The Best Clothing for Pelvic Floor Health

Taking care of your pelvic area is vital to your overall health because it has a direct impact on different areas of the body. The pelvic floor muscles surround the abdominal cavity and support the pelvic organs, including the bladder, uterus, urethra and bowel.

Some of the reasons these muscles are essential include:

• preventing fecal and urinary incontinence
• sexual function
• supporting the fetus during pregnancy
• stabilizing the spine

The excessive pressure of clothes on your abdomen can cause pelvic floor dysfunction—not overnight, but as a cumulative consequence of habits. Wearing tight belts and clothes could contribute to musculoskeletal disorders due to poor pelvic and spinal postures, which could lead to problems in visceral organs and cardiovascular systems, according to researchers.

You don't need to avoid certain clothes forever, but on a day-to-day basis, the choices you make might help prevent future problems. These choices can be tough when society and culture put such a strong emphasis on the image we present through clothing.

It's crucial to weigh the risks versus rewards of social pressures and potentially sacrificing health in favor of fashion.

Social pressure to look good

Latinos have the popular expression, "Para ser bella hay que ver estrellas" (to be beautiful you have to see stars), referring to the pain you have to go through to look pretty.

However, beauty standards are not exclusive to one culture; they are present in all of them with certain variations. Nor are they exclusive to gender; everyone can be influenced by these patterns, though women have arguably had greater pressure throughout history to dress and behave according to certain guidelines.

"Women have faced pressure for centuries to conform to existing clothing trends and expectations. From layered hoop skirts to bustles to swimming dresses, function tended to lose out to fashion designed to garner admiring glances," explained Jennifer Reid, M.D., a psychiatrist, writer and podcast host based in Philadelphia.

Modern times have created an increasingly limited view of the ideal body, Reid said. As each person grows in their own way, with varying sizes and shapes, these differences are frequently described as flaws and abnormalities, rather than a natural part of human diversity.

The excessive pressure of clothes on your abdomen can cause pelvic floor dysfunction—not overnight, but as a cumulative consequence of habits.

"It creates an environment where women's self-assessment is increasingly critical, diets that are ineffective and often unsafe flourish, and feelings of guilt and anxiety increase," Reid noted.

These patterns are seen in eating disorders, behaviors and clothing. For example, in past generations, women wore tight corsets that barely let them breathe. This type of behavior, encouraged by social and cultural pressure, affected them mentally and physically.

"We can be dressed nice and fashionable, but there are exceptions," said Luz Jaimes, M.D., a sexologist based in Caracas, Venezuela.

Many women have the goal of always looking thinner, however, the effects can negatively impact pelvic floor health, Jaimes continued.

"The pressure of the pants on the abdomen makes you contract the muscles by sucking [them in], and you increase the pressure on the abdomen," Jaimes said.

If you are not sucking your abdomen in, then you might be pushing it out, which increases the health risks, too.

What clothes impact pelvic floor health?

Certain clothes can increase the risk of pelvic floor dysfunction. Rigid and super-tight clothing around the abdomen increases pressure in this area, which can lead to problems if the practice is constant over time.

"The abdomen can be thought of as a closed air system or like a balloon filled with air," said Rhiannon LeGarde, a doctor of physical therapy in Minneapolis-St. Paul. "When it is constricted in one area, the pressure has to go elsewhere and this can lead to increased downward pressure into the pelvic floor. Some examples are high-waist pants or skirts with a tight waistband or abdominal binders/corsets."

It is best to wear cotton panties and underwear to avoid the proliferation of bacteria, Jaimes recommended. Additionally, the right pelvic floor panties or underwear should not be so tight they leave marks on the skin, which indicate it is damaging.

Posture begins at the feet, and high heels can affect pelvic alignment.

"Raising the heel of a shoe causes the center of gravity to move forward, which creates a chain reaction for the structures above," LeGarde said.

"Very high heels trigger back, foot and pelvic floor problems. So if we want to be tall, there are days when we can use cork or wooden wedges," Jaimes said, adding that these can be alternated with low-heeled shoes because the ones that affect the body the most are very thin heels without a platform in front.

The consequences on the body

Very tight clothing may interfere with proper breathing, impede pelvic blood flow and cause digestive problems, vulvar pain, back pain, tingling in the legs and excess vaginal discharge.

"This doesn't happen from one day to the next. This can be reversed, but the abdominal area is especially vulnerable if there is a lot of pressure," Jaimes said.

"It is an important area for women and men," Jaimes continued. "If it is affected, it can cause damage to the genitourinary apparatus, but also to adnexal areas, which can produce pathologies of urine, pain, and pathologies of sexual function."

Additionally, restrictive clothing may cause itching because it affects the vaginal microbiome, said Sonia Bahlani, M.D., an OB-GYN and pelvic pain specialist practicing in New York.

These clothing-related habits put patients at risk of recurrent bacterial vaginosis (BV), in addition to causing unexplained inflammation with itchiness, Bahlani explained.

