Pelvic floor exercises. Don’t worry – I rolled my eyes too even just by writing this! The pelvic floor muscles and associated exercises are harped on about for women, particularly during pregnancy and post childbirth. We all know we’re supposed to be doing these exercises… but how many of us actually do? Or are doing them properly and effectively? And who knows what the pelvic floor muscles even ARE? Even as a physiotherapist, with a very good awareness of the importance of doing my exercises… I must admit I’ve been pretty slack so far in doing them. I forget, completely, most of the time.
So let’s start with the basics – what even ARE pelvic floor muscles? I feel like it’s a term sometimes that’s thrown around (a bit like ‘working your “core” muscles’ – huh?).
The pelvic floor is literally just that – the floor inside your pelvis! It’s a thin sheet or sling of muscles and ligaments trying to support and hold everything in and up inside your pelvis – think your bladder, uterus (for women) and your bowel. It has small openings in it (obviously, or we wouldn’t be able to go to the toilet, have sex, deliver a baby) and also acts to control our bladder and bowel function.
When the pelvic floor is strong, it helps prevent incontinence, prolapse, and supports the weight of the developing baby in pregnancy.
So why do they become weak? Well, remember, they’re a thin sheet of muscle, so they can become weakened easily especially with constant or extra weight and pressure on them.
Common causes of pelvic floor muscle weakness include:
- childbirth – particularly following delivery of a large baby or prolonged pushing during delivery
- being overweight
- constipation (excessive straining to empty your bowel)
- persistent heavy lifting
- excessive coughing – causing repetitive straining
- changes in hormonal levels at menopause
- growing older
Here are some basic exercises (adapted from the Royal Women’s Hospital website) to work on strengthening your pelvic floor. I have placed some other websites at the bottom that can also be a good resource.
Step 1: Sit, stand tall, or lie on your back with your knees bent and legs comfortably apart or kneel on your hands and knees.
Step 2: Close your eyes, imagine what muscles you would tighten to stop yourself from passing wind or to ‘hold on’ from passing urine. If you can’t feel a distinct tightening of these muscles, ask for some help from a women’s health physiotherapist. They will help you to get started.
Step 3: Now that you can feel your pelvic floor muscles working, tighten them around your front passage, vagina and back passage as strongly as possible and hold for three to five seconds. By doing this, you should feel your pelvic floor muscles ‘lift up’ inside you and feel a definite ‘let go’ as the muscles relax. If you can hold longer (but no more than a maximum of eight seconds), then do so. Remember, the squeeze must stay strong and you should feel a definite ‘let go’. Repeat up to ten times or until you feel your pelvic floor muscles fatigue. Rest for a few seconds in between each squeeze.
Steps one to three count as one exercise set. If you can, do three sets per day in different positions. Do your pelvic floor exercises every day.
Exercise 2 (quick squeeze for power)
Squeeze and lift your pelvic floor muscles as strongly and as quickly as possible. Do not try to hold on to the contraction, just squeeze and let go. Rest for a few seconds in between each squeeze. Repeat this 10 to 20 times or until you feel your pelvic floor muscles fatigue.
If you can, do this exercise set one to three times per day.
During both exercises you should:
- feel your pelvic floor muscles ‘lift up’ inside you, rather than feel a downward movement
- relax your thighs and buttocks – they shouldn’t feel clenched at all
- keep breathing normally
- stop exercising if your muscles fatigue or you can’t feel them activate (to give them a rest)
That’s all well and good… but what are the actual consequences of not doing exercises?
I was having a talk to a good friend recently about this (as I was quietly freaking out about being unprepared for this baby, and was asking her advice as she’s had a few kids). We got onto the topic of my blog, and she was sharing her story about pelvic floor exercises.
‘I remember the midwife coming and seeing me after I had (baby) and talking about pelvic floor exercises, and why I needed to do them after having my bub. I brushed it off at the time, thinking I would get around to it later, and then kind of forgot about them. Life, a new baby, running a household and then later returning to work all just got in the way.
It wasn’t until recently when I returned to playing sport that it finally become personal for me. I was running down the netball court, and all of a sudden I felt the urge to go to toilet and just couldn’t control it and had some leakage. I had to stop, and the urge passed, but as soon as I started running it would happen again. I’ve had to start wearing thick pads during games, which end up saturated by the end. In hindsight I wish I’d actually listened to the midwife and had done the exercises earlier’.
Pelvic floor exercises sound simple – but can actually be tricky to do properly. If you have any symptoms of weakness, or are having trouble actually activating and completing these exercises, I would highly recommend seeing a specialist Women’s Health physiotherapist who can do a more thorough assessment and make sure you’re on the right path.
Now I just have to come up with a way to remember to do them… maybe I’ll set reminders on my phone.
Resources and References: