Pelvic Floor Exercises
Women know they should be doing their pelvic floor exercises. Still, most of us are not confident about how to do them correctly. It helps if you understand what a pelvic floor is and what it does.
The pelvic floor is a series of muscles at the bottom of your pelvis. Their job is to squeeze openings shut and support the organs above them. When you laugh, sneeze, cough or run, there is a downward pressure in your tummy and one of your pelvic floors job is to support the neck of your bladder. If the muscles are not strong enough or coordinated enough to resist the pressure, then you will leak when you do those things. (3)Pelvic floor exercises encourage your muscles to respond to these pressures with enough force and the right timing to support your bladder and stop you from leaking.A pelvic floor contraction creates a squeeze and lift. The best way to make sure you are working your pelvic floor correctly is to take a deep breath in, sigh out, then squeeze and lift your anus – imagine you are trying to hold in a fart. (4)
The muscles also have to be able to relax so you can pee or poo – so it is essential that you don’t hold your breath when you contract your pelvic floor.
The muscles move up and down as you breathe – if you hold your breath, they can’t relax properly. A fixed, stiff pelvic floor can cause as many leaks as a weak one.
Pelvic floor exercises will not help a fixed, or “dysfunctional”, pelvic floor. So if the exercises don’t work come to physio clinic and we’ll give you a bunch of other stuff to try.
To get your pelvic floor to contract properly, first of all, find an uninterrupted 10 minutes…that’s the trickiest part.
– sit with your knees slightly apart
– take a deep breath in
– sigh out
– squeeze and lift your anus – imagine you are holding in a fart
– really concentrate on what you can feel – the muscle should squeeze and lift, don’t bear down
-check where you feel the contraction – it should only be around your anus, not your thighs or buttocks
– hold for a count of 10 seconds
– keep breathing!
– relax – you should feel your anus relax and drop back down
That exercise will help strengthen the muscles so you can “hold on” if you need to go to the toilet and there is a longer queue than you were expecting. It won’t help you if you laugh, cough or sneeze – you need to practice co-ordination for that with quick flicks of your pelvic floor:
-take a deep breath in
-squeeze and lift your anus as if you think you are suddenly about to fart
-then, just as quickly, relax
-squeeze and lift for another second
-relax for a second
-do ten “squeeze and lift and relax” cycles in a row.
You need to do those two exercises three times a day for at least three months (5)
Pelvic floor exercises are usually part of a wider treatment plan for leaking urine, so if they don’t help, if the exercises hurt or if you are not sure you are doing them correctly then come to clinic and see a pelvic health physiotherapist (6)
The difficult thing with pelvic floor exercises is remembering to do them. There are apps available, you could set an alarm to remind you. Or, make a habit of doing them every time you put on the kettle, when you check social media or empty the dishwasher.
The most important thing is to do them and do them consistently every day, for life!
(1) Gynaecol Can. 2018 Apr;40(4):418-425. doi: 10.1016/j.jogc.2017.10.022.
Pregnancy-Associated Pelvic Floor Health Knowledge and Reduction of Symptoms: The PREPARED Randomized Controlled Trial
Momoe T Hyakutake 1 , Vanessa Han 2 , Lauren Baerg 2 , Nicole A Koenig 2 , Geoffrey W Cundiff 2 , Terry Lee 3 , Roxana Geoffrion
(2) Int Urogynecol J. 2017 Mar 14. doi: 10.1007/s00192-017-3309-4. [Epub ahead of print]
Pregnant women’s awareness, knowledge and beliefs about pelvic floor muscles: a cross-sectional survey.
Hill AM1, McPhail SM2,3, Wilson JM4, Berlach RG5.
(3) ICS statement https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206217/
(4) Ami and Dar 2018
(5) Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2010;1
Huebner M, Riegel K, Hinninghofen H, et al. Pelvic floor muscle training for stress urinary incontinence: A randomized, controlled trial comparing different conservative therapies. Physiother Res Int. 2010 doi: 10.1002/pri.489.
Herbruck LF. Stress urinary incontinence: prevention, management, and provider education. Urol Nurs. 2008;28:200–6. quiz 7
(6) Multi-centre study in Australia found that 84% of were cured of SUI with Physiotherapy treatment (Neuman 2006)