It is often thought that all pelvic floor dysfunctions that cause this discomfort may be due to a weakened or hypotonic pelvic floor. However, the dysfunction is also related to a very tight pelvic floor.

"Hypertonic pelvic floor dysfunction can mimic similar symptoms," Bahlani said.

Meanwhile, the change in the center of gravity caused by high heels often causes the body to try to compensate by tilting the pelvis, arching the back or widening the ribs.

"Taking the pelvis and spine out of neutral puts the pelvic and core muscles at a less than ideal length to be able to fire. These muscles typically cannot respond as well to forces put through it like walking, squatting, jumping or even sneezing," LeGarde said.

Recommended clothes to wear on a daily basis

Even if you love fashion, you should take care of your health, including your pelvic floor. The most suitable clothing for everyday wear allows you to breathe freely and move easily. To be clear, no one is saying you need to permanently eliminate the high-waisted jeans and stilettos you love. You just need to listen to your body, check in on your comfort and make sure you're able to breathe properly.

"You can test this out yourself when you try on that new pair of high-waisted mom jeans. Ask yourself, when I take a deep breath, can my belly expand? Is this causing me to have to pull in my stomach constantly?" LeGarde advised.

She also recommended trying different positions, such as sitting or standing, to ensure comfort in your clothes.

"Again, remembering the pressure system, if the belly cannot expand out, the pressure can go down into the pelvic floor," she said.

Shoes with a neutral heel allow you to maintain a more natural posture, which helps with pelvic floor care. LeGarde said it's not necessary to avoid high heels altogether, though.

"Of course, wearing heels from time to time will not ruin your pelvic floor," she said. "However, individuals who wear heels frequently or have pelvic floor symptoms may want to take this into consideration."

LeGarde emphasized that making clothing choices is not a matter of demonizing certain fashions, but rather just being careful with pelvic health.

"If you do not have any pelvic floor dysfunction and you wear clothing like this from time to time, likely you will be just fine. Wearing this type of clothing frequently, and especially if you already have some pelvic floor symptoms, is where problems may occur."

The pelvic floor's role in sexual function

"If you don't have your pelvic floor toned, your sexuality is affected in the capacity of stimulation and orgasmic capacity," Jaimes explained, recommending patients exercise their whole body and, specifically, the pelvic muscles.

In addition to lifestyle changes to maintain health, Jaimes invites people to be creative in their approach to pelvic floor care.

"All day long, we wear underwear...the perineum has been exposed all day long to pressure. Many times, you can sleep without underwear to let the pelvic floor rest," Jaimes said.

Who knows? Sleeping panties or underwear-free might also increase intimacy in the bedroom.

The shame of not being perfect

The guilt of feeling "not enough" is a constant for many patients who come to Reid's office. Whether it's thin enough, fit enough, muscular enough or otherwise, these concerns can drive a life not aligned with needs, leading to eating and body obsessions, the psychiatrist said.

"The time and attention they spend on achieving often unattainable bodies also replaces more pleasurable activities, which can worsen mood and motivation, leading to depression and isolation," she added.

Similarly, patients with pelvic floor dysfunction can be mentally affected by medical consequences, such as urinary incontinence, yet not feel comfortable talking about them, either because of embarrassment, shame or the belief that it's not important enough to bring up with their providers, Reid said.

"Throughout my training and clinical work, I have maintained an interest in women's sexual health and body image, and therefore, I may ask about some of these issues more than the average therapist. However, it is very common for individuals not to share these concerns," Reid continued.

This lack of communication leads to underdiagnosis and lack of treatment, along with self-diagnosis and the use of unproven and unsafe treatments recommended by "Dr. Google."

Treatments for mental and physical health

Ideally, you should see an expert when you begin to notice certain symptoms. Many therapy programs and exercises are available to improve pelvic floor health.

"Very rarely is the answer simply: do your Kegels. If this were the case, my profession would not exist," LeGarde emphasized.

Pelvic floor physical therapy is the best way to find out what is happening, because everyone has a different cause of dysfunction, such as weakness, tightness or difficulty knowing how to control the muscles.

"Sometimes pelvic floor issues can be a compensation coming from an issue in a different part of your body. Pelvic floor physical therapy helps you to learn about your body and gives you the tools to be able to live a healthy life without pelvic floor dysfunction," LeGarde said.

For pelvic floor dysfunction, it is also advisable to see a psychologist or psychiatrist to discuss, for example, issues of shame in case of incontinence or how to cope with social pressure by working on self-esteem. This step can help you take care of both your physical and mental health.

A specialist can guide you to the root cause while understanding that the consequences did not occur overnight. Being clear about what makes you feel good and what hurts you is essential to changing your mental image of what it means to have a healthy body.

"Our goals include shifting self-critical thoughts to more neutral or even more positive beliefs about themselves, highlighting the parts of their body that allow them to live according to their values and interests, and practicing positive self-talk," Reid said.