they can also be too tight. In Dr. Bri’s clinical experience, and in the experience of most pelvic floor physical therapists, a great many of the women they see are actually too tight in their pelvic floor.
Causes of Pelvic Floor Tightness
She traced that tightness to three common contributors.
- The first is too much sitting, especially with the tailbone tucked under, which over time shortens the pelvic floor.
- The second is shallow, restricted breathing. Because the breathing diaphragm and the pelvic floor are so closely linked, the unconscious breath-holding that comes with daily stress translates directly into pelvic floor tension.
- The third is emotional and mental stress itself. The pelvic floor, Dr. Bri told me, is one of the first and fastest areas of the body to contract, brace, and guard when we feel anxious, uncertain, or threatened.
She gave a striking example. During the pandemic she saw a dramatic rise in pelvic floor tension and tightness in her clients. Strengthening programs that had once worked beautifully began making her clients’ symptoms worse, because the underlying problem was not weakness at all. It was tension. That, she said, was a lightbulb moment, and it shifted her focus toward helping women learn to release first.
Ask Yourself These Questions
So if you are not sure where your symptoms are coming from, and you cannot get to a pelvic floor physical therapist in person, Dr. Bri suggested asking yourself a short list of questions. Do you clench your glutes often? Is your anus or buttock area tight throughout the day? Do you hold your breath without realizing it? Do you feel a kind of density and tension in your body? And, she added with a smile, do you have stress in your life?
I had to laugh, because pretty much anyone is going to answer yes to that last one. And that is exactly her point. For most women, learning to release is the right place to start. Even if you assume you need to clench harder to hold in your urine, you almost certainly need to begin with release first, so that your muscles can actually work well once you do begin to strengthen them.
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How to Recognize a Pelvic Organ Prolapse
I want to be open with readers that this is a topic I have personal experience with. I had two large babies, an episiotomy, and a forceps delivery. Like many women of my generation, I was never sent to a pelvic floor therapist afterwards. Years later I learned I had a prolapse, and a pessary has worked wonderfully for me. I asked Dr. Bri to walk readers through what a prolapse actually is, and how a woman might begin to recognize one in herself.
Prolapse, she explained, is when one or more of the pelvic organs (the bladder, the uterus, or the rectum) shifts downward.
- Bladder prolapse, also called a cystocele, is the most common. The bladder drops down and presses into the front wall of the vagina. In some cases, particularly the more advanced ones, a woman can actually see a shiny bulge using a hand mirror beneath the vulva. The organs are not going to fall out, Dr. Bri reassured me. Ligaments and surrounding structures hold everything in place. But the position has shifted. What a woman tends to feel is a sensation of heaviness or dragging, sometimes back pain, and a feeling she described as like a golf ball in the vagina, or like sitting on a small ball or bulge.
- Rectocele is similar in feel, but the rectum has pressed into the back wall of the vagina. With a rectocele there can also be trouble fully evacuating the bowels, and constipation can become more difficult to manage.
- Uterine prolapse is when the uterus itself has come down into the vagina. A woman may actually see or feel the cervix at the vaginal entrance or within the vaginal canal.
What to Do If You Suspect a Prolapse
When I asked Dr. Bri what a woman should do if she suspects she has a prolapse, beyond trying to find a pelvic floor therapist, the first thing she wanted readers to hear was reassuring. If you Google your symptoms, or ask an AI, you may come away thinking surgery is your only option. It is not, she said, especially for milder cases. There is a great deal a woman can do on her own to manage prolapse conservatively.
Pessary for Pelvic Floor
A pessary is one such tool. Dr. Bri described it memorably as “a sports bra for your vagina.” It is a small device inserted vaginally to help support the organ or organs that have shifted downward. Some women insert and remove a pessary around exercise, putting it in beforehand and taking it out afterwards. Others wear it for longer stretches. There are many styles and options available.
Breathing for Pelvic Floor
The second area, she emphasized, is how a woman breathes throughout the day, and how she engages and releases her pelvic floor along with the rest of her core. She covers this in detail on her YouTube channel and in her program called Lift, and she pointed out that there is genuinely a lot a woman can learn on her own about managing internal pressure.
Sitting and Your Pelvic Floor
And then she added one more thing that I found especially relevant for my own readers. How you sit and how you stand matters enormously. Many of us unconsciously tuck our tailbone under when sitting, which puts significant downward pressure on the pelvic organs. Untucking the tailbone, sitting up on the sit bones, and letting the tailbone release out behind us opens up space in the pelvic cavity and supports the organs in their proper position. The same principle applies to standing. The tailbone should not be tucked.
I told Dr. Bri how perfectly this aligned with what I teach women with osteoporosis. We work hard to help them regain their lumbar lordosis, the natural inward curve of the lower back, because without it the vertebrae cannot stack properly for safe posture. And of course this principle is not only for sitting and standing. It is the proper base of alignment for every exercise, standing or seated.
