Proprioception & Your Pelvic Floor

If you haven’t heard the term ‘proprioception,’ we’re delighted to introduce you to the super power you never knew you had. In fact, proprioception is so powerful, it's often considered a sixth sense. What exactly is it?

Proprioception is the ability to perceive the position and movement of the parts of your body within space, allowing you to interact with the environment around you without having to completely rely on visual feedback.

Proprioception occurs thanks to sensory receptors in the muscles, skin, tendons, ligaments, and joints. These receptors are constantly transferring sensory input to the brain. Conscious proprioception involves aspects like your ability to judge the weight of an object or maintain spatial awareness of your limbs. Subconscious proprioception allows you to sense things like limb and joint position, direction of movement, and whether your muscles are tensed or relaxed.

Proprioception is involved in acquiring and maintaining complex motor skills, like walking, talking, or learning to drive. It’s also key to maintaining pelvic floor functions like peeing, pooping, and having pain-free sex. And if you’re dealing with pelvic floor dysfunction, improving proprioception will likely be part of your treatment plan.

Proprioception in Action

When your sense of proprioception is functioning at its best, your body moves fluidly, you’re balanced and stable, and you can respond to and interact with your environment without much conscious thought.

Think about driving a car. Are you staring down at your feet or consciously deciding how to move your joints and muscles in order to push the pedals? No, you don’t have to. Your brain is firing signals informing your legs to move. Your sense of proprioception is providing feedback to your brain that your legs, ankles, and feet are where they need to be, and are applying the right amount of pressure to the gas or brake pedal at exactly the right time.

This didn't all come naturally. Learning a new skill — whether it’s how to drive a car or how to contract and relax your pelvic floor muscles on cue — takes conscious effort to build and strengthen those proprioceptive pathways. Over time, subconscious proprioception takes over. You could also call this process strengthening the mind-body connection.

Proprioception & Your Pelvic Floor

Proprioception is involved in optimizing motor control and the ability of your joints, muscles, tendons, and ligaments to function properly. In the context of your pelvic floor, those functions include peeing, pooping, and your ability to have penetrative sex and even achieve orgasm.

Just like your brain’s awareness of whether your hamstring is contracting or relaxing impacts your ability to walk — proprioception is vital to the proper functioning of your pelvic floor muscles. That’s because how well your pelvic floor functions depends, in part, on your brain’s ability to perceive and control what’s going on down there.

In terms of proprioception, using your pelvic floor to protect against urinary leakage when you laugh or cough is similar to applying the brakes in the car.

In terms of proprioception, using your pelvic floor to protect against urinary leakage when you laugh or cough is similar to applying the brakes in the car. If all is working well, your body responds appropriately — your pelvic floor muscles contract with some force during a giggle, but know to contract with more force when you find yourself in a laugh attack. Ideally, you don’t have to think about making force adjustments to your pelvic floor muscles when you laugh. It just happens, and you don’t leak.

When Pelvic Floor Proprioception is Compromised

It may be easy to take proprioception for granted, but it’s hard to miss the symptoms when it’s not functioning optimally.

When parts of your body are weakened — whether via injury, immobility, surgery, swelling, or underuse — it can reduce the sensitivity of the proprioceptive sensors in that area. Without effective proprioception, your muscle control is compromised and can lead to poor awareness, coordination, and the ability to use those muscles intuitively.

As women and individuals with vaginal anatomy, we face other unique risk factors that can lead to a loss of pelvic floor proprioception.

• Pregnancy
• Vaginal delivery
• Emotional and physical trauma
• Loss of estrogen during breastfeeding or menopause
• Increased tendency towards constipation

Losing proprioceptive connection to your pelvic floor impacts motor control and may look like:

• Leakage of gas, urine, or poop — you may be aware of this but unable to generate the right force needed to do anything about it
• Urgency — when non relaxing pelvic floor muscles can contribute to irritation of the urinary tract
• Pain during sex and sexual dysfunction — your pelvic floor may have difficulties releasing for comfortable sex, or limitations in force generation and timing for arousal and orgasm
• Constipation — your pelvic floor and sphincter have a difficult time lengthening and opening to release stool

Reconnecting with Your Pelvic Floor

If you’re already experiencing pelvic floor symptoms, you can work with a pelvic floor physical therapist to improve proprioception and regain proper functioning. Strengthening your sense of proprioception may even help prevent pelvic floor issues.

“You want to build awareness of your pelvic floor muscle movement, coordination and timing ability” says Dr. Rawlins. “Biofeedback techniques, which often use tactile or visual feedback to assist in your learning, are one helpful way to enhance proprioception. Essentially, you’re using mindfulness practices to retrain your body to respond the right way at the right time.”

4 ways to boost pelvic floor proprioception:

1. Breathe! But not just any breath. We’re talking mindful breath. Lie flat on your back, draw attention to your pelvic floor. Inhale — feel your pelvic floor lengthen reflexively. Exhale — feel it move back up into your abdomen. This practice of mindful recognition can help you (re)connect to your pelvic floor.
2. Use Weights. Vaginal weights, which are small weights placed inside of the vagina, are really helpful in improving your proprioceptive sensitivity. The pressure of the weight on your pelvic floor muscles can help you understand where the muscles are, and how to move them effectively against the resistance of the weights.
3. Connect visually by placing a mirror between your legs and observing your vagina as you breathe. Inhale deeply. Exhale fully. Do you see any movement in your perineal body (the tissue between your vaginal opening and your anus)? Do the movements connect with your breath? Visual feedback is helpful in building proprioception.
4. Get familiar with your pelvic floor. Feel your pelvic floor move, touch the areas that move with it (both your lower abdomen and inside your vagina and anus). Look around down there. Like a breast self-exam, it’s easier to notice when something is off that might affect proprioception when you’re familiar with what normal feels and looks like.

Learn more about observing and connecting with your pelvic floor here.

Pelvic floor symptoms are often complex and take time to resolve — but they can get better. Working with a pelvic floor physical therapist or a similar trained professional will help you find the support needed to boost your proprioception and heal your pelvic floor.