Dr. Bri agreed warmly, noting that this gives my readers one more reason to do the work. Good alignment supports the spine, the bones, and the pelvic organs. As she put it, we cannot isolate parts of the body from one another. What is good for bone health is good for organ health, for circulation, for the nervous system. It all adds up, and it all works together.
Preparing Your Pelvic Floor for Lifting Heavier
There is a strong current movement encouraging women to lift heavy weights for their bones, and the evidence for the benefits is real. But I am a strong proponent of progressive build-up. Most women are not ready to lift heavy on day one, and beginning too aggressively is a fast route to injury and setback. I asked Dr. Bri how she would coach a woman to prepare her pelvic floor for heavier lifting.
Her first principle was straightforward. Always start with less than you think you can handle. If you believe you could comfortably curl five pounds, back off and start with two. Build from there to five, to ten, to twenty, gradually and patiently. The goal is to make sure your body can maintain core stability, what she called the pre-activation of your core muscles, all the way through the lift.
Zipping Up: Pelvic Floor Health Test
To test whether the pelvic floor is doing its job, she described a technique she calls “zipping up.” She was careful to note that you do not want to walk around zipping up your core all day long. Your core is always working at some baseline level. The pelvic floor, the abdominal muscles, the back muscles, and the breathing diaphragm together form the whole middle of the body, and they are always slightly on, because they have to be to keep you upright. But when you lift heavy, you need them to come on a little more strongly. Dr. Bri compared it to turning up a dimmer switch.
She suggested practicing from any position, standing, lying on your back, or on your hands and knees, since each feels slightly different. The cue she uses is a soft “shh” sound, as if you were a librarian quieting a room, or the exhale you would use to blow out a candle. Those simple cues activate the pelvic floor. You should feel a gentle lift of the pelvic floor and a drawing in of the low abdominals, the transversus abdominis, which she described as the “seatbelt muscles” that wrap around to support the back.
That, she said, is what you want active when you lift heavy. Can you find it? Can you feel it? And just as importantly, can you release it once the lift is done? If you can, you are ready to begin a progressive weightlifting program. If you cannot yet feel it at all, that is the place to start.
Safely Integrating Jumping for Bone Health
Jumping is one of the most powerful activities for building bone, and yet it is one that many women with osteoporosis are afraid to attempt. Once a woman has learned to feel her pelvic floor and to switch it on and off intentionally, how, I asked Dr. Bri, would she introduce jumping safely?
Before answering the jumping question directly, Dr. Bri wanted to clarify the difference between true core activation and what many women mistakenly do, which is simply pulling the belly in.
The metaphor she offered was vivid. Imagine you have a full tube of toothpaste with the cap off. If you squeeze around the middle of the tube, all of that pressure pushes downward, and the toothpaste shoots straight out the open end. That, she said, is what happens to the pelvic floor when we contract only the belly. Now put the cap on, and gently engage the whole tube at once. Nothing is forced anywhere. That, she said, is true core activation, and it is what the body needs before any heavy lift or any jump.
A Gradual Approach to Jumping and Pelvic Floor
For introducing jumping, Dr. Bri described a graduated progression that I think is wonderfully accessible. Begin by squatting just a little, swinging your arms naturally, and rising onto your tiptoes, never actually leaving the floor. As you rise, exhale, which reinforces that zipping-up sensation. You do not need to zip and unzip with each repetition. Stay gently zipped throughout, but let the exhale strengthen the engagement, and keep your breath flowing freely.
That tiptoe rise, performed with intention, is itself a powerful preparation. From there, you can add a small heel drop. Many women also find success with a gentle side-to-side bounce or shuffle, rather than an up-and-down motion. Each of these gives a small dose of impact in a very controlled way, and lets the pelvic floor and the bones adapt at a sensible pace.
Closing Thoughts on Pelvic Floor Health and Your Bones
As Dr. Bri’s answers make clear, your pelvic floor is not an isolated part of your body. It is the foundation of your core, and the foundation of safe, confident movement at any age. For women with osteoporosis or osteopenia, that connection is particularly important. Every exercise that protects your bones, from resistance training to weight-bearing impact, depends on the pelvic floor doing its job quietly in the background.
Key Takeaways on Pelvic Floor Health
A few takeaways from my conversation with Dr. Bri are worth holding onto.
- A “weak” pelvic floor is very often actually a tight pelvic floor, and many women need to learn to release before they can effectively strengthen.
- Breathing is not a footnote to exercise but the central tool for managing the pressure that travels down through the core to the pelvic floor.
- Posture matters everywhere, and untucking the tailbone while maintaining the natural lumbar curve protects the spine, the organs, and the pelvic floor all at once.
- And both lifting heavy and jumping are wonderful for bone health, but each one needs a coordinated pelvic floor as its foundation. Build that foundation first.
Pelvic Floor Dysfunction
If you suspect pelvic floor dysfunction, see a pelvic floor physical therapist in person whenever you can. If that is not accessible to you, Dr. Bri’s YouTube channel and her Lift program are excellent starting points. And if you are working through Exercise for Better Bones, you can carry the principles in this conversation (breath, alignment, and pre-activation) directly into your program.
A huge thank-you to Dr. Bri for so generously sharing her expertise with the MelioGuide community.
About Dr. Brianne Grogan
Dr. Brianne Grogan is a Doctor of Physical Therapy. With over 500,000 subscribers (and counting!) on YouTube, articles featured on MindBodyGreen, courses on DailyOM, and a 5-star reviewed podcast and book, Dr. Bri is a leading voice in the field of holistic pelvic health and wellness. She is loved for her down-to-earth, compassionate approach and for making pelvic floor fitness fun, mainstream, and accessible.
Bri graduated as a Doctor of Physical Therapy in 2006 from Pacific University in Forest Grove, Oregon. Inspired by her own pregnancy and postpartum experiences, she specialized in women’s health PT. Her mission is to help women and men with pelvic health challenges live vibrant lives.
Frequently Asked Questions
What does the pelvic floor have to do with osteoporosis?
The pelvic floor sits at the base of the core and works with the diaphragm, abdominal muscles, and back muscles to manage the internal pressure generated during lifting, jumping, and weight-bearing impact. Because women with osteoporosis are typically asked to do exactly these activities to protect their bones, a coordinated pelvic floor is essential. When the pelvic floor cannot manage that pressure well, the same exercises that build bone density can trigger urinary leakage, pelvic organ prolapse symptoms, or low back pain.
What are the symptoms of pelvic floor dysfunction?
The most familiar symptoms are urinary leakage when jumping, laughing, sneezing, or coughing, and sudden urinary urgency. Other signs include painful intercourse, difficulty inserting a tampon, a heaviness or dragging sensation in the pelvis, low back pain, difficulty with balance, pain or tension in the pelvic area, and even jaw clenching or teeth grinding at night. Many of these are not commonly connected to the pelvic floor, but according to Dr. Bri, they often are.
Is my pelvic floor weak or just too tight?
Most women assume a "weak" pelvic floor means loose, lax muscles that need strengthening with Kegels. But weakness can come from muscles that are underused, or from muscles that are too tight. In Dr. Brianne Grogan's clinical experience, many women are actually too tight in their pelvic floor due to prolonged sitting with a tucked tailbone, shallow breathing, and chronic stress. If you clench your glutes, hold your breath, or feel constant tension in the pelvic area, learning to release first is usually the right starting point.
What is a pelvic organ prolapse?
A pelvic organ prolapse is when one or more of the pelvic organs (the bladder, uterus, or rectum) shifts downward. Bladder prolapse (cystocele) is the most common, followed by uterine prolapse and rectocele. Common sensations include heaviness or dragging in the pelvis, back pain, and a feeling of fullness or a small ball in the vagina. The organs do not fall out, because ligaments and surrounding structures hold them in place, but their position has shifted.
Is surgery the only treatment for prolapse?
No. For milder cases of prolapse, there is a great deal a woman can do on her own to manage it conservatively. Options include using a pessary (a small device inserted vaginally to support the shifted organ), working with a pelvic floor physical therapist, practicing proper breathing and core engagement, and improving posture by untucking the tailbone when sitting and standing.
How should I prepare my pelvic floor before lifting heavier weights?
Start with significantly less weight than you think you can handle, and progress gradually. Learn to pre-activate your core (pelvic floor, abdominals, back muscles, and diaphragm together) before each lift, using cues like a soft "shh" sound or the exhale used to blow out a candle. You should feel a gentle lift of the pelvic floor and a drawing in of the lower abdominal muscles. If you cannot yet sense those muscles turning on, you are not ready to begin a progressive weightlifting program.
How do I safely add jumping to my routine for bone health?
Start by squatting just a little, swinging your arms, and rising onto your tiptoes without leaving the floor. Exhale on the rise, which reinforces core engagement. From there, you can add a small heel drop, or try a gentle side-to-side bounce rather than an up-and-down motion. These gradual progressions let the pelvic floor and the bones adapt to impact at a sensible pace.
Do I need to see a pelvic floor physical therapist?
If you can, yes. An in-person assessment by a pelvic floor physical therapist is the gold standard for accurate evaluation and personalized treatment. If you cannot access one, Dr. Brianne Grogan's YouTube channel and her Lift program are excellent starting points for learning the foundational principles of release, breathing, and coordinated core engagement.
Margaret Martin